Medical Provider Networks Approved by DWC (Sorted by · PDF file ·...
205
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. Approved MPN Applications: 2402 *MPN Approval Status Legend BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 1 MPN ID # Name of Applicant with Mailing Address Name of MPN Type of Applicant Date of Approval Internet Website Address of MPN MPN Approval Status * 1564 99 Cents Only Stores LLC 4000 Union Pacific Avenue Commerce CA 90023 Broadspire Signature MPN Self-Insured Employer 8/24/2009 T 1302 99¢ Only Stores 4000 Union Pacific Avenue City of Commerce CA 90023 WellComp Medical Provider Network Self-Insured Employer 7/31/2007 T 2301 A. Teichert & Son, Inc. 3500 American River Dr. Sacramento CA 95851 WellComp Medical Provider Network Self-Insured Employer 6/11/2014 www.WellComp.com T 1751 A.B. Ag Services, Inc. 2020 So. East Ave Fresno CA 93721 Zacky Farms Custom CorVel MPN Self-Insured Employer 1/12/2011 www.corvel.com 0229 ABC Unified School District 16700 Norwalk Boulevard Cerritos CA 90703 Prime Advantage Medical Network Self-Insured Employer 3/1/2005 T 0169 ABM Industries Incorporated 1775 The Exchange 6th Floor Atlanta GA 30339 ABM ESIS MPN Self-Insured Employer 2/2/2005 T 1938 ABM Industries, Incorporated 1775 The Exchange, 6th Floor Atlanta GA 30339 ABM MPN Self-Insured Employer 4/20/2012 T 0080 ACE American Insurance Company (Broadspire- Boeing MPN) 1601 Market Street Philadelphia PA 19103 Broadspire MPN Insurer 3/7/2005 T 0716 ACE American Insurance Company 1 Beaver Valley Road Suite 4E Wilmington DE 19803 Medex-ACE-GB Insurer 4/19/2005 T 1560 ACE American Insurance Company 1 Beaver Valley Road Suite 4E Wilmington DE 19803 Wal-Mart-Medex MPN Insurer 8/13/2009 www.medexhco.com 0340 ACE American Insurance Company 1601 Chestnut Street Philadelphia PA 19103 Broadspire MPN Insurer 2/17/2005 T 0384 ACE American Insurance Company 1601 Chestnut Street Philadelphia PA 19103 FARA-CVTY Insurer 4/21/2005 T
Transcript of Medical Provider Networks Approved by DWC (Sorted by · PDF file ·...
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
1
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1564
99 Cents Only Stores LLC
4000 Union Pacific Avenue
Commerce CA 90023 Broadspire Signature MPN
Self-Insured
Employer 8/24/2009 T
1302
99¢ Only Stores
4000 Union Pacific Avenue
City of Commerce CA 90023 WellComp Medical Provider Network
Self-Insured
Employer 7/31/2007 T
2301
A. Teichert & Son, Inc.
3500 American River Dr.
Sacramento CA 95851 WellComp Medical Provider Network
Self-Insured
Employer 6/11/2014 www.WellComp.com T
1751
A.B. Ag Services, Inc.
2020 So. East Ave
Fresno CA 93721 Zacky Farms Custom CorVel MPN
Self-Insured
Employer 1/12/2011 www.corvel.com
0229
ABC Unified School District
16700 Norwalk Boulevard
Cerritos CA 90703 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0169
ABM Industries Incorporated
1775 The Exchange 6th Floor
Atlanta GA 30339 ABM ESIS MPN
Self-Insured
Employer 2/2/2005 T
1938
ABM Industries, Incorporated
1775 The Exchange, 6th Floor
Atlanta GA 30339 ABM MPN
Self-Insured
Employer 4/20/2012 T
0080
ACE American Insurance Company (Broadspire-
Boeing MPN)
1601 Market Street
Philadelphia PA 19103 Broadspire MPN Insurer 3/7/2005 T
0716
ACE American Insurance Company
1 Beaver Valley Road Suite 4E
Wilmington DE 19803 Medex-ACE-GB Insurer 4/19/2005 T
1560
ACE American Insurance Company
1 Beaver Valley Road Suite 4E
Wilmington DE 19803 Wal-Mart-Medex MPN Insurer 8/13/2009 www.medexhco.com
0340
ACE American Insurance Company
1601 Chestnut Street
Philadelphia PA 19103 Broadspire MPN Insurer 2/17/2005 T
0384
ACE American Insurance Company
1601 Chestnut Street
Philadelphia PA 19103 FARA-CVTY Insurer 4/21/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
2
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0677
ACE American Insurance Company
1601 Chestnut Street
Philadelphia PA 19103
ACE American Insurance Company -
Crawford Select Insurer 6/16/2005 T
0960
ACE American Insurance Company
1601 Chestnut Street
Philadelphia PA 19103 Intracorp-Gates McDonald MPN Insurer 7/28/2005 T
0983
ACE American Insurance Company
1601 Chestnut Street
Philadelphia PA 19103 ACE-Medex Select B Insurer 8/5/2005 T
0394
ACE American Insurance Company
1601 Market Street
Philadelphia PA 19103
First Health Comp America HCO Select
Network Insurer 3/16/2005 T
0125
ACE American Insurance Company
1601 Market Street
Philadelphia PA 19103
First Health CompAmerica Primary
Network Insurer 4/13/2005 T
0506
ACE American Insurance Company
1601 Market Street
Philadelphia PA 19103
First Health Comp America HCO Select
Network Insurer 4/21/2005 T
0748
ACE American Insurance Company
1601 Market Street
Philadelphia PA 19103
MedInsights MPN accessing Prudent
Buyer PPO Insurer 4/29/2005 T
0427
ACE American Insurance Company
1601 Market Street
Philadelphia PA 19103
ACE/Frank Gates First Health
CompAmerica Select Network Insurer 5/11/2005 W
1826
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE GBMCS KOJ MPN Insurer 5/3/2011 T
2070
Ace American Insurance Company
436 Walnut Ave
Philadelphia PA 19105 CorVel/Kaiser Select MPN Insurer 10/25/2012 www.corvel.com
0157
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106 Sedgwick CMS MPN Insurer 2/17/2005 T
0159
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106 Sedgwick CMS Extended MPN Insurer 2/17/2005 T
0646
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106
Genex Medical Provider Network
(MPN) Insurer 6/2/2005 www.genexservices.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
3
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1573
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106
Sedgwick CMS/Harbor Net - Ross
Stores Insurer 12/14/2009 T
1581
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106 Coventry Network Insurer 1/21/2010 T
1623
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106
Sedgwick CMS/Harbor MPN - Ace
CEC Insurer 4/20/2010 T
1650
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106 WellComp Medical Provider Network Insurer 6/22/2010 www.wellcomp.com T
1673
ACE American Insurance Company
436 Walnut St
Philadelphia PA 19106 Broadspire Signature MPN Insurer 8/10/2010 T
1764
ACE AMERICAN INSURANCE COMPANY
436 Walnut St
Philadelphia PA 19106
ACE American Insurance Company-
GENEX MPN Insurer 2/1/2011 genexservices.com T
1961
Ace American Insurance Company
436 Walnut St
Philadelphia PA 19106 Sedgwick/Harbor MPN Insurer 5/15/2012 T
0103
ACE American Insurance Company
436 Walnut St.
Philadelphia PA 19106 ACE ESIS MPN Insurer 2/3/2005 T
0768
ACE American Insurance Company
436 Walnut St.
Philadelphia PA 19106 ACE/BUNCH Network Insurer 5/6/2005 T
1605
ACE American Insurance Company
436 Walnut St.
Philadelphia PA 19105 CorVel MPN Insurer 4/1/2010 T
1734
ACE American Insurance Company
436 Walnut St.
Philadelphia PA 19106 Medtronic CV Santa Rosa MPN Insurer 12/22/2010 T
1857
ACE American Insurance Company
436 Walnut St.
Philadelphia PA 19106 ACE/Bunch/Buffets MPN Insurer 7/15/2011
1547
ACE American Insurance Company
436 Walnut St., P.O. Box 1000
Philadelphia PA 19105
CCMSI/ACE First Health Comp
America Select HCO Network Insurer 6/25/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
4
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0044
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Medex Insurer 12/7/2004 http://www.medexhco.com/
0391
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE/Gallagher Bassett/Coventry MPN Insurer 2/23/2005 www.talispoint.com/cvty/gbcvtympn
0180
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 TCT CA MPN Insurer 3/7/2005 www.mywcinfo.com T
0361
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
Sedgwick First Health CompAmerica
Primary HCO Network Insurer 3/7/2005 T
0362
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/7/2005 T
0302
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 CorVel MPN/ACE American/GB Insurer 3/14/2005 T
0218
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
First Health CompAmerica Select HCO
Network Insurer 3/17/2005 www.talispoint.com/cvty/matrix
0821
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 TRISTAR MPN Insurer 5/3/2005 T
0587
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 INTRACORP Insurer 5/9/2005 W
0404
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
ACE/Gallagher Bassett/First Health
MPN Insurer 5/13/2005 www.talispoint.com/cvty/gbfhmpnselect T
0796
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE-Medex Select A Insurer 5/27/2005 T
1014
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Genex Insurer 8/2/2005 www.genexservices.com
0480
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Ace USA Cambridge MPN Insurer 9/12/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
5
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1192
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Intracorp/ACE Insurer 5/2/2006 T
1179
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Liberty Mutual Group MPN Insurer 6/1/2006 T
1220
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Genex Insurer 7/21/2006 T
1321
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 INTRACORP/Customized ACE MPN Insurer 11/20/2007 T
1380
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE/Bunch/Barnes Group MPN Insurer 5/14/2008 T
1466
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick CMS / Harbor Net - ACE Insurer 1/15/2009 T
1434
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn
1568
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
Sedgwick CMS / Harbor MPN - Ace
Boeing Insurer 10/20/2009 T
1576
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 MLB CA MPN Insurer 2/11/2010
1620
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 CorVel MPN Insurer 4/8/2010 T
1846
Ace American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Wellcomp Medical Provider Network Insurer 6/16/2011 T
1864
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ACE MPN - HCA Insurer 8/4/2011 www.talispoint.com/cvty/hcawc
1995
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106
Sedgwick CMS / Harbor MPN - ACE
FD Insurer 11/8/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
6
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1904
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Randstad/ACEAm/Bunch MPN Insurer 2/14/2012
1909
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor MPN - ACE SUMC Insurer 2/14/2012 W
1917
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor MPN - ACE Nestle Insurer 2/17/2012 T
1975
Ace American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor MPN-ACE SSL Insurer 5/24/2012 W
2055
Ace American Insurance Company
436 Walnut Street
Philadelphia PA 91906 Sedgwick/Harbor 2 MPN Insurer 9/20/2012 T
2181
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 CorVel/Prime Healthcare MPN Insurer 6/18/2013 www.Corvel.com
2227
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 CorVel MPN Insurer 10/18/2013 www.corvel.com
2259
ACE AMERICAN INSURANCE COMPANY
436 Walnut Street
Philadelphia PA 19106 Iron Mountain/GENEX MPN Insurer 12/30/2013 T
2249
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Coventry Medical Provider Network Insurer 4/18/2014 www.talispoint.com/cvty/matrix
2286
Ace American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor 3 MPN Insurer 5/27/2014 www.harborsys.com/sedgwick3 T
2287
Ace American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor 4 MPN Insurer 5/27/2014 www.harborsys.com/sedgwick4 T
2316
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 None Provided Insurer 7/3/2014 www.genexservices.com T
2364
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 ACE American/BBSI MPN Insurer 2/27/2015 www.barrettbusiness.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
7
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2422
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 ALSCO Inc. Medical Provider Network Insurer 2/22/2016 www.talispoint.com/cvty/alsmpn
2462
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106 Driscoll's MPN Insurer 3/25/2016 www.intermedccs.com/DriscollsMPN
2423
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 ACE/EI Pollo Loco MPN Insurer 4/21/2016 www.corvel.com
2490
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 ACE/Lineage MPN Insurer 6/21/2016 www.corvel.com
2508
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19105 CorVel/Cheesecake Factory MPN Insurer 10/28/2016 www.corvel.com
0838
ACE American Insurance Company
PO Box 15059
Wilmington DE 19850
First Health CompAmerica Select HCO
Network Insurer 5/31/2005 T
0682
ACE Employers Insurance Company (CEI)
1601 Chestnut Street
Philadelphia PA 19103
ACE Employers Insurance Company
(CEI) - Crawford Select Insurer 6/16/2005 W
1546
ACE Fire Underwriters Insurance Company
436 Walnut St.
Philadelphia PA 19105
CCMSI/ACE First Health Comp
America Select HCO Network Insurer 6/25/2009 T
2206
Ace Fire Underwriters Insurance Company
436 Walnut Street
Philadelphia PA 19106 Liberty Mutual Group MPN Insurer 7/24/2013 T
2234
ACE Fire Underwriters Insurance Company
436 Walnut Street
Philadelphia PA 19106
Sedgwick/Harbor MPN - ACE Irvine
Company Insurer 12/3/2013 T
0681
ACE Guaranty RE
1601 Chestnut Street
Philadelphia PA 19103 ACE Guaranty RE - Crawford Primary Insurer 6/16/2005 W
0892
ACE Indemnity/ACE American Insurance
Company
1601 Market Street
Philadelphia PA 19103 CorVel MPN/ACE/LWP MPN Insurer 5/19/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
8
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1548
ACE Property and Casualty Insurance Company
436 Walnut St., PO Box 1000
Philadelphia PA 19105
CCMSI/ACE First Health Comp
America Select HCO Network Insurer 6/25/2009 T
0899
ACIG Insurance Company
2600 No. Central Expressway, Ste 800
Richardson TX 75080 Medex Insurer 7/1/2005 www.medexhco.com
0589
ACWA/JPIA
5620 Birdcage Street
Citrus Heights CA 95610 ACWA/JPIA MPN
Joint Powers
Authority 5/9/2005 W
1689
Administrative Concepts Corp.
406 43rd St West
Bradenton FL 34209 Broadspire Signature
Self-Insured
Employer 8/19/2010 T
1865
Administrative Office of the Courts
455 Golden Gate Avenue
San Francisco CA 94102 CorVel MPN State 8/23/2011 T
0749
Advance Auto Parts
5673 Airport Road
Roanoke VA 24012
MedInsights Medical Provider Network
accessing Prudent Buyer HCO
Self-Insured
Employer 4/29/2005 W
1304
Advantage Workers Compensation Insurance
Company
P.O. Box 571918
Salt Lake City UT 84157
Advantage Workers Compensation
Insurance Company Medical Provider
Network Insurer 9/13/2007 T
0528
AIG Casualty Company fka Birmingham Fire
Insurance Company of Pennsylvania
175 Water Street
New York NY 10038 Chartis - Cambridge MPN Insurer 3/24/2005 W
3003
AIG Claims, Inc.
175 Water Street
New York NY 10038 AIG Select Advantage
Entity that
provides
physician
network
services 3/3/2017 http://www.talispoint.com/aig/mpnselect/
3054
AIG Claims, Inc.
175 Water Street
New York NY 10039 AIG EP MPN
Entity that
provides
physician
network
services 10/27/2017 www.talispoint.com/aig/EP
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
9
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3072
AIG Claims, Inc.
175 Water Street
New York NY 10039 AIG JCP MPN
Entity that
provides
physician
network
services 12/11/2017 www.talispoint.com/aig/jcp
3002
AIG Claims, Inc.
175 Water Street
NY NY 10039 AIG Primary Advantage
Entity that
provides
physician
network
services 3/6/2017 www.talispoint.com/aig/com
2042
AIG Property Casualty Company
175 Water St - 18th Floor
New York NY 10038
Sedgwick/Harbor MPN - CHARTIS
EPS Insurer 8/16/2012 T
1658
AIG Property Casualty Company
175 Water St 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/23/2010 T
1757
AIG Property Casualty Company
175 Water St., 18th Flr
New York NY 10038 AIG Select MPN Insurer 1/19/2011 www.talispoint.com/aig/mpnselect
1407
AIG Property Casualty Company
175 Water Street - 18 Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
0115
AIG Property Casualty Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
1986
AIG Property Casualty Company
175 Water Street - 18th Floor
New York NY 10038 Sedgwick/Harbor 2 MPN Insurer 6/1/2012 T
1978
AIG Property Casualty Company
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor MPN Insurer 5/24/2012 T
0116
AIU Insurance Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0526
AIU Insurance Company
70 Pine Street
New York NY 10270 Cambridge-Concentra MPN Insurer 3/23/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
10
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0649
AIU Insurance Company
70 Pine Street
New York NY 10270
AIU Insurance/Gallagher
Bassett/Concentra MPN Insurer 3/24/2005 W
0465
AIU Insurance Company
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0919
AIU Insurance Company
70 Pine Street
New York NY 10270
MedInsights/GAB Robins Medical
Provider Network, accessing Prudent
Buyer HCO Insurer 5/19/2005 W
1025
AIU Insurance Company
70 Pine Street
New York NY 10270
AIU Gallagher Bassett First Health
Select MPN Insurer 8/5/2005 W
0855
AIU Insurance Company
AIG 70 Pine Street
New York NY 10270
AIU Insurance Company, Crawford
Select Insurer 7/1/2005 W
0864
AIU Insurance Company
AIG 70 Pine Street
New York NY 10270
AIU Insurance Company, Crawford
Select Insurer 7/1/2005 W
0610
AIU Insurance Company
Chartis 32 Old Slip 19th FL
New York NY 10006 AIG ESIS MPN Insurer 3/28/2005 T
1326
AIX, Inc.
2 Waterside Crossing, Suite 400
Windsor CT 06095
AIX/Gallagher Bassett/First Health
MPN Insurer 11/16/2007 W
1328
AIX, Inc.
2 Waterside Crossing, Suite 400
Windsor CT 06095 AIX/Gallagher Bassett/Coventry MPN Insurer 11/16/2007 W
1697
Alameda Contra Costa Transit District
1600 Franklin St.
Oakland ca 94612 AC Transit MPN
Self-Insured
Employer 9/29/2010 www.actransitmpn.com T
0767
Alameda County Schools Insurance Group
5776 Stoneridge Mall Road, Suite 130
Pleasanton CA 94588
ACSIG/AccessMedical Provider
Network
Joint Powers
Authority 5/19/2005 T
1345
Alameda County Schools Insurance Group
P O Box 2487
Dublin CA 94568 PRIME Plus Medical Provider Network
Joint Powers
Authority 1/28/2008 T
1032
Alameda County
1106 Madison Street
Oakland CA 94607
First Health CompAmerica Primary
Network
Self-Insured
Employer 8/12/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
11
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1780
Alameda Health System
7677 Oakport Street, Suite 1200
Oakland CA 94612 Alameda Health System MPN
Self-Insured
Employer 2/3/2011 http://www.talispoint.com/AHS
1799
Alaska National Insurance Company
1111 Third Ave, Suite 2600
Seattle WA 94101 Alaska National Customized MPN Insurer 3/10/2011 www.corvel.com
1383
Alaska National Insurance Company
1111 Third Avenue Suite 2600
Seattle WA 98101 CorVel MPN Insurer 6/19/2008 www.corvel.com
0155
Alaska National Insurance Company
450 Sansome Street
San Francisco CA 94111
Alaska National Preferred Choice
Network Insurer 2/1/2005 T
0827
Alea North America Insurance Company
55 Capital Blvd
Rocky Hill CT 06067 TRISTAR CompAmerica Primary HCO Insurer 5/3/2005 W
0415
Alea North America Insurance Company
55 Capital Blvd. - Corporate Ridge
Rocky Hill CT 06067 Medex Insurer 2/24/2005 W
0411
Alea North America Insurance Company
55 Capital Blvd.
Rocky Hill CT 06067 CorVel MPN Insurer 2/28/2005 T
0307
Alea North America Insurance Company
555 Capital Blvd, Corporate Ridge
Rocky Hill CT 06032
Alea/Frank Gates First Health Comp
America Select HCO Network ("First
Health Select") Insurer 5/11/2005 W
0185
Alea North American Insurance Company
55 Capital Blvd
Rocky Hill CT 06067 First Health CompAmerica Select MPN Insurer 3/8/2005 W
0163
Alea North American Insurance Company
55 Capital Blvd.
Rocky Hill CT 06067 CompUSA Primary MPN Insurer 2/17/2005 W
1224
Alisal Union School District
1205 E. Market St.
Salinas CA 93905
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 10/5/2006 T
0951
Alliance of Schools for Cooperative Insurance
Programs (ASCIP)
16550 Bloomfield Ave
Cerritos CA 90703 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
12
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1699
Alliance of Schools for Cooperative Insurance
Programs (ASCIP)
16550 Bloomfield Ave.
Cerritos CA 90703 ASCIP-Athens MPN
Joint Powers
Authority 9/29/2010 www.medexhco.com
3089
Allianz Global Risks US Insurance Company
225 W Washington Street, Suite 1800
Chicago IL 60606 Allianz Global Risk US Select
Entity that
provides
physician
network
services 3/7/2018 http://www.talispoint.com/cvty/agcs
2360
Allied Managed Care Incorporated
10445 Old Placerville Road
Sacramento CA 95827 Allied Managed Care MPN
Entity that
provides
physician
network
services 3/11/2015 www.alliedmanagedcare.com/mpn
3059
Allied Property And Casualty Insurance Company
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 10/20/2017 www.corvel.com
1817
Allmerica Financial Benefit Insurance Company
440 Lincoln Street
Worcester MA 01615 CorVel/Kaiser Select MPN Insurer 4/22/2011 www.Corvel.com
1746
Alpha aka Association of California Hospital
Districts, Inc. (Alpha Fund-ACHD)
P.O. Box 419068
Rancho Cordova CA 95741 Medex MPN
Joint Powers
Authority 1/19/2011 T
1460
Alta-Dena Certified Dairy, LLC
17637 East Valley Blvd
City of Industry CA 91744 Liberty Mutual Group MPN
Self-Insured
Employer 10/20/2008 T
3073
Alternative Service Concepts, L.L.C.
5620 Birdcage Tree Road
Citrus Heights CA 95610
Alternative Service Concepts Select
MPN
Entity that
provides
physician
network
services 1/26/2018 www.talispoint.com/cvty/asc
1809
Alvord Unified School District
10365 Keller Ave
Riverside CA 92505
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 3/24/2011 T
0638
Alvord Unified School District
10365 Keller Avenue
Riverside CA 92505 Broadspire-Concentra Standard MPN
Self-Insured
Employer 4/4/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
13
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3062
AMCO Insurance Company
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 10/31/2017 www.corvel.com
1891
Amcor Packaging Distribution
6600 Valley View St
Buena Park CA 90620 Broadspire Signature MPN
Self-Insured
Employer 11/22/2011 T
1190
Amcor Sunclipse North America
6600 Valley View
Buena Park CA 90620 Suncare
Self-Insured
Employer 7/21/2006 T
1215
American Alternative Insurance Corporation
(AAIC)
555 College Rd. East
Princeton NJ 08543
American Alternative/Gallagher
Basset/First Health MPN Insurer 7/18/2006 T
1531
American Alternative Insurance Corporation
555 College Rd East
Princeton NJ 08543 American Alternative GBMCS MPN Insurer 5/8/2009 T
1763
American Alternative Insurance Corporation
555 College Road East
Princeton NJ 08543 WellComp Medical Provider Network Insurer 1/19/2011 T
1899
American Alternative Insurance Corporation
555 College Road East
Princeton NJ 08543 ACM/Munich RE MPN Insurer 1/19/2012 T
0621
American Automobile Insurance Company
777 San Marin Dr.
Novato CA 94998 First Health Select Insurer 2/14/2005 www.agcs.allianz.com/usclaims
1735
American Casualty Company of Reading, PA
333 S. Wabash, 39th Flr.
Chicago IL 60604
MedInsights MPN accessing Prudent
Buyer PPO Insurer 12/2/2010 T
2094
American Casualty Company of Reading,
Pennsylvania
333 South Wabash
Chicago IL 60604 Sedgwick/Harbor MPN Insurer 12/27/2012 T
1869
American Casualty Company of Reading,
Pennsylvania
333 S Wabash Ave.
Chicago IL 60685
Longwood Management Group/Anthem
Medical Provider Network Insurer 7/28/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
14
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2161
American Casualty Company of Reading,
Pennsylvania
333 S Wabash Avenue
Chicago IL 60604 GENEX Insurer 5/6/2013 www.genexservices.com T
1420
American Casualty Company of Reading,
Pennsylvania
333 S. Wabash Ave
Chicago IL 60604
Sedgwick First Health CompAmerica
Primary HCO Network Insurer 12/17/2008 T
1513
American Casualty Company of Reading,
Pennsylvania
333 S. Wabash, 24 Fl
Chicago IL 60604 Sedgwick CMS MPN Insurer 3/5/2009 T
1878
American Casualty Company of Reading,
Pennsylvania
333 S. Wabash, Floor 24
Chicago IL 60604 Sedgwick CMS Extended MPN Insurer 8/31/2011 T
1770
American Casualty Company Of Reading,
Pennsylvania
333 South Wabash Avenue
Chicago IL 60604 Broadspire Signature MPN Insurer 2/2/2011 T
1844
American Casualty Company of Reading,
Pennsylvania
333 South Wabash
Chicago IL 60604
American Casualty/Gallagher
Bassett/First Health MPN Insurer 6/16/2011 www.talispoint.com/cvty/gbfhmpnselect
1905
American Casualty Company Of Reading,
Pennsylvania
333 South Wabash Avenue
Chicago IL 60604 CorVel MPN Insurer 2/14/2012 www.corvel.com
2095
American Casualty Company of Reading,
Pennsylvania
CAN 333 South Wabash
Chicago IL 60604 Sedgwick/Harbor 2 MPN Insurer 12/27/2012 T
0518
American Economy Insurance Company
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 2/14/2005
http://www.libertymutualgroup.com/providernetwork
s
T
2153
American Family Home Insurance Company
555 College Road East
Princeton NJ 08543 ACM/American Family Home MPN Insurer 5/6/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
15
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0894
American Fuji Fire & Marine
3380 RFD Salem Lake Dr Suite E
Long Grove IL 60047 CorVel/American Fuji Fire & Marine Insurer 5/19/2005 T
0154
American Guarantee & Liability Insurance
Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0836
American Guarantee & Liability Insurance
Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 5/31/2005 T
0700
American Guarantee & Liability Insurance
Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
1262
American Guarantee & Liability Insurance
Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 American Guarantee/CorVel MPN Insurer 12/7/2006 T
0435
American Guarantee & Liability
1299 Zurich Way
Schaumburg IL 60196 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0669
American Guarantee & Liability
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
American Guarantee & Liability,
Crawford Select Insurer 7/1/2005 W
0173
American Guarantee and Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196 TCT CA MPN Insurer 3/8/2005 www.mywcinfo.com T
0137
American Guarantee and Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196 Zurich ESIS MPN Insurer 4/18/2005 T
0210
American Guarantee And Liability Insurance
Company
1299 Zurich Way 3W
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 4/18/2005 www.zurichna.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
16
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1141
American Guarantee And Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 www.zurichna.com
1350
American Guarantee and Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
1684
American Guarantee And Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196 Broadspire Signature Network MPN Insurer 8/18/2010 T
1824
American Guarantee and Liability Insurance
Company
1299 Zurich Way
Schaumburg IL 60196
ACM/American Guarantee and Liability
MPN Insurer 5/3/2011 http://mpn.acmclaims.com/zurich T
2262
American Guarantee and Liability Insurance
Company
1400 American Lane, Tower 2-6th Floor
Schaumburg IL 60196
American Guarantee and Liability
Insurance Company GBMCS MPN Insurer 12/30/2013 T
2261
American Guarantee and Liability Insurance
Company
1400 American Lane, Tower 2-6th Floor
Schaumburg IL 60196
American Guarantee and Liability
Insurance Company/Gallagher
Bassett/Coventry MPN Insurer 1/15/2014 www.talispoint.com/cvty/gbcvtympn T
2283
American Guarantee and Liability Insurance
Company
1400 American Lane, Tower 2-6th Floor
Schaumburg IL 60196
American Guarantee and Liability
Insurance Company/Gallagher
Bassett/First Health MPN Insurer 1/16/2014 www.talispoint.com/cvty/gbfhmpnselect T
1725
American Home Assurance Company
175 Water St - 18th Floor
New York NY 10038 AIG Select Medical Provider Network Insurer 12/8/2010 www.talispoint.com/aig/mpnselect
1167
American Home Assurance Company
175 Water St 18th Floor
New York NY 10038 PCIC MPN Insurer 7/24/2006 T
0913
American Home Assurance Company
175 Water St, 18th Floor
New York NY 10038
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 5/19/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
17
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0114
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0099
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038
American Home Assurance
Company/Lowe's Insurer 3/18/2005 T
0363
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/28/2005 T
0367
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Primary HCO Network Insurer 3/28/2005 T
0996
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 CorVel MPN Insurer 8/12/2005 www.corvel.com
1404
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
1656
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 Broadspire Signature MPN Insurer 6/22/2010 www.broadspireppo.com T
2296
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 Mentor/AmHome/Bunch MPN Insurer 5/8/2014 http://providernet.bunchcare.com T
2348
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038
Sedgwick/Harbor MPN- AHAC
Verizon Insurer 10/1/2014 www.harborsys.com/verizon
3010
American Home Assurance Company
175 Water Street - 18th Floor
New York NY 10038 Silverado MPN Insurer 2/8/2017 www.corvel.com
1980
American Home Assurance Company
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor MPN Insurer 5/24/2012 T
1984
American Home Assurance Company
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
1295
American Home Assurance Company
175 Water Street 17th Floor
New York NY 10038 Chartis/Foster's Americas Insurer 6/8/2007 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
18
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1320
American Home Assurance Company
175 Water Street 17th Floor
New York NY 10038 FARA - FHS Insurer 12/3/2007 T
1033
American Home Assurance Company
175 Water Street- 18th Floor
New York NY 10038
American Home Assurance/The GEO
Group, Inc. Insurer 7/21/2005 T
1366
American Home Assurance Company
175 Water Street 18th Floor
New York NY 10038 WellComp Medical Provider Network Insurer 5/27/2008 T
1381
American Home Assurance Company
175 Water Street 18th floor
New York NY 10038 Chartis/JCP Insurer 7/1/2008 T
1518
American Home Assurance Company
175 Water Street 18th Floor
New York NY 10038 Walmart-Medex MPN Insurer 3/13/2009 www.medexhco.com
0527
American Home Assurance Company
175 Water Street
New York NY 10038 Chartis - Cambridge MPN Insurer 3/24/2005 T
0650
American Home Assurance Company
175 Water Street, 18th Floor
New York NY 10038
American Home/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 www.talispoint.com/cvty/gbcvtympn
0625
American Home Assurance Company
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
0483
American Home Assurance Company
175 Water Street, 18th Floor
New York NY 10038 TCT CA MPN Insurer 4/12/2005 www.mywcinfo.com T
1024
American Home Assurance Company
175 Water Street, 18th Floor
New York NY 10038
American Home Assurance
Company/Gallagher Bassett/First Health
MPN Insurer 8/5/2005 www.talispoint.com/cvty/gbfhmpnselect T
1453
American Home Assurance Company
175 Water Street, 18th Floor
New York NY 10038
American Home Assurance Company
GBMCS MPN Insurer 5/8/2009 www.talispoint.com/cvty/gbmpn T
1424
American Home Assurance Company
70 Pine St
New York NY 10270
CCMSI/ AIG/ First Health
CompAmerica Select HCO Network Insurer 1/7/2009 T
0501
American Home Assurance Company
70 Pine Street
New York NY 10270
Sedgwick CMS Extended Medical
Provider Network Insurer 3/10/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
19
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0491
American Home Assurance Company
70 Pine Street
New York NY 10270
Sedgwick CMS Medical Provider
Network Insurer 3/16/2005 T
0421
American Home Assurance Company
70 Pine Street
New York NY 10270 Tetra-FARA Insurer 4/21/2005 W
0422
American Home Assurance Company
70 Pine Street
New York NY 10270 Matrix - FARA Insurer 4/21/2005 W
0464
American Home Assurance Company
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0479
American Home Assurance Company
70 Pine Street
New York NY 10270 Wal-Mart - First Health Primary MPN Insurer 5/10/2005 T
0517
American Home Assurance Company
70 Pine Street
New York NY 10270 AIGDC/Bank of America Insurer 5/10/2005 T
0788
American Home Assurance Company
70 Pine Street
New York NY 10270 FARA-CVTY Insurer 5/15/2005 T
0615
American Home Assurance Company
70 Pine Street
New York NY 10270 Intracorp - Gates McDonald MPN Insurer 6/2/2005 T
0868
American Home Assurance Company
70 Pine Street
New York NY 10270 AIGDC/Manpower Insurer 8/8/2005 T
1149
American Home Assurance Company
70 Pine Street
New York NY 10270
American Home Assurance/Central
Parking Insurer 5/12/2006 T
1374
American Home Assurance Company
70 Pine Street
New York NY 10270
Athens/American Home Assurance
MPN Insurer 4/15/2008 T
0851
American Home Assurance Company
AIG 70 Pine Street
New York NY 10270
American Home Assurance Company-
Crawford Select Insurer 7/1/2005 W
0861
American Home Assurance Company
AIG 70 Pine Street
New York NY 10270
American Home Assurance Company,
Crawford Primary Insurer 7/1/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
20
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0540
American Honda Motor Co., Inc.
700 Van Ness Ave., Bldg. #300
Torrance CA 90501
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 3/22/2005 T
1729
American Manufacturers Mutual Insurance
Company
1 Corporate Dr
Long Grove IL 60047 Broadspire Signature MPN Insurer 12/10/2010 T
2154
American Modern Home Insurance Company
555 College Road East
Princeton NJ 08543 ACM/American Modern Home MPN Insurer 5/6/2013 T
1730
American Motorist Insurance Company
1 Corporate Dr
Long Grove IL 60047 Broadspire Signature MPN Insurer 12/10/2010 T
0101
American Motorists Insurance Company
One Kemper Drive
Long Grove IL 60049 First Health CompAmerica Select HCO Insurer 2/15/2005 T
0708
American Racing Equipment, Inc.
19067 S. Reyes Avenue
Rancho Dominguez CA 90211
MedInsights Medical Provider
Network/Prudent Buyer HCO
Self-Insured
Employer 4/20/2005 R
0519
American States Insurance Company of Texas
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 2/14/2005
http://www.libertymutualgroup.com/providernetwork
s
T
0520
American States Insurance Company
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 2/14/2005
http://www.libertymutualgroup.com/providernetwork
s
T
0211
American Zurich Insurance Company
1299 Zurich Way 3W
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 4/18/2005 www.zurichna.com
1142
American Zurich Insurance Company
1299 Zurich Way 3W
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 www.zurichna.com
2402
American Zurich Insurance Company
1299 Zurich Way
Schaumberg IL 60196
American Zurich Insurance
Company/GENEX MPN Insurer 9/3/2015 www.genexservices.com T
0358
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/7/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
21
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0438
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 TCT CA MPN Insurer 3/8/2005 www.mywcinfo.com T
0434
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0134
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Zurich ESIS MPN Insurer 4/19/2005 T
0840
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 www.zurichna.com
1348
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
1522
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 5/4/2009 T
1682
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Broadspire Signature Network MPN Insurer 8/18/2010 T
1821
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 ACM/American Zurich MPN Insurer 5/3/2011 http://mpn.acmclaims.com/zurich T
1876
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196
American Zurich Insurance
Company/CorVel MPN Insurer 8/23/2011 www.corvel.com
1892
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick CMS Extended Medical
Provider Network Insurer 11/29/2011 T
1910
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 TRISTAR MPN Insurer 2/14/2012 T
2098
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Sedgwick/Harbor MPN Insurer 12/24/2012 T
2101
American Zurich Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Sedgwick/Harbor 2 MPN Insurer 12/27/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
22
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0356
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
SRS First Health CompAmerica
Primary HCO Network (or "SRS First
Health Primary") Insurer 3/7/2005 W
0147
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0837
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 5/31/2005 T
0672
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
American Zurich Insurance Company,
Crawford Select Insurer 7/1/2005 W
1005
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
American Zurich Insurance Company -
Crawford Primary Insurer 7/1/2005 W
1337
American Zurich Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 American Zurich Ins./The GAP, Inc. Insurer 2/5/2008 T
2256
American Zurich Insurance Company
1400 American Lane Tower 2-6th Floor
Schaumburg IL 60196
American Zurich/Gallagher
Bassett/First Health MPN Insurer 12/30/2013 T
0345
AmerisourceBergen Corporation
1300 Morris Drive
Chesterbrook PA 19087
First Health CompAmerica/Select HCO
Network
Self-Insured
Employer 3/8/2005 T
1835
AmerisourceBergen Corporation
1300 Morris Drive
Chesterbrook PA 19087 Broadspire Signature MPN
Self-Insured
Employer 5/24/2011 T
0166
AmGuard Insurance
16 South River Street
Wilkes Barre PA 18703
AM Guard Insurance (GUARD
Insurance) Insurer 1/24/2005 T
0201
Anaheim Union High School District
501 Crescent Way
Anaheim CA 92801
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/1/2005 T
1049
Antelope Valley Community College District
3041 West Avenue "K"
Lancaster CA 93536 Prime Advantage Medical Network
Self-Insured
Employer 7/27/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
23
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2397
Anthem Workers' Compensation, LLC
120 Monument Circle
Indianapolis IN 46204 Anthem Premier MPN
Entity that
provides
physician
network
services 6/26/2015
https://www.anthemwc.com/medical_provider_netw
orks
2415
Anthem Workers' Compensation, LLC
120 Monument Circle
Indianapolis IN 46204 Anthem Premier Plus MPN
Entity that
provides
physician
network
services 10/29/2015
https://www.anthemwc.com/medical_provider_netw
orks.asp
1808
Apple Valley Unified School District
22974 Bear Valley Road
Apple Valley CA 92308
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 3/24/2011 T
0907
ARCH Insurance Company
300 First Stamford Place 5th Flr
Stamford CT 06902
MedInsights Medical Provider Network
accessing Prudent Buyer HCO Insurer 6/1/2005 W
0402
ARCH Insurance Company
300 First Stamford Place
Stamford CT 06902
ARCH Insurance Company Cambridge
MPN Insurer 2/24/2005 W
2127
Arch Insurance Company
300 Plaza 3 3rd Floor
Jersey City NJ 07311 LWP Signature MPN Insurer 2/20/2013 http://www.lwpsignaturempn.com
1402
ARCH Insurance Company
300 Plaza 3
Jersey City NJ 07311 ARCH ESIS MPN Insurer 9/29/2008 T
1484
ARCH Insurance Company
300 Plaza 3
Jersey City NJ 07311 WellComp Medical Provider Network Insurer 1/8/2009 T
2128
Arch Insurance Company
300 Plaza 3, 3rd Floor
Jersey City NJ 07311 LWP Kaiser Signature MPN Insurer 2/20/2013 www.lwpkaisersignaturempn.com
1606
Arch Insurance Company
300 Plaza Three - 3rd Floor
Jersey City NJ 07311 Wellcomp Medical Provider Network Insurer 3/10/2010 T
1685
Arch Insurance Company
300 Plaza Three, 3rd FL
Jersey City NJ 07311 Broadspire Signature Network Insurer 8/18/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
24
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1996
Arch Insurance Company
300 Plaza Three, 3rd Floor
Jersey City NJ 07311
CCMSI/Arch/First Health Comp
America Select HCO Network Insurer 10/20/2011 T
2362
ARCH Insurance Company
300 Plaza Three, 3rd Floor
Jersey City NJ 07311 Athens MPN Insurer 1/30/2015 www.medexhco.com
2170
Arch Insurance Company
300 Plaza Three-3rd floor
Jersey City NJ 07311 Liberty Mutual Group MPN Insurer 5/6/2013 T
1323
ARCH Insurance Company
One Liberty Plaza - 53rd Flr
New York NY 10006 Broadspire MPN Insurer 11/5/2007 T
1419
ARCH Insurance Company
One Liberty Plaza 53rd Floor
New York NY 10006 ARCH-FARA Insurer 3/24/2009 T
1791
Arch Insurance Company
One Liberty Plaza 53rd Floor
New York NY 10006 Arch GBMCS KOJ MPN Insurer 3/2/2011 www.talispoint.com/cvty/gbkoj
1035
ARCH Insurance Company
One Liberty Plaza 53rd Flr
New York NY 10006 Arch/Gallagher Bassett/Coventry MPN Insurer 7/18/2005 T
1266
Arch Insurance Company
One Liberty Plaza
New York NY 10006
Sedgwick First Health CompAmerica
Select HCO Network Insurer 2/27/2007 T
1277
Arch Insurance Company
One Liberty Plaza
New York NY 10006
Sedgwick First Health CompAmerica
Primary HCO Network Insurer 3/1/2007 T
1292
ARCH Insurance Company
One Liberty Plaza
New York NY 10006 Arch/Bunch/BBY Ca MPN Insurer 5/18/2007 T
1330
ARCH Insurance Company
One Liberty Plaza
New York NY 10006 Sedgwick CMS MPN Insurer 11/26/2007 T
1600
Arch Insurance Company
One Liberty Plaza
New York NY 10006
Sedgwick CMS/Harbor MPN-Arch
Ross Insurer 3/2/2010 T
1615
Arch Insurance Company
One Liberty Plaza
New York NY 10006 Sedgwick CMS/Harbor MPN - Big Lots Insurer 3/26/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
25
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1796
Arch Insurance Company
One Liberty Plaza
New York NY 10006 Arch/WSonoma/Bunch MPN Insurer 3/10/2011 W
1895
ARCH Insurance Company
One Liberty Plaza
New York NY 10006 ARCH/Big Lots/Bunch MPN Insurer 12/20/2011 T
2008
Arch Insurance Company
One Liberty Plaza
New York NY 10006 Sedgwick/Harbor MPN Insurer 6/1/2012 T
2009
Arch Insurance Company
One Liberty Plaza
New York NY 10006 Sedgwick/Harbor 2 MPN Insurer 6/1/2012 T
1464
ARCH Insurance Company
One Liberty Plaza, 53rd Fl.
New York NY 10006 Sedgwick CMS Extended MPN Insurer 11/10/2008 T
0331
Arch Insurance Company
One Liberty Plaza, 53rd Floor
New York NY 10006 CorVel MPN Insurer 3/7/2005 www.corvel.com
1447
ARCH Insurance Company
One Liberty Plaza, 53rd Floor
New York NY 10006 ARCH GBMCS MPN Insurer 5/7/2009 T
0689
ARCH Insurance Company
One Liberty Plaza, 53rd Flr
New York NY 10006
Arch/Gallagher Bassett/First Health
MPN Insurer 5/24/2005 T
1206
Archer-Daniels-Midland Company
4666 Faries Parkway
Decatur IL 62525 CorVel MPN/Archer Daniels-Midland
Self-Insured
Employer 5/31/2006 www.corvel.com √
1664
Argonaut Great Central Insurance Company
225 W Washington Street, 6th Floor
Chicago IL 60606
Argonaut Great Central Insurance
Company/GENEX MPN Insurer 9/29/2010 www.genexservices.com T
1708
Argonaut Great Central Insurance Company
225 West Washington St. 8th Floor
Chicago IL 60606 Broadspire Signature Network Insurer 10/20/2010 T
0424
Argonaut Insurance Company
10101 Reunion Place Suite 500
San Antonio TX 78216 Broadspire MPN Insurer 3/21/2005 T
1663
Argonaut Insurance Company
225 W. Washington Stree, 6th Floor
Chicago IL 60606
Argonaut Insurance Company/GENEX
MPN Insurer 9/29/2010 www.genexservices.com T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
26
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1705
Argonaut Insurance Company
225 West Washington St. 8th Floor
Chicago IL 60606 Broadspire Signature Network Insurer 10/20/2010 T
0053
Argonaut Insurance Company
5250 North Palm Avenue, Suite 210
Fresno CA 93704 CorVel MPN/Argonaut Insurer 2/17/2005 T
1666
Argonaut-Midwest Insurance Company
225 W. Washington Street, 6th Floor
Chicago IL 60606
Argonaut Midwest Insurance
Company/GENEX MPN Insurer 9/29/2010 www.genexservices.com T
1707
Argonaut-Midwest Insurance Company
225 West Washington St. 8th Floor
Chicago IL 60606 Broadspire Signature Network Insurer 10/20/2010 T
1665
Argonaut-Southwest Insurance Company
225 W. Washington Street, 6th Floor
Chicago IL 60606
Argonaut Southwest Insurance
Company/GENEX MPN Insurer 9/29/2010 www.genexservices.com T
1706
Argonaut-Southwest Insurance Company
225 West Washington St. 8th Floor
Chicago IL 60606 Broadspire Signature Network Insurer 10/20/2010 T
1896
Arrowood Indemnity Company
3600 Arch Corporate Dr.
Charlotte NC 28273
Arrowood Indemnity-EK Health Select
MPN Insurer 12/20/2011 T
1344
Artisan Confections Company
c/o Hershey Co 100 Crystal A Drive
Hershey PA 17033 Sedgwick CMS CA MPN
Self-Insured
Employer 1/18/2008 T
1079
Asplundh Tree Expert Co.
708 Blair Mill Road
Willow Grove PA 19090 Liberty Mutual Group MPN
Self-Insured
Employer 10/11/2005 T
0620
Associated Indemnity Corporation
777 San Marin Dr.
Novato CA 94998 First Health Select Insurer 2/14/2005 www.agcs.allianz.com/usclaims
0151
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0212
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
FirstHealth CompAmerica Select HCO
Network Insurer 4/18/2005 T
0674
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Assurance Company of America -
Crawford Select Insurer 7/1/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
27
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1008
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Assurance Company of America -
Crawford Primary Insurer 7/1/2005 W
0841
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
1143
Assurance Company of America
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 T
1351
Assurance Company of America
1400 American Lane Tower 1-13th Floor
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
0751
AT&T Corporation
One AT & T Way
Bedminster NJ 07921 Broadspire-Concentra Standard MPN
Self-Insured
Employer 4/4/2005 R
1237
AT&T Inc.
208 South Akard Street, 27th Floor
Dallas TX 75202
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 9/22/2006 T
2377
ATHENS INSURANCE SERVICE, INC.
2552 STANWELL DR
Concord CA 94520 Athens Administrators
Entity that
provides
physician
network
services 4/1/2015
http://www.athensmci.com/services/athens-
administrators-california-mpn/
0941
Atlantic Mutual Insurance Company
PO Box 2307
Brea CA 92822
Atlantic Mutual Companies/Coventry
MPN Insurer 9/6/2005 T
2373
Atlantic Specialty Insurance Company
150 Royal Street
Canton MA 02021 WellComp Medical Provider Network Insurer 2/24/2015 www.wellcomp.com T
3005
Atlantic Specialty Insurance Company
605 Highway 169 North Ste 800
Plymouth MN 55441
Atlantic Specialty Insurance Company -
Select MPN
Entity that
provides
physician
network
services 12/14/2016 www.coventrywcs.com
0777
Auto Dealers Compensation of California, Inc.
c/o Bickmore Risk Services 1831 K St.
Sacramento CA 95814 AD-COMP MPN
Group of
Self-Insured
Employers 9/15/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
28
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0530
B.V. General, Inc.
1506 South Glendale Avenue
Glendale CA 91205 First Health Comp America HCO Select
Self-Insured
Employer 4/21/2005 www.talispoint.com/cvty/mpnsel
1259
Bakersfield City School District
1300 Baker Street
Bakersfield CA 93305
Self-Insured Schools Of
California(SISC)/California Foundation
For Medical Care Network
Self-Insured
Employer 12/7/2006 www.cfmcnet.org/SISC
0348
Ball Corporation, Ball Metal Beverage Container
Corp., and Ball Plastic Corp.,Ball Metal Food
Container LLC, Ball Aerosol and Specialty
Container, Inc.
10 Longs Peak Drive
Broomfield CO 80021
First Health CompAmerica Select HCO
Network (or "First Health Select")
Self-Insured
Employer 3/8/2005 T
1268
Bancinsure Inc.
5104 N. Francis Ave., Suite 101
Oklahoma City OK 73105 Midwest/CorVel MPN Insurer 12/14/2006 T
1335
BancInsure, Inc.
5005 N. Lincoln Blvd.
Oklahoma City OK 73108 BancInsure MPN Insurer 2/5/2008 T
0702
Bankers Standard Insurance Company (BSI)
1601 Chestnut Street
Philadelphia PA 19103
Bankers Standard Insurance Company
(BSI), Crawford Select Insurer 6/16/2005 W
0703
Bankers Standard Insurance Company (BSI)
1601 Chestnut Street
Philadelphia PA 19103
Bankers Standard Insurance Company
(BSI), Crawford Primary Insurer 6/16/2005 W
0769
Bankers Standard Insurance Company
436 Walnut St
Philadelphia PA 19106 ACE/BUNCH Network Insurer 5/6/2005 T
0417
Bari Management, Inc.
620 N. Brand Blvd., 6th Floor
Glendale CA 91203 FH Select MPN
Self-Insured
Employer 5/10/2005 T
0409
Barrett Business Services, Inc.
8100 NE Parkway Drive, Ste 200
Vancouver WA 98662 BBSI MPN
Self-Insured
Employer 2/28/2005 www.barrettbusiness.com √
0112
Bay Cities JPA/Bickmore Risk Services
1831 K Street
Sacramento CA 95814
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/13/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
29
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0141
BCI Coca-Cola Bottling Company of Los Angeles
(Coca-Cola Enterprises, Inc.)
1334 South Central Avenue
Los Angeles CA 90012
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 2/1/2005 T
1329
Benchmark Insurance Company
100 Lake Street West
Wayzata MN 55391 CorVel/Kaiser Select MPN Insurer 11/30/2007 www.corvel.com
2275
Benchmark Insurance Company
100 West Lake St.
Wayzata MN 55391 Sierra MPN Insurer 5/27/2014 www.bmiclaims.com
1332
Benchmark Insurance Company
6405 Metcalf Ave., Suite 400
Overland Park KS 66202 Rising Interplan MPN Insurer 12/28/2007 T
1610
Benchmark Insurance Company
775 Prairie Center Dr Ste 420
Eden Prairie MN 55344 Athens MPN Insurer 3/18/2010 T
0959
Benefit & Liability Programs of California
16703 S. Clark Ave.
Bellflower CA 90706 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 www.wellcomp.com
1459
Berkeley Farms, LLC
25500 Clawiter Road
Hayward CA 94545 Liberty Mutual Group MPN
Self-Insured
Employer 10/20/2008 T
1942
Berkley National Insurance Company
215 Shuman Blvd., Ste 200
Naperville IL 60563 WellComp Medical Provider Network Insurer 5/2/2012 T
1945
Berkley Regional Insurance Company
11201 Douglas Ave
Urbandale IA 50322 WellComp Medical Provider Network Insurer 5/2/2012 T
1229
Berkley Regional Insurance Company
11201 Douglas Ave.
Urbandale IA 50322 San Francisco 49er MPN Insurer 9/1/2006 T
1038
Berkshire Hathaway Homestate Companies-
Cypress Insurance Company
P.O. Box 7008
Pasadena CA 91109
Berkshire Hathaway Homestate
Companies MPN Insurer 8/16/2005 W
0454
Berkshire Hathaway Homestate Companies-Oak
River Insurance Co.
P.O. Box 7008
Pasadena CA 91109
Berkshire Hathaway Homestate
Companies MPN Insurer 2/16/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
30
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1037
Berkshire Hathaway Homestate Companies-
Redwood Fire & Casualty Company
P.O. Box 7008
Pasadena CA 91109
Berkshire Hathaway Homestate
Companies MPN Insurer 8/16/2005 W
2225
Big 5 Corp.
2525 E. El Segundo Blvd
El Segundo CA 90245 CorVel MPN
Self-Insured
Employer 10/18/2013 www.corvel.com
0791
Big 5 Corp.
2525 E. El Segundo Blvd.
El Segundo CA 90245 Big 5 ESIS MPN
Self-Insured
Employer 5/24/2005 T
0900
Birmingham Fire Insurance Company of
Pennsylvania
AIG 70 Pine St.
New York NY 10270
Birmingham Fire Insurance Company of
Pennsylvania, Crawford Primary Insurer 10/5/2005 W
0859
Birmingham Fire Insurance Company of
Pennsylvania
Birmingham Fire Ins Co of PA
New York NY 10038
Birmingham Fire Insurance Company of
Pennsylvania Crawford Select Insurer 10/19/2005 W
0388
Bourns, Inc.
1200 Columbia Avenue
Riverside CA 92507 Medex
Self-Insured
Employer 2/23/2005 W
2265
Bright Health Physicians PIH
12401 Washington Blvd.
Whittier CA 90602 Athens MPN
Self-Insured
Employer 1/8/2014 T
2399
Broadspire Services, Inc.
1391 NW 136th Avenue
Sunrise FL 33323 Broadspire MPN
Entity that
provides
physician
network
services 11/5/2015
www.choosebroadspire.com/resources/medicalmana
gement
2403
Bunch CareSolutions LLC
3500 Reynolds Rd
Lakeland FL 33803 Aramark Bunch CS MPN
Entity that
provides
physician
network
services 8/7/2015 www.bunchcare.com
2386
Bunch CareSolutions LLC
3500 Reynolds Rd.
Lakeland FL 33803 BunchCS KOJ HS MPN
Entity that
provides
physician
network
services 6/25/2015 www.bunchcare.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
31
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2478
Bunch CareSolutions LLC
3500 Reynolds Rd.
Lakeland FL 33803 BunchCS FHSelect MPN
Entity that
provides
physician
network
services 5/9/2016 www.bunchcare.com
2088
Cajon Valley Union School District
750 E.Main Street
El Cajon CA 92020
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 12/6/2012 T
0712
Calexico Unified School District
901 Andrade Ave
Calexico CA 92231 Prime Advantage Medical Network
Self-Insured
Employer 4/19/2005 T
1129
California Agricultural Network Self Insured
Group (CANSIG)
2151 Convention Center Way #203
Ontario CA 91764 CANSIG-MPN
Group of
Self-Insured
Employers 5/16/2006 T
2156
California Agricultural Network, Inc.
430 N Vineyard #102
Ontario CA 91764
California Agricultural Network, Inc.
MPN
Group of
Self-Insured
Employers 5/6/2013 www.intermedccs.com/CANSIGMPN
1284
California Agricultural Products, Inc. Self Insured
Group
2151 Convention Ctr Way #203
Ontario CA 91764 California Agricultural Products MPN
Group of
Self-Insured
Employers 6/1/2007 T
1646
California Agricultural Products, Inc.
2151 Convention Center Way #203
Ontario CA 91764 WellComp Medical Provider Network
Group of
Self-Insured
Employers 6/10/2010 www.wellcomp.com
2406
California Association for Park and Recreation
Indemnity(CAPRI)
6341 Auburn Blvd., SuiteA
Citrus Heights CA 95621 EIA Medical Provider Network
Joint Powers
Authority 1/13/2016 www.eiampn.csac-eia.org
0426
California Autism Foundation
4075 Lakeside Drive
San Pablo CA 94806 Medex
Self-Insured
Employer 2/28/2005 W
0745
California Casualty & Fire Insurance Company
PO Box M
San Mateo CA 94402
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
0743
California Casualty Compensation Insurance
Company
P.O. Box M
San Mateo CA 94402
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
32
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0744
California Casualty General Insurance Company
of Oregon
10260 SW Greenburg Rd., Suite 448
Portland OR 97223
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
0747
California Casualty Indemnity Exchange (The)
P.O. Box M
San Mateo CA 94402
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
0746
California Casualty Insurance Company
P.O. Box M
San Mateo CA 94402
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
1207
California Contractors Network Self Insured
Group
2151 Convention Ctr Way #203
Ontario CA 91764 California Contractors Network (CCN)
Group of
Self-Insured
Employers 7/26/2006 T
2152
California Contractors Network, Inc.
430 North Vineyard Ave, Ste 102
Ontario CA 91764
ACM/California Contractors Network
MPN
Group of
Self-Insured
Employers 5/6/2013 T
1643
California Contractors Network-Self-Insured
Group
430 N. Vinyard Ave., Ste 102
Ontario CA 91764 WellComp Medical Provider Network
Group of
Self-Insured
Employers 6/10/2010 T
1334
California Farm Management Self-Insured Group
2151 Convention Ctr Dr #203
Ontario CA 91764
Group of
Self-Insured
Employers 3/12/2008 T
2018
California Farm Management, Inc.
430 N Vineyard, Suite 102
Ontario CA 91764 California Farm Management MPN
Group of
Self-Insured
Employers 10/5/2012 www.intermedccs.com/CFMSIGMPN
1644
California Farm Management-Self-Insured Group
2151 Convention Center Way #203
Ontario CA 91764 WellComp Medical Provider Network
Group of
Self-Insured
Employers 6/10/2010 T
0510
California Indemnity Insurance Company
2716 North Tenaya Way
Las Vegas NV 89130 CIIC MPN Insurer 5/20/2005 T
1054
California Insurance Company
10805 Old Mill Road
Omaha NE 68154 Promesa Health MPN Insurer 7/20/2005
www.auw.com/promesa_california_provider_search.
aspx
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
33
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0508
California Insurance Guarantee Association
(CIGA)
101 N. Brand Blvd. #600
Glendale CA 91203 CIGA MPN Insurer 9/16/2005 http://www.talispoint.com/cvty/cigampn
1289
California Livestock Producers, Inc. Self-Insured
Group
2151 Convention Ctr. Way #203
Ontario CA 91764
Group of
Self-Insured
Employers 6/1/2007 T
2379
California Livestock Producers, Inc.
430 N Vineyard Ave #102
Ontario CA 91764 CLPSIG MPN
Group of
Self-Insured
Employers 9/29/2015 www.intermedccs.com/CLPSIGMPN
1645
California Livestock Producers-Self-Insured
Group
2151 Convention Center Way #203
Ontario CA 91764 WellComp Medical Provider Network
Group of
Self-Insured
Employers 6/10/2010 T
1325
California Private Schools Self Insurance Group
Inc.
1750 Creekside Oaks Ste 200
Sacramento CA 95833 TRISTAR MPN
Group of
Self-Insured
Employers 11/15/2007 T
1712
California Restaurant Mutual Benefit Corporation
430 N Vineyard Ave. #102
Ontario CA 91764 One Source Medical Network
Group of
Self-Insured
Employers 11/4/2010 www.one-source-medical.com
0933
California Risk Management Authority
40356 Oak Park Way, Suite A
Oakhurst CA 93644 CRMA MPN
Joint Powers
Authority 7/25/2005 T
1709
California Risk Management Authority
9493 North Ft Washington Rd. Suite 101
Fresno CA 93730 CRMA MPN
Joint Powers
Authority 1/12/2011 www.intermedccs.com/CRMAMPN
1012
California Sanitation Risk Management Authority
100 Pine Street, 11th Floor
San Francisco CA 94111 Healthsmart
Joint Powers
Authority 7/26/2005 T
2375
California Sanitation Risk Management Authority
100 Pine Street, 11th Floor
San Francisco CA 94111 WellComp Medical Provider Network
Joint Powers
Authority 2/24/2015 www.wellcomp.com
1183
California Truckers Safety Association
985 Old Eagle School Rd., Suite 504
Wayne PA 19087 Medex
Group of
Self-Insured
Employers 4/20/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
34
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2062
Caminol Management, LLC
2360 Lindbergh Street
Auburn CA 95602 MedInsights Medical Provider Network
Self-Insured
Employer 10/9/2012 T
2107
Caminol Management, LLC
2360 Lindbergh Street
Auburn CA 95602
Caminol Management, LLC GBMCS
MPN
Self-Insured
Employer 1/11/2013 T
2385
Cannon Cochran Management Services, Inc.
2 East Main Street
Danville IL 61832
CCMSI/First Health CompAmerica
Select HCO Network
Entity that
provides
physician
network
services 8/6/2015 http://www.coventrywcs.com/client-tools/index.htm
2392
Cannon Cochran Management Services, Inc.
2 East Main Street
Danville il 61832 CCMSI Custom Network
Entity that
provides
physician
network
services 8/6/2015 http://www-sf.talispoint.com/talispoint/login.pl
0687
Capistrano Unified School District
33122 Valle Road
San Juan Capistrano CA 92675 Capistrano USD/CorVel Select MPN
Self-Insured
Employer 5/20/2005 http://www.corvel.com
1112
Care West Insurance Company
2521 Warren Drive
Rocklin CA 95677 Care West MPN Insurer 1/13/2006 www.statusmedical.com/carewest
2387
CareWorks Managed Care Services, Inc.
P.O.Box 59914
Riverside CA 92517 WellComp Medical Provider Network
Entity that
provides
physician
network
services 4/13/2015 www.wellcomp.com
1267
Cargill Incorporated and its subsidiaries
15407 McGinty Road West MS12
Wayzata MN 55391
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 2/27/2007 T
2310
Casa Pacifica, dba Freedom Village
23442 El Toro Road
Lake Forrest CA 92630 Medex MPN
Self-Insured
Employer 9/5/2014 www.medexhco.com
1561
Castaic Union School District
28131 Livingston Ave
Valencia CA 91355
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/13/2009 T
1016
CastlePoint National Insurance Company
120 Broadway, 31st Floor
New York NY 10271 Tower Group Companies MPN Insurer 8/5/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
35
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1662
CastlePoint National Insurance Company
1655 Grant Street
Concord CA 94524 WellComp Medical Provider Network Insurer 7/15/2010 www.wellcomp.com T
0902
Catholic Mutual
10843 Old Mill Rd
Omaha NE 68154
TRISTAR/First Health
CompAmerica/HCO
Self-Insured
Employer 5/19/2005 R
2124
CBS Operations Inc.
51 West 52nd Street
New York NY 10019
First Health CompAmerica HCO Select
Network
Self-Insured
Employer 2/26/2013 https://www.talispoint.com/cvty/mandb
0776
Cedars-Sinai Medical Center
8700 Beverly Blvd.
Los Angeles CA 90048 Cedars-Sinai Medical Provider Network
Self-Insured
Employer 8/10/2005
http://www.cedars-sinai.edu/Patients/Programs-and-
Services/Medical-Provider-Network/
0942
Centennial Insurance Company
7 Giralda Farms Suite 120
Madison NJ 07940
Atlantic Mutual Companies/Coventry
MPN Insurer 9/6/2005 T
2313
Central Concrete Supply Co., Inc.
331 N. Main Street
Euless TX 76039 Medex
Self-Insured
Employer 9/5/2014 www.medexhco.com T
0910
Central Contra Costa Transit Authority aka
CCCTA/County Connection
2477 Arnold Industrial Way
Concord CA 94596 Interplan/Kaiser
Self-Insured
Employer 6/28/2005 W
1491
Central Region School Insurance Group
4101 Tully Road Ste 501
Modesto CA 95356 WellComp Medical Provider Network
Joint Powers
Authority 1/22/2009 T
3007
Central Region School Insurance Group
4101 Tully Road, Ste. 501
Modesto CA 95356 Central Region School MPN
Joint Powers
Authority 12/23/2016 secure.simon-companies.com/crsig/
0872
Central Region Schools Insurance Group
3600 Sisk Road, #2D
Modesto CA 95356 CRSIG MPN
Joint Powers
Authority 7/25/2005 T
1285
Centre Insurance Company
105 E. 17th Street
New York NY 10003 PRIME Advantage MPN Insurer 3/27/2007 T
0780
Cerritos Community College District
11110 East Alondra Blvd
Norwalk CA 90650 Prime Advantage Medical Network
Self-Insured
Employer 5/6/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
36
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1232
CertainTeed Corporation
20 Moores Road
Malvern PA 19355 CertainTeed Corporation ESIS MPN
Self-Insured
Employer 12/20/2006 T
1340
Chabot-Las Positas Community College District
5020 Franklin Drive
Pleasanton CA 94588 PRIME Plus Medical Provider Network
Self-Insured
Employer 1/28/2008 W
1104
Chaffey Joint Union High School District
211 West Fifth Street
Ontario CA 91762
Chaffey Joint Union High School
District/CorVel Select MPN
Self-Insured
Employer 1/31/2006 www.corvel.com
0778
Charming Shoppes, Inc.
450 Winks Lane
Bensalem PA 19020
MedInsights Medical Provider Network,
accessing Prudent Buyer HCO Insurer 5/6/2005 W
0651
Chartis Property Casualty Company
175 Water Street, 18th Floor
New York NY 10038
Chartis Property Casualty
Company/Gallagher Bassett/Coventry
MPN Insurer 3/24/2005 T
0628
Chartis Property Casualty Company
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
1026
Chartis Property Casualty Company
175 Water Street, 18th Floor
New York NY 10038
Chartis Property Casualty
Company/Gallagher Bassett/First Health
MPN Insurer 8/5/2005 T
1525
Chartis Property Casualty Company
175 Water Street, 18th Floor
New York NY 10038 Chartis Property GBMCS MPN Insurer 5/7/2009 T
0503
Chartis Property Casualty Company
70 Pine Street
New York NY 10270
Sedgwick CMS Extended Medical
Provider Network Insurer 3/10/2005 T
0493
Chartis Property Casualty Company
70 Pine Street
New York NY 10270
Sedgwick CMS Medical Provider
Network Insurer 3/16/2005 T
0914
Chartis Property Casualty Company
70 Pine Street
New York NY 10270
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 5/19/2005 T
0463
Chartis Property Casualty Company, (fka AIG
Casualty Company)
175 Water St, 18th Floor
New York NY 10038 Broadspire MPN Insurer 4/26/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
37
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1261
Chevron Corporation
6001 Bollinger Canyon Road
San Ramon CA 94583 Chevron Medical Provider Network
Self-Insured
Employer 3/14/2007
http://hr2.chevron.com/disabilitymanagement/8_FA
Q_2.asp
1436
Chevron Stations, Inc.
6001 Bollinger Canyon Road
San Ramon CA 94583
Chevron Stations Medical Provider
Network
Self-Insured
Employer 3/18/2009 T
0452
Children's Hospital of Los Angeles
4650 Sunset Blvd.
Los Angeles CA 90027
Children's Hospital of Los Angeles,
MPN
Self-Insured
Employer 12/9/2005 T
1999
Children's Hospital of Los Angeles
4650 Sunset Boulevard
Los Angeles CA 90027 Medex MPN
Self-Insured
Employer 10/28/2011 T
3094
Children's Hospital Of Orange County
1201 W. La Veta Ave
Orange CA 92868
Children's Hospital Of Orange County
MPN
Self-Insured
Employer 3/26/2018 http://choc.employermpn.com
0270
Chubb Indemnity Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1472
Chubb Indemnity Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
0271
Chubb National Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1479
Chubb National Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
0962
Chula Vista Elementary School District
84 East "J" Street
Chula Vista CA 91910 TRISTAR MPN
Self-Insured
Employer 7/26/2005 T
2237
Church Mutual Insurance Company
3000 Schuster Lane
Merrill WI 54452
Church Mutual Insurance Company
Medical Provider Network Insurer 11/21/2013
https://www.churchmutual.com/3261/California-
Medical-Provider-Network
0416
CIMM'S Incorporated
620 N. Brand Blvd., 6th Floor
Glendale CA 91203 FH Select MPN
Self-Insured
Employer 5/10/2005 T
0854
Circuit City Stores, Inc.
9954 Mayland Drive
Richmond VA 23223
Sedgwick CMS Extended Medical
Provider
Self-Insured
Employer 6/6/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
38
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1316
Circuit City Stores, Inc.
9954 Mayland Drive
Richmond VA 23223
SRS First Health CompAmerica
Primary
Self-Insured
Employer 10/11/2007 W
1819
Citizens Insurance Company Of America
440 Lincoln Street
Worcester MA 01615 CorVel/Kaiser Select MPN Insurer 4/22/2011 www.Corvel.com
0196
Citrus Community College District
1000 West Foothill Blvd
Glendora CA 91741 Prime Advantage Medical Network
Self-Insured
Employer 3/2/2005 T
2372
Citrus Valley Health Partners, Inc.
1115 S. Sunset Ave.
West Covina CA 91790 CorVel/CVHP MPN
Self-Insured
Employer 4/2/2015 www.corvel.com
1258
City And County Of San Francisco
1 South Van Ness Avenue, 4th Floor
San Francisco CA 94103
City And County Of San Francisco
MPN
Self-Insured
Employer 2/21/2007 www.talispoint.com/intermed/ccsfmpn
1256
City of Bakersfield, CA
1501 Truxtun Ave.
Bakersfield CA 93301 City of Bakersfield MPN
Self-Insured
Employer 3/29/2007 T
1305
City Of Barstow
220 E. Mountain View Street
Barstow CA 92311 CorVel/City Of Barstow MPN
Self-Insured
Employer 7/27/2007 http://www.corvel.com
0904
City of Campbell
70 N. First St.
Campbell CA 95008
First Health CompAmerica Primary
HCO
Self-Insured
Employer 5/19/2005 W
2077
City of Carlsbad
1635 Faraday Ave.
Carlsbad CA 92008
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 12/13/2012 T
0473
City of Carlsbad
1635 Faraday Avenue
Carlsbad CA 92008 TRISTAR MPN
Self-Insured
Employer 3/18/2005 T
0905
City of Carmel-by-the-Sea
PO Box CC
Carmel CA 93921
First Health CompAmerica Primary
HCO
Self-Insured
Employer 5/19/2005 W
2021
City of Carson
701 East Carson Street
Carson CA 90749 City of Carson MPN
Self-Insured
Employer 6/28/2012 www.medexhco.com T
0806
City of Clovis
1033 Fifth Street
Clovis CA 93612
City of Clovis Medical Provider
Network
Self-Insured
Employer 5/15/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
39
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0459
City of Colton
650 N. La Cadena Drive
Colton CA 92324 TRISTAR MPN
Self-Insured
Employer 3/18/2005 T
0808
City of Compton
205 S. Willowbrook Ave.
Compton CA 90220
TRISTAR - CompAmerica Primary
HCO
Self-Insured
Employer 7/9/2007 W
2030
City of Corona
400 S. Vicentia Avenue
Corona CA 92882 Sedgwick CMS Extended MPN
Self-Insured
Employer 7/20/2012 T
0998
City of Corona
400 S. Vicentia
Corona CA 92882 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
0814
City of Culver City
9770 Culver Blvd.
Culver City CA 90230
Self-Insured
Employer 5/27/2005 T
1314
City of Culver City
9770 Culver Blvd.
Culver City CA 90232 WellComp Medical Provider Network
Self-Insured
Employer 8/22/2007 T
3018
City Of Desert Hot Springs
65-950 Pierson Blvd.
Desert Hot Springs CA 92240 CorVel MPN
Self-Insured
Employer 4/17/2017 www.corvel.com T
1057
City of Escondido
201 North Broadway
Escondido CA 92025
City of Escondido Medical Provider
Network
Self-Insured
Employer 12/19/2005 T
1269
City of Fremont
3300 Capitol Ave.
Fremont CA 94538 WellComp Medical Provider Network
Self-Insured
Employer 1/16/2007 W
0901
City Of Fresno
2600 Fresno Street
Fresno CA 93721 Risico TMC City Of Fresno MPN
Self-Insured
Employer 8/9/2005 http://www.risico.com
0278
City of Glendale
613 E. Broadway, Room 100
Glendale CA 91206 City of Glendale/Concentra
Self-Insured
Employer 3/28/2005 W
0338
City of Hawthorne
4455 W. 126th Street
Hawthorne CA 90250 Broadspire-Concentra Standard MPN
Self-Insured
Employer 2/17/2005 W
1202
City of Hawthorne
4455 W. 126th Street
Hawthorne CA 90250 City of Hawthorne MPN
Self-Insured
Employer 7/13/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
40
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1652
City of Hesperia
9700 Seventh Avenue
Hesperia CA 92345 WellComp Medical Provider Network
Self-Insured
Employer 6/22/2010 T
0797
City of Huntington Beach
2000 Main Street
Huntington Beach CA 92648
Huntington Beach Medical Provider
Network, accessing Prudent Buyer HCO
Self-Insured
Employer 5/15/2005 T
0694
City of Irvine
One Civic Center Plaza P.O. Box19575
Irvine CA 92623 State Fund Medical Provider Network
Self-Insured
Employer 4/14/2005 T
0461
City of Lemon Grove
3232 Main Street
Lemon Grove CA 91945 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 3/18/2005 W
0661
City of Long Beach
333 W. Ocean Blvd., 8th Floor
Long Beach CA 90802 City of Long Beach MPN
Self-Insured
Employer 7/19/2005 T
2365
City of Long Beach
333 West Ocean Blvd. 8th Floor
Long Beach CA 90802 Medex MPN
Self-Insured
Employer 5/6/2015 www.medexhco.com
0507
City of Los Angeles
700 East Temple Street, Room 210
Los Angeles CA 90012 First Health CompAmerica Select HCO
Self-Insured
Employer 3/22/2005 W
0509
City of Los Angeles
700 East Temple Street, Room 210
Los Angeles CA 90012 Interplan Health Group
Self-Insured
Employer 3/22/2005 W
0965
City of Merced
678 West 18th Street
Merced CA 95340 TRISTAR MPN
Self-Insured
Employer 7/26/2005 T
1109
City of Milpitas
455 East Calaveras Blvd.
Milpitas CA 95035 WellComp Medical Provider Network
Self-Insured
Employer 1/9/2006 T
1015
City of Monterey Park
320 W. Newmark Avenue
Monterey Park CA 91754 City of Monterey Park - MPN
Self-Insured
Employer 7/20/2005 W
1257
City Of Monterey
735 Pacific Street, Suite B
Monterey CA 93940 City Of Monterey MPN
Self-Insured
Employer 6/29/2007 https://secure.simon-companies.com/cityofmonterey/
1185
City Of Murrieta
1 Town Square
Murrieta CA 92562 CorVel/City Of Murrieta MPN
Self-Insured
Employer 4/24/2006 www.corvel.com √
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
41
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0451
City of Napa
1541 2nd Street
Napa CA 94559 North Bay MPN
Self-Insured
Employer 7/20/2005 T
0386
City of National City
1243 National City Boulevard
National City CA 91950 State Fund Medical Provider Network
Self-Insured
Employer 3/14/2005 W
2300
City Of Oakland
150 Frank H. Ogawa Plaza #2352
Oakland CA 94612 EIA Medical Provider Network
Self-Insured
Employer 6/24/2014 www.eiampn.csac-eia.org
0757
City of Oceanside
300 N. Coast Highway
Oceanside CA 92054 Tristar MPN
Self-Insured
Employer 6/6/2005 T
0217
City of Orange Risk Management
637 W. Struck Avenue
Orange CA 92867 State Fund Medical Provider Network
Self-Insured
Employer 3/14/2005 T
1122
City Of Perris
101 North D Street
Perris CA 92570 CorVel/City Of Perris MPN
Self-Insured
Employer 1/31/2006 www.corvel.com
0929
City of Rancho Cucamonga
1525 Response Road Ste 1
Sacramento CA 95815 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
1965
City Of Rialto
150 S. Palm Ave.
Rialto CA 92376 CorVel MPN
Self-Insured
Employer 5/15/2012 www.corvel.com T
0481
City of Riverside
3900 Main St 2nd Flr
Riverside CA 92522 City of Riverside - Network
Self-Insured
Employer 4/6/2005 www.riversideca.gov/human/workerscomp/mpn.asp
2196
City of San Bernardino
300 N. D Street
San Bernardino CA 92418 WellComp Medical Provider Network
Self-Insured
Employer 7/11/2013 T
0695
City of San Clemente
100 Avenida Presidio
San Clemente CA 92672 State Fund Medical Provider Network
Self-Insured
Employer 4/14/2005 T
0439
City of San Diego
P.O. Box 129013
San Diego CA 92112
City of San Diego Medical Provider
Network
Self-Insured
Employer 3/16/2005 www.sandiego.gov/riskmanagement/services
1058
City of San Gabriel
8081 Moody St.
La Palma CA 90623 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
42
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3038
City Of San Jose
200 E. Santa Clara Street
San Jose CA 95113 City Of San Jose MPN
Self-Insured
Employer 8/18/2017 www.talispoint.com/intermed/sanjosempn
2241
City of San Jose
200 East Santa Clara Street
San Jose CA 95113 City of San Jose MPN
Self-Insured
Employer 12/4/2013 www.medexhco.com T
0817
City of San Leandro
835 E. 14th Street
San Leandro CA 94577 InterPlan/Kaiser
Self-Insured
Employer 12/15/2005 W
0923
City of Santa Maria
110 E. Cook St
Santa Maria CA 93454 InterPlan
Self-Insured
Employer 6/29/2005 W
1029
City of Santa Rosa
P.O. Box 1674
Santa Rosa CA 95402 Santa Rosa K
Self-Insured
Employer 10/28/2005 W
0597
City of Solana Beach
635 South Highway 101
Solana Beach CA 92075 TRISTAR MPN
Self-Insured
Employer 3/18/2005 T
2064
City Of Stockton
22 E. Weber Ave., Ste 150
Stockton CA 95202 City Of Stockton MPN
Self-Insured
Employer 10/11/2012 www.corvel.com
2361
City of Temecula
41000 Main Street
Temecula CA 92590 Medex MPN
Self-Insured
Employer 1/30/2015 www.medexhco.com T
1101
City of Thousand Oaks
2100 E. Thousand Oaks Blvd.
Thousand Oaks CA 91362 WellComp Medical Provider Network
Self-Insured
Employer 4/7/2006 W
2211
City of Turlock
156 S. Broadway Ste. 235
Turlock ca 95380
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 11/18/2013 T
0303
City of Tustin
300 Centennial Way
Tustin CA 92780 State Fund Medical Provider Network
Self-Insured
Employer 3/14/2005 T
1181
City of Upland
460 N. Euclid Ave.
Upland CA 93009 CorVel MPN
Self-Insured
Employer 4/24/2006 T
0639
City of Vernon
4305 Santa Fe Avenue
Vernon CA 90058 City of Vernon MPN
Self-Insured
Employer 3/24/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
43
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1861
City of Vernon
4305 Santa Fe Avenue
Vernon CA 90058 Athens MPN
Self-Insured
Employer 8/23/2011 T
0562
City of Visalia
707 W. Acequia
Visalia CA 93291 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0456
City of Vista
600 Eucalyptus Avenue
Vista CA 92085
First Health CompAmerica Primary
HCO
Self-Insured
Employer 3/18/2005 W
2388
City of West Covina
1444 W. Garvey Avenue
West Covina CA 91790 CorVel MPN
Self-Insured
Employer 4/23/2015 www.corvel.com W
1048
City of West Covina
1444 West Garvey Ave.
West Covina CA 91793 City of West Covina
Self-Insured
Employer 9/8/2005 T
0316
Civic Property & Casualty
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health MPN Network) Insurer 3/9/2005 T
0323
Civic Property & Casualty
4680 Wilshire Blvd
Los Angeles CA 90010
FirstHealth CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
1592
Civic Property And Casualty Company
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 3/11/2010 www.corvel.com
0081
Clarendon American Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel HCO Insurer 2/4/2005 W
0274
Clarendon American Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751
Clarendon Medical Provider Network
One Insurer 2/9/2005 W
0100
Clarendon National Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel MPN Insurer 2/4/2005 T
0231
Clarendon National Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 Clarendon Medical Provider Network 1 Insurer 2/9/2005 W
0385
Clarendon National Insurance Company
6831 Edgewater Commerce Pkwy #1101
Orlando FL 32810 Clarendon TMC Provider Network Insurer 2/22/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
44
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0186
Clougherty Packing, LLC
3049 E. Vernon Avenue
Los Angeles CA 90058 Clougherty Packing Company MPN
Self-Insured
Employer 2/22/2005 T
2235
Clougherty Packing, LLC
3049 E. Vernon Ave.
Los Angeles CA 90058 CorVel MPN
Self-Insured
Employer 12/12/2013 http://www.corvel.com
1264
Coachella Valley Water District
85-995 Avenue 52
Coachella CA 92236 Interplan through CompPartners (CP)
Self-Insured
Employer 1/5/2007 T
2108
Coachella Valley Water District
Attn Risk Management PO Box 1058
Coachella CA 92236 CorVel/Coachella VWD MPN
Self-Insured
Employer 1/15/2013 www.corvel.com
0460
Coachella Valley Water District
P.O. Box 1058
Coachella CA 92236 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 3/18/2005 T
0228
Coast Community College District
1370 Adams Avenue
Costa Mesa CA 92626 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0032
Coherent, Inc (Coherent)
5100 Patrick Henry Drive
Santa Clara CA 95054 First Health Comp America Select HCO
Self-Insured
Employer 4/7/2005 T
0675
Colonial American Casualty Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Colonial American Casualty Insurance
Company, Crawford Select Insurer 7/1/2005 W
1007
Colonial American Casualty Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Colonial American Casualty Insurance
Company - Crawford Primary Insurer 7/1/2005 W
0893
Colton Joint Unified School District
1212 Valencia Drive
Colton CA 92324 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
1759
Commerce And Industry Insurance Company
175 Water St., 18th Flr
New York NY 10038 AIG Select MPN Insurer 1/19/2011 www.talispoint.com/aig/mpnselect
0119
Commerce And Industry Insurance Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0763
Commerce And Industry Insurance Company
175 Water Street - 18th Floor
New York NY 10038
Commerce And Industry Insurance
Company/Gallagher Bassett/CorVel
MPN Insurer 5/5/2005 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
45
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1660
Commerce And Industry Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/30/2010 www.broadspireppo.com T
2298
Commerce and Industry Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Mentor/Commerce/Bunch MPN Insurer 5/8/2014 http://providernet.bunchcare.com T
1408
Commerce And Industry Insurance Company
175 Water Street- 18th Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
0525
Commerce and Industry Insurance Company
175 Water Street
New York NY 10038 Chartis - Cambridge MPN Insurer 3/24/2005 W
0652
Commerce and Industry Insurance Company
175 Water Street, 18th Floor
New York NY 10038
Commerce and Industry/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 T
0631
Commerce and Industry Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
1027
Commerce and Industry Insurance Company
175 Water Street, 18th Floor
New York NY 10038
Commerce and Industry/Gallagher
Bassett/First Health MPN Insurer 8/5/2005 T
1486
Commerce and Industry Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Commerce and Industry GBMCS MPN Insurer 5/8/2009 T
1426
Commerce and Industry Insurance Company
70 Pine St
New York NY 10270
CCMSI/ AIG/ First Health Comp
America Select HCO Network Insurer 12/16/2008 T
0368
Commerce and Industry Insurance Company
70 Pine Street
New York NY 10270
SRS First Health CompAmerica
Primary HCO Network Insurer 3/28/2005 W
0469
Commerce and Industry Insurance Company
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0921
Commerce and Industry Insurance Company
70 Pine Street
New York NY 10270
MedInsights Medical Provider Network,
accessing Prudent Buyer PPO Insurer 5/19/2005 T
1377
Commerce and Industry Insurance Company
70 Pine Street
New York NY 10270
Athens/Commerce and Industry Ins. Co.
MPN Insurer 4/15/2008 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
46
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0850
Commerce and Industry Insurance Company
AIG 70 Pine Street
New York NY 10270
Commerce and Industry Insurance
Company-Crawford Select Insurer 7/1/2005 W
0860
Commerce and Industry Insurance Company
AIG 70 Pine Street
New York NY 10270
Commerce and Industry Insurance
Company, Crawford Primary Insurer 7/1/2005 W
0364
Commerce and Industry Insurance Group
70 Pine Street
New York NY 10270
SRS First health CompAmerica Select
HCO Network Insurer 3/28/2005 W
0511
Commercial Casualty Insurance Company
30 South 17th St.
Philadelphia PA 19103 CCIC MPN Insurer 5/20/2005 www.talispoint.com/sierra/shle
2340
Commercial Protective Services, Inc.
436 W. Walnut St.
Gardena CA 90248 WellComp Medical Provider Network
Self-Insured
Employer 8/26/2014 www.WellComp.com T
1875
Community Hospital of the Monterey Peninsula
23625 Holman Highway
Monterey CA 93942 CHOMP MPN
Self-Insured
Employer 1/12/2012 W
3048
Community Hospitals Of Central California
7370 N. Palm
Fresno CA 93711
CorVel/Community Hospitals Of
Central CA MPN
Self-Insured
Employer 9/18/2017 www.corvel.com
1613
Companion Property & Casualty Insurance
Company
51 Clemson Rd
Columbia SC 29202 Athens MPN Insurer 3/25/2010 T
1778
Companion Property & Casualty Insurance
Company
51 Clemson Rd
Columbia SC 29229 Sedgwick CMS MPN Insurer 2/3/2011 T
1779
Companion Property & Casualty Insurance
Company
51 Clemson Rd.
Columbia SC 29229 Sedgwick CMS Extended MPN Insurer 2/10/2011 T
1898
Companion Property & Casualty Insurance
Company
P.O. Box 100165
Columbia SC 29202
Companion Property & Casualty
Insurance Company GBMCS MPN Insurer 12/22/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
47
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1788
Companion Property and Casualty Insurance
Company
51 Clemson Rd
Columbia SC 29202 Medex Insurer 2/24/2011 T
2157
Companion Property and Casualty Insurance
Company
51 Clemson Road, PO Box 100165
Columbia SC 29202 WellComp Medical Provider Network Insurer 5/28/2013 W
1894
Companion Property and Casualty Insurance
Company
PO Box 100165
Columbia SC 29202
Companion Property and Casualty
Insurance Company Medical Provider
Network Insurer 2/8/2012 T
2351
COMPPARTNERS, INC.
4 Park Plaza Suite 750
Irvine CA 92614 COMPPARTNERS MPN
Entity that
provides
physician
network
services 3/12/2015 www.comppartners.com
1313
Compton Community College District
1111 East Artesia Blvd
Compton CA 90221
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/6/2007 T
1128
Compton Unified School District
500 S. Santa Fe Avenue
Compton CA 90221 Compton USD/CorVel Select MPN
Self-Insured
Employer 1/31/2006 T
0107
CompWest Insurance Company
P.O. Box 40790
Lansing MI 48901-7990 CompWest Select MPN Insurer 3/1/2005
http://www.compwestinsurancecompany.com/comp
west-insurance-company-mpn/
0079
CompWest Insurance Company
P.O. Box 40790
Lansing MI 48901-7990 CompWest Select MPN
Entity that
provides
physician
network
services 3/8/2005
http://www.compwestinsurance.com/compwest-
toolbox/claims/medical-provider-search/
0220
ConAgra Foods, Inc & Subsidiaries
One ConAgra Drive
Omaha NE 68102
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 2/2/2005 T
0285
Conejo Valley Unified School District
1400 E. Janss Road
Thousand Oaks CA 91362
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/1/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
48
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0931
Conejo Valley Unified School District
1400 E. Janss Road
Thousand Oaks CA 91362 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
1039
Conopco, Inc.
33 Benedict Place
Greenwich CT 06836 Broadspire-Concentra Standard MPN
Self-Insured
Employer 9/27/2005 W
0420
Consolidated RIBS, Inc.
620 N. Brand Blvd., 6th Floor
Glendale CA 91203
FOCUS - CONCENTRA [FARA-
CIMMS]
Self-Insured
Employer 5/10/2005 T
1741
Construction Protective Services, Inc.
436 W. Walnut St.
Gardena CA 90248 Medex
Self-Insured
Employer 12/22/2010 T
2341
Construction Protective Services, Inc.
436 W. Walnut St.
Gardena CA 90248 WellComp Medical Provider Network
Self-Insured
Employer 9/16/2014 www.WellComp.com T
0647
Continental Casualty Company (CNA)
333 S. Wabash
Chicago IL 60604 CNA/Gallagher Bassett/Coventry MPN Insurer 3/24/2005 T
0966
Continental Casualty Company (CNA)
C N A Plaza
Chicago IL 60685
Continental Casualty Company,
Crawford Primary Insurer 6/16/2005 W
0967
Continental Casualty Company (CNA)
C N A PLAZA
Chicago IL 60685
Continental Casualty Company,
Crawford Select Insurer 6/16/2005 W
0985
Continental Casualty Company (CNA)
CNA Plaza
Chicago IL 60685 First Health CompAmerica Select HCO Insurer 6/23/2005 T
0871
Continental Casualty Company
333 S Wabash
Chicago IL 60604 CNA ESIS MPN Insurer 5/24/2005 T
1062
Continental Casualty Company
333 S. Wabash Ave.
Chicago IL 60604 Liberty Mutual Group MPN Insurer 8/9/2005 T
2096
Continental Casualty Company
333 S. Wabash
Chicago IL 60604 Sedgwick/Harbor MPN Insurer 12/24/2012 T
0728
Continental Casualty Company
333 S. Wabash
Chicago IL 60685
First Health Comp America Select HCO
Network (First Health Select) Insurer 4/26/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
49
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0732
Continental Casualty Company
333 S. Wabash
Chicago IL 60685
First Health CompAmerica Primary
HCO Network (First Health Primary) Insurer 4/28/2005 W
0798
Continental Casualty Company
333 S. Wabash
Chicago IL 60685 Broadspire MPN Insurer 5/16/2005 T
1837
Continental Casualty Company
333 S. Wabash, Floor 24
Chicago IL 60604 Sedgwick CMS Extended MPN Insurer 5/24/2011 T
1838
Continental Casualty Company
333 S. Wabash, Floor 24
Chicago IL 60604 Sedgwick CMS MPN Insurer 5/24/2011 T
2097
Continental Casualty Company
333 S. Wabash, Floor 39
Chicago IL 60604 Sedgwick/Harbor 2 MPN Insurer 12/24/2012 T
1768
Continental Casualty Company
333 South Wabash
Chicago IL 60604 Broadspire Signature MPN Insurer 2/2/2011 T
1131
Continental Casualty Company
CNA Plaza 38S
Chicago IL 60685 Medex Insurer 5/10/2006 T
0560
Continental Casualty Company
PO Box 8317
Chicago IL 60680 CNA CA Medical Provider Network Insurer 3/24/2005 www.cna.com
1116
Contractors Access Program of California
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/5/2006 T
0938
Converium Insurance (North America) Inc. (n/k/a
Allied World Reinsurance Company)
100 First Stamford Place, 2nd Floor
Hartford CT 06902
PRIME Advantage Medical Provider
Network Insurer 7/8/2005 T
0886
Cooper US, Inc.
P O Box 4446
Houston TX 77210 The Liberty Mutual Group MPN
Self-Insured
Employer 8/9/2005 T
0585
Coors Brewing Company
311 10th Street
Golden CO 80401
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 3/24/2005 R
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
50
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2069
Cornerstone Comp, Inc.
255 Great Valley Parkway, Ste 255
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 10/25/2012 www.monumentllc.com T
1483
Cornerstone Comp, Inc.
255 Great Valley Pkwy Ste 200
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 3/17/2009 T
0430
Cornerstone Comp, Inc.
7405 N. First Street
Fresno CA 93720 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 3/3/2005 T
0887
Corona-Norco Unified School District
2820 Clark Ave
Norco CA 92860
TRISTAR/First Health CompAmerica
Primary HCO
Self-Insured
Employer 7/19/2005 W
1915
Corona-Norco Unified School District
2820 Clark Avenue
Norco CA 92860
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 3/27/2012 W
2238
Corporation of the President of the Church of
Jesus Christ of Latter Day Saints
50 E North Temple Fl 16
Salt Lake City UT 81450 Deseret Signature MPN
Self-Insured
Employer 12/13/2013 T
0310
Corporation of the Presiding Bishop of The
Church of Jesus Christ of the Latter-day Saints
50 E North Temple, Floor 16
Salt Lake City UT 81450 Deseret Signature MPN
Self-Insured
Employer 2/16/2005 www.deseretsignaturempn.com T
2041
Costco Wholesale Corporation
999 Lake Dr.
Issaquah WA 98027 Costco Wholesale MPN
Self-Insured
Employer 8/16/2012 www.helmsmantpa.com/CAMPN
0382
Costco Wholesale Corporation
999 Lake Drive
Issaquah WA 98027 Costco MPN
Self-Insured
Employer 4/8/2005 T
1150
Cottage Health System
PO Box 689 Pueblo at Bath St
Santa Barbara CA 93102
PRIME Advantage Medical Network
for HealthCare
Self-Insured
Employer 5/4/2006 W
0187
Countrywide Financial Corporation
c/o Bank of America, One Bank of America
Center, NC1-028-16-01, 150 N. College St
Charlotte NC 28255
Countrywide Financial Corporation
ESIS MPN
Self-Insured
Employer 1/20/2005 T
1211
County Of Fresno
2220 Tulare Street 16th Floor
Fresno CA 93721 County Of Fresno MPN 1211
Self-Insured
Employer 5/31/2006 http://www.countyoffresnompn.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
51
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0822
County of Kern
1115 Truxtun Avenue, 4th Floor
Bakersfield CA 93301
County of Kern Medical Provider
Network
Self-Insured
Employer 8/10/2005 www.co.kern.ca.us/rm/MPNList
0061
County of Los Angeles
333 Wilshire Blvd, Suite 820
Los Angeles CA 90010 First Health CompAmerica Select HCO
Self-Insured
Employer 2/21/2005 T
0062
County of Los Angeles
333 Wilshire Blvd, Suite 820
Los Angeles CA 90010 Interplan Health Group
Self-Insured
Employer 2/21/2005 T
0060
County Of Los Angeles
3333 Wilshire Blvd, Suite 1000
Los Angeles CA 90010 County Of Los Angeles/CorVel MPN
Self-Insured
Employer 2/7/2005 www.corvel.com
0790
County of Madera
333 West Olive Ave.
Madera CA 93637
Self-Insured
Employer 5/15/2005 W
1908
County of Monterey
168 W Alisal Street, 3rd Fl
Salinas CA 93901 COM MPN
Self-Insured
Employer 3/21/2012 www.intermedccs.com/COMMPN
0816
County of Monterey
230 Church St Bldg 3
Salinas CA 93901 Liberty Mutual Group MPN
Self-Insured
Employer 7/27/2005 T
1273
County of Orange
12 Civic Center Plaza Room 324
Santa Ana CA 92701 Cambridge Orange County MPN
Self-Insured
Employer 2/6/2007 T
0375
County of Orange
12 Civic Center Plaza, Suite 324
Santa Ana CA 92701 Intracorp
Self-Insured
Employer 4/12/2005 T
1412
County of Orange
600 W. Santa Ana Blvd., Suite 104
Santa Ana CA 92701 WellComp Medical Provider Network
Self-Insured
Employer 9/10/2008 T
2345
County Of Riverside
3403 10th Street, 5th Floor
Riverside CA 92501
County Of Riverside Workers'
Compensation Division MPN
Self-Insured
Employer 9/24/2014 www.corvel.com
1309
County of Riverside
3880 Lemon Street, Suite 100
Riverside CA 92501 CorVel MPN/County of Riverside
Self-Insured
Employer 9/6/2007 T
0688
County of San Bernardino
222 West Hospitality Lane, 3rd Floor
San Bernardino CA 92408 CorVel MPN
Self-Insured
Employer 4/11/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
52
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0131
County of San Luis Obispo
1087 Santa Rosa Street
San Luis Obispo CA 93408
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/13/2005 W
0784
County of San Mateo
455 County Center
Redwood City CA 94063 San Mateo County MPN
Self-Insured
Employer 7/13/2005 smcmpn.info
0126
County of Santa Cruz
701 Ocean Street
Santa Cruz CA 95060 First Health Primary Network
Self-Insured
Employer 4/13/2005 W
1138
County Of Stanislaus
1010 10th Street Suite 5900
Modesto CA 95354 Stanislaus County MPN
Self-Insured
Employer 5/11/2006 www.wellcomp.com
0198
County of Tulare
2900 West Burrell, County Civic Center
Visalia CA 93291
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 4/6/2005 T
1300
County Of Tulare
3530 W. Mineral King, Ste. E
Visalia CA 93291 Corvel MPN
Self-Insured
Employer 7/20/2007 www.corvel.com
0786
County of Tuolumne
2 South Green Street
Sonora CA 95270 Interplan/Kaiser MPN
Self-Insured
Employer 8/8/2005 T
3065
Coventry Health Care Workers Compensation,
INC
750 Riverpoint Drive
West Sacramento CA 95605 CVTY Aramark Custom MPN
Entity that
provides
physician
network
services 10/10/2017 http://www.talispoint.com/cvty/arampn
2430
Creative Risk Solutions, LLC
P.O. Box 9207
Des Moines IA 50306 Creative Risk Solutions/Coventry MPN
Entity that
provides
physician
network
services 1/14/2016
www.creativerisksolutions.com/network-provider-
directory.aspx
2239
Crum & Forster Indemnity Company
1100 Town And Country Rd., Ste. 550
Orange CA 92868 Broadspire Signature MPN Insurer 11/19/2013 T
2369
Crum & Forster Indemnity Company
305 Madison Avenue
Morristown NJ 07962 CorVel/C&F Select MPN Insurer 4/2/2015 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
53
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1163
CSAC Excess Insurance Authority
75 Iron Point Circle, Ste 200
Folsom CA 95630 EIA Medical Provider Network
Joint Powers
Authority 3/27/2006 www.eiampn.csac-eia.org
0577
Cupertino Union School District
10301 Vista Drive
Cupertino CA 95014
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/23/2005 W
0145
Cypress Insurance Company
P.O. Box 881716
San Francisco CA 94118
Berkshire Hathaway Homestate
Companies MPN
Entity that
provides
physician
network
services 2/16/2005 https://www.bhhc.com
0876
Daimler Chrysler
4400 Chrysler Dr.
Toledo OH 43608 TRISTAR/First Health CompAmerica
Self-Insured
Employer 5/3/2005 R
1052
Dameron Hospital Association
525 West Acacia Street
Stockton CA 95203 San Joaquin MPN
Self-Insured
Employer 9/22/2005 www.netbyd.com/sanjoaquinmpn/dameronhospital
1059
Dansk Investment Group, Inc.
6591 Collins Drive, Ste E-11
Moorpark CA 93021 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 www.wellcomp.com
0354
De La Rue, Inc.
6401 Commerce Drive
Irving TX 75063
First Health CompAmerica Select HCO
Network (or "First Health Select")
Self-Insured
Employer 3/7/2005 R
1227
Dean Foods Company of California, LLC
3600 North River Road
Franklin Park IL 60131 Liberty Mutual Group MPN
Self-Insured
Employer 8/18/2006 T
1254
Delos Insurance Company
120 West 45th Street 36th Floor
New York NY 10036
Delos Insurance Company/TMC
Medical Provider Network Insurer 11/13/2006 T
1317
Delos Insurance
120 West 45th Street 36th Floor
New York NY 10036 Athens/Delos MPN Insurer 10/12/2007 T
0567
Desert Community College District
43-500 Monterey Avenue
Palm Desert CA 92260 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0573
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta CA 92253 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
54
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0344
DHL Holdings (USA), Inc.
1571 Sawgrass Corporate Parkway, 2nd Flr
Sunrise FL 33323
First Health CompAmerica Select HCO
Network (or "First Health Select")
Self-Insured
Employer 3/8/2005 W
1680
Discover Property & Casualty Insurance Company
1 Tower Square- MS 12
Hartford CT 06183 Broadspire Signature Network Insurer 8/18/2010 T
0401
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Discover Re Cambridge MPN Insurer 2/24/2005 W
0497
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS Extended MPN Insurer 3/10/2005 T
0486
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS MPN Insurer 3/15/2005 T
0550
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
First Health CompAmerica Primary
HCO Network (or "First Health
Primary") Insurer 3/22/2005 W
0552
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
SRS First Health CompAmerica Select
HCO Network (or "First Health Select") Insurer 3/22/2005 W
0595
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Discover Re/DP&C/GAB-MedInsights Insurer 3/22/2005 T
0445
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Frank Gates/DRE/First Health
CompAmerica Select HCO Network Insurer 5/11/2005 W
0538
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Discover Property & Casualty/Gallagher
Bassett/First Health MPN Insurer 5/13/2005 T
0812
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
CorVel MPN/Discover Property &
Casualty/Frank Gates Insurer 5/18/2005 W
0832
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Intracorp - Dre GatesMcDonald MPN Insurer 6/2/2005 T
0662
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Discover Property & Casualty Insurance
Company - Crawford Select Insurer 6/16/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
55
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2115
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor MPN Insurer 2/1/2013 T
2116
Discover Property & Casualty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor 2 MPN Insurer 2/1/2013 T
0259
Discover Property & Casualty Insurance Company
500 Madison Street, Suite 2600
Chicago IL 60661 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
0189
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Discover Re ESIS MPN Insurer 2/2/2005 T
0722
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0514
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
Discover Property & Casualty/Gallagher
Bassett/Coventry MPN Insurer 4/27/2005 T
0882
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 TRISTAR CompAmerica Primary HCO Insurer 5/3/2005 W
0969
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington IL 06032
Discover Property & Casualty Insurance
Company - Crawford Primary Insurer 6/16/2005 W
1369
Discover Property & Casualty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
SCRMA-WellComp Medical Provider
Network Insurer 5/27/2008 W
0289
Discover Property & Casualty Insurance Company
C/O Discover Re, 5 Batterson Park Road
Farmington CT 06032
CorVel MPN/Discover Property &
Casualty/LWP Insurer 2/17/2005 www.CorVel.com
0408
Discover Property & Casualty Insurance Company
C/O Discover Re, 5 Batterson Park Road
Farmington CT 06032 CorVel MPN Insurer 2/28/2005 www.CorVel.com
1444
Discover Property & Casualty Insurance Company
c/o Discover Re, 5 Batterson Park Road
Farmington CT 06032
Discover Property & Casualty GBMCS
MPN Insurer 5/7/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
56
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1385
Discover Property & Casualty Insurance Company
c/o Traveler's National Accounts Unbundled, 5
Batterson Park Rd
Farmington CT 06032 Wellcomp Medical Provider Network Insurer 6/20/2008 T
0987
Discover Property & Casualty Insurance Company
c/o Travelers National Accounts Unbundled One
Tower Square, 12-MS
Hartford CT 06183 Liberty Mutual Group MPN Insurer 7/28/2005 T
1732
Discover Property & Casualty Insurance Company
One Tower Square MS-12
Hartford CT 06183
Sedgwick CMS/Harbor MPN - DPC
POG Insurer 12/8/2010 www.sedgwickproviders.com/POG T
0691
DNC Parks & Resorts at Yosemite, Inc.
Yosemite-Administration Center
Yosemite CA 95389 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
1924
Dole Food Company, Inc.
One Dole Dr.
Westlake Village CA 91362 Sedgwick CMS Extended MPN
Self-Insured
Employer 3/15/2012 T
0548
Dole Food Company, Inc.
One Dole Drive
Westlake Village CA 91362
First Health CompAmerica Select HCO
Network (or "First Health Select")
Self-Insured
Employer 3/22/2005 T
2151
Dole Packaged Foods, LLC
One Dole Drive
Westlake Village CA 91362 Sedgwick CMS Extended MPN
Self-Insured
Employer 4/25/2013 T
2264
Downey Regional Medical Center - Hospital, Inc.
11500 Brookshire Avenue
Downey CA 90241 Athens MPN
Self-Insured
Employer 1/8/2014 T
0132
Downey Regional Medical Center
1150 Brookshire Avenue
Downey CA 90241
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/13/2005 T
1293
Downey Regional Medical Center
11500 Brookshire Avenue
Downey CA 90241 WellComp Medical Provider Network
Self-Insured
Employer 5/22/2007 T
0961
Downey Unified School District
11627 Brookshire Avenue
Downey CA 90241 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
1718
E. & J. Gallo Winery
PO Box 1130
Modesto CA 95353 Gallo-Status MPN
Self-Insured
Employer 11/23/2010 https://secure.simon-companies.com/gs/
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
57
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0738
E.I.I. Holding Co.
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
0164
East Guard Insurance
16 South River Street
Wilkes Barre PA 18703 GUARD Insurance MPN Insurer 1/24/2005 T
1076
Eastern Municipal Water District
2270 Trumble Road
Perris CA 92572
Eastern Municipal Water
District/CorVel Select MPN
Self-Insured
Employer 9/13/2005 T
1563
Eastside Union School District
45006 North 30th St East
Lancaster CA 93535
PRIME Advantage Medical Provider
Network Insurer 8/13/2009 T
2342
ECAMSECURE
436 W. Walnut Street
Gardena CA 90248 WellComp Medical Provider Network
Self-Insured
Employer 9/16/2014 www.WellComp.com T
0133
Economy Foods, dba Facciola Meat Company
PO Box 14160
Fremont CA 94539
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/13/2005 R
0766
Eden Medical Center and San Leandro Hospital
(EMC & SLH)
20103 Lake Chabot Road
Castro Valley CA 94546 Medical Partners @ Work (MPW)
Self-Insured
Employer 6/29/2005 W
1099
Eisenhower Medical Center
39000 Bob Hope Dr, Probst Bldg Suite 311
Rancho Mirage CA 92270
PRIME Advantage Medical Network
for HealthCare MPN
Self-Insured
Employer 5/11/2006 W
2282
EK Health Services, Inc.
992 S. De Anza Blvd., Ste. 101
San Jose CA 95129 EK Health Select MPN
Entity that
provides
physician
network
services 5/21/2014 www.ekhealthselect.ekhealth.com
0280
El Camino Community College District
16007 Crenshaw Blvd
Torrance CA 90506 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
2201
El Camino Hospital
2500 Grant Road
Mountain View CA 94040 ACM/ El Camino Hospital MPN
Self-Insured
Employer 7/11/2013 T
1303
Electric Insurance Company
75 Sam Fonzo Dr.
Beverly MA 01915 Electric Insurance Insurer 9/19/2007 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
58
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0441
Electric Insurance Company
75 Sam Fonzo Drive
Beverly MA 01915 Intracorp Insurer 4/4/2005 W
1437
Electric Insurance Company
75 Sam Fonzo Drive
Beverly MA 01915 Sedgwick CMS Extended MPN Insurer 11/10/2008 W
1438
Electric Insurance Company
75 Sam Fonzo Drive
Beverly MA 01915 Sedgwick CMS MPN Insurer 11/10/2008 T
2203
Electric Insurance Company
75 Sam Fonzo Drive
Beverly MA 01915 Sedgwick/Harbor MPN -EIC GE Insurer 7/12/2013 T
0431
Elite Golf Club Program, Inc.
1357 E. Lassen Avenue, Suite 100
Chico CA 95927 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 3/3/2005 T
2068
Elite Golf Club Program, Inc.
255 Great Valley Parkway, Ste 255
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 12/7/2012 www.monumentllc.com T
1480
Elite Golf Club Program, Inc.
255 Great Valley Pkwy Ste 200
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 3/17/2009 T
0474
Emanuel Medical Center
825 Delbon Avenue
Turlock CA 95832
First Health CompAmerica Primary
HCO
Self-Insured
Employer 3/18/2005 W
1175
Emanuel Medical Center, Inc.
825 Delbon Ave.
Turlock CA 95382 EMC - MPN
Self-Insured
Employer 6/2/2006 https://www.statusmedical.com T
0037
Employers Compensation Insurance Company
10375 Professional Circle
Reno NV 89521 Employers MPN
Entity that
provides
physician
network
services 1/12/2005
https://www.employers.com/workers/provider_locato
r.aspx
0091
Employers Insurance Company of Wausau
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
1127
Endurance Assurance Corporation
4 Manhattanville Rd
Purchase NY 10577 Rising MPN Insurer 2/27/2006 https://www.markelfirstcomp.com/injured-workers T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
59
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1490
Ensign Facility Services, Inc.
27101 Puerta Real #450
Mission Viejo CA 92691
Self-Insured
Employer 1/27/2009 T
0839
Ensign Facility Services, Inc.
27101 Puerta Real Ste 450
Mission Viejo CA 92691 Ensign Coventry Network
Self-Insured
Employer 5/24/2005 T
2050
Ensign Services, Inc.
27101 Puerta Real #450
Mission Viejo CA 92691 WellComp Medical Provider Network
Self-Insured
Employer 9/14/2012 www.wellcomp.com
1031
Episcopal Homes Foundation
3650 Mt. Diablo Blvd., #100
Lafayette CA 94549
First Health's CompAmerica Primary
Network
Self-Insured
Employer 8/12/2005 T
1465
Episcopal Senior Communities
2185 N. California Blvd., Suite 575
Walnut Creek CA 94596 Sedgwick CMS Extended MPN
Self-Insured
Employer 11/10/2008 T
2433
ESIS, INC.
436 Walnut St
Philadelphia PA 19106 ESIS Medical Impact MPN
Entity that
provides
physician
network
services 3/24/2016 http://www.acegroup.com/esis-en/client-resources/
2054
Eskaton Properties, Incorporated
5105 Manzanita Ave.
Carmichael CA 95608 WellComp Medical Provider Network
Self-Insured
Employer 12/6/2012 T
0389
Esparza Enterprises, Inc.
7201 Schirra Court, Suite A
Bakersfield CA 93313 Medex
Self-Insured
Employer 2/23/2005 T
0021
Everest National Insurance Company
477 Martinsville Rd PO Box 830
Liberty Corner NJ 07968
Everest National Medical Provider
Network Insurer 1/11/2005 www.everestnational.com/workcomp T
0888
Everest National Insurance Company
477 Martinsville Rd PO Box 830
Liberty Corner NJ 07938
Everest National MPN-Coventry
Broadbase Insurer 7/19/2005 W
1034
Everest National Insurance Company
477 Martinsville Rd PO Box 830
Liberty Corner NJ 07968
Everest National MPN-Coventry
Standard Insurer 7/26/2005 www.everestnational.com/workcomp T
1719
Everest National Insurance Company
477 Martinsville Rd
Liberty Corner NJ 07938 Everest Medical Provider Network Insurer 11/5/2010 www.everestnational.com/workcomp
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
60
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1421
Everest National Insurance Company
477 Martinsville Road PO Box 830
Liberty Corner NJ 07938 Everest National MPN-ACM Insurer 10/17/2008 www.everestnational.com/workcomp T
0315
Exact Property & Casualty
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health MPN Network) Insurer 3/9/2005 T
1590
Exact Property And Casualty Company
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 2/11/2010 www.corvel.com
0322
Exact Property and Casualty
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
0272
Executive Risk Indemnity Inc.
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1475
Executive Risk Indemnity Inc.
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
0273
Executive Risk Specialty Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 T
1474
Executive Risk Specialty Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 T
0870
Explorer Insurance Company
11455 El Camino Real
San Diego CA 92130
PRIME Advantage Medical Network,
accessing Prudent Buyer HCO Insurer 5/3/2005 T
0723
Farmer Bros. Co.
20333 S. Normandie Avenue
Torrance CA 90502
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 5/13/2005 T
0319
Farmers Insurance Exchange
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
0311
Farmers Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
(First Health MPN Network) Insurer 3/9/2005 T
1593
Farmers Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 2/11/2010 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
61
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0246
Farmington Casualty Company
One Tower Square 4MS
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0245
Farmington Casualty Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
2144
Farmland Mutual Insurance Company
1100 Locust St., Dept 3010
Des Moines IA 50391
Farmland Mutual Insurance Company-
GENEX MPN Insurer 4/8/2013 www.genexservices.com T
0010
FBO Marin General and Novato Community
Hospital
166 Hillside Ave.
Mill Valley CA 94941 Mezzo Forte Medical Provider Network
Self-Insured
Employer 1/31/2005 W
1510
Federal Express Corporation
3620 Hacks Cross Rd Bldg B
Memphis TN 38125
GENEX-Federal Express Corporation
Medical Provider Network
Self-Insured
Employer 4/1/2009 www.genexservices.com
1792
Federal Insurance Company
15 Mountain View Rd
Warren NJ 07059 Dick's Sporting Goods MPN Insurer 3/2/2011 T
1939
Federal Insurance Company
15 Mountain View Rd
Warren NJ 07059 Forever 21 Broadspire Signature MPN Insurer 4/20/2012 T
2186
Federal Insurance Company
15 Mountain View Rd
Warren NJ 07059
American Campus Communities
GBMCS MPN Insurer 6/12/2013 T
2052
Federal Insurance Company
15 Mountain View Rd.
Warren NJ 07059
American Cancer Society GBMCS
MPN Insurer 9/13/2012 T
2103
Federal Insurance Company
15 Mountain View Rd.
Warren NJ 07059
Edward Thomas Companies GBMCS
MPN Insurer 1/10/2013 T
0267
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1476
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
62
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1851
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Columbia Sussex MPN Insurer 7/28/2011 T
1871
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Guckenheimer GBMCS MPN Insurer 8/4/2011 T
1872
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Hot Topic GBMCS MPN Insurer 8/4/2011 T
1873
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Starr Aviation GBMCS MPN Insurer 8/4/2011 T
1874
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 American Assets GBMCS MPN Insurer 8/4/2011 T
1990
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Berry Plastics GBMCS MPN Insurer 9/22/2011 T
1991
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 American Golf GBMCS MPN Insurer 9/22/2011 T
1994
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
OLS Hotels & Resorts LP GBMCS
MPN Insurer 10/27/2011 T
1902
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Taylor Corporation GBMCS MPN Insurer 2/14/2012 T
1903
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Invacare Medical Provider Network Insurer 3/2/2012 T
2014
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
KSL DC Management LLC GBMCS
MPN Insurer 6/7/2012 T
2037
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
Nevins Lewbel Property Management,
Inc. GBMCS MPN Insurer 9/27/2012 T
2043
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Pacifica Hotels GBMCS MPN Insurer 9/27/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
63
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2044
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
BCBG Max Azria Group, Inc. GBMCS
MPN Insurer 9/27/2012 T
2084
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Medallion Hotels GBMCS MPN Insurer 1/10/2013 T
2111
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
Crestline Hotels & Resorts, Inc.
GBMCS MPN Insurer 2/11/2013 T
2112
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Moana Corporation GBMCS MPN Insurer 2/11/2013 T
2091
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
Goldrich & Kest Industries, LLC
GBMCS MPN Insurer 3/13/2013 T
2137
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 The Container Store GBMCS MPN Insurer 3/27/2013 T
2174
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
CordeValle, LP dba CordeValle Golf
Club GBMCS MPN Insurer 5/28/2013 T
2175
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 TRG Hospitality, LLC GBMCS MPN Insurer 5/28/2013 T
2184
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Hersha Group, LLC GBMCS MPN Insurer 6/12/2013 T
2185
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
Richman Property Services, Inc.
GBMCS MPN Insurer 6/12/2013 T
2202
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Starr Aviation GBMCS KOJ MPN Insurer 7/29/2013 T
2233
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 The Olympic Club GBMCS MPN Insurer 11/12/2013 T
2243
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059 Northwood Hospitality GBMCS MPN Insurer 12/6/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
64
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2254
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
Apartment Management Consultants,
LLC GBMCS MPN Insurer 12/20/2013 T
2268
Federal Insurance Company
15 Mountain View Road
Warren NJ 07059
SoHo House West Hollywood, LLC
GBMCS MPN Insurer 1/10/2014 www.coventrywcs.com/client-tools/index.htm T
0055
Federated Dept. Stores, Inc.
7 West Seventh Street
Cincinnati OH 45202
CorVel MPN/Federated Department
Stores
Self-Insured
Employer 2/17/2005 T
1881
FedEx Freight Inc.
2200 Forward Drive
Harrison AR 72601 Sedgwick CMS Extended MPN
Self-Insured
Employer 8/31/2011 T
0803
Fedex Freight West, Inc.
6411 Guadalupe Mines Rd #3180
San Jose CA 95120 Cambridge Fedex West MPN
Self-Insured
Employer 5/16/2005 W
0149
Fidelity & Deposit Company of Maryland
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0670
Fidelity & Deposit Company of Maryland
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Fidelity and Deposit of Maryland
Crawford Select Insurer 7/1/2005 W
1000
Fidelity & Deposit Company of Maryland
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Fidelity and Deposit of Maryland -
Crawford Primary Insurer 7/1/2005 W
0842
Fidelity & Deposit Company of Maryland
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
0916
Fidelity & Guaranty Insurance Company
(Discover Re Managers, Inc.)
5 Batterson Park Road
Farmington CT 06032
Fidelity & Guaranty Insurance
Company/The GAP, Inc. Insurer 5/12/2005 T
0398
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Discover Re Cambridge MPN Insurer 2/24/2005 T
0499
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS Extended MPN Insurer 3/10/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
65
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0488
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS MPN Insurer 3/15/2005 T
0720
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0555
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032
SRS First Health CompAmerica
Primary HCO Network (or "SRS First
Health Primary") Insurer 3/22/2005 W
0592
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Discover Re/FGIC/GAB-Medinsights Insurer 3/22/2005 T
0443
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Frank Gates/DRE/First Health
CompAmerica Select HCO Network Insurer 5/11/2005 W
0811
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032
CorVel/Fidelity & Guaranty/Frank
Gates Insurer 5/18/2005 W
0830
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Intracorp - Dre GatesMcDonald MPN Insurer 6/2/2005 T
0664
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Fidelity and Guaranty Insurance
Company - Crawford Select Insurer 6/16/2005 W
0828
Fidelity & Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 AIGDC/Discover Re Insurer 7/26/2005 W
0188
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Discover Re ESIS MPN Insurer 2/2/2005 T
0516
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
Fidelity and Guaranty Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 4/27/2005 T
0883
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 TRISTAR CompAmerica Primary HCO Insurer 5/3/2005 W
0970
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington IL 06032
Fidelity and Guaranty Insurance
Company - Crawford Primary Insurer 6/16/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
66
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1081
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
First Health Network - DRe Matrix
MPN Insurer 12/7/2005 W
1169
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 DRe Sedgwick Intracorp OD MPN Insurer 5/4/2006 T
1370
Fidelity & Guaranty Insurance Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
SCRMA-WellComp Medical Provider
Network Insurer 5/27/2008 T
1387
Fidelity & Guaranty Insurance Company
c/o Traveler's National Accounts Unbundled 5
Batterson Park Rd.
Farmington CT 06032 WellComp Medical Provider Network Insurer 6/20/2008 T
0399
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032 Discover Re Cambridge MPN Insurer 2/24/2005 W
0498
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS Extended MPN Insurer 3/10/2005 T
0487
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS MPN Insurer 3/15/2005 T
0547
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
SRS First Health CompAmerica
Primary HCO Network (or "SRS First
Health Primary") Insurer 3/22/2005 W
0551
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
First Health CompAmerica Select HCO
Network (or "First Health Select") Insurer 3/22/2005 W
0593
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032 Discover Re/FGIU/GAB-MedInsights Insurer 3/22/2005 T
0444
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
Frank Gates/DRE/First Health
CompAmerica Select HCO Network Insurer 5/11/2005 W
0539
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
Fidelity and Guaranty Insurance
Underwriters, Inc./Gallagher
Bassett/First Health MPN Insurer 5/13/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
67
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0810
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
CorVel MPN/Fidelity and
Guaranty/Frank Gates Insurer 5/18/2005 W
0831
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032 Intracorp - Dre GatesMcDonald MPN Insurer 6/2/2005 T
0663
Fidelity & Guaranty Insurance Underwriters, Inc
5 Batterson Park Road
Farmington CT 06032
Fidelity and Guaranty Insurance
Underwriters, Inc. - Crawford Select Insurer 6/16/2005 W
0721
Fidelity & Guaranty Insurance Underwriters, Inc
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0971
Fidelity & Guaranty Insurance Underwriters, Inc
c/o Discover Re 5 Batterson Park Road
Farmington IL 06032
Fidelity and Guaranty Insurance
Underwriters, Inc. - Crawford Primary Insurer 6/16/2005 W
1368
Fidelity & Guaranty Insurance Underwriters, Inc.
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
SCRMA-WellComp Medical Provider
Network Insurer 5/27/2008 W
1388
Fidelity & Guaranty Insurance Underwriters, Inc.
c/o Travelers National Accounts Unbundled, 5
Batterson Park Road
Farmington CT 06032 Wellcomp Medical Provider Network Insurer 6/20/2008 T
1144
Fidelity And Deposit Company Of Maryland
1299 Zurich Way 3W
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 www.zurichna.com
0213
Fidelity And Deposit Company Of Maryland
1299 Zurich Way
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 4/18/2005 www.zurichna.com
1352
Fidelity And Deposit Company Of Maryland
1299 Zurich Way
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
1597
Fidelity and Guarantee Insurance Company
c/o Discover Re 5 Batterson Park
Farmington CT 06032 Medex/CCMSI Insurer 1/25/2010 www.medexhco.com T
1676
Fidelity And Guaranty Insurance Company
1 Tower Square - MS 12
Hartford CT 06183 Broadspire Signature Network/FGIC Insurer 8/18/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
68
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0556
Fidelity and Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/22/2005 T
2117
Fidelity and Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor MPN Insurer 2/1/2013 T
2118
Fidelity and Guaranty Insurance Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor 2 MPN Insurer 2/1/2013 T
0288
Fidelity And Guaranty Insurance Company
C/o Discover Re, 5 Batterson Park Road
Farmington CT 06032 CorVel MPN Insurer 2/17/2005 www.corvel.com
0407
Fidelity And Guaranty Insurance Company
C/O Discover Re, 5 Batterson Park Road
Farmington CT 06032 CorVel MPN Insurer 2/28/2005 www.CorVel.com
1441
Fidelity and Guaranty Insurance Company
c/o Discover Re, 5 Batterson Park Road
Farmington CT 06032
F & G Insurance Company GBMCS
MPN Insurer 5/7/2009 T
0989
Fidelity and Guaranty Insurance Company
c/o Travelers National Accounts Unbundled One
Tower Square, 12-MS
Hartford CT 06183 Liberty Mutual Group MPN Insurer 7/28/2005 T
0535
Fidelity and Guaranty Insurance Company
One Tower Square MS-12
Hartford CT 06183
Fidelity and Guaranty/Gallagher
Bassett/First Health MPN Insurer 5/13/2005 T
0260
Fidelity and Guaranty Insurance Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
2245
Fidelity And Guaranty Insurance Company
One Towers Square
Hartford CT 06183 Coventry Medical Provider Network Insurer 4/18/2014 www.talispoint.com/cvty/matrix
1443
Fidelity and Guaranty Insurance Underwriters Inc
c/o Discover Re, 5 Batterson Park Road
Farmington CT 06032
F & G Insurance Underwriters, Inc.
GBMCS MPN Insurer 5/7/2009 T
0261
Fidelity and Guaranty Insurance Underwriters, Inc
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
69
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1677
Fidelity And Guaranty Insurance Underwriters,
Inc.
1 Tower Square- MS 12
Hartford CT 06183 Broadspire Signature Network/FGIU Insurer 8/18/2010 T
2119
Fidelity and Guaranty Insurance Underwriters, Inc.
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor MPN Insurer 2/1/2013 T
2120
Fidelity and Guaranty Insurance Underwriters, Inc.
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor 2 MPN Insurer 2/1/2013 T
0191
Fidelity and Guaranty Insurance Underwriters, Inc.
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Discover Re ESIS MPN Insurer 2/2/2005 T
0290
Fidelity And Guaranty Insurance Underwriters,
Inc.
C/o Discover Re, 5 Batterson Park Road
Farmington CT 06032 CorVel MPN Insurer 2/17/2005 www.corvel.com
0410
Fidelity And Guaranty Insurance Underwriters,
Inc.
C/O The Travelers Companies, Inc. National
Accounts UnbundledOne Tower Square MS-12
Hartford CT 06183 CorVel MPN/Fidelity & Guaranty/LWP Insurer 2/28/2005 www.corvel.com
0990
Fidelity and Guaranty Insurance Underwriters, Inc.
c/o Travelers National Accounts Unbundled, One
Tower Square, 12-MS
Hartford CT 06183 Liberty Mutual Group MPN Insurer 7/28/2005 T
0512
Fidelity and Guaranty Insurance Underwriters, Inc.
One Tower Square MS-12
Hartford CT 06183
Fidelity and Guaranty Insurance
Underwriters, Inc./Gallagher
Bassett/Coventry MPN Insurer 4/27/2005 T
2461
Finish Line Self Insurance Group, Inc.
4961 Katella Ave
Los Alamitos CA 90720 Finish Line MPN
Self-Insured
Employer 3/25/2016 Flsig.EmployerMPN.com
1225
Finish Line Self-Insurance Group, Inc.
4961 Katella Ave.
Los Alamitos CA 90720 Finish Line MPN
Group of
Self-Insured
Employers 1/13/2012 www.tristarrisk.com T
0317
Fire Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health MPN Network) Insurer 3/9/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
70
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0324
Fire Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010
FirstHealth CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
1596
Fire Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 2/11/2010 www.corvel.com
0042
Fireman's Fund Insurance Company
777 San Marin Dr.
Novato CA 94998 First Health Select Insurer 2/1/2005 www.agcs.allianz.com/usclaims
0326
Fireman's Fund Insurance Company
777 San Marin Drive, Ste A12
Novato CA 94945
First Health CompAmerica Primary
Network Insurer 4/21/2005 T
0521
First National Insurance Company of America
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 2/14/2005
http://www.libertymutualgroup.com/providernetwork
s
T
1288
FirstComp Underwriters Group Inc., dba
FirstComp Insurance Agency
222 S 15th Street Suite 1200
Omaha NE 68102 FirstComp/CorVel MPN Insurer 4/19/2007 R
0035
Fleetwood Enterprises, Inc. (Fleetwood)
3125 Myers Street
Riverside CA 92513 First Health CompAmerica Select HCO
Self-Insured
Employer 4/7/2005 T
2059
Florists' Mutual Insurance Company
1 Horticultural
Edwardsville IL 62025 Hortica California Signature MPN Insurer 10/11/2012 T
1504
Florists' Mutual Insurance Company
One Horticultural Lane, Box 428
Edwardsville IL 62025 Hortica California MPN Insurer 2/24/2009 T
1505
Florists' Mutual Insurance Company
One Horticultural Lane, Box 428
Edwardsville IL 62025 Hortica California Select MPN Insurer 2/24/2009 T
2499
Florists' Mutual Insurance Company
PO Box 8032
Stevens Point WI 54481 Hortica MPN Insurer 9/9/2016 www.hortica.com
1906
Flyers Energy, LLC
2360 Lindbergh Street
Auburn CA 95602 MedInsights Medical Provider Network
Self-Insured
Employer 2/14/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
71
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2105
Flyers Energy, LLC
2360 Lindbergh Street
Auburn CA 95602 Flyers Energy, LLC GBMCS MPN
Self-Insured
Employer 1/11/2013 T
1010
Flyers Transportation LLC
2360 Lindbergh Street
Auburn CA 95602 MedInsights Medical Provider Network
Self-Insured
Employer 7/26/2005 T
2106
Flyers Transportation, LLC
2360 Lindbergh St.
Auburn CA 95602
Flyers Transportation, LLC GBMCS
MPN
Self-Insured
Employer 1/11/2013 T
0958
Fontana Unified School District
9680 Citrus Avenue
Fontana CA 92335
Self-Insured
Employer 6/3/2005 T
1422
Fontana Unified School District
9680 Citrus Avenue
Fontana CA 92335 WellComp Medical Provider Network
Self-Insured
Employer 10/1/2008 T
1228
Food Products of California Workers'
Compensation Program Inc.
11601 Wilshire Blvd., Suite 500
Los Angeles CA 90025
Group of
Self-Insured
Employers 8/18/2006 W
1614
Food Products of California Workers'
Compensation Program, Inc.
11601 Wilshire Blvd, Ste 50, Brentwood Center
Los Angeles CA 90025 Medex
Group of
Self-Insured
Employers 4/8/2010 www.medexhco.com
2102
Ford Motor Company
16800 Executive Plaza
Dearborn MI 48121 Corvel MPN
Self-Insured
Employer 1/10/2013 www.corvel.com
2509
Foremost Insurance Company Grand Rapids,
Michigan
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 10/27/2016 www.talispoint.com/farmers/com
2512
Foremost Property And Casualty Insurance
Company
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 10/27/2016 www.talispoint.com/farmers/com
2511
Foremost Signature Insurance Company
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 10/27/2016 www.talispoint.com/farmers/com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
72
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0380
Foster Dairy Farms
1707 McHenry Ave.
Modesto CA 95350 Medex Healthcare Inc. MPN
Self-Insured
Employer 2/17/2005 www.medexhco.com T
1339
Foster Farms
1000 Davis Street
Livingston CA 95334 CorVel Custom MPN
Self-Insured
Employer 1/15/2008 T
0378
Foster Farms, LLC
1000 Davis Street
Livingston CA 95334 Medex Healthcare Inc. MPN
Self-Insured
Employer 2/17/2005 T
1502
Foster Farms, LLC
1000 Davis Street
Livingston CA 95334 Foster Farms Custom CorVel MPN
Self-Insured
Employer 2/18/2009 T
0379
Foster Poultry Farms
1000 Davis Street
Livingston CA 95334 Medex Healthcare Inc. MPN
Self-Insured
Employer 2/17/2005 T
1503
Foster Poultry Farms
1000 Davis Street
Livingston CA 95334 Foster Farms Custom CorVel MPN
Self-Insured
Employer 2/18/2009 T
2455
Foster Poultry Farms
1000 Davis Street
Livingston CA 95334 Foster Farms MPN
Self-Insured
Employer 3/18/2016 www.fosterfarmsmpn.com
0230
Fountain Valley School District
17210 Oak Street
Fountain Valley CA 92708 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
1102
Frank C. Alegre Trucking, Inc.
PO Box 1508
Lodi CA 95241 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 1/17/2006 R
0043
Freedom Communications, Inc.
17666 Fitch
Irvine CA 92617
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 2/11/2005 T
1773
Freedom Communications, Inc.
625 N. Grand Ave.
Santa Ana CA 92710 Broadspire Signature Network
Self-Insured
Employer 2/2/2011 T
2309
Freedom Properties-Hemet, LLC
2200 West Acacia
Hemet CA 92545 Medex MPN
Self-Insured
Employer 9/5/2014 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
73
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1073
Fresno County Self-Insurance Group
c/o Tuker-Alexander Ins Assoc. 2133 High St
Suite E
Selma CA 93662 TRISTAR MPN
Joint Powers
Authority 8/12/2005 T
0059
Frito-Lay, Inc.
7701 Legacy Drive
Plano TX 75024
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 1/24/2005 T
1554
Front Porch Communities and Services
800 North Brand Blvd, 19th Fl
Glendale CA 91203 First Health Comp America HCO Select
Self-Insured
Employer 7/21/2009 www.talispoint.com/cvty/mpnsel
0139
Front Porch
303 No. Glen Oaks, Suite 1000
Burbank CA 91502 Front Porch Network
Self-Insured
Employer 3/7/2005 T
1103
Fullerton Joint Union High School District
1051 W. Bastanchury Rd
Fullerton CA 92883
Fullerton Joint Union High School
District - Comp Care MPN
Self-Insured
Employer 1/31/2006 T
1964
Fullerton School District
1401 W. Valencia Dr.
Fullerton CA 92833 WellComp Medical Provider Network
Self-Insured
Employer 5/16/2012 T
0283
Futures Academy
3701 Stephens Drive
North Highlands CA 95660
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/1/2005 W
2470
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 Gallagher Bassett Platinum-H MPN
Entity that
provides
physician
network
services 4/13/2016 www.talispoint.com/cvty/gbmpn
2396
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 Gallagher Bassett First Health MPN
Entity that
provides
physician
network
services 9/4/2015 www.talispoint.com/cvty/gbfhmpnselect
2346
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 Gallagher Bassett Platinum MPN
Entity that
provides
physician
network
services 10/15/2014 www.talispoint.com/cvty/gbmpn
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
74
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2349
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008
Gallagher Bassett Chubb Real Estate
Unit MPN
Entity that
provides
physician
network
services 10/17/2014 www.talispoint.com/cvty/gbmpn
2350
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008
Gallagher Bassett Chubb Risk
Management Group MPN
Entity that
provides
physician
network
services 10/17/2014 www.talispoint.com/cvty/gbmpn
2395
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 Gallagher Bassett Coventry MPN
Entity that
provides
physician
network
services 9/9/2015 www.talispoint.com/cvty/gbcvtympn
2471
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 Gallagher Bassett Platinum-M MPN
Entity that
provides
physician
network
services 4/13/2016 www.talispoint.com/cvty/gbmpn
3075
Gallagher Bassett Services, Inc.
2850 Golf Road
Rolling Meadows IL 60008 GB Care MPN
Entity that
provides
physician
network
services 12/19/2017 www.talispoint.com/cvty/gbmpn
2445
Gallagher Bassett Services, Inc.
Two Pierce Place, 4th Floor
Itasca IL 60143 ORCPG MPN
Entity that
provides
physician
network
services 1/21/2016 www.talispoint.com/cvty/gbmpn T
1397
General Casualty Company of Wisconsin
One General Drive
Sun Prairie WI 53596 Genex MPN Insurer 11/19/2008 T
2168
General Casualty Company of Wisconsin
One General Drive
Sun Prairie WI 53596 Sedgwick/Harbor MPN Insurer 5/10/2013 T
2169
General Casualty Company of Wisconsin
One General Drive
Sun Prairie WI 53596 Sedgwick/Harbor 2 MPN Insurer 5/10/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
75
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0611
General Motors LLC
300 Renaissance Center - Mail Code 482-C26-
A68
Detroit MI 48256
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 3/28/2005 T
2401
GENEX Services LLC
440 E Swedesford Road
Wayne PA 19087 GENEX
Entity that
provides
physician
network
services 9/3/2015 www.genexservices.com
2472
Genex Services, LLC
440 E Swedesford Road
Wayne PA 19087 Genex
Entity that
provides
physician
network
services 4/13/2016 www.genexservices.com
2500
Genex Services, LLC
440 E Swedesford Road
Wayne PA 19087 Genex
Entity that
provides
physician
network
services 8/10/2016 www.genexservices.com
3074
Genex Services, LLC
440 E Swedesford Road
Wayne PA 19087 Genex
Entity that
provides
physician
network
services 12/13/2017 http://www.genexservices.com
3084
Genex Services, LLC
440 E Swedesford Road
Wayne PA 19087 Genex
Entity that
provides
physician
network
services 2/5/2018 http://www.genexservices.com
3021
Genex Services, LLC
440 E. Swedesford Road
Wayne PA 19087 Genex/United Airlines
Entity that
provides
physician
network
services 5/1/2017 genexservices.com
0295
Georgia Pacific
133 Peachtree Street NE, 8th Floor
Atlanta GA 30303
First Health CompAmerica HCO Select
Network
Self-Insured
Employer 3/8/2005 R
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
76
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2082
Giorgio Beverly Hills, Inc.
6300 Center Hill Rd.
Cincinnati OH 45224 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 11/28/2012 W
2200
Giorgio Beverly Hills, Inc.
6300 Center Hill Rd.
Cincinnati OH 45224 Sedgwick/ Harbor MPN- PG
Self-Insured
Employer 7/9/2013 T
1283
Global Experience Specialists, Inc.
7000 Lindell Road
Las Vegas NV 89118 CorVel MPN
Self-Insured
Employer 3/15/2007 www.corvel.com
0095
Golden Eagle Insurance Corporation
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
2046
Golden Empire Transit District
1830 Golden State Avenue
Bakersfield CA 93301
Risico TMC Golden Empire Transit
District MPN
Self-Insured
Employer 9/11/2012 http://www.risico.com
2332
Golden Gate Bridge Highway and Transportation
District
1011 Anderson Drive
San Rafael CA 94901 ATHENS MPN
Self-Insured
Employer 9/5/2014 www.medexhco.com
1290
Golden Gate Bridge Highway and Transportation
District
1101 Andersen Dr.
San Rafael CA 93108 WellComp Medical Provider Network
Self-Insured
Employer 5/25/2007 T
0178
Golden Oaks Upholstery Inc.
16000 Heron Ave
La Mirada CA 90638 First Health CompAmerica Select
Self-Insured
Employer 3/7/2005 R
0641
Golden State Risk Management Authority
P.O. Box 706
Willows CA 95988 GSRMA MPN
Joint Powers
Authority 9/13/2005 T
2294
Golden State Water Company
630 E. Foothill Blvd.
San Dimas CA 91773 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 6/17/2014 www.harborsys.com/sedgwick2 T
1458
Golden State Water Company
630 E Foothill Blvd
San Dimas CA 91773 WellComp Medical Provider Network
Self-Insured
Employer 11/25/2008 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
77
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1161
Good Samaritan Hospital
1225 Wilshire Blvd
Los Angeles CA 90017
Good Samaritan Hospital-Comp Care
MPN
Self-Insured
Employer 4/20/2006 W
0352
Goodrich Corporation Which Will Do Business In
California As New York Goodrich Corporation
Four Coliseum Center, 2730 West Tyvola Rd
Charlotte NC 28217
Goodrich/Chartis Medical Provider
Network
Self-Insured
Employer 3/18/2005 www.talispoint.com/aig/goodrich √
1265
Goodwill Industries Of San Diego County
3663 Rosecrans Street
San Diego CA 92110
Goodwill Industries Of San Diego
County MPN
Self-Insured
Employer 3/6/2007 http://www.corvel.com
2318
Goodwill Industries of San Francisco, San Mateo,
and Marin Counties, Inc.
1500 Mission Street
San Francisco CA 94103 ATHENS MPN
Self-Insured
Employer 8/12/2014 www.medexhco.com T
0717
Goodwill Industries of Southern California
342 N. San Fernando Road
Los Angeles CA 90031 Medex
Self-Insured
Employer 4/19/2005 www.medexhco.com
1223
Gordon Trucking Inc.
151 Stewart Rd. SW
Pacific WA 98047 Cambridge Gordon Trucking MPN
Self-Insured
Employer 8/8/2006 T
1867
Gordon Trucking, Inc.
151 Steward Rd SW
Pacific WA 98047
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 7/28/2011 T
0911
Granite State Insurance Company
175 Water St, 18th Floor
New York NY 10038
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 5/18/2005 T
1760
Granite State Insurance Company
175 Water St., 18th Floor
New York NY 10038 AIG Select MPN Insurer 1/19/2011 www.talispoint.com/aig/mpnselect
0117
Granite State Insurance Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0762
Granite State Insurance Company
175 Water Street - 18th Floor
New York NY 10038
Granite State Insurance
Company/Gallagher Bassett/CorVel
MPN Insurer 5/5/2005 www.corvel.com
1405
Granite State Insurance Company
175 Water Street - 18th Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
78
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1659
Granite State Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/30/2010 www.broadspireppo.com T
0529
Granite State Insurance Company
175 Water Street
New York NY 10038 Chartis - Cambridge MPN Insurer 3/24/2005 W
0653
Granite State Insurance Company
175 Water Street, 18th Floor
New York NY 10038
Granite State/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 T
0623
Granite State Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
1023
Granite State Insurance Company
175 Water Street, 18th Floor
New York NY 10038
Granite State/Gallagher Bassett/First
Health MPN Insurer 8/5/2005 T
1452
Granite State Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Granite State GBMCS MPN Insurer 5/7/2009 T
0462
Granite State Insurance Company
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
1376
Granite State Insurance Company
70 Pine Street
New York NY 10270 Athens/Granite State Ins. Co. MPN Insurer 4/15/2008 T
0858
Granite State Insurance Company
AIG 70 Pine Street
New York NY 10270
Granite State Insurance Company,
Crawford Select Insurer 7/1/2005 W
0867
Granite State Insurance Company
AIG 70 Pine Street
New York NY 10270
Granite State Insurance Company,
Crawford Primary Insurer 7/1/2005 W
0194
Grant Community Outreach Academy
3180 Del Paso Blvd
Sacramento CA 95815
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/2/2005 W
0195
Grant Joint Union High School District
1333 Grand Avenue
Sacramento CA 95838
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/2/2005 W
2335
Great American Alliance Insurance Company
301 E. Fourth Street
Cincinnati OH 45202 WellComp Medical Provider Network Insurer 8/26/2014 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
79
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2475
Great American Alliance Insurance Company
301 East 4th Street 16NE
Cincinnati OH 45202 Strategic Comp MPN Insurer 4/7/2016 www.strategiccompmpn.com
2190
Great American Alliance Insurance Company
310 E. Fourth Street, 24th Floor
Cincinnati OH 45202 Athens MPN Insurer 6/21/2013 T
2338
Great American Assurance Company
301 E. Fourth Street
Cincinnati OH 45202 WellComp Medical Provider Network Insurer 8/28/2014 www.WellComp.com T
2188
Great American Assurance Company
310 E Fourth Street, 24th Floor
Cincinnati OH 45202 Athens MPN Insurer 6/21/2013 T
0727
Great American Custom Insurance Services, Inc.
725 So. Figueroa St. Ste 3400
Los Angeles CA 90017
First Health Comp America Select HCO
Network (First Health Select) Insurer 4/26/2005 W
2374
Great American Insurance Company of New York
301 E. Fourth Street
Cincinnati OH 45202 WellComp Medical Provider Network Insurer 2/24/2015 www.wellcomp.com T
2187
Great American Insurance Company of New York
310 E. Fourth Street, 24th Floor
Cincinnati OH 45202 Athens MPN Insurer 6/21/2013 T
2337
Great American Insurance Company
301 E. Fourth Street
Cincinnati OH 45202 WellComp Medical Provider Network Insurer 8/28/2014 www.WellComp.com T
2289
Great American Insurance Company
301 East Fourth St, Suite 2400
Cincinnati OH 45202
Great American Alternative Markets
MPN Insurer 6/17/2014 www.talispoint.com/gaic/external
2189
Great American Insurance Company
310 E Fourth St, 24th Floor
Cincinnati OH 45202 Athens MPN Insurer 6/20/2013 T
1286
Great American Insurance Company
4 East 4th Street
Cincinnati OH 45202
First Health CompAmerica Select HCO
Network Insurer 3/26/2007 T
1907
Great Divide Insurance Company
600 East Las Colinas Blvd Suite 1400
Irving TX 75039 Berkley Specialty MPN Insurer 2/14/2012 www.talispoint.com/cvty/berkley
1230
Great Divide Insurance Company
7233 Butherus Drive
Scottsdale AZ 85260 San Francisco 49er MPN Insurer 9/1/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
80
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0269
Great Northern Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1477
Great Northern Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
1493
Great West Casualty Company
1100 West 29th Street
South Sioux City NE 68776 CorVel MPN Insurer 1/8/2009 T
1678
Greenwich Insurance Company
100 Caitlin Constitution Plaza
Hartford CT 06103 Broadspire Signature Network MPN Insurer 8/18/2010 T
1669
Greenwich Insurance Company
200 Liberty Street, 21st Floor
New York NY 10281
Greenwich Insurance
Company/ACS/GENEX Insurer 9/29/2010 www.genexservices.com T
0908
Greenwich Insurance Company
520 Eagleview Blvd
Exton PA 19341
MedInsights Medical Provider Network
accessing Prudent Buyer HCO Insurer 6/1/2005 W
0956
Greenwich Insurance Company
One World Financial Center 200 Liberty St
New York NY 10281 CorVel MPN Insurer 8/2/2005 www.corvel.com
0973
Greenwich Insurance Company
One World Financial Center 200 Liberty St
New York NY 10281
Greenwich Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 12/7/2006 T
1551
Greenwich Insurance Company
One World Financial Center 200 Liberty St
New York NY 10281 Avizent/Greenwich Insurance Co. MPN Insurer 9/17/2009 T
1448
Greenwich Insurance Company
One World Financial Center,200 Liberty Street
21st Floor
New York NY 10281
Greenwich Insurance Company
GBMCS MPN Insurer 5/7/2009 T
1173
Greenwich Insurance Company
One World Financial Center-200 Liberty St.
New York NY 10281
Sedgwick CMS Extended Medical
Provider Network Insurer 3/24/2006 T
1174
Greenwich Insurance Company
One World Financial Center-200 Liberty St.
New York NY 10281
Sedgwick CMS Medical Provider
Network Insurer 3/24/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
81
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0986
Greenwich Insurance Company
One World Financial Center-200 Liberty St. 21st
Flr
New York NY 10281
Greenwich Insurance
Company/Gallagher Bassett/First Health
MPN Insurer 1/27/2012 T
0945
Greenwich Insurance Company
XL Insurance Inc-One World Financial Center,
200 Liberty Street
New York NY 10281
First Health CompAmerica Primary
HCO Network (or "First Health
Primary") Insurer 6/16/2005 W
0946
Greenwich Insurance Company
XL Insurance Inc-One World Financial Center,
200 Liberty Street
New York NY 10281
First Health CompAmerica Select HCO
Network (or "First Health Select") Insurer 6/16/2005 W
0954
Greenwich Insurance Company
XL Insurance Inc-One World Financial Center,
200 Liberty Street
New York NY 10281 Broadspire MPN Insurer 7/12/2005 T
0715
Grimmway Enterprises, Inc.
14141 Di Giorgio Road
Arvin CA 93203 Medex
Self-Insured
Employer 4/19/2005 www.medexhco.com
0710
Grossmont Cuyamaca Community College
District
8800 Grossmont College Dr
El Cajon CA 92020
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 4/19/2005 T
1482
Guardian Comp, Inc.
255 Great Valley Pkwy Ste 200
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 3/17/2009 T
0428
Guardian Comp, Inc.
700 W. Center Street
Visalia CA 93291 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 3/3/2005 T
0146
Guardian Industries Corp
2300 Harmon Road
Auburn Hills MI 48326 Guardian Industries ESIS MPN
Self-Insured
Employer 2/21/2005 T
2067
GuardianComp, Inc.
255 Great Valley Parkway, Ste 255
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 10/19/2012 www.monumentllc.com T
0287
GuideOne Mutual Insurance Company
1111 Ashworth Road
West Des Moines IA 50265 CorVel MPN/GuideOne Insurer 2/17/2005 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
82
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1111
Hacienda La Puente Unified School District
15959 E. Gale Avenue
City of Industry CA 91716 WellComp Medical Provider Network
Self-Insured
Employer 2/1/2006 T
0558
Harbor Specialty Insurance Company
1177 6th Avenue of the Americas, 45th Floor
New York City NY 10036 Harbor Specialty MPN Insurer 3/22/2005 W
0232
Harbor Specialty Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 Clarendon Medical Provider Network 1 Insurer 2/9/2005 W
0083
Harbor Specialty Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel MPN Insurer 2/17/2005 T
0701
Harco National Insurance Company
2850 West Golf Road
Rolling Meadows IL 60008 Harco National Insurance Company Insurer 4/18/2005 www.networkhco.com
0432
Harco National Insurance Company
P.O. Box 68309
Schaumburg IL 60168 Broadspire-Concentra Standard MPN Insurer 7/11/2005 T
0787
Harker School
1471 Saratoga Ave., Suite 100
San Jose CA 95129 Inter Plan/Kaiser MPN
Self-Insured
Employer 6/24/2005 T
0583
Harrah's Rincon Hotel and Casino, HCAL
Corporation aka Harrah's Rincon
33750 Valley Center Road
Valley Center CA 92082 Intracorp
Self-Insured
Employer 6/2/2005 R
2104
Harris Farms, Inc.
RR 1, Box 400
Coalinga CA 93210 Tristar MPN
Self-Insured
Employer 1/14/2013 www.tristarrisk.com T
0075
Hartford Accident and Indemnity Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
1130
Hartford Accident and Indemnity Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Accident and Indemnity
Company accessing Anthem Blue Cross
Prudent Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
1517
Hartford Accident and Indemnity Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Accident and
Indemnity/Gallagher Bassett/First
Health MPN Insurer 4/23/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
83
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1970
Hartford Accident and Indemnity Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 5/24/2012 T
1987
Hartford Accident and Indemnity Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
0076
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
1602
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sedgwick CMS Medical Provider
Network Insurer 2/25/2010 T
1603
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sedgwick CMS Extended Medical
Provider Network Insurer 2/25/2010 T
1632
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 HA&IC/ESIS MPN Insurer 5/26/2010 T
1637
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 RISICO TMC HARTFORD A&I MPN Insurer 6/1/2010 www.risico.com
1711
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Hartford/Regis/Bunch MPN Insurer 12/3/2010 T
1847
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford Accident and Indemnity
Company GBMCS MPN Insurer 7/28/2011 T
1900
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Medex wcSolutions MPN Insurer 1/19/2012 T
1932
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 CCMSI/HA&I/First Health Select HCO Insurer 4/19/2012 T
1941
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford/A&I/CCMSI/RISING
MEDICAL/SOI MPN Insurer 4/26/2012 www.viiad.com/anthemcompass/kbccmsih000 T
2017
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Medex/CCMSI/HA&I/SJK MPN Insurer 6/15/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
84
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2045
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 CorVel/HA&I/Caliber MPN Insurer 8/30/2012 T
2208
Hartford Accident and Indemnity Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sedgwick/ Harbor MPN- HAIC
Hendrick Insurer 8/27/2013 T
2019
Hartford Accident And Indemnity Company
One Hartford Plaza HO-1-09
Hartford CT 06155 CorVel/HA&I/Prime Healthcare MPN Insurer 6/22/2012 http://www.corvel.com
3017
Hartford Accident And Indemnity Company
One Hartford Plaza HO-1-09
Hartford CT 06155 CorVel/HA&I/ChicosFAS MPN Insurer 4/12/2017 www.corvel.com
1159
Hartford Accident and Indemnity Company
One Hartford Plaza
Hartford CT 06155
Hartford Accident &
Indemnity/Gallaher Bassett/Coventry
MPN Insurer 3/20/2006 T
1648
Hartford Accident and Indemnity Company
One Hartford Plaza
Hartford CT 06155 Athens MPN - HA&I Insurer 6/10/2010 www.medexhco.com T
2412
Hartford Accident And Indemnity Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 Corvel/HA&I/AdvanceAmerica MPN Insurer 10/2/2015 www.corvel.com
2210
Hartford Accident And Indemnity Company
One Hartford Plaza, HO-I-09
Hartford CT 06155 CorVel/HA&I/BB&T MPN Insurer 8/1/2013 www.corvel.com
1834
Hartford Accident And Indemnity Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 HA&I/Broadspire Signature MPN Insurer 5/13/2011 T
2138
Hartford Accident And Indemnity Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HA&I/Kirkland's MPN Insurer 4/2/2013 www.corvel.com
2139
Hartford Accident And Indemnity Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HA&I/HMSHost MPN Insurer 4/3/2013 www.corvel.com
1248
Hartford Casualty Insurance Company
690 Asylum Ave
Hartford CT 06115
Frank Gates Svc Co/Hartford/CorVel
MPN Insurer 9/29/2006 W
0074
Hartford Casualty Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
85
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1137
Hartford Casualty Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Casualty Insurance Company
accessing Anthem Blue Cross Prudent
Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
1516
Hartford Casualty Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Casualty/Gallagher
Bassett/First Health MPN Insurer 4/23/2009 T
0073
Hartford Casualty Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
1158
Hartford Casualty Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford Casualty/Gallagher
Bassett/Coventry MPN Insurer 3/20/2006 T
3022
Hartford Casualty Insurance Company
One Hartford Plaza HO-1-09
Hartford CT 06155 CorVel/HCIC/Burberry MPN Insurer 4/25/2017 www.corvel.com
1855
Hartford Casualty Insurance Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 HCIC/Broadspire Signature MPN Insurer 7/15/2011 T
2494
Hartford Casualty Insurance Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HCIC/AdvanceAmerica MPN Insurer 8/15/2016 www.corvel.com
2496
Hartford Casualty Insurance Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HCIC/BB&T MPN Insurer 8/15/2016 www.corvel.com
0022
Hartford Fire Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
0023
Hartford Fire Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
1133
Hartford Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Fire Insurance Company
accessing Anthem Blue Cross Prudent
Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
1514
Hartford Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Fire/Gallagher Bassett/First
Health MPN Insurer 4/23/2009 www.talispoint.com/cvty/gbfhmpnselect T
1971
Hartford Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 5/24/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
86
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2004
Hartford Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
1884
Hartford Fire Insurance Company
One Hartford Plaza (HO-I-09)
Hartford CT 06155 Sedgwick CMS MPN Insurer 9/20/2011 T
1885
Hartford Fire Insurance Company
One Hartford Plaza (HO-I-09)
Hartford CT 06155 Sedgwick CMS Extended MPN Insurer 9/20/2011 T
1153
Hartford Fire Insurance Company
One Hartford Plaza [HO-1-09)
Hartford CT 06155
Hartford Fire Ins. Co./Gallagher
Bassett/Coventry MPN Insurer 3/20/2006 T
1633
Hartford Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 HFIC/ESIS MPN Insurer 5/26/2010 T
2023
Hartford Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford Fire Insurance Company
GBMCS MPN Insurer 7/20/2012 T
2142
Hartford Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Athens MPN-HFIC Insurer 3/28/2013 T
2134
Hartford Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
WellComp Medical Provider Network-
York- HFIC Insurer 5/2/2013 T
1856
Hartford Fire Insurance Company
One Hartford Plaza HO-1-09
Hartford CT 06155 HFIC/Broadspire Signature MPN Insurer 7/15/2011 T
3044
Hartford Fire Insurance Company
One Hartford Plaza HO-1-09
Hartford CT 06155 The Hartford Select Network Insurer 7/20/2017 http://thehartfordselectnetworkmpn.com/
3083
Hartford Fire Insurance Company
One Hartford Plaza HO-1-09
Hartford CT 06155 Hartford Choice MPN
Entity that
provides
physician
network
services 2/2/2018 http://www.hartfordchoicempn.com
1187
Hartford Insurance Company of the Midwest
1 College Park 8910 Purdue Rd
Indianapolis IN 46268
Sedgwick CMS Medical Provider
Network Insurer 4/19/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
87
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1250
Hartford Insurance Company of the Midwest
690 Asylum Ave
Hartford CT 06115
Frank Gates Svc Co/Hartford/CorVel
MPN Insurer 9/29/2006 W
0071
Hartford Insurance Company of the Midwest
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
0072
Hartford Insurance Company of the Midwest
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
1134
Hartford Insurance Company of the Midwest
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Insurance Company of the
Midwest accessing Anthem Blue Cross
Prudent Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
2003
Hartford Insurance Company of the Midwest
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
1439
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Wellcomp Medical Provider Network-
York-HICM Insurer 1/20/2009 T
1509
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155 HICM/GABRobins-MedInsights MPN Insurer 2/23/2009 T
1494
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford Insurance Company of the
Midwest/Gallagher Bassett/First Health
MPN Insurer 4/23/2009 www.talispoint.com/cvty/gbfhmpnselect T
1572
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155
HICMW Broadspire First Health
CompAmerica Primary Network Insurer 10/28/2009 T
1594
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Hartford Insurance Company of the
Midwest GBMCS MPN Insurer 1/20/2010 www.talispoint.com/cvty/gbmpn T
1580
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155
CCMSI/HICM/First Health
CompAmerica Select HCO Network Insurer 2/10/2010 T
1635
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155 RISICO TMC Hartford IMC MPN Insurer 6/1/2010 www.risico.com
1969
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 5/24/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
88
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2229
Hartford Insurance Company of the Midwest
One Hartford Plaza [HO-1-09]
Hartford Ct 06155 Hartford MW Bunch MPN Insurer 10/29/2013 T
1156
Hartford Insurance Company of the Midwest
One Hartford Plaza
Hartford CT 06155
Hartford Ins. Co. Midwest./Gallagher
Bassett/Coventry MPN Insurer 3/20/2006 T
1468
Hartford Insurance Company of the Midwest
One Hartford Plaza
Hartford CT 06155 Sedgwick CMS Extended MPN Insurer 11/10/2008 T
1649
Hartford Insurance Company of the Midwest
One Hartford Plaza
Hartford CT 06155 Athens MPN - HICM Insurer 6/10/2010 www.medexhco.com T
1737
Hartford Insurance Company Of The Midwest
One Hartford Plaza, HO-1-09
Hartford CT 06155 Broadspire Signature MPN Insurer 12/16/2010 T
2078
Hartford Insurance Company Of The Midwest
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HICM/TX Roadhouse MPN Insurer 11/15/2012 www.corvel.com
2419
Hartford Insurance Company Of The Midwest
One Hartford Plaza, HO-1-09
Hartford CT 06155 CorVel/HICM/RL Carriers MPN Insurer 10/9/2015 www.corvel.com
1246
Hartford Underwriters Insurance Company
690 Asylum Ave
Hartford CT 06115
Frank Gates Svc Co/Hartford/CorVel
MPN Insurer 9/29/2006 W
0069
Hartford Underwriters Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica-Primary
HCO Network Insurer 1/12/2005 T
0070
Hartford Underwriters Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
1136
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Underwriters Insurance
Company accessing Anthem Blue Cross
Prudent Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
1515
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Hartford Underwriters/Gallagher
Bassett/First Health MPN Insurer 4/23/2009 T
1607
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
HUIC Broadspire First Health
CompAmerica Select HCO Network Insurer 4/27/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
89
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1933
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Sedgwick CMS Extended Medical
Provider Network Insurer 4/18/2012 T
1935
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Sedgwick CMS Medical Provider
Network Insurer 4/18/2012 T
2176
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/ Harbor MPN Insurer 5/10/2013 T
2177
Hartford Underwriters Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/ Harbor 2 MPN Insurer 5/10/2013 T
1157
Hartford Underwriters Insurance Company
One Hartford Plaza [HO-1-09)
Hartford CT 06155
Hartford Underwriters/Gallagher
Bassett/Coventry MPN Insurer 3/20/2006 T
1638
Hartford Underwriters Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
HUIC Redwoods First Health
CompAmerica Select HCO Network Insurer 5/26/2010 T
2141
Hartford Underwriters Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Athens MPN--HUIC Insurer 3/28/2013 T
2135
Hartford Underwriters Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
WellComp Medical Provider Network-
York-HUIC Insurer 5/2/2013 T
1738
Hartford Underwriters Insurance Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 Broadspire Signature MPN Insurer 12/16/2010 T
0578
Hartnell Community College District
411 Central Avenue
Salinas CA 93901
Prime Advantage Medical Provider
Network
Self-Insured
Employer 3/23/2005 T
1997
HDI Global Insurance Company
161 North Clark Street, 48th Floor
Chicago IL 60601
Energi-WellComp Medical Provider
Network Insurer 1/27/2012 www.Wellcomp.com
1177
Healthcare Industry Self-Insurance Program
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/5/2006 T
1555
Healthcare Industry Self-Insured Program
2600 Michelson Dr Ste 1620
Irvine CA 92612
CorVel/Healthcare Industry Self-
Insured Program
Group of
Self-Insured
Employers 6/26/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
90
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1299
Heartland Employment Services, LLC dba HCR
Manor Care
P.O. Box 10086
Toledo OH 43699 Tristar MPN
Self-Insured
Employer 7/13/2007 T
2331
Heartland Express Inc. of Iowa
151 Stewart Rd. SW
Pacific WA 98047 Sedgwick/Harbor MPN
Self-Insured
Employer 9/22/2014 www.harborsys.com/Sedgwick W
1110
Heavenly Valley, Limited Partnership
PO Box 2180
Stateline NV 89449 Liberty Mutual Group MPN
Self-Insured
Employer 7/6/2006 T
1651
Hesperia Fire Protection District
9700 Seventh Avenue
Hesperia CA 92345 WellComp Medical Provider Network
Self-Insured
Employer 6/22/2010 T
0219
Hewlett-Packard Company
3000 Hanover Street
Palo Alto CA 94304
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 5/10/2005 T
0031
Hexcel Corporation
281 Tresser Blvd
Stamford CT 06901 First Health Comp America Select HCO
Self-Insured
Employer 4/7/2005 T
0446
Hilton Hotels Corporation
9336 Civic Center Drive
Beverly Hills CA 90210 Intracorp
Self-Insured
Employer 4/12/2005 T
1191
Hilton Hotels Corporation
9336 Civic Center Drive
Beverly Hills CA 90210 Intracorp
Self-Insured
Employer 5/31/2006 T
2220
Hilton Worldwide, Inc.
7926 Jones Branch Drive
McLean VA 22102 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 9/17/2013 T
1722
Hilton Worldwide, Inc.
7930 Jones Branch Dr.
McLean VA 22102 CorVel MPN
Self-Insured
Employer 12/7/2010 T
1065
Hoag Memorial Hospital Presbyterian, The
301 Newport Blvd. Ste. 200
Newport Beach CA 92663
Hoag Memorial Hospital Presbyterian
MPN
Self-Insured
Employer 8/12/2005 http://hoag.employermpn.com/
0392
Home Depot U.S.A., Inc.
2455 Paces Ferry Road, Bldg C-20
Atlanta GA 30339
The Home Depot Medical Provider
Network
Self-Insured
Employer 2/23/2005 www.helmsmantpa.com/CAMPN
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
91
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2000
Household Industries Self-Insured Group
c/o CHSI, 770 Pilot Road, Suite 1
Las Vegas NV 89119 Athens MPN
Group of
Self-Insured
Employers 10/28/2011 T
0549
Hughes Supply, Inc.
One Hughes Way
Orlando FL 32805
First Health CompAmerica Primary
HCO Network (or "First Health
Primary")
Self-Insured
Employer 3/22/2005 R
2011
Huntington Beach City School District
20451 Craimer Lane
Huntington Beach CA 92646
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 6/1/2012 T
0063
Huntington Beach Union High School District
5832 Bolsa Ave
Huntington Beach CA 92649 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 1/11/2005 T
1193
Hydro Conduit Corporation
1501 Belvedere Road
West Palm Beach FL 33406 CorVel HCO
Self-Insured
Employer 4/10/2006 T
1078
Imperial County Office of Education
1398 Sperber Rd.
El Centro CA 92243 WellComp Medical Provider Network
Self-Insured
Employer 9/12/2005 T
0475
Imperial Irrigation District
P.O. Box 937
Imperial CA 92251 TRISTAR MPN
Self-Insured
Employer 3/18/2005 T
1830
Imperium Insurance Company
120 West 45th Street, 36th Floor
New York NY 10036 CorVel MPN Insurer 5/4/2011 www.corvel.com
0706
Indemnity Insurance Co. of North American (IND)
1601 Chestnut Street
Philadelphia PA 19103
Indemnity Insurance Co. of North
American (IND), Crawford Select Insurer 6/16/2005 W
0707
Indemnity Insurance Co. of North American (IND)
1601 Chestnut Street
Philadelphia PA 19103
Indemnity Insurance Co of North
America (IND) - Crawford Primary Insurer 6/16/2005 W
0405
Indemnity Insurance Company of North America
1601 Market Street
Philadelphia PA 19103
CorVel MPN/Indemnity Ins Co of
NA/LWP Insurer 2/28/2005 T
1963
Indemnity Insurance Company of North America
436 Walnut St.
Philadelphia PA 19106 Sedgwick/Harbor MPN Insurer 5/15/2012 T
0683
Indemnity Insurance Company of North America
436 Walnut Street
Philadelphia PA 19106 Sedgwick CMS MPN Insurer 4/1/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
92
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0686
Indemnity Insurance Company of North America
436 Walnut Street
Philadelphia PA 19106
Sedgwick CMS Extended Medical
Provider Network Insurer 4/1/2005 T
0770
Indemnity Insurance Company of North America
436 Walnut Street
Philadelphia PA 19106 ACE/BUNCH Network Insurer 5/6/2005 T
2057
Indemnity Insurance Company of North America
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor 2 MPN Insurer 9/20/2012 T
2226
Indemnity Insurance Company Of North America
436 Walnut Street
Philadelphia PA 19106 Broadspire Signature MPN Insurer 10/18/2013 T
2248
Indemnity Insurance Company Of North America
436 Walnut Street
Philadelphia PA 19106 Coventry Medical Provider Network Insurer 4/18/2014 http://www.talispoint.com/cvty/matrix
1545
Indemnity Insurance Company of North America
436 Walnut Street, P.O. Box 1000
Philadelphia PA 19105
CCMSI/ACE First Health Comp
America Select HCO Network Insurer 6/25/2009 T
2207
Inglewood Unified School District
401 S. Inglewood Ave.
Inglewood CA 90301
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/15/2013 T
0823
Inland Empire Utilities Agency
6075 Kimball Avenue, Bldg. A
Chino CA 91710 WellComp Medical Provider Network
Self-Insured
Employer 7/20/2005 T
0704
Insurance Company of North America (INA)
1601 Chestnut Street
Philadelphia PA 19103
Insurance Company of North America
(INA), Crawford Primary Insurer 6/16/2005 W
0705
Insurance Company of North America (INA)
1601 Chestnut Street
Philadelphia PA 19103
Insurance Company of North America
(INA), Crawford Select Insurer 6/16/2005 W
0049
Insurance Company of the West (ICW)
11455 El Camino Real
San Diego CA 92130 Medex MPN Insurer 12/3/2004 T
1982
Insurance Company of the West
11455 El Camino Real
San Diego CA 92130 ICW Group Premier MPN Insurer 5/25/2012 T
1172
Insurance Corporation of Hanover
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel HCO Insurer 2/28/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
93
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1747
Integrated Grain & Milling, Inc.
2020 So. East Ave.
Fresno CA 93721 Zacky Farms Custom CorVel MPN
Self-Insured
Employer 1/12/2011 T
1089
Intel Corporation
2200 Mission College Blvd.
Santa Clara CA 95052 Broadspire MPN
Self-Insured
Employer 1/23/2006 T
2279
Intel Corporation
2200 Mission College Blvd., RN6-68
Santa Clara CA 95054 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 4/7/2014 www.harborsys.com/sedgwick2 T
1691
Intel Corporation
RN6-68 2200 Mission College Blvd.
Santa Clara CA 95052 Broadspire Signature MPN
Self-Insured
Employer 8/19/2010 T
1106
International Paper Company
6400 Poplar Avenue Tower III Room 110
Memphis TN 38197
Sedgwick CMS Medical Provider
Network
Self-Insured
Employer 4/12/2006 T
1854
Interstate Distributor Co
11707 21st Ave Ct S
Tacoma WA 98444 Broadspire Signature MPN
Self-Insured
Employer 7/15/2011 T
1075
Irvine Ranch Water District
15600 Sand Canyon Ave
Irvine CA 92618 WellComp Medical Provider Network
Self-Insured
Employer 1/9/2006 T
0570
Irvine Unified School District
5050 Barranca Parkway
Irvine CA 92604 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0877
ITT Industries Inc.
666 E. Dyer Rd.
Santa Ana CA 92705 ITT ESIS MPN
Self-Insured
Employer 5/4/2005 T
0873
J. G. Boswell Company
PO Box 877
Corcoran CA 86321
Self-Insured
Employer 5/16/2005 W
1667
J.T. Wimsatt Contracting Company, Inc.
28064 Avenue Stanford Ste B
Valencia CA 91355
J.T. Wimsatt Contracting Company, Inc.
GBMCS MPN
Self-Insured
Employer 7/16/2010 T
0172
John Muir Health
1601 Ignacio Valley Road
Walnut Creek CA 94598 TRISTAR MPN
Self-Insured
Employer 5/6/2005 T
0895
Johnson Controls, Inc.
PO Box 591
Milwaukee WI 53201
Johnson Controls Medical Provider
Network MPN
Self-Insured
Employer 5/16/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
94
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1251
Johnson Machinery Company
800 E. La Cadena Drive
Riverside CA 92502 N/A
Self-Insured
Employer 3/12/2008 T
0175
Judicial Council of California
455 Golden Gate Avenue
San Francisco CA 94102
First Health CompAmerica Primary
HCO State 2/16/2005 T
1695
Kaiser Foundation Health Plan, Inc.
1800 Harrison St, 20th Floor
Oakland CA 94612 Kaiser Permanente/Harbor Net MPN
Self-Insured
Employer 12/29/2010 T
1087
Kaiser Foundation Health Plan, Inc., a California
Corporation
1800 Harrison St. 20th Floor
Oakland CA 94612 Kaiser Permanente MPN
Self-Insured
Employer 9/7/2005 T
1696
Kaiser Foundation Hospitals
1800 Harrison St. 20th Floor
Oakland CA 94612 Kaiser Permanente/Harbor Net MPN
Self-Insured
Employer 12/29/2010 T
1084
Kaiser Foundation Hospitals, a California
Corporation
1800 Harrison St., 20th Floor
Oakland CA 94612 Kaiser Permanente MPN
Self-Insured
Employer 9/7/2005 T
0590
Kaweah Delta Health Care District
400 W. Mineral King
Visalia CA 93291 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 3/18/2005 W
2481
Kellogg Company
One Kellogg Square
Battle Creek MI 49017 CorVel MPN
Self-Insured
Employer 5/17/2016 www.corvel.com T
0167
Kelly Services, Inc.
999 W. Big Beaver Road
Troy MI 48084 Kelly Services MPN
Self-Insured
Employer 2/2/2005 T
3068
Kern County Hospital Authority
1700 Mt. Vernon Ave.
Bakersfied CA 93306
Foundation For Medical Care Of Kern
County MPN
Self-Insured
Employer 1/8/2018 http://www.kernmedicalmpn.kernfmc.com
0807
Kern Ridge Growers, LLC
25429 Barbara St.
Arvin CA 93203 Allied Managed Care MPN
Self-Insured
Employer 5/16/2005 T
2194
Kiewit Infrastructure West Co.
Kiewet Plaza
Omaha NE 68131 Sedgwick CMS Extended MPN
Self-Insured
Employer 6/25/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
95
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0300
Kimco Staffing Services, Inc.
17872 Cowan Avenue
Irvine CA 92614
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/21/2005 T
0299
KimStaffHR, Inc.
17872 Cowan Avenue
Irvine CA 92614
First Health CompAmerica Primary
Network
Self-Insured
Employer 4/29/2005 T
0328
Kmart Corporation
3100 W. Big Beaver Rd.
Troy MI 48084
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 2/14/2005 T
1467
K-Mart Corporation
3333 Beverly Road
Hoffman Estates IL 60179
Sedgwick CMS-Harbor MPN - Sears
Holdings Management Corporation
Self-Insured
Employer 1/15/2009 T
2222
Knight Transportation, Inc. Which will do
Business in California as Arizona Knight
Transportation, Inc.
5601 W Buckeye Road
Phoenix AZ 85043 WellComp Medical Provider Network
Self-Insured
Employer 10/16/2013 W
0350
Kwikset Corporation/Price Pfister, Inc.
19701 Da Vinci
Lake Forest CA 92610
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 3/8/2005 T
0419
L&R Construction, Inc.
620 N. Brand Blvd., 6th Floor
Glendale CA 91203 FH Select MPN
Self-Insured
Employer 5/10/2005 T
1358
L.F.P., Inc.
8484 Wilshire Blvd., #900
Beverly Hills CA 90211 CorVel/L.F.P., Inc. MPN
Self-Insured
Employer 7/23/2008 www.corvel.com
0820
Lake Elsinore Unified School District
545 Chaney Street
Lake Elsinore CA 92530 Tristar MPN
Self-Insured
Employer 5/3/2005 T
0222
Lancaster School District
44711 North Cedar Avenue
Lancaster CA 93534 Prime Advantage Medical Network
Self-Insured
Employer 2/11/2005 T
1655
Landmark Insurance Company
175 Water St 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/22/2010 T
1758
Landmark Insurance Company
175 Water St., 18th Flr
New York NY 10038
Chartis Select Medical Provider
Network Insurer 1/19/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
96
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0655
Landmark Insurance Company
175 Water Street 18th Floor
New York NY 10038
Landmark Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 3/24/2005 T
0579
Landmark Insurance Company
175 Water Street
New York NY 10038 Chartis-Cambridge MPN Insurer 3/24/2005 W
0626
Landmark Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Chartis - Coventry MPN Insurer 3/28/2005 T
1021
Landmark Insurance Company
175 Water Street, 18th Floor
New York NY 10038
Landmark Insurance
Company/Gallagher Bassett/First Health
MPN Insurer 8/5/2005 T
0466
Landmark Insurance Company
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0760
Landmark Insurance Company
70 Pine Street
New York NY 10270
Landmark Insurance
Company/Gallagher Bassett / CorVel
MPN Insurer 5/5/2005 T
0918
Landmark Insurance Company
70 Pine Street
New York NY 10270
MedInsights Medical Provider Network,
accessing Prudent Buyer PPO Insurer 5/19/2005 T
0120
Landmark Insurance Company
80 Pine Street, 10th Floor
New York NY 10005
Chartis Primary Medical Provider
Network Insurer 2/17/2005 T
0856
Landmark Insurance Company
AIG 70 Pine Street
New York NY 10270
Landmark Insurance Company,
Crawford Primary Insurer 7/1/2005 W
0865
Landmark Insurance Company
AIG 70 Pine Street
New York NY 10270
Landmark Insurance Company
Crawford Select Insurer 7/1/2005 W
2236
LA-Z-BOY, Incorporated
301 Tennessee St.
Redlands CA 92373 Sedgwick/Harbor MPN - LZB
Self-Insured
Employer 12/13/2013 T
0029
Leprino Foods Company
1830 West 38th Avenue
Denver CO 80211 First Health Comp America Select HCO
Self-Insured
Employer 3/24/2005 www.talispoint.com/cvty/matrix
2075
Les Schwab Tire Centers of California, Inc
20900 Cooley Road
Bend OR 97701 Sedgwick/Harbor MPN-Les Schwab
Self-Insured
Employer 11/28/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
97
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1221
Les Schwab Tire Centers of California, Inc.
P.O. Box 5350
Bend OR 97708 Les Schwab ESIS MPN
Self-Insured
Employer 12/20/2006 T
2086
Liberty Insurance Corporation
175 Berkeley St.
Boston MA 02116
Liberty Mutual-Gerald Desmond Bridge
MPN Insurer 12/21/2012 www.libertymutualgroup.com/providernetworks
0086
Liberty Insurance Corporation
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
0305
Liberty Insurance Corporation
175 Berkeley Street
Boston MA 02116 The Liberty Mutual UPS MPN Insurer 3/5/2005 T
1279
Liberty Insurance Corporation
175 Berkeley Street
Boston MA 02116 UPS-Liberty Mutual MPN Insurer 4/18/2007 T
0085
Liberty Mutual Fire Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
0089
Liberty Mutual Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
2378
Liberty Mutual Managed Care LLC
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN
Entity that
provides
physician
network
services 4/16/2015
http://www.libertymutualgroup.com/providernetwork
s
2411
Liberty Mutual Managed Care LLC
175 Berkeley Street
Boston MA 02116 Helmsman Management Services MPN
Entity that
provides
physician
network
services 11/24/2015 www.helmsmantpa.com/CAMPN
2453
Liberty Mutual Managed Care LLC
175 Berkeley Street
Boston MA 02116 Liberty Mutual Managed Care MPN
Entity that
provides
physician
network
services 2/17/2016 www.libertymutualgroup.com/providernetworks
0397
Liberty Northwest Insurance Corporation
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 3/8/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
98
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0349
Limited Brands, Inc. and its subsidiaries
Three Limited Parkway
Columbus OH 43230
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 3/8/2005 T
1242
Lincoln General Insurance Co.
3350 Whiteford Road
York PA 17402
Lincoln General Ins. Co/LWP/CorVel
MPN Insurer 9/25/2006 T
1398
Lincoln General Insurance Company
3501 Concord Rd.
York PA 17402
American Claims Management Inc.
MPN Insurer 5/14/2009 http://mpn.acmclaims.com/ T
2160
Lion Farms L.L.C.
9500 S. De Wolf
Selma CA 93622 Risico TMC Lion Farms MPN
Self-Insured
Employer 5/6/2013 http://www.risico.com
2158
Lion Raisins, Inc.
9500 S. De Wolfe Ave
Selma CA 93622 Risico TMC Lion Raisins MPN
Self-Insured
Employer 5/6/2013 http://risico.com
0088
LM Insurance Corporation
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
1322
Lockheed Martin Corporation
1011 Lockheed Way
Palmdale CA 93599 GENEX/Lockheed Martin MPN
Self-Insured
Employer 11/20/2007 genexservices.com
0457
Lodi Memorial Hospital
975 S. Fairmont Avenue
Lodi CA 95240
First Health CompAmerica Primary
HCO
Self-Insured
Employer 3/18/2005 W
0282
Long Beach Community College District
4901 E Carson
Long Beach CA 90808 Prime Advantage Medical Network
Self-Insured
Employer 4/6/2005 T
1324
Long Beach Transit
1963 E. Anaheim Street
Long Beach CA 90801
TRISTAR - CompAmerica Primary
HCO
Self-Insured
Employer 11/15/2007 W
0997
Long Beach Transit
P.O. Box 731
Long Beach CA 90801 Long Beach Transit - Comp Care MPN
Self-Insured
Employer 7/20/2005 T
2032
Los Angeles Community College District
770 Wilshire Blvd. 3rd Floor
Los Angeles CA 90017 WellComp Medical Provider Network
Self-Insured
Employer 9/13/2012 T
1069
Los Angeles County Office of Education
9300 Imperial Highway
Downey CA 90242
Los Angeles County Office of
Education - Comp Care MPN
Self-Insured
Employer 8/11/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
99
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2215
Los Angeles County Office Of Education
9300 Imperial Highway
Downey CA 90242
LACOE- WellComp Medical Provider
Network
Self-Insured
Employer 8/14/2013 www.wellcomp.com T
0058
Los Angeles Dept. of Water & Power
PO Box 5111, Room 553
Los Angeles CA 90051 CorVel HCO / CorVel HCO Select
Self-Insured
Employer 2/17/2005 W
1189
Los Angeles Jewish Home for the Aging
7150 Tampa Ave.
Reseda CA 91335 WellComp Medical Provider Network
Self-Insured
Employer 4/25/2006 T
0162
Los Angeles Unified School District
333 S. Beaudry Avenue, 28th Floor
Los Angeles CA 90017
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 2/9/2005 T
0193
Louisiana Pacific Corporation
805 SW Broadway, Suite 900
Portland OR 97205
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 1/26/2005 T
1100
Lowe's HIW, Inc.
1000 Lowe's Blvd,
P.O. Box 1000
Mooresville NC 28117 Lowe's CA MPN
Self-Insured
Employer 10/3/2005 T
2284
Lowe's Home Centers, LLC
1000 Lowe's Blvd, P.O. Box 1000
Mooresville NC 28117 Lowe's Home Centers/Bunch MPN
Self-Insured
Employer 2/28/2014 providernet.bunchcare.com T
0030
LSI Logic Corporation (LSI)
1621 Barber Lane, MS D263
Milpitas CA 95035 First Health Comp America Select HCO
Self-Insured
Employer 4/7/2005 T
0472
Lumbermens Mutual Casualty Co.
1 Kemper Lane 12SW
Long Grove IL 60049 First Health CompAmerica Select Insurer 4/12/2005 T
0337
Lumbermens Mutual Casualty Co.
One Kemper Drive
Long Grove IL 60049 Kemper Cambridge MPN Insurer 2/16/2005 W
0160
Lumbermens Mutual Casualty Company
1 Corporate Dr Ste 200
Lake Zurich IL 60047
Sedgwick CMS Extended Medical
Provider Network Insurer 9/23/2010 T
0161
Lumbermens Mutual Casualty Company
1 Corporate Dr
Lake Zurich IL 60047
Sedgwick CMS Medical Provider
Network Insurer 9/23/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
100
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0341
Lumbermens Mutual Casualty Company
1 Kemper Lane 12SW0781
Long Grove IL 60049 Broadspire Signature MPN Insurer 2/22/2005 T
0448
Lumbermen's Underwriting Alliance
1905 N.W. Corporate Blvd.
Boca Raton FL 33431
Coventry/First Health Comp America
HCO Select Network Insurer 4/21/2005 www.genexservices.com T
2376
LWP Claims Solutions, Inc.
2081 Arena Blvd, Ste 200
Sacramento CA 95834 LWP Claims Solutions Platinum MPN
Entity that
provides
physician
network
services 4/3/2015 www.lwpclaimsplatinummpn.com
2394
LWP Claims Solutions, Inc.
2081 Arena Blvd, Ste 200
Sacramento CA 95834 LWP Claims Solutions Premier MPN
Entity that
provides
physician
network
services 6/3/2015 www.lwpclaimsPremierMPN.com
1205
Lynwood Unified School District
11321 Bullis Road
Lynwood CA 90262
PRIME Advantage Medical Provider
Network, accessing Prudent Buyer HCO
Self-Insured
Employer 8/17/2006 T
1297
Lynwood Unified School District
11321 Bullis Road
Lynwood CA 90262 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 6/14/2007 T
1852
Lynwood Unified School District
11321 Bullis Road
Lynwood CA 90262 CorVel MPN
Self-Insured
Employer 7/8/2011 T
1235
LZB Manufacturing Incorporated
301 Tennessee St.
Redlands CA 92373 La-Z-Boy West MPN
Self-Insured
Employer 4/5/2007 W
1470
Macy's Retail Holdings, Inc.
7 West Seventh St
Cincinnati OH 45202 Macy's Inc. Medical Provider Network
Self-Insured
Employer 12/16/2008 T
0676
Maine Bonding and Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Maine Bonding and Casualty Company
- Crawford Select Insurer 7/1/2005 W
1003
Maine Bonding and Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Maine Bonding and Casualty Company
- Crawford Primary Insurer 7/1/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
101
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1275
Mainstay Business Solutions
1180 Iron Point Rd Ste 210
Folsom CA 95630 WellComp Medical Provider Network
Self-Insured
Employer 2/22/2007 T
0144
Majestic Insurance Company
101 California St., 22nd Flr.
San Francisco CA 94111 Majestic Insurance Company MPN Insurer 2/14/2005 T
0304
Manpower Inc.
5301 N Ironwood Road
Milwaukee WI 53217 Concentra MPN
Self-Insured
Employer 3/9/2005 T
1372
Manpower, Inc.
100 Manpower Place
Milwaukee WI 53212 Sedgwick CMS MPN
Self-Insured
Employer 4/8/2008 T
0731
Manufacturers' Alliance Insurance Company
(MAICO)
380 Sentry Parkway
Blue Bell PA 19422 First Health Comp America Select MPN Insurer 5/23/2005 T
1410
Manufacturers Alliance Insurance Company
380 Sentry Parkway
Blue Bell PA 19422
American Claims Management Inc.
MPN Insurer 5/14/2009 http://mpn.acmclaims.com/ T
1239
Manufacturers Alliance Insurance Company
6990 Snowdrift Road Building A
Allentown PA 18106 Rising Interplan MPN Insurer 9/18/2006 T
1836
Markel Insurance Company
4521 Highwoods Parkway
Glen Allen VA 23060 Rising MPN Insurer 5/24/2011 https://www.markelfirstcomp.com/injured-workers T
0802
Markstein Beverage Co.
60 Main Avenue
Sacramento CA 95838 Broadspire Signature MPN
Self-Insured
Employer 5/16/2005 T
2485
Marquee Managed Care Solutions, Inc.
PO Box 511274
Los Angeles CA 90051 Marquee Managed Care Solutions MPN
Entity that
provides
physician
network
services 6/21/2016 https://www.viiad.com/anthemcompass/bcacmnse
2486
Marquee Managed Care Solutions, Inc.
PO Box 511274
Los Angeles CA 90051
Marquee Managed Care Solutions Plus
MPN
Entity that
provides
physician
network
services 6/21/2016 https://www.viiad.com/anthemcompass/kbacmnse
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
102
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1086
Marriott International, Inc.
3130 S. Harbor Blvd., #550
Santa Ana CA 92704 Marriott's Medical Provider Network
Self-Insured
Employer 10/12/2005 www.talispoint.com/marriott/campn
0153
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 3/8/2005 T
0214
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
FirstHealth CompAmerica Select HCO
Network Insurer 4/18/2005 T
0668
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Maryland Casualty Company-Crawford
Select Insurer 7/1/2005 W
1004
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Maryland Casualty Company -
Crawford Primary Insurer 7/1/2005 W
0843
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
1145
Maryland Casualty Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 T
1355
Maryland Casualty Company
1400 American Lane Tower 1-13th Floor
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
0376
Masco Corporation
21001 Van Born Road
Taylor MI 48180 TCT CA MPN
Self-Insured
Employer 3/7/2005 www.mywcinfo.com
1818
Massachusetts Bay Insurance Company
440 Lincoln Street
Worcester MA 01615 CorVel/Kaiser Select MPN Insurer 4/22/2011 www.Corvel.com
3049
Matrix Absence Management, Inc.
2421 W. Peoria Ave., Ste 200
Phoenix AZ 85029 Matrix MPN
Entity that
provides
physician
network
services 1/4/2018 http://www.talispoint.com/cvty/matmpn
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
103
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3099
Matrix Absence Management, Inc.
2421 W. Peoria Avenue, Suite 200
Phoenix AZ 85029 Matrix KOJ MPN
Entity that
provides
physician
network
services 3/29/2018 http://www.talispoint.com/cvty/matkoj
0182
May Department Stores Company dba
Robinsons*May-David's Bridal
PO Box 4699
Redondo Beach CA 90278 Medex Healthcare, Inc
Self-Insured
Employer 1/28/2005 T
0390
MCM Construction, Inc.
6413 32nd Street
No. Highlands CA 95660 Broadspire-Concentra Standard MPN
Self-Insured
Employer 2/23/2005 W
0881
McWane, Inc. dba Anaco
1001 El Camino Ave.
Corona CA 92879 TRISTAR MPN
Self-Insured
Employer 5/3/2005 T
2476
Meadowbrook, Inc.
26255 American Drive
Southfield MI 48034 Meadowbrook, Inc. MPN
Entity that
provides
physician
network
services 5/26/2016
http://www.meadowbrookinsgrp.com/report-a-
claim/workers-compensation-claims/
1365
MeadWestvaco
11013 West Broad Street
Glen Allen VA 23060 Sedgwick CMS MPN
Self-Insured
Employer 4/8/2008 T
2266
Med Site - Hacienda Heights
12401 Washington Blvd.
Whittier CA 90602 Athens MPN
Self-Insured
Employer 1/8/2014 T
2437
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Athens MPN
Entity that
provides
physician
network
services 2/16/2016 www.medexhco.com
2436
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex MPN
Entity that
provides
physician
network
services 2/18/2016 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
104
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2438
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage MPN
Entity that
provides
physician
network
services 2/18/2016 www.medexhco.com
2439
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage Plus MPN
Entity that
provides
physician
network
services 2/18/2016 www.medexhco.com
2454
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage Plus-POG MPN
Entity that
provides
physician
network
services 2/26/2016 www.medexhco.com
2459
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-wcSolutions MPN
Entity that
provides
physician
network
services 3/17/2016 www.medexhco.com
2458
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-KPC MPN
Entity that
provides
physician
network
services 3/18/2016 www.medexhco.com
2465
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660
Medex Advantage-City of Oceanside
MPN
Entity that
provides
physician
network
services 4/14/2016 www.medexhco.com
2466
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-City of Carson MPN
Entity that
provides
physician
network
services 4/14/2016 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
105
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3040
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-ACIG MPN
Entity that
provides
physician
network
services 8/4/2017 http://www.medexhco.com
3041
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-DMS MPN
Entity that
provides
physician
network
services 8/4/2017 http://www.medexhco.com
3042
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-Republic MPN
Entity that
provides
physician
network
services 8/4/2017 http://www.medexhco.com
3043
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-Servicon MPN
Entity that
provides
physician
network
services 8/4/2017 www.medexhco.com
3045
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-Goodwill MPN
Entity that
provides
physician
network
services 8/4/2017 www.medexhco.com
3027
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-SHARP MPN
Entity that
provides
physician
network
services 9/14/2017 www.medexhco.com
3050
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage - Grimmway MPN
Entity that
provides
physician
network
services 9/25/2017 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
106
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3051
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage Plus - CFINS MPN
Entity that
provides
physician
network
services 9/25/2017 www.medexhco.com
3088
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage-Walmart MPN
Entity that
provides
physician
network
services 2/26/2018 www.medexhco.com
3085
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660
Medex Advantage-City Of Long Beach
MPN
Entity that
provides
physician
network
services 2/27/2018 www.medexhco.com
3086
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage Plus-Best Buy MPN
Entity that
provides
physician
network
services 2/28/2018 www.medexhco.com
3087
Medex Healthcare
1201 Dove Street, Ste 300
Newport Beach CA 92660 Medex Advantage Plus-Hilton MPN
Entity that
provides
physician
network
services 2/28/2018 www.medexhco.com
1777
MEMIC INDEMNITY COMPANY
PO Box 3606
Portland ME 04104 MEMIC-GENEX MPN Insurer 2/17/2011 T
2482
MEMIC Indemnity Company
PO Box 3606
Portland ME 04104 CorVel MPN Insurer 5/17/2016 www.corvel.com
0108
Memorial Health Services
17360 Brookhurst St
Fountain Valley CA 92708 TRISTAR MPN
Self-Insured
Employer 5/3/2005 T
0932
Memorial Hospital Association
1800 Coffee Road Suite 116
Modesto CA 95355 Memorial Hospital MPN
Self-Insured
Employer 7/25/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
107
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1744
Merchants Building Maintenance Company
1190 Monterey Pass Rd
Monterey Park CA 91754 Merchants Building Maintenance MPN
Self-Insured
Employer 1/7/2011 merchants.employermpn.com
0393
Merchants Building Maintenance Company
1190 Monterey Pass Road
Monterey Park CA 91754 Interplan MPN
Self-Insured
Employer 3/18/2005 T
0889
MERGE Risk Management Joint Powers
Authority
3540 N. Lexington Ave
El Monte CA 91731 MERGE MPN
Joint Powers
Authority 8/4/2005 T
3014
Methodist Hospital Of Southern California
300 W Huntington Drive
Arcadia CA 91007 Methodist Hospital MPN
Self-Insured
Employer 3/14/2017 methodisthospital,employermpn.com
1993
Methodist Hospital of Southern California
300 West Huntington Drive
Arcadia CA 91066
PRIME Advantage Medical Provider
Network for Healthcare
Self-Insured
Employer 10/19/2011 T
0658
Metro Risk Management
720 East "E" Street
Wilmington CA 90748 First Health Select
Self-Insured
Employer 6/8/2005 W
0009
Metropolitan Stevedore Company
720 East "E" Street
Wilmington CA 90748
Self-Insured
Employer 6/28/2005 W
1743
Mid Valley Plastering, Inc.
15300 McKinly Ave.
Lathrop CA 95330 MVP MPN
Self-Insured
Employer 2/16/2011 T
0318
Mid-Century Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
0313
Mid-Century Insurance Company
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health Select Network) Insurer 3/9/2005 T
0752
Mid-Century Insurance Company
4680 Wilshire Blvd
Los Angeles CA 90010 Liberty Mutual Group MPN Insurer 4/28/2005 T
1591
Mid-Century Insurance Company
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 2/11/2010 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
108
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0947
Midwest Employers Casualty Company
14755 North Outer Forty
Chesterfield MO 63017
Midwest Employers/Gallagher
Bassett/First Health MPN Insurer 7/11/2005 T
1449
Midwest Employers Casualty Company
14775 North Forty Drive
Chesterfield MO 63017 Midwest Employers GBMCS MPN Insurer 5/7/2009 T
2391
Midwest General Insurance Agency, LLC
300 South Bradfordton Rd
Springfield IL 62711 Midwest MPN
Entity that
provides
physician
network
services 6/25/2015 https://www.midins.com/ClaimsServices.php
1544
Milpitas Unified School District
1331 E Calaveras Blvd
Milpitas CA 95035 PRIME Plus Medical Provider Network
Self-Insured
Employer 6/8/2009 T
0056
Mitsui Sumitomo Insurance Company Of America
15 Independence Blvd
Warren NJ 07059 CorVel MPN Insurer 2/7/2005 www.corvel.com
1430
Mitsui Sumitomo Insurance Company of America
15 Independence Blvd.
Warren NY 07059 MSIG MPN Insurer 11/4/2008 T
1832
Mitsui Sumitomo Insurance Company of America
15 Independence Blvd
Warren NJ 07059 MSIGBunch MPN Insurer 6/1/2011 T
1860
Mitsui Sumitomo Insurance Company of America
15 Independence Blvd.
Warren NJ 07059 Broadspire Signature MPN Insurer 8/4/2011 T
2389
Mitsui Sumitomo Insurance Company Of America
15 Independence Blvd.
Warren NJ 07059 Mitsui/CorVel-Kaiser Select MPN Insurer 10/2/2015 www.corvel.com
1535
Mitsui Sumitomo Insurance USA Inc.
15 Independence Blvd
Warren NJ 07059
Sedgwick First Health CompAmerica
Select HCO Network Insurer 5/12/2009 T
1724
MITSUI SUMITOMO INSURANCE USA INC.
15 Independence Blvd.
Warren NJ 07059 MITSUI SUMITOMO GBMCS MPN Insurer 1/12/2011 T
2039
Mitsui Sumitomo Insurance USA Inc.
15 Independence Blvd.
Warren NJ 07059 CorVel MPN Insurer 8/3/2012 http://www.corvel.com/
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
109
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2390
Mitsui Sumitomo Insurance USA Inc.
15 Independence Blvd.
Warren NJ 07059 Mitsui/CorVel-Kaiser Select MPN Insurer 10/2/2015 www.corvel.com
1833
Mitsui Sumitomo Insurance USA, Inc.
15 Independence Blvd
Warren NJ 07059 MSIGBunch MPN Insurer 6/1/2011 T
1431
Mitsui Sumitomo Insurance USA, Inc.
15 Independence Blvd.
Warren NY 07059 MSIG MPN Insurer 11/4/2008 T
0906
Modesto Irrigation District
1241 11th Street
Modesto CA 95354
First Health CompAmerica Primary
HCO
Self-Insured
Employer 5/19/2005 W
0926
Montebello Unified School District
123 S. Montebello Blvd. Room 14
Montebello CA 90640 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
0934
Monterey County Schools Workers' Compensation
Joint Powers Authority
76 Stephanie Drive
Salinas CA 93901 Monterey County Schools MPN
Joint Powers
Authority 5/19/2005 T
2383
Monterey Educational Risk Management
Authority
76 Stephanie Drive
Salinas CA 93901 MERMA MPN
Joint Powers
Authority 1/15/2016 www.intermedccs.com/MERMAMPN
0298
Monterey Mushrooms, Inc
260 Westgate Drive
Watsonville CA 95076 Monterey Mushrooms Inc. MPN.
Self-Insured
Employer 3/8/2005 http://mmimpn.com/ T
1276
Monterey Peninsula Unified School District
700 Pacific St PO Box 1030
Monterey CA 93940 PRIME Advantage Medical Provider
Self-Insured
Employer 2/21/2007 T
1888
Monterey-Salinas Transit
One Ryan Ranch Rd.
Monterey CA 93940 Monterey-Salinas Transit MPN
Self-Insured
Employer 9/20/2011 T
2213
Moreno Valley Unified School District
25634 Alessandro Blvd
MorenoValley CA 92553
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 4/3/2014 www.keenan.com T
1080
Moreno Valley Unified School District
25634 Alessandro Blvd.
Moreno Valley CA 92553
Moreno Valley Unified School
District/CorVel Select MPN
Self-Insured
Employer 9/13/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
110
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0202
Mt. San Antonio Community College District
1100 North Grand Avenue
Walnut Creek CA 91789 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0571
Mt. San Jacinto Community College
1499 N. State Street
San Jacinto CA 92583 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
3030
MWIA Insurance Services, LLC
3333 Camino Del Rio South, Suite 235
San Diego CA 92108
Midwestern Insurance Alliance Select
MPN
Entity that
provides
physician
network
services 9/19/2017 www.talispoint.com/cvty/mia
0824
National American Insurance Company of
California
444 West Ocean Blvd 18th Floor
Long Beach CA 90802 TRISTAR MPN Insurer 5/3/2005 T
2136
National Casualty Company
1100 Locust St., Dept 3010
Des Moines IA 50391
First Health CompAmerica Primary
HCO Network Insurer 3/5/2013 www.genexservices.com T
1880
National Fire Insurance Company of Hartford
333 South Wabash
Chicago IL 60604 ESIS MPN Insurer 8/31/2011 T
1182
National Interstate Insurance Company
3250 Interstate Drive
PO Box 521
Richfield OH 44286
CorVel MPN/National Interstate
Insurance Insurer 4/4/2006 T
2420
National Interstate Insurance Company
3250 Interstate Drive
Richfield OH 44826 National Interstate MPN Insurer 12/28/2015 www.natlmpn.com
0051
National Liability & Fire (NLF)
100 First Stamford Place
Stamford CT 06902 ACCA/NLF Interplan MPN Insurer 1/31/2005 T
0336
National RV, Inc.
411 N Perris Blvd
Perris CA 92571 National RV MPN
Self-Insured
Employer 3/9/2005 T
0027
National Semiconductor Corporation
2900 Semiconductor Drive
Santa Clara CA 95052 First Health Comp America Select HCO
Self-Insured
Employer 3/24/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
111
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0619
National Surety Corporation
777 San Marin Dr.
Novato CA 94998 First Health Select Insurer 2/14/2005 www.agcs.allianz.com/usclaims
0113
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0656
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street 18th Floor
New York NY 10038
National Union Fire/Gallagher
Bassett/Coventry MPN Insurer 3/4/2005 www.talispoint.com /cvty/gbcvtympn
0524
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street
New York NY 10038 Chartis-Cambridge MPN Insurer 3/24/2005 W
0366
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/28/2005 T
0633
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
0759
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038
National Union Fire Insurance
Company Of Pittsburgh, PA/Gallagher
Bassett/CorVel MPN Insurer 5/5/2005 www.corvel.com
1020
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038
National Union Fire/Gallagher
Bassett/First Health MPN Insurer 8/5/2005 www.talispoint.com/cvty/gbfhmpnselect
0924
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 Chartis/Kaiser OCIP Insurer 8/8/2005 www.talispoint.com/aig/KaiserMPN
0912
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 Liberty Mutual Group MPN Insurer 8/9/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
112
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1406
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
1415
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 WellComp Medical Provider Network Insurer 9/16/2008 T
1489
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street 18th Floor
New York NY 10038 WellComp Medical Provider Network Insurer 1/22/2009 T
1496
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street- 18th Floor
New York NY 10038
Nat'l Union Fire Ins/The GEO Group,
Inc. Insurer 2/9/2009 T
1520
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street 18th Floor
New York NY 10038 Walmart-Medex MPN Insurer 4/1/2009 www.medexhco.com
1457
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 National Union Fire GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn
1657
National Union Fire Insurance Company Of
Pittsburgh, Pa
175 Water Street - 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/24/2010 www.broadspireppo.com T
1731
National Union Fire Insurance Company Of
Pittsburgh, Pa
175 Water Street, 18th Floor
New York NY 10038
Chartis/Treasury Wine Estates Medical
Provider Network Insurer 12/8/2010 www.talispoint.com/aig/Treasury
1733
National Union Fire Insurance Company Of
Pittsburgh, Pa
175 Water St - 18th Flr
New York NY 10038 Chartis/JCP MPN Insurer 12/15/2010 www.talispoint.com/aig/JCP
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
113
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1742
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water St., 18th Floor
New York NY 10038 AIG Select MPN Insurer 12/23/2010 www.talispoint.com/aig/mpnselect
1810
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 National Union Fire GBMCS KOJ MPN Insurer 3/24/2011 www.talispoint.com/cvty/gbkoj
1811
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water St. 18th floor
New York NY 10038 Nat'l Union/Tractor/Bunch MPN Insurer 4/12/2011 T
1843
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 Randstad/NUnion/Bunch MPN Insurer 6/2/2011
1849
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038
Helmsman Management Services-First
Health MPN Insurer 6/17/2011 http://lmi.com/Lmnetworks T
1998
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 Wellcomp Medical Provider Network Insurer 11/10/2011 T
1937
National Union Fire Insurance Company of
Pittsburgh, Pa
175 Water St 18th Floor
New York NY 10038 PCIC MPN Insurer 4/18/2012 T
1976
National Union Fire Insurance Company of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 Sedgwick/Harbor MPN Insurer 5/24/2012 T
1989
National Union Fire Insurance Company of
Pittsburgh, Pa
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
114
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2047
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 TRISTAR MPN Insurer 7/12/2013 T
2214
National Union Fire Insurance Company Of
Pittsburgh, Pa
175 Water Street - 18th Floor
New York NY 10038 AIG/ Bristol-Myers Squibb MPN Insurer 9/17/2013 www.talispoint.com/aig/BristolMyersSquibb
2448
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 TCT CA MPN Insurer 4/25/2016 www.mywcinfo.com T
2507
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street - 18th Floor
New York NY 10038 Silverado MPN Insurer 10/13/2016 www.corvel.com
3012
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038
National Union Fire GBMCS-M KOJ
MPN Insurer 2/23/2017 http://www.talispoint.com/cvty/gbkoj T
3052
National Union Fire Insurance Company Of
Pittsburgh, PA
175 Water Street, 18th Floor
New York NY 10038 CareFirst MPN Insurer 10/2/2017 http://www.talispoint.com/cvty/care1
0502
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270
Sedgwick CMS Extended Medical
Provider Network Insurer 3/10/2005 T
0492
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270
Sedgwick CMS Medical Provider
Network Insurer 3/16/2005 T
0370
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270
SRS First Health CompAmerica
Primary HCO Network Insurer 3/28/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
115
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0423
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270 Gainey-FARA Insurer 4/21/2005 W
0467
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0922
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270
MedInsights Medical Provider Network,
accessing Prudent Buyer PPO Insurer 5/19/2005 T
0614
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine Street
New York NY 10270 Intracorp-Gates McDonald MPN Insurer 6/2/2005 T
1427
National Union Fire Insurance Company of
Pittsburgh, PA
70 Pine St
New York NY 10270
CCMSI/ AIG/ First Health Comp
America Select HCO Network Insurer 1/7/2009 T
0857
National Union Fire Insurance Company of
Pittsburgh, PA
AIG 70 Pine Street
New York NY 10270
National Union Fire Insurance
Company of Pittsburgh, Pa., Crawford
Select Insurer 7/1/2005 W
0866
National Union Fire Insurance Company of
Pittsburgh, PA
Nat'l Union Fire of Pittsburg, Pa 70 Pine St.
New York NY 10038
National Union Fire Insurance
Company of Pittsburgh, Pa-Crawford
Primary Insurer 10/5/2005 W
2061
Nationwide Agribusiness Insurance Company
1100 Locust St., Dept 3010
Des Moines IA 50391 GENEX Insurer 12/7/2012 www.genexservices.com T
3060
Nationwide Insurance Company Of America
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 10/20/2017 www.corvel.com
3057
Nationwide Mutual Fire Insurance Company
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 11/6/2017 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
116
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3058
Nationwide Mutual Insurance Company
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 11/7/2017 www.corvel.com
3061
Nationwide Property And Casualty Insurance
Company
N2128-Nationwide/Three Nationwide Plaza
Columbus OH 43214 CorVel MPN Insurer 10/31/2017 www.corvel.com
0450
Naumes, Inc.
P.O. Box 996
Medford OR 97501 CorVel MPN
Self-Insured
Employer 4/8/2005 T
0447
Nautilus International Holding Corporation
("Nautilus")
P.O. Box 547
Wilmington CA 90748 First Health
Self-Insured
Employer 5/16/2005 R
0314
Neighborhood Spirit P & C
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health MPN Network) Insurer 3/22/2005 T
0321
Neighborhood Spirit P & C
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/22/2005 T
1589
Neighborhood Spirit Property And Casualty
Company
6301 Owensmouth Ave
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 3/11/2010 www.corvel.com
1011
Nella Oil Company
2349 Rickenbacker Way
Auburn CA 95602 MedInsights Medical Provider Network
Self-Insured
Employer 7/26/2005 T
3093
Networks By Design, Inc.
231 W Tenth Street
Tracy CA 95376 Healthcare Services Group MPN
Entity that
provides
physician
network
services 3/26/2018 http://HCSG.employermpn.com
2404
Networks By Design, Inc.
231 West Tenth Street
Tracy CA 95376 NBD Plus MPN
Entity that
provides
physician
network
services 9/3/2015 www.netbyd.com/NBDMPN/
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
117
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2463
Networks By Design, Inc.
231 West Tenth Street
Tracy CA 95376 NBD MPN
Entity that
provides
physician
network
services 4/6/2016 www.netbyd.com/nbdmpn
2002
New Albertson's, Inc.
19011 Lake Drive East
Chanhassen MN 55317
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 11/15/2011 www.sedgwickproviders.com √
0077
New Albertsons, Inc.(A SuperValu Company)
1421 So. Manhattan Avenue
Fullerton CA 92831 New Albertson's Inc. CA MPN
Self-Insured
Employer 2/2/2005 T
1624
New Hampshire Insurance Company
175 Water St - 18th Floor
New York NY 10038 NH Ins/CVS/Bunch MPN Insurer 4/14/2010 T
1762
New Hampshire Insurance Company
175 Water St 18th Floor
New York NY 10038 AIG Select MPN Insurer 1/19/2011 www.talispoint.com/aig/mpnselect
0121
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0758
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038
New Hampshire Insurance
Company/Gallagher Bassett/CorVel
MPN Insurer 5/4/2005 www.corvel.com
1654
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Broadspire Signature Network Insurer 6/22/2010 www.broadspireppo.com T
1850
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038
Sedgwick CMS/Harbor MPN - NHIC
AMR Insurer 7/8/2011 T
1879
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Medex MPN Insurer 8/31/2011 www.medexhco.com
2297
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038 Mentor/NewHampshire/Bunch MPN Insurer 5/8/2014 http://providernet.bunchcare.com T
2498
New Hampshire Insurance Company
175 Water Street - 18th Floor
New York NY 10038
New Hampshire Insurance/Cambridge
MPN Insurer 7/28/2016 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
118
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1979
New Hampshire Insurance Company
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor MPN Insurer 5/25/2012 T
1983
New Hampshire Insurance Company
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
2028
New Hampshire Insurance Company
175 Water Street -18th Floor
New York NY 10038 Sedgwick/Harbor MPN – NHIC DESC Insurer 7/20/2012 T
1400
New Hampshire Insurance Company
175 Water Street- 18th Floor
New York NY 10038 CorVel MPN Insurer 7/18/2008 www.corvel.com
2071
New Hampshire Insurance Company
175 Water Street- 18th Floor
New York NY 10038 Athens MPN Insurer 10/31/2012 T
0657
New Hampshire Insurance Company
175 Water Street 18th Floor
New York NY 10038
New Hampshire Insurance/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 www.talispoint.com/cvty/gbcvtympn T
1359
New Hampshire Insurance Company
175 Water Street 18th Floor
New York NY 10038 Liberty Mutual Group MPN Insurer 3/17/2008 T
1360
New Hampshire Insurance Company
175 Water Street 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/25/2008 T
0523
New Hampshire Insurance Company
175 Water Street
New York NY 10038 Chartis - Cambridge MPN Insurer 3/23/2005 W
0627
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038 Chartis ESIS MPN Insurer 3/28/2005 T
1019
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038
New Hampshire/Gallagher Bassett/First
Health MPN Insurer 8/5/2005 www.talispoint.com/cvty/gbfhmpnselect
1450
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038 New Hampshire GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn
2290
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038 CVS/Coventry MPN Insurer 3/11/2014 www.talispoint.com/cvty/mpnfhp T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
119
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2317
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038 WellComp Medical Provider Network Insurer 7/9/2014 www.WellComp.com T
2447
New Hampshire Insurance Company
175 Water Street, 18th Floor
New York NY 10038 TCT CA MPN Insurer 4/25/2016 www.mywcinfo.com T
1394
New Hampshire Insurance Company
70 Pine Street
New York NY 10270 Sedgwick CMS MPN Insurer 6/9/2008 T
1462
New Hampshire Insurance Company
70 Pine Street
New York NY 10270 Sedgwick CMS Extended MPN Insurer 11/10/2008 T
1423
New Hampshire Insurance Company, Ltd.
70 Pine St
New York NY 10270
CCMSI/ AIG/ First Health Comp
America Select HCO Network Insurer 12/16/2008 T
0470
New Hampshire Insurance Company, Ltd.
70 Pine Street
New York NY 10279 Broadspire MPN Insurer 4/26/2005 T
0920
New Hampshire Insurance Company, Ltd.
70 Pine Street
New York NY 10270
MedInsights/ Medical Provider
Network, accessing Prudent Buyer PPO Insurer 5/19/2005 T
0852
New Hampshire Insurance Company, Ltd.
AIG 70 Pine Street
New York NY 10270
New Hampshire Insurance Company,
Ltd.-Crawford Select Insurer 7/1/2005 W
0862
New Hampshire Insurance Company, Ltd.
AIG 70 Pine Street
New York NY 10270
New Hampshire Insurance Company,
Ltd., Crawford Primary Insurer 7/1/2005 W
0793
New United Motor Manufacturers, Inc.
45500 Fremont Blvd
Fremont CA 94538 NUMMI MPN
Self-Insured
Employer 5/24/2005 R
1887
New York Marine & General Insurance Company
412 Mt. Kemble Ave Ste 300C
Morristown NJ 07960 Sedgwick CMS MPN Insurer 9/20/2011 T
1886
New York Marine and General Insurance
Company
412 Mt. Kemble Ave Ste 300C
Morristown NJ 07960 ProSight Coventry Primary MPN Insurer 9/20/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
120
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2126
New York Marine And General Insurance
Company
412 Mt. Kimble Ave
Morristown NJ 07960 LWP Signature MPN Insurer 2/20/2013 http://www.lwpsignaturempn.com
2125
New York Marine And General Insurance
Company
412 Mt. Kimble Ave.
Morristown NJ 07960 LWP Kaiser Signature MPN Insurer 2/20/2013 http://www.lwpsignaturempn.com
1222
Newport-Mesa Unified School District
2985 Bear St.
Costa Mesa CA 92626
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 10/5/2006 T
0237
Nipponkoa Insurance Company, LTD (US
Branch)
14 Wall Street, 8th Floor
New York NY 10005 TCT CA MPN Insurer 3/2/2005 T
0238
Nipponkoa Insurance Company, LTD (US
Branch)
14 Wall Street, 8th Floor
New York NY 10005 CorVel CorCare Insurer 3/9/2005 T
0607
Non Profits' United Workers' Compensation
Group Inc.
344 Thomas Berkley Way, Suite 340
Oakland CA 94612 Interplan/Kaiser
Group of
Self-Insured
Employers 12/15/2005 T
1723
Nonprofits' United Workers Compensation Group,
Inc.
431 I St., Ste 200
Sacramento CA 95814 WellComp Medical Provider Network
Group of
Self-Insured
Employers 11/23/2010 www.wellcomp.com
1218
Norcal Waste System, Inc.
160 Pacific Avenue, Suite 200
San Francisco CA 94111 Interplan through CompPartners
Self-Insured
Employer 11/15/2006 T
0543
Norcal Waste Systems, Inc. and its Subsidiaries
160 Pacific Avenue, Suite 200
San Francisco CA 94111
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 3/22/2005 W
1203
Nordstrom, Inc.
PO Box 25799
Santa Ana CA 92799 Nordstrom Medical Provider Network
Self-Insured
Employer 9/13/2006 www.nordstromcampn.com
0084
NorGuard Insurance
16 South River Street
Wilkes Barre PA 18703
Nor Guard Insurance (GUARD
Insurance) Insurer 12/14/2004 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
121
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3082
North American Risk Services, Inc.
240 East Central Parkway, Suite 4010
Altamonte Springs FL 32701 NARS Select MPN
Entity that
provides
physician
network
services 3/13/2018 www.talispoint.com/cvty/nrs
2228
North Bay Schools Insurance Authority
380 A Chadbourne Rd
Fairfield CA 94534 NBSIA/ CorVel Custom MPN
Self-Insured
Employer 10/31/2013 T
0106
North Bay Schools Insurance Authority
380-A Chadbourne Road
Fairfield CA 94534 TriCounty MPN
Joint Powers
Authority 2/2/2005 T
2505
North Bay Schools Insurance Authority
380A Chadbourne Road
Fairfield CA 94534 NBSIA MPN
Joint Powers
Authority 9/29/2016 www.netbyd.com/nbsiampn/
1918
North County Transit District
810 Mission Avenue
Oceanside CA 92054 Tristar MPN
Self-Insured
Employer 2/17/2012 T
0692
North County Transit District
810 Mission Avenue
San Diego CA 92054 North County District-Comp Care MPN
Self-Insured
Employer 5/20/2005 T
1077
North Orange County Community College District
1830 N. Romneya Drive
Anaheim CA 92801 WellComp Medical Provider Network
Self-Insured
Employer 9/12/2005 T
0226
North Orange County Self-funded Workers'
Compensation Agency
14121 Cedarwood Ave. c/o Westminster SD
Westminster CA 92683 Prime Advantage Medical Network
Joint Powers
Authority 3/2/2005 T
2058
NORTH POINTE INSURANCE COMPANY
One General Drive
Sun Prairie WI 53596
North Pointe Insurance Company
GBMCS MPN Insurer 9/27/2012 T
0205
North Valley Schools Insurance Group
2882 Prospect Park Dr., Ste 200
Rancho Cordova CA 95670
Prime Advantage Medical Provider
Network
Joint Powers
Authority 4/28/2005 T
0206
Northeastern JPA
609 South Gold Street
Eureka CA 96097 Prime Advantage Medical Network
Joint Powers
Authority 3/1/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
122
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1336
Northern California Auto Dealers Self-Insurance
Group, Inc.
Brentwood Cntr 11601 Wilshire Blvd #500
Los Angeles CA 90025 CorVel MPN
Group of
Self-Insured
Employers 1/15/2008 T
2292
Northern California Cities Self Insurance Fund
1792 Tribute Road, Ste. 450
Sacramento CA 95818 WellComp Medical Provider Network
Joint Powers
Authority 5/8/2014 www.WellComp.com T
1233
Northern California Cities Self-Insurance Fund
100 Pine Street 11th Floor
San Francisco CA 94111 NCCSIF MPN
Joint Powers
Authority 12/7/2006 T
0779
Northern California Community Colleges Pool
(NCCCP)
c/o Cabrillo CCD-6500 Soquell Dr
Aptos CA 95003 Prime Advantage Medical Network
Joint Powers
Authority 5/6/2005 T
0642
Northern California Special Districts Insurance
Authority
9280 West Stockton Blvd., #102
Willows CA 95988 NCSDIA MPN
Joint Powers
Authority 9/14/2005 W
0215
Northern Insurance Company of New York
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
FirstHealth CompAmerica Select HCO
Network Insurer 4/18/2005 T
0666
Northern Insurance Company of New York
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Northern Insurance Company of NY,
Crawford Select Insurer 7/1/2005 W
1002
Northern Insurance Company of New York
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Northern Insurance Company of NY -
Crawford Primary Insurer 7/1/2005 W
0844
Northern Insurance Company of New York
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
1146
Northern Insurance Company of New York
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 T
1354
Northern Insurance Company of New York
1400 American Lane Tower 1-13th Floor
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
0152
Northern Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
123
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0265
Northwestern Pacific Indemnity Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 W
1478
Northwestern Pacific Indemnity Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 W
0927
Norwalk-La Mirada Unified School District
12820 Pioneer Blvd
Norwalk CA 90650 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
2501
Norwalk-La Mirada Unified School District
12820 Pioneer Blvd.
Norwalk CA 90650 CorVel MPN
Self-Insured
Employer 9/6/2016 www.corvel.com
1552
Nova Casualty Company
2 Waterside Crossing Ste 400
Windsor CT 06095 Wellcomp Medical Provider Network Insurer 8/26/2009 T
1357
Nova Casualty Company
2 Waterside Crossing Suite 400
Windsor CT 06095 AIX/Gallagher Bassett/Coventry MPN Insurer 3/7/2008 T
1356
Nova Casualty Company
2 Waterside Crossing Suite 400
Windsor CT 06095
AIX/Gallagher Bassett/First Health
MPN Insurer 3/17/2008 www.talispoint.com/cvty/gbfhmpnselect T
1361
Nova Casualty Company
2 Waterside Crossing, Suite 400
New York NY 10036 Athens/Nova Casualty Company MPN Insurer 3/25/2008 T
1616
Nova Casualty Company
726 Exchange St Ste 1200
Buffalo NY 14210 TRISTAR MPN Insurer 5/5/2010 T
1622
Nova Casualty Company
726 Exchange Street, Suite 1020
Buffalo NY 14210 WellComp Medical Provider Network Insurer 4/14/2010 www.wellcomp.com T
1798
Nova Casualty Company
726 Exchange Street, Suite 1020
Buffalo NY 14210 Athens MPN Insurer 3/11/2011 T
0418
O.R.G. Restaurants, LLC
620 N. Brand Blvd., 6th Floor
Glendale CA 91203 FARA-CIMMS ORG
Self-Insured
Employer 5/10/2005 R
1036
Oak River Insurance Company
P.O. Box 881716
San Francisco CA 94188
Berkshire Hathaway Homestate
Companies MPN Insurer 8/16/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
124
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0949
Oakland Unified School District
1025 2nd Avenue Room 112
Oakland CA 94606 Oakland Unified School District MPN
Self-Insured
Employer 7/12/2005 W
1500
Oceanside Unified School District
2111 Mission Ave
Oceanside CA 92058
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 2/23/2009 T
2432
OCM Coastal Acquisition Co., LLC
3501 Jamboree Rd. North Tower Suite 3000
Newport Beach CA 92660 State Fund MPN By Harbor Health
Entity that
provides
physician
network
services 12/24/2015 www.statefundca.com/mpn
2299
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Harbor One MPN
Entity that
provides
physician
network
services 5/21/2014 http://www.harborsys.com/harborone
2323
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor 2 MPN
Entity that
provides
physician
network
services 8/18/2014 www.harborsys.com/sedgwick2
2325
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor 4 MPN
Entity that
provides
physician
network
services 8/19/2014 www.harborsys.com/Sedgwick4 W
2328
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Arissa/Harbor MPN
Entity that
provides
physician
network
services 8/20/2014 www.harborsys.com/ArissaMPN
2334
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 HarborOne/Genex MPN
Entity that
provides
physician
network
services 8/20/2014 www.harborsys.com/GENEXMPN
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
125
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2357
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660
PRIME Plus MPN Powered By Harbor
Health Systems
Entity that
provides
physician
network
services 12/19/2014 www.harborsys.com/KeenanPlus
2358
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660
PRIME Advantage MPN Powered By
Harbor Health Systems
Entity that
provides
physician
network
services 12/19/2014 www.harborsys.com/Keenan.
2359
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN -AG
Entity that
provides
physician
network
services 2/12/2015 www.SedgwickProviders.com/AG
2428
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Carl Warren SmartComp/Harbor MPN
Entity that
provides
physician
network
services 12/3/2015 www.harborsys.com/CarlWarren
2429
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Pacific Claims/Harbor MPN
Entity that
provides
physician
network
services 12/10/2015 www.harborsys.com/PacClaims
2495
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Genex/Harbor 2 MPN
Entity that
provides
physician
network
services 8/1/2016 www.harborsys.com/GenexMPN2
2503
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Genex/Harbor 3 MPN
Entity that
provides
physician
network
services 8/10/2016 www.harborsys.com/GenexMPN3
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
126
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3019
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Hendrick
Entity that
provides
physician
network
services 4/10/2017 www.SedgwickProviders.com/Hendrick
2322
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN
Entity that
provides
physician
network
services 8/18/2014 www.harborsys.com/Sedgwick
2324
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor 3 MPN
Entity that
provides
physician
network
services 8/19/2014 www.harborsys.com/Sedgwick3 W
2393
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660
Sedgwick/Harbor MPN-Sears Holdings
Corporation
Entity that
provides
physician
network
services 8/27/2015 www.sedgwickProviders.com/Sears
2405
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - CEC
Entity that
provides
physician
network
services 9/17/2015 www.SedgwickProviders.com/CEC
2407
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Nestle
Entity that
provides
physician
network
services 10/29/2015 www.sedgwickProviders.com/Nestle
2408
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Eaton
Entity that
provides
physician
network
services 10/30/2015 www.SedgwickProviders.com/Eaton
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
127
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2409
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Scripps
Entity that
provides
physician
network
services 10/30/2015 www.SedgwickProviders.com/Scripps
2410
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - DTFD
Entity that
provides
physician
network
services 11/2/2015 www.SedgwickProviders.com/FamilyDollar
2414
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - UHG
Entity that
provides
physician
network
services 11/2/2015 www.SedgwickProviders.com/UHG
2424
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - LLNS
Entity that
provides
physician
network
services 12/1/2015 www.SedgwickProviders.com/LLNS W
2431
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - DESC
Entity that
provides
physician
network
services 3/15/2016 www.SedgwickProviders.com/DESC
2460
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - EPS
Entity that
provides
physician
network
services 3/21/2016 www.SedgwickProviders.com/EPS
2487
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Les Schwab
Entity that
provides
physician
network
services 6/16/2016 www.SedgwickProviders.com/LesSchwab
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
128
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2488
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Express
Entity that
provides
physician
network
services 6/20/2016 www.SedgwickProviders.com/Express T
2489
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660
Sedgwick/Harbor MPN - Vallarta
Markets
Entity that
provides
physician
network
services 6/20/2016 www.SedgwickProviders.com/Vallarta
2504
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN-Boeing
Entity that
provides
physician
network
services 9/6/2016 www.sedgwickproviders.com/Boeing
3004
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Target
Entity that
provides
physician
network
services 3/17/2017 www.SedgwickProviders.com/Target
3006
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - GE
Entity that
provides
physician
network
services 3/17/2017 www.SedgwickProviders.com/GE
3008
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Tenet
Entity that
provides
physician
network
services 3/17/2017 www.SedgwickProviders.com/Tenet
3026
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Kaiser/Harbor MPN
Entity that
provides
physician
network
services 6/27/2017 www.sedgwickproviders.com/Kaiser
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
129
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3029
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - LZB
Entity that
provides
physician
network
services 7/10/2017 www.SedgwickProviders.com/LZB
3001
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road, North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Ross
Entity that
provides
physician
network
services 3/17/2017 www.SedgwickProviders.com/RossStores
3028
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road, North Tower, Suite 3000
Newport Beach CA 92660
Sedgwick/Harbor MPN - Irvine
Company
Entity that
provides
physician
network
services 7/6/2017 www.SedgwickProviders.com/IrvineCompany
3079
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road, North Tower, Suite 3000
Newport Beach CA 92660
Sedgwick/Harbor MPN - American
Airlines
Entity that
provides
physician
network
services 12/29/2017 www.IODMedical.com
3090
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road, North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Verizon
Entity that
provides
physician
network
services 3/15/2018 http://www.sedgwickproviders.com/verizon
3091
OCM Coastal Acquisition Co., LLC
3501 Jamboree Road, North Tower, Suite 3000
Newport Beach CA 92660 Sedgwick/Harbor MPN - Kroger
Entity that
provides
physician
network
services 3/15/2018 http://www.SedgwickProviders.com/Kroger
1831
Ohlone Community College District
43600 Mission Boulevard
Fremont CA 94539
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 5/13/2011 T
1278
Old Republic General Insurance Corporation
307 N. Michigan
Chicago IL 60601
Old Republic Construction Program
Group Coventry MPN Insurer 3/13/2007 www.talispoint.com/cvty/gbcvtympn
1584
Old Republic General Insurance Corporation
307 North Michigan
Chicago IL 60601 GBMCS MPN Insurer 1/19/2010 www.talispoint.com/cvty/gbmpn
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
130
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0135
Old Republic Insurance Company
133 Oakland Ave
Greensburg PA 15601 Old Republic ESIS MPN Insurer 2/21/2005 T
2244
Old Republic Insurance Company
133 Oakland Avenue
Greensburg PA 15601 Coventry Medical Provider Network Insurer 4/18/2014 www.talispoint.com/cvty/matrix
1495
Old Republic Insurance Company
445 S. Moorland Rd
Brookfield WI 53005 WellComp Medical Provider Network Insurer 1/27/2009 T
1051
Old Republic Insurance Company
445 S. Moorland Rd, Suite 300
Brookfield WI 53005 CorVel MPN Insurer 8/10/2005 www.CorVel.com
1912
Old Republic Insurance Company
445 S. Moorland Rd., Suite 300
Brookfield WI 53005 CorVel/Kaiser Select MPN Insurer 2/14/2012 http://www.corvel.com
2131
Old Republic Insurance Company
445 S. Moorland Road
Brookfield WI 53005 Ryder/Bunch MPN Insurer 2/20/2013
1532
Old Republic Insurance Company
445 South Moorland Rd
Brookfield WI 53005
CCMSI/Old Republic First Health
Comp America Select HCO Network Insurer 5/14/2009 T
0156
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
Sedgwick CMS Medical Provider
Network Insurer 2/3/2005 T
0158
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
Sedgwick CMS Extended Medical
Provider Network Insurer 2/3/2005 T
0309
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 Old Republic Cambridge MPN Insurer 2/16/2005 T
0177
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 TCT CA MPN Insurer 3/7/2005 www.mywcinfo.com T
0343
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
First Health CompAmerica/Primary
HCO Network (or "First Health
Primary") Insurer 3/8/2005 W
0546
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
Sedgwick First Health CompAmerica
Select HCO Network (or "First Health
Select") Insurer 3/22/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
131
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0714
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
Old Republic/Gallagher Bassett
Coventry MPN Insurer 3/24/2005 www.talispoint.com/cvty/gbcvtympn T
0383
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 FOCUS - CVTY Insurer 4/21/2005 T
0374
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 Broadspire MPN Insurer 4/26/2005 T
0764
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 4/29/2005 T
0950
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 Liberty Mutual Group MPN Insurer 7/28/2005 T
0885
Old Republic Insurance Company
445 South Moorland Rd, Ste 300
Brookfield WI 53005 Interplan Insurer 9/22/2005 W
0995
Old Republic Insurance Company
445 South Moorland Rd, Suite 300
Brookfield WI 53005 CorVel MPN/Old Republic/LWP Insurer 8/12/2005 www.CorVel.com
0129
Old Republic Insurance Company
445 South Moorland Rd. Ste 300
Brookfield WI 53005
First Health CompAmerica Primary
Network Insurer 4/13/2005 T
0292
Old Republic Insurance Company
445 South Moorland Rd., Suite 300
Brookfield WI 53005 CorVel MPN/Old Republic Insurer 2/18/2005 www.CorVel.com
1557
Old Republic Insurance Company
445 South Moorland Road
Brookfield WI 53005 Eaton Corporation MPN Insurer 7/31/2009 W
2020
Old Republic Insurance Company
445 South Moorland Road
Brookfield WI 53005
Genex Medical Provider Network
(MPN) Insurer 9/21/2012 www.genexservices.com
1698
Old Republic Insurance Company
445 South Moorland Road, Ste. 300
Brookfield WI 53005 Broadspire Signature MPN Insurer 9/29/2010 T
1862
Old Republic Insurance Company
445 South Moorland Road, Suite 300
Brookfield WI 53005 Medex MPN Insurer 7/20/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
132
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0690
Old Republic Insurance Company
445 South Moreland Rd, Ste 300
Brookfield WI 53005
Old Republic/Gallagher Bassett/First
Health MPN Insurer 5/27/2005 www.talispoint.com/cvty/gbfhmpnselect
1455
Old Republic Insurance Company
445 South Moreland Rd, Ste. 300
Brookfield WI 53005
Old Republic Insurance Company
GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn
1802
Old Republic Insurance Company
455 S Moorland Rd
Brookfield WI 53005
Sedgwick CMS/Harbor MPN - OR
EATON Insurer 3/15/2011 T
2197
Old Republic Insurance Company
455 S Moorland Road
Brookfield WI 53005 Sedgwick/ Harbor MPN - OR PG Insurer 7/9/2013 T
1926
Old Republic Insurance Company
455 S. Moorland Rd.
Brookfield WI 53005 Sedgwick/Harbor MPN Insurer 3/22/2012 T
1973
Old Republic Insurance Company
455 s. Moorland Rd.
Brookfield WI 53005 Sedgwick/Harbor 2 MPN Insurer 5/24/2012 T
3064
Omaha National Underwriters, LLC
11128 John Galt Blvd Ste. 500
Omaha NE 68137 Omaha National MPN
Entity that
provides
physician
network
services 12/4/2017 http://mpn.omahanational.com
1234
OneBeacon Insurance Company
3 Battery March Park
Quincy MA 02169 OneBeacon-Coventry CA MPN Insurer 1/4/2007 www.coventrywcs.com
0572
Ontario-Montclair School District
950 W. D. Street
Ontario CA 91762
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 3/23/2005 T
0026
Optical Coating Laboratory, Inc. (OCLI)
2789 Northpoint Parkway
Santa Rosa CA 95407 First Health Comp America Select
Self-Insured
Employer 3/24/2005 T
0034
Oracle America, Inc.
901 San Antonio Road, Ms Sjc01-202
Palo Alto CA 94303 First Health Select MPN
Self-Insured
Employer 4/7/2005 www.talispoint.com/cvty/matrix √
2327
Orange County Fire Authority
1 Fire Authority Road
Irvine CA 92602 OCFA/CorVel MPN
Self-Insured
Employer 9/5/2014 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
133
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0741
Orange County Sanitation District
PO Box 8127
Fountain Valley CA 92728
Cambridge Orange County Sanitation
District MPN
Self-Insured
Employer 8/31/2006 T
0890
Orange Unified School District
1401 North Handy Street
Orange CA 92867 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
2232
Orchard Supply Company, LLC
1000 Lowe's Blvd,
P.O. Box 1000
Mooresville NC 28117 Orchard Bunch MPN
Self-Insured
Employer 11/21/2013 T
2366
Orora North America
6600 Valley View Street
Buena Park CA 90620 ATHENS MPN
Self-Insured
Employer 10/13/2015 www.medexhco.com T
1064
Orthopaedic Hospital
2400 South Flower St
Los Angeles CA 90007
PRIME Advantage Medical Network
for HealthCare Medical Provider
Network, accessing selected physicians
Blue Cross of California Prudent Buyer
PPO
Self-Insured
Employer 8/12/2005 T
0372
PACCAR Inc.
777-106th Avenue N.E.;
Bellevue WA 98004 Broadspire-Concentra Standard MPN
Self-Insured
Employer 2/17/2005 T
0755
Pacific Bell Telephone Co.
One AT&T Plaza, 208 South Akard, Room 2731
Dallas TX 75202 Liberty Mutual Group MPN
Self-Insured
Employer 4/28/2005 T
0482
Pacific Bell Telephone Company
208 South Akard Street, 27th Floor
Dallas TX 75202
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 3/16/2005 T
2195
Pacific Bell Telephone Company
One AT&T Plaza, 208 S. Akard St., Room 2732
Dallas TX 75202 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 7/24/2013 T
1018
Pacific Compensation Insurance Company
1 Baxter Way, Suite 170
Westlake Village CA 91362 PCIC on the Job MPN Insurer 8/16/2005 http://www.pacificcomp.com/MPNinfo
0039
Pacific Compensation Insurance Company
30301 Agoura Road 1# Floor
Agoura Hills CA 91301
Employers Direct Insurance Company
Medical Provider Network Insurer 2/2/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
134
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0678
Pacific Employers Insurance Company
1601 Chestnut Street
Philadelphia PA 19103
Pacific Employers Insurance Company -
Crawford Primary Insurer 6/16/2005 W
0532
Pacific Employers Insurance Company
1601 Market Street
Philadelphia PA 19103
Broadspire-First Health CompAmerica
Select HCO MPN Insurer 3/24/2005 T
0684
Pacific Employers Insurance Company
1601 Market Street
Philadelphia PA 19103
Sedgwick CMS Extended Medical
Provider Network Insurer 4/1/2005 T
0685
Pacific Employers Insurance Company
1601 Market Street
Philadelphia PA 19103
Sedgwick CMS Medical Provider
Network Insurer 4/1/2005 T
1670
Pacific Employers Insurance Company
436 Walnut St
Philadelphia PA 19106 Broadspire Signature MPN Insurer 8/10/2010 T
1962
Pacific Employers Insurance Company
436 Walnut St
Philadelphia PA 19106 Sedgwick/Harbor MPN Insurer 5/15/2012 T
2056
Pacific Employers Insurance Company
436 Walnut Street
Philadelphia PA 19106 Sedgwick/Harbor 2 MPN Insurer 9/20/2012 T
2247
Pacific Employers Insurance Company
436 Walnut Street
Philadelphia PA 19106 Coventry Medical Provider Network Insurer 4/18/2014 http://www.talispoint.com/cvty/matrix
0819
Pacific Employers Insurance Company
P.O. Box 15059
Wilmington DE 19850
PRIME Advantage Medical Network
Medical, MPN, accessing Prudent
Buyer HCO Insurer 5/3/2005 T
0339
Pacific Gas And Electric Company
77 Beale St
San Francisco CA 94105
Pacific Gas And Electric Company
MPN
Self-Insured
Employer 4/11/2005
http://www.mypgebenefits.com/physical-medical-
provider-network.shtml
0266
Pacific Indemnity Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1473
Pacific Indemnity Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
135
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3056
Pacific Secured Equities, Inc.
PO Box 358
Roseville CA 95661 InterMed Select MPN
Entity that
provides
physician
network
services 3/1/2018 www.talispoint.com/intermed/InterMedSelectMPN
0038
Pacific Warehouse Company
720 East "E" Street
Wilmington CA 90748 First Health Select
Self-Insured
Employer 6/8/2005 W
3013
Packard Claims Administration, Inc.
2739 US HWY 19 North
Holiday FL 34691 Packard MPN
Entity that
provides
physician
network
services 3/1/2017 www.netbyd.com/packardmpn/
1050
Pajaro Valley Unified School District
294 Green Valley Road
Watsonville CA 95076
Pajaro Valley Unified School District
Medical Provider Network
Self-Insured
Employer 7/27/2005 T
3066
Paladin Managed Care Services, Inc.
770 The City Drive, Suite 3000
Orange CA 92868
Paladin Primary Medical Provider
Network (CA)
Entity that
provides
physician
network
services 11/8/2017 http://www.paladinmc.com/providers.html
3078
Paladin Managed Care Services, Inc.
770 The City Drive, Suite 3000
Orange CA 92868
Allianz Resolution Management
Coventry Select MPN
Entity that
provides
physician
network
services 12/21/2017 http://www.paladinmc.com/providers.html
1789
Palm Springs Unified School District
980 East Tahquitz Canyon Way
Palm Springs CA 92262
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 3/15/2011 T
1790
Palo Alto Unified School District
25 Churchill Ave
Palo Alto CA 94306 PRIME Plus Medical Provider Network
Self-Insured
Employer 2/25/2011 T
0596
Palo Alto Unified School District
25 Churchill Avenue
Palo Alto CA 94306
First Health CompAmerica Primary
HCO
Self-Insured
Employer 3/24/2005 W
0200
Palomar College
1140 W Mission Road
San Marcos CA 92069 Prime Advantage Medical Network
Self-Insured
Employer 3/2/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
136
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1180
Park and Recreation District Employee
Compensation
910 Entrada Road
Sacramento CA 95864 PARDEC MPN
Joint Powers
Authority 2/1/2007 T
1200
Parker Hannifin Corporation
6035 Parkland Blvd.
Cleveland OH 44124 Sedgwick CMS MPN
Self-Insured
Employer 5/5/2006 T
1736
Parker Hannifin Corporation
6035 Parkland Blvd.
Cleveland OH 44124 Parker Select MPN
Self-Insured
Employer 12/10/2010 T
2416
Parking Concepts Inc.
12 Mauchly, Building I
Irvine CA 92618 Medex MPN
Self-Insured
Employer 11/6/2015 www.medexhco.com
0804
PARSAC Public Agency Risk Sharing Authority
of CA
1525 Response Rd #1
Sacramento CA 95815 Interplan
Joint Powers
Authority 6/29/2005 W
0568
Pasadena Area Community College District
1570 E. Colorado Blvd., C-215
Pasadena CA 91106 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
1056
Pasadena Unified School District
351 South Hudson Ave.
Pasadena CA 91106
CorVel/Pasadena Unified School
District MPN
Self-Insured
Employer 8/11/2005 T
2291
Patriot Risk Services, Inc.
Po Box 746
Woodland Hills CA 91365 Patriot Risk Services MPN
Entity that
provides
physician
network
services 9/30/2014 www.patriotmpn.com/ca
2257
Pebble Beach Company
220 Country Club Gate Center #27
Pacific Grove CA 93950 PEBBLE BEACH COMPANY MPN
Self-Insured
Employer 1/23/2014 www.intermedccs.com/PebbleBeachMPN W
1543
Peerless Indemnity Insurance Company
27201 Bella Vista Parkway Ste 130
Warrenville IL 60555 Liberty Mutual Group MPN Insurer 6/29/2009 T
1542
Peerless Insurance Company
62 Maple Ave
Keene NH 03431 Liberty Mutual Group MPN Insurer 6/29/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
137
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1409
Pennsylvania Manufacturers Association
Insurance Company (PMAIC)
380 Sentry Parkway
Blue Bell PA 19422
American Claims Management Inc.
MPN Insurer 5/14/2009 http://mpn.acmclaims.com/ T
0730
Pennsylvania Manufacturers' Association
Insurance Company (PMAIC)
380 Sentry Parkway
Blue Bell PA 19422 First Health Comp America Select MPN Insurer 5/23/2005 T
1240
Pennsylvania Manufacturers' Association
Insurance Company
6990 Snowdrift Road Building A
Allentown PA 18106 Rising Interplan MPN Insurer 9/18/2006 T
0729
Pennsylvania Manufacturers' Indemnity Company
(PMIC)
380 Sentry Parkway
Blue Bell PA 19422 First Health Comp America Select MPN Insurer 5/23/2005 T
1411
Pennsylvania Manufacturers Indemnity Company
(PMIC)
380 Sentry Parkway
Blue Bell PA 19422
American Claims Management Inc.
MPN Insurer 5/14/2009 http://mpn.acmclaims.com/ T
0563
Perris Union High School District
155 East 4th Street
Perris CA 92570 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0346
Peter Kiewit Sons', Inc.
Kiewit Plaza
Omaha NE 68131
First Health CompAmerica/Select HCO
Network
Self-Insured
Employer 3/8/2005 T
1238
Pictsweet
Ten Pictsweet Drive
Bells TN 38006
First Health
Select/Medrisk/Progressive/One Call
MPN
Self-Insured
Employer 10/5/2006 T
2267
PIH Foundation
12401 Washington Blvd.
Whittier CA 90602 Athens MPN
Self-Insured
Employer 1/8/2014 T
2183
Pitman Family Farms
1489 K Street
Sanger CA 93657 Pitman Family Farms MPN
Self-Insured
Employer 5/20/2013 T
0897
Placentia-Yorba Linda Unified School District
1301 E. Orangethorpe Ave.
Placentia CA 92870 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
138
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1653
Placentia-Yorba Linda Unified School District
1301 E. Orangethorpe Ave.
Placentia CA 92870 Athens MPN
Self-Insured
Employer 6/22/2010 www.medexhco.com
1178
Plastics Manufacturers Self-Insurance Program
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/19/2006 T
1784
Pomona Unified School District
800 South Garey Ave
Pomona CA 91766
Pomona Unified School District/CorVel
Select MPN
Self-Insured
Employer 2/10/2011 T
1151
Pomona Valley Hospital Medical Center
1798 N. Garey Ave.
Pomona CA 91767
PRIME Advantage Medical Network
for HealthCare MPN accessing selected
physicians of CA Prudent Buyer PPO
Self-Insured
Employer 5/4/2006 T
1715
PomWonderful LLC
11444 W. Olympic Blvd. 5th FL
Los Angeles CA 90064 Broadspire Signature MPN
Self-Insured
Employer 11/4/2010 T
0564
Poway Unified School District
13626 Twin Peaks Road
Poway CA 92064 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
1389
PPG Industries, Inc.
4325 Rosanna Drive Suite G
Allison Park PA 15101 PPG Medical Provider Network
Self-Insured
Employer 6/20/2008 T
0896
PPG Industries, Inc.
4325 Rosanna Drive
Allison Park PA 15101 PPG Medical Provider Network
Self-Insured
Employer 9/9/2005 T
2123
Praetorian Insurance Company
116 Pine Street, Suite 320
Harrisburg PA 17101
CCMSI/Praetorian/First Health Comp
America Network Insurer 2/19/2013 T
1171
Praetorian Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751
Praetorian Medical Provider Network
One Insurer 4/26/2006 T
1291
Praetorian Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel MPN Insurer 5/7/2007 T
1195
Praetorian Insurance Company
557 N. Wynore Rd, #202
Maitland FL 32751
QBE The Americas/TMC Medical
Provider Network Insurer 7/5/2006 T
1923
Praetorian Insurance Company
88 Pine 4th Floor
New York NY 10005
Praetorian Insurance Company GBMCS
MPN Insurer 3/15/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
139
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1946
Praetorian Insurance Company
88 Pine 4th Floor
New York NY 10005 WellComp Medical Provider Network Insurer 5/2/2012 T
2230
Praetorian Insurance Company
88 Pine 4th Floor
New York NY 10005
Praetorian Insurance
Company/Gallagher Bassett/First Health
MPN Insurer 10/29/2013 T
1911
Praetorian Insurance Company
88 Pine St 16th Floor Wall St. Plaza
New York NY 10005
QBE Insurance Company, Praetorian
MPN Insurer 3/6/2012 T
2205
Praetorian Insurance Company
88 Pine Street
New York NY 10005 CorVel MPN Insurer 7/15/2013 T
2167
Praetorian Insurance Company
88 Pine Street, 16h floor
New York NY 10005 Sedgwick/Harbor 2 MPN Insurer 5/10/2013 T
2166
Praetorian Insurance Company
88 Pine Street, 16th floor
New York NY 10005 Sedgwick/Harbor MPN Insurer 5/10/2013 T
1858
Praetorian Insurance Company
88 Pine, 4th Floor
New York NY 10005
Praetorian Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 7/20/2011 T
1901
Praetorian Insurance Company
Wall Street Plaza 88 Pine St 18th Flr
New York NY 10005 Sedgwick CMS Extended MPN Insurer 1/27/2012 T
1117
Preferred Auto Dealers Self-Insurance Program
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/5/2006 T
0640
Preferred Employers Insurance Company
1455 Frazee Road Suite 1000
San Diego CA 92108
Quality Care Medical Provider Network
(MPN) Insurer 3/30/2005 T
1226
Preferred Employers Insurance Company
9797 Aero Drive, Suite 200
San Diego CA 92123 Preferred Select MPN Insurer 8/28/2006 www.peiwc.com
1066
Presbyterian Intercommunity Hospital
12401 Washington Blvd.
Whittier CA 90602
PRIME Advantage Medical Provider
Network for HealthCare
Self-Insured
Employer 8/12/2005 T
2263
Presbyterian Intercommunity Hospital
12401 Washington Blvd.
Whittier CA 90602 Athens MPN
Self-Insured
Employer 1/8/2014 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
140
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1567
Preserver Insurance Company
120 Broadway 31st Floor
New York NY 10217 WellComp Medical Provider Network Insurer 9/15/2009 T
1631
Preserver Insurance Company
120 Broadway, 31st Floor
New York NY 10271 Tower Group Companies MPN Insurer 6/10/2010 T
2182
Preserver Insurance Company
120 Broadway, 31st Floor
New York NY 10271 ACM/Preserver MPN Insurer 5/20/2013 T
2473
Prime Health Services, Inc.
7110 Crossroads Blvd
Brentwood TN 37027 PHS MPN
Entity that
provides
physician
network
services 6/21/2016 www.primehealthservicesmpn.com
2474
Prime Health Services, Inc.
7110 Crossroads Blvd
Brentwood TN 37027 Prime Health MPN
Entity that
provides
physician
network
services 6/21/2016 www.primehealthservicesincmpn.com
1920
ProCentury Insurance Company
465 Cleveland Ave
Westerville OH 43082 Rising Interplan MPN Insurer 3/6/2012 T
3015
Programs Plus, Inc.
1431 Greenway Drive, Ste 620
Irving TX 75038 Assurex Medical Provider Network
Entity that
provides
physician
network
services 3/22/2017 www.talispoint.com/cvty/irm
1155
Property and Casualty Insurance Company of
Hartford
100 Hartford Plaza [HO-1-09]
Hartford CT 06155
Property and Casualty Insurance Co. of
Hartford/Gallagher Bassett/Coventry
MPN Insurer 3/20/2006 T
0067
Property and Casualty Insurance Company of
Hartford
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
0068
Property and Casualty Insurance Company of
Hartford
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
141
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1188
Property and Casualty Insurance Company of
Hartford
690 Asylum Ave
Hartford CT 06115
Property and Casualty Insurance
Company of Hartford accessing Anthem
Blue Cross Prudent Buyer HCO Insurer 3/17/2006 W
1244
Property and Casualty Insurance Company of
Hartford
690 Asylum Avenue
Hartford CT 06115
Frank Gates SVC Co/Hartford/CorVel
MPN Insurer 9/29/2006 W
1523
Property and Casualty Insurance Company of
Hartford
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Property & Casualty/Gallagher
Bassett/First Health MPN Insurer 5/7/2009 T
2382
Property and Casualty Insurance Company of
Hartford
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Property and Casualty Insurance
Company of Hartford accessing Anthem
Blue Cross Prudent Buyer PPO Insurer 10/9/2015 www.thehartford.com/ca-workers-compensation T
1766
ProSight Global, Inc.
412 Mt. Kemble Ave Ste 300C
Morristown NJ 07960 Sedgwick CMS Extended MPN Insurer 2/2/2011 W
3069
Prospect Medical Holdings, Inc.
3415 S. Sepulveda Blvd., Fl 9
Los Angeles CA 90034 CorVel MPN
Self-Insured
Employer 12/1/2017 www.corvel.com
2510
Protective Insurance Company
P.O. Box 7099
Indianapolis IN 46207 Protective/CorVel MPN Insurer 10/27/2016 www.corvel.com
2015
Protective Insurance Company
PO Box 7099
Indianapolis IN 46207 CorVel MPN Insurer 6/14/2012 www.corvel.com
0207
Providence Health System Southern California
(Self Insurance Certificate #2245)
506 2nd Avenue, Suite 1200
Seattle WA 98104 First Health CompAmerica Select
Self-Insured
Employer 3/7/2005 T
1170
Providence Health System-Southern California
1801 Lind Avenue SW #9016
Renton WA 98057
Genex-Providence Medical Provider
Network
Self-Insured
Employer 5/4/2006 T
0598
Prudential Overall Supply
1661 Alton Parkway
Irvine CA 92606 Prudential Overall Supply MPN
Self-Insured
Employer 3/18/2005 www.tristarmanagedcare.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
142
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0952
Public Agencies Self-Insured Systems (PASIS)
c/o Apple Valley Fire Protection District
22400 Headquarters Drive
Apple Valley CA 92307 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 T
1618
Public Entity Risk Management Authority
36-951 Cook Street, Suite 101
Palm Desert CA 92211 WellComp Medical Provider Network
Joint Powers
Authority 4/6/2010 www.wellcomp.com
1507
Public Service Insurance Company
One Park Avenue
New York NY 10016 CorVel MPN Insurer 2/10/2009 http://www.corvel.com
1162
Public Service Mutual Insurance Company
11755 Wilshire Blvd., Suite 1850
Los Angeles CA 90025 Concentra Integrated Services, Inc. Insurer 8/3/2006 T
1919
QBE Insurance Corporation
88 Pine 4th Floor
New York NY 10005
QBE Insurance Corporation GBMCS
MPN Insurer 11/2/2012 T
2171
QBE Insurance Corporation
88 Pine Street, 16th Floor
New York NY 10005 Sedgwick/ Harbor 2 MPN Insurer 5/6/2013 T
2172
QBE Insurance Corporation
88 Pine Street, 16th Floor
New York NY 10005 Sedgwick/ Harbor MPN Insurer 5/6/2013 T
0429
Quality Comp, Inc.
1357 E. Lassen Avenue, Suite 100
Chico CA 95927 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 3/3/2005 T
2066
Quality Comp, Inc.
255 Great Valley Parkway, Ste 255
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 10/31/2012 www.monumentllc.com T
1481
Quality Comp, Inc.
255 Great Valley Pkwy Ste 200
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 3/17/2009 T
1845
Raley's
500 W. Capitol Ave.,
West Sacramento CA 95605 Athens MPN
Self-Insured
Employer 6/16/2011 T
2435
Raley's
500 W. Capitol Avenue
West Sacramento CA 95605 Raley's-CorVel MPN
Self-Insured
Employer 1/22/2016 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
143
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1327
Raley's
500 West Capitol Ave.
West Sacramento CA 95605
Raley's Quality Medical Provider
Network
Self-Insured
Employer 11/20/2007 T
0605
Raley's
500 West Capitol Avenue
Sacramento CA 95814 CorVel HCO/CorVel HCO Select
Self-Insured
Employer 7/14/2005 T
0795
Ravendale-Termo Elementary School District
472-13 Johnstonville Road North
Susanville CA 96130
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 4/21/2005 W
2076
Ravenswood City School District
2120 Euclid Ave
East Palo Alto CA 94303 PRIME Plus Medical Provider Network
Self-Insured
Employer 12/11/2012 T
0575
Ravenswood City School District
2160 Euclid Avenue
East Palo Alto CA 94303 PRIME Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
2053
Recology Inc.
50 California Street, 24th Floor
San Francisco CA 94111 CorVel/Recology MPN
Self-Insured
Employer 9/6/2012 http://www.corvel.com
1196
Redland Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751
Redland Insurance Company/TMC
Medical Provider Network Insurer 7/5/2006 W
0082
Redlands Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751 CorVel MPN/ Redlands Insurance Insurer 2/4/2005 T
0275
Redlands Insurance Company
2600 West Hall Lane, Suite 400
Maitland FL 32751
Clarendon Medical Provider Network
One Insurer 2/9/2005 W
0565
Redlands Unified School District
20 West Lugonia Ave
Redlands CA 92374 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0455
Redwood Fire and Casualty Insurance Company
P.O. Box 881716
San Francisco CA 94188
Berkshire Hathaway Homestate
Companies MPN Insurer 2/16/2005 T
2036
Regent Insurance Company
One General Dr.
Sun Prairie WI 53396
Regent Insurance Company GBMCS
MPN Insurer 11/2/2012 T
2164
Regent Insurance Company
One General Drive
Sun Prairie WI 53596 Sedgwick/ Harbor MPN Insurer 5/6/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
144
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2165
Regent Insurance Company
One General Drive
Sun Prairie WI 53596 Sedgwick/ Harbor 2 MPN Insurer 5/6/2013 T
1009
Regents of The University of California
1111 Franklin Street, 10th Floor
Oakland CA 94607
Regents of The University of California
MPN
Self-Insured
Employer 7/28/2005 W
0433
Reinsurance Company of America
1310 Utica Street
Oriskany NY 13424 CorVel MPN Insurer 3/3/2005 T
2491
Republic Capital Claims Administrators, Inc.
2648 E Workman Ave., #223
West Covina CA 91791
Republic Capital Claims Administrators
Kaiser MPN
Entity that
provides
physician
network
services 8/10/2016 www.rccakaisermpn.com
2492
Republic Capital Claims Administrators, Inc.
2648 E Workman Ave., #223
West Covina CA 91791
Republic Capital Claims Administrators
MPN
Entity that
provides
physician
network
services 8/10/2016 www.rccampn.com
0102
Republic Indemnity Company of America
PO Box 20036
Encino CA 91416 Republic Indemnity MPN Insurer 2/14/2005 T
0782
Republic Indemnity Company of America
PO Box 20036
Encino CA 91416
Republic Indemnity Kaiser On-the Job
Medical Provider Network Insurer 5/10/2005 T
2005
Republic Indemnity Company Of America
PO Box 20036
Encino CA 91416 Republic Indemnity Company MPN Insurer 6/6/2012 www.talispoint.com/ri
2006
Republic Indemnity Company Of California
PO Box 20036
Encino CA 91416 Republic Indemnity Company MPN Insurer 6/6/2012 www.talispoint.com/ri
0327
Republic Indemnity Company of California
PO Box 20036
Encino CA 91416 Republic Indemnity MPN Insurer 2/14/2005 T
0781
Republic Indemnity Company of California
PO Box 20036
Encino CA 91416
Republic Indemnity Kaiser On-the Job
Medical Provider Network Insurer 5/10/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
145
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1702
Republic Underwriters Insurance Company
5525 LBJ Freeway
Dallas TX 95240 Athens MPN Insurer 9/29/2010 www.medexhco.com T
2191
Republic Underwriters Insurance Company
5525 LBJ Freeway
Dallas TX 75240 Sedgwick/ Harbor MPN- Republic AG Insurer 6/21/2013 T
0569
Rialto Unified School District
182 E. Walnut Avenue
Rialto CA 92376 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
0566
Rio Hondo College
3600 Workman Mill Road
Whittier CA 90608 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
3023
Rising Medical Solutions, LLC
325 N. LaSalle St., Suite 600
Chicago IL 60654 Rising Select MPN
Entity that
provides
physician
network
services 5/24/2017 https://www.risingms.com/risingmpn/
3024
Rising Medical Solutions, LLC
325 N. LaSalle St., Suite 600
Chicago IL 60654 Rising FHSelectKOJ MPN
Entity that
provides
physician
network
services 6/15/2017 https://www.risingms.com/risingmpn/
3025
Rising Medical Solutions, LLC
325 N. LaSalle St., Suite 600
Chicago IL 60654 Rising FHSelect MPN
Entity that
provides
physician
network
services 6/15/2017 https://www.risingms.com/risingmpn/
1944
Riverport Insurance Company
222 So 9th St., Ste 1300
Minneapolis MN 55402 WellComp Medical Provider Network Insurer 5/2/2012 T
2040
Riverside Community College District
4800 Magnolia Ave.
Riverside CA 92506 WellComp Medical Provider Network
Self-Insured
Employer 8/23/2012 www.wellcomp.com
0281
Riverside Schools Risk Management Authority
41870 McAlby Court
Murrieta CA 92562 Prime Advantage Medical Network
Joint Powers
Authority 3/1/2005 T
1629
Riverside Transit Agency (RTA)
1825 Third St
Riverside CA 92517 RTA MPN
Joint Powers
Authority 5/26/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
146
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1501
Riverside Transit Authority
1825 Third St
Riverside CA 92507 CorVel MPN
Self-Insured
Employer 2/18/2009 T
1829
RLI Insurance Company
9025 N. Lindbergh Drive
Peoria IL 60615
RLI Insurance/Gallagher Bassett/First
Health MPN Insurer 5/3/2011 www.talispoint.com/cvty/gbfhmpnselect T
2193
Roadway Express, Inc.
10990 Roe Avenue
Overland Park KS 66211 Roadway Express, Inc. GBMCS MPN
Self-Insured
Employer 7/24/2013 T
0630
Robertson's Ready Mix, Ltd
200 South Main, # 200
Corona CA 92882 WellComp Medical Provider Network
Self-Insured
Employer 6/8/2005 T
2231
Robertson's Transport, Ltd
200 South Main, #200
Corona CA 92882 WellComp Medical Provider Network
Self-Insured
Employer 11/12/2013 T
0293
Roll International Corporation
11444 West Olympic Blvd, 10th Floor
Los Angeles CA 90064 Broadspire MPN
Self-Insured
Employer 2/10/2005 T
1701
Roll International Corporation
11444 West Olympic Blvd., 10th Flr.
Los Angeles CA 90064 Broadspire Signature MPN
Self-Insured
Employer 10/20/2010 T
0726
Roman Catholic Archbishop of Los Angeles, a
corporation sole
3424 Wilshire Blvd
Los Angeles CA 90010 First Health Comp America Select MPN
Self-Insured
Employer 6/23/2005 T
0936
Royal & SunAlliance
9300 Arrowpoint Blvd.
Charlotte NC 28201 Royal & SunAlliance MPN Insurer 9/28/2005 T
0351
RR Donnelley
77 West Wacker Drive
Chicago IL 60601
First Health CompAmerica Primary
HCO Network (or "First Health
Primary")
Self-Insured
Employer 3/7/2005 T
0783
Sacramento Metropolitan Fire District
2101 Hurley Way
Sacramento CA 95825 InterPlan/Kaiser
Self-Insured
Employer 6/24/2005 W
1263
Sacramento Municipal Utility District
6201 S St.
Sacramento CA 95817 SMUD MPN
Self-Insured
Employer 1/3/2007 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
147
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1053
Sacramento Municipal Utility District
6201 S Street
Sacramento CA 95817 Medical Partners @ Work (MPW)
Self-Insured
Employer 9/22/2005 T
1553
Sacramento Municipal Utility District
6201 S. Street
Sacramento CA 95817 SMUD MPN
Self-Insured
Employer 8/11/2009 www.smud.ekhealth.com
0937
Saddleback Valley Unified School District
25631 Peter A. Hartman Way
Mission Viejo CA 92691
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Self-Insured
Employer 5/19/2005 T
1307
Safeco Insurance Company of America
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 7/10/2008
http://www.libertymutualgroup.com/providernetwork
s
T
1308
Safeco Insurance Company of Illinois
175 Berkeley Street
Boston MA 02116 Safeco Preferred California MPN Insurer 7/10/2008
http://www.libertymutualgroup.com/providernetwork
s
T
0054
Safeco Property & Casualty Insurance Companies
120 Vantis
Aliso Viejo CA 92656 Safeco Preferred California MPN Insurer 12/2/2004 W
1442
Safety First Insurance Company
1832 Schuetz Road
St Louis MO 63146 Safety First GBMCS MPN Insurer 5/7/2009 T
0976
Safety First Insurance Company
1832 Schuetz Road
St. Louis MO 63146
Safety First /Gallagher Bassett/Coventry
MPN Insurer 7/12/2005 T
0800
Safety First Insurance Company
1834 Schuetz Road
St. Louis MO 63146
Safety First/Gallagher Basset/First
Health MPN Insurer 5/27/2005 T
0991
Safety First Insurance Company
2043 Woodland Pkwy
St. Louis MO 63146 Broadspire MPN Insurer 6/10/2005 T
3053
Safety National Casualty Corporation
15509 Collections Center Drive
Chicago IL 60693 Glidewell Dental MPN Insurer 11/22/2017 www.talispoint.com/intermed/glidewelldentalmpn
1710
Safety National Casualty Corporation
1832 Scheutz Rd.
St. Louis MO 63146 Athens MPN Insurer 10/20/2010 www.medexhco.com
0127
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146
First Health CompAmerica Select
Network Insurer 2/17/2005 www.talispoint.com/cvty/matrix
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
148
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0740
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 Safety National Cambridge MPN Insurer 6/22/2005 T
1565
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 Sedgwick CMS MPN Insurer 9/29/2009 T
1566
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 Sedgwick CMS Extended MPN Insurer 9/29/2009 T
1621
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 WellComp Medical Provider Network Insurer 4/13/2010 www.wellcomp.com T
1625
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 Safety Nat'l/GAP/Bunch MPN Insurer 4/29/2010 T
1672
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 Broadspire Signature Network Insurer 8/10/2010 T
1782
Safety National Casualty Corporation
1832 Schuetz Rd
St. Louis MO 63146 CorVel MPN Insurer 2/10/2011 www.corvel.com
1958
Safety National Casualty Corporation
1832 Schuetz Rd.
St. Louis MO 63146
First Health Comp America Primary
HCO Network Insurer 5/2/2012 T
1968
Safety National Casualty Corporation
1832 Schuetz Rd.
St. Louis MO 63146 Sedgwick/Harbor MPN Insurer 5/24/2012 T
2007
Safety National Casualty Corporation
1832 Schuetz Rd.
St. Louis MO 63146 Sedgwick/Harbor 2 MPN Insurer 6/1/2012 T
2129
Safety National Casualty Corporation
1832 Schuetz Rd.
St. Louis MO 63146 LWP Kaiser Signature MPN Insurer 2/20/2013 http://www.lwpsignaturempn.com
2130
Safety National Casualty Corporation
1832 Schuetz Rd.
St. Louis MO 63146 LWP Signature MPN Insurer 2/20/2013 http://www.lwpsignaturempn.com
1416
Safety National Casualty Corporation
1832 Schuetz Road
St Louis MO 63146
CCMSI/SafetyNationalCasualty
Corporation/First Health Comp America
Select HCO Network Insurer 10/2/2008 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
149
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1445
Safety National Casualty Corporation
1832 Schuetz Road
St Louis MO 63146 Safety National GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn
0412
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146
CorVel MPN/Safety National
Casualty/LWP Insurer 2/28/2005 www.corvel.com
0975
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146
Safety National/Gallagher
Bassett/Coventry MPN Insurer 7/12/2005 www.talispoint.com/cvty/gbcvtympn
1017
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146
First Health Comp America Select And
Kaiser-on-the-Job Network Insurer 9/13/2005 www.talispoint.com/cvty/matrix
1863
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 Medex MPN Insurer 8/23/2011 T
2001
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 CorVel/Kaiser Select MPN Insurer 11/10/2011 www.corvel.com
1916
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146
Sedgwick/Harbor MPN - Safety
National SUMC Insurer 2/17/2012 W
2110
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 Sedgwick/Harbor MPN - SN Vallarta Insurer 2/1/2013 T
2083
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146
PRIME Advantage Medical Provider
Network for Healthcare Insurer 2/11/2013 T
2179
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 Liberty Mutual Group MPN Insurer 6/12/2013 T
2180
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 CorVel/Prime Healthcare MPN Insurer 6/25/2013 www.corvel.com
2434
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 Safety National GBMCS KOJ MPN Insurer 12/16/2015 www.talispoint.com/cvty/gbkoj T
2446
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 TCT CA MPN Insurer 4/25/2016 www.mywcinfo.com T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
150
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2506
Safety National Casualty Corporation
1832 Schuetz Road
St. Louis MO 63146 El Pollo Loco MPN Insurer 10/13/2016 www.corvel.com
1559
Safety National Casualty Corporation
1932 Schuetz Rd
St. Louis MO 63146 Safety National ESIS MPN Insurer 8/25/2009 T
0359
Safety National Casualty Corporation
2043 Woodland Pkwy
St. Louis MO 63146
First Health CompAmerica Select HCO
Network Insurer 3/7/2005 W
0360
Safety National Casualty Corporation
2043 Woodland Pkwy
St. Louis MO 63146
First Health CompAmerica Primary
HCO Network Insurer 3/7/2005 W
0643
Safety National Casualty Corporation
2043 Woodland Pkwy
St. Louis MO 63146 Broadspire MPN Insurer 4/4/2005 T
0789
Safety National Casualty Corporation
2043 Woodland Pkwy
St. Louis MO 63146 Insurer 5/15/2005 T
0799
Safety National Casualty Corporation
2043 Woodland Pkwy
St. Louis MO 63146
Safety National/Gallagher Bassett/First
Health MPN Insurer 5/27/2005 T
0335
Safeway Inc.
11555 Dublin Canyon Rd.
Pleasanton CA 94558 Safeway MPN
Entity that
provides
physician
network
services 4/8/2005 http://www.talispoint.com/safewaympn
0505
Saint John's Health Center
2420 W 26th Ave Ste 100 D
Denver CO 80211 Broadspire Signature MPN
Self-Insured
Employer 3/10/2005 T
2031
Samsung Fire & Marine Insurance Co., Ltd. (US
Branch)
85 Challenger Rd.
Ridgefield Park NJ 07660 Broadspire Signature MPN Insurer 8/3/2012 T
1083
San Antonio Community Hospital
999 San Bernardino Rd
Upland CA 91789
PRIME Advantage Medical Network
for HealthCare Medical Provider
Network, accessing selected physicians
Blue Cross of California Prudent Buyer
PPO
Self-Insured
Employer 9/30/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
151
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0334
San Bernardino City Unified School District
777 North F Street
San Bernardino CA 92410 SBCUSD MPN
Joint Powers
Authority 4/12/2005 W
0576
San Bernardino Community College District
114 S. Del Rosa Drive
San Bernardino CA 92408 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 T
1928
San Diego Community College District
3375 Camino Del Rio South
San Diego CA 92108 San Diego CCD/CorVel Select MPN
Self-Insured
Employer 4/19/2012 www.corvel.com
1401
San Diego County Schools Risk Management
Joint Powers Authority
6401 Linda Vista Road
San Diego CA 92111 San Diego County Schools JPA MPN
Joint Powers
Authority 7/23/2008
Http://www.sdcoe.net/business-services/risk-
management/Pages/workers-compensation-
forms.aspx
0094
San Diego Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 www.libertymutualprs.com T
1801
San Diego Metropolitan Transit System
1255 Imperial Ave., Ste 1000
San Diego CA 92101 SD MTS MPN
Self-Insured
Employer 3/11/2011 T
0413
San Diego Transit Corporation
1255 Imperial Ave Suite 1000
San Diego CA 92101 SD MTS MPN
Self-Insured
Employer 4/27/2005 T
1800
San Diego Trolley, Inc.
1255 Imperial Ave., Ste 1000
San Diego CA 92101 SD MTS MPN
Self-Insured
Employer 3/11/2011 T
0963
San Diego Unified School District
4100 Normal Street
San Diego CA 92103
TRISTAR - CompAmerica Primary
HCO
Self-Insured
Employer 7/26/2005 T
1418
San Diego Unified School District
4100 Normal Street
San Diego CA 92103 WellComp Medical Provider Network
Self-Insured
Employer 9/16/2008 T
1375
San Diego Unified School District
Revere Center Rm 7, 2100 Normal St
San Diego CA 92103 State Fund Medical Provider Network
Self-Insured
Employer 3/21/2008 T
0992
San Diego/Imperial County Schools Joint Power
Authority
6401 Linda Vista Rd #505
San Diego CA 92111 Interplan through CompPartners
Joint Powers
Authority 7/20/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
152
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0875
San Francisco Unified School District
135 Van Ness, Room 217
San Francisco CA 94102
First Health CompAmerica Primary
HCO
Self-Insured
Employer 5/3/2005 W
0928
San Gabriel Valley School Districts' Self-
Insurance Authority
C/o Glendora Unified School District 500 N.
Lorraine Ave
Glendora CA 91741 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 www.wellcomp.com
1281
San Joaquin County Schools WC Insurance Group
JPA
P.O. Box 213030
Stockton CA 95213 PRIME Plus Medical Provider Network
Joint Powers
Authority 4/5/2007 T
1890
San Joaquin Delta Community College District
5151 Pacific Ave.
Stockton CA 95207
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 11/18/2011 T
2027
San Jose Unified School District
2222 Unified Way, Bld T
San Jose CA 95125 Athens MPN
Self-Insured
Employer 7/24/2012 T
0903
San Jose Unified School District
855 Lenzen Avenue
San Jose CA 95126
First Health CompAmerica Primary
HCO
Self-Insured
Employer 5/19/2005 W
1252
San Jose/Evergreen Community College District
4750 San Felipe Road
San Jose CA 95135 PRIME Plus Medical Network
Self-Insured
Employer 5/3/2007 T
1013
San Mateo County Community College District
3401 CSM Drive
San Mateo CA 94402 Prime Advantage Medical Network
Self-Insured
Employer 7/26/2005 T
0794
San Mateo County Schools Insurance Group
1791 Broadway
Redwood City CA 94063
Prime Advantage Medical Provider
Network
Joint Powers
Authority 4/21/2005 T
2258
San Mateo County Schools Insurance Group
1791 Broadway
Redwood City CA 94063 PRIME Plus Medical Provider Network
Joint Powers
Authority 1/3/2014 www.keenan.com T
1132
Santa Ana Unified School District
1601 East Chestnut Avenue
Santa Ana CA 92701 WellComp Medical Provider Network
Self-Insured
Employer 4/9/2006 T
0284
Santa Barbara Community College District
721 Cliff Drive
Santa Barbara CA 93109 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
153
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0898
Santa Barbara County Schools - SIPE
c/o Santa Barbara County Education Office - 4400
Cathedral Oaks
Santa Barbara CA 93160 PacMed, Inc. HCO
Self-Insured
Employer 6/3/2005 T
0476
Santa Clara County Office of Education
1290 Ridder Park Drive
San Jose CA 95141
First Health CompAmerica Primary
HCO
Self-Insured
Employer 3/18/2005 W
1253
Santa Clara County Schools Insurance Groups
3233 Union Ave.
San Jose CA 95124 PRIME Plus Medical Network
Joint Powers
Authority 1/17/2007 T
0711
Santa Clara Schools Insurance Group (SCCSIG)
3233 Union Avenue
San Jose CA 95124
Prime Advantage Medical Network
accessing Prudent Buyer HCO
Joint Powers
Authority 4/19/2005 W
0574
Santa Clara Unified School District
1889 Lawrence Road
Santa Clara CA 95052 Prime Advantage Medical Network
Self-Insured
Employer 3/23/2005 W
0168
Santa Clara Valley Transportation Authority
3331 North First Street
San Jose CA 95134
Santa Clara Valley Transportation
Authority Network
Self-Insured
Employer 2/1/2005 T
1294
Santa Clara Valley Transportation Authority
3331 North First Street
San Jose CA 95134
Santa Clara Valley Transportation
Authority
Self-Insured
Employer 6/7/2007 www.genexservices.com T
0224
Santa Clarita Community College District
26455 North Rockwell Canyon Road
Valencia CA 91355 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0204
Santa Cruz/San Benito County Schools Insurance
Group
97 South 2nd Street, Suite 300
San Jose CA 95113 Prime Advantage Medical Network
Joint Powers
Authority 4/6/2005 T
2319
Santa Fe Aggregates, Inc.
3500 American River Dr.
Sacramento CA 95851 WellComp Medical Provider Network
Self-Insured
Employer 7/22/2014 www.WellComp.com T
0176
Santa Monica Community College District
1900 Pico Blvd
Santa Monica CA 90405 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0930
Saticoy Lemon Association
7560 E. Bristol
Santa Paula CA 93061 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
154
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0197
Saugus Union School District
24930 Avenue Stanford
Santa Clarita CA 91355 Prime Advantage Medical Network
Self-Insured
Employer 3/2/2005 T
3047
Save Mart Supermarkets
1800 Standiford Avenue
Modesto CA 95350 CorVel MPN
Self-Insured
Employer 8/18/2017 www.corvel.com
0052
Save Mart Supermarkets
1800 Standiford Avenue
Modesto CA 95356 Status MPN-Save Mart
Self-Insured
Employer 12/2/2004 https://secure.simon-companies.com/sm/
0754
Schneider National Carriers, Inc.
3101 South Packerland Drive, P.O. Box 2545
Green Bay WI 54306 Liberty Mutual Group MPN
Self-Insured
Employer 4/28/2005 T
0123
Schnitzer Steel Industries, Inc.
3200 NW Yeon Ave.
Portland OR 97210 Schnitzer Steel ESIS MPN
Self-Insured
Employer 12/20/2004 T
0105
Schools Insurance Group (SIG)
550 High Street, Suite 210
Auburn CA 95603 SIG MPN
Joint Powers
Authority 2/1/2005 T
1390
Schools Insurance Group
550 High Street Suite 210
Auburn CA 95603 Allied Managed Care/SIG MPN
Joint Powers
Authority 6/20/2008 T
0279
Schools Linked For Insurance Management
4111 Las Virgenes Rd
Calabasas CA 91302 PRIME Advantage Medical Network
Joint Powers
Authority 3/1/2005 T
2315
Schools Linked for Insurance Management
4111 Las Virgenes Road
Calabasas CA 91302 PRIME Plus Medical Provider Network
Joint Powers
Authority 7/30/2014 www.keenan.com T
0183
Scope Industries
233 Wilshire Blvd, Suite 310
Santa Monica CA 90401
Scope Industries First Health
CompAmerica Select
Self-Insured
Employer 4/27/2005 T
1841
Scripps Health
4275 Campus Point Court
San Diego CA 92121 Sedgwick CMS/Harbor MPN-Scripps
Self-Insured
Employer 6/1/2011 T
0013
Sea Bright Insurance Company
2101 4th Avenue, Ste 1600
Seattle WA 98121 First Health Comp America Select HCO Insurer 2/15/2005 W
0381
Sea Bright Insurance Company
2101 4th Avenue, Ste 1600
Seattle WA 98121 Broadspire-Concentra Standard MPN Insurer 2/22/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
155
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1119
SeaBright Insurance Company
1501 4th Avenue, Suite 2600
Seattle WA 98101 SeaBright BrightCure Customized MPN Insurer 12/16/2005 www.sbic.com T
1628
Securitas Security Services USA, Inc.
4330 Park Terrace Dr
Westlake Village CA 92361 Sedgwick CMS Extended MPN
Self-Insured
Employer 4/29/2010 T
0591
Securitas Security Services USA, Inc.
4330 Park Terrace Drive
Westlake Village CA 92361 Securitas Broadspire SNP
Self-Insured
Employer 4/4/2005 T
2295
Securitas Security Services USA, Inc.
4330 Park Terrace Drive
Westlake Village CA 91361 Sedgwick/Harbor MPN
Self-Insured
Employer 5/21/2014 www.harborsys.com/sedgwick W
1806
Security National Insurance Company
12490 Merit Drive
Dallas TX 76251 Medex MPN Insurer 3/25/2011 W
1639
Security National Insurance Company
12790 Merit Dr
Dallas TX 75251
Majestic Insurance Company Medical
Provider Network Insurer 5/26/2010 T
1775
Security National Insurance Company
12790 Merit Dr
Dallas TX 76251 Medex MPN Insurer 2/1/2011 T
1608
Security National Insurance Company
12790 Merit Dr. Ste 200
Dallas TX 95251 WellComp Medical Provider Network Insurer 4/20/2010 T
1577
Security National Insurance Company
12790 Merit Drive
Dallas TX 75251
Security National/Gallagher
Bassett/Coventry MPN Insurer 1/14/2010 T
1805
Security National Insurance Company
12790 Merit Drive
Dallas TX 75251
Security National Insurance Company
accessing MedInsights Medical Provider
Network Insurer 3/18/2011 W
1579
Security National Insurance Company
12790 Merit Drive
Dallas TX 95251
Security National/Gallagher
Bassett/First Health MPN Insurer 1/12/2010 T
1578
Security National Insurance Company
12790 Merit Drive
Dallas TX 95251 Security National GBMCS MPN Insurer 1/14/2010 T
1627
Security National Insurance Company
12790 Merit Drive, Suite 200
Dallas TX 75251 CorVel MPN Insurer 4/28/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
156
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2479
Sedgwick Claims Management Services, Inc.
1100 Ridgeway Loop Road
Memphis TN 38120
Sedgwick Extended Medical Provider
Network
Entity that
provides
physician
network
services 6/1/2016 www.sedgwickproviders.com
2480
Sedgwick Claims Management Services, Inc.
1100 Ridgeway Loop Road
Memphis TN 38120
Sedgwick Standard Medical Provider
Network
Entity that
provides
physician
network
services 6/1/2016 www.sedgwickproviders.com
1260
Self-Insured Schools Of California
2000 K Street
Bakersfield CA 93301
Self-Insured Schools Of
California(SISC)/California Foundation
For Medical Care Network
Joint Powers
Authority 12/7/2006 www.cfmcnet.org/SISC
2079
Sentinel Insurance Company, LTD
One Hartford Plaza [HO-1-09]
Hartford CT 06155 RISICO TMC Sentinel IC MPN Insurer 11/15/2012 www.risico.com
2060
Sentinel Insurance Company, LTD
One Hartford Plaza
Hartford CT 06155 Athens MPN - SIC Insurer 10/5/2012 T
2092
Sentinel Insurance Company, Ltd.
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 12/24/2012 T
2093
Sentinel Insurance Company, Ltd.
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 12/24/2012 T
1913
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sentinel Insurance Company accessing
Anthem Blue Cross Prudent Buyer PPO Insurer 2/24/2012 www.thehartford.com/ca-workers-compensation T
2016
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
First Health CompAmerica Primary
HCO Network Insurer 6/15/2012 T
2022
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
First Health CompAmerica Select HCO
Network Insurer 6/29/2012 T
2024
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sentinel Insurance Company GBMCS
MPN Insurer 8/1/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
157
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2025
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sentinel Insurance Company/Gallagher
Bassett/First Health MPN Insurer 8/1/2012 T
2026
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Sentinel Insurance Company/Gallagher
Bassett/Coventry MPN Insurer 8/1/2012 T
2051
Sentinel Insurance Company, Ltd.
One Hartford Plaza [HO-1-09]
Hartford CT 06155
WellComp Medical Provider Network-
York-SIC Insurer 9/14/2012 T
2255
Sentry Casualty Company
1800 North Point Drive
Stevens Point WI 54481 Medex MPN Insurer 12/4/2013 T
0584
Sentry Insurance A Mutual Company
PO Box 8032
Stevens Point WI 54481 Sentry MPN Insurer 3/24/2005 www.Sentry.com
1585
Sequoia Insurance Company
31 Upper Ragsdale Dr
Monterey CA 93940 Broadspire MPN Insurer 1/26/2010 T
1700
Sequoia Insurance Company
31 Upper Ragsdale Dr.
Monterey CA 93940 Sequoia Signature MPN Insurer 10/4/2010 T
2090
Sequoia Insurance Company
31 Upper Ragsdale Drive
Monterey CA 93940 Sedgwick/Harbor MPN Insurer 12/12/2012 T
2212
Sequoia Insurance Company
31 Upper Ragsdale Drive
Monterey CA 93940 Medex MPN Insurer 8/19/2013 T
0449
Seven-Up Bottling Co. of San Francisco
1981 N. Broadway, Suite 215
Walnut Creek CA 94596
CorVel HCO/CorVel HCO Select as
CorVel MPN
Self-Insured
Employer 3/3/2005 T
1184
Seven-Up/RC Bottling Company of So. California
3220 East 26th Street
Vernon CA 90023 CorVel HCO
Self-Insured
Employer 4/4/2006 T
0414
Seven-Up/RC Bottling Company of Southern
California, Inc.
3220 East 26th Street
Los Angeles CA 90023 Medex
Self-Insured
Employer 2/24/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
158
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1508
Shasta-Trinity Schools Insurance Group JPA
6724 Lockheed Dr Ste 3A
Redding CA 96002
Shasta-Trinity Schools Insurance Group
JPA MPN
Joint Powers
Authority 2/23/2009 T
0935
Shasta-Trinity Schools Insurance Group
6724 Lockheed Drive Ste 3A
Redding CA 96002
CorVel MPN/ Shasta-Trinity
Schools/LWP
Joint Powers
Authority 5/19/2005 T
0792
SIGNAL I Joint Powers Authority Insurance
Group
c/o Mendocino COE-2240 Eastside Road
Ukiah CA 95482 Prime Advantage Medical Network
Joint Powers
Authority 5/15/2005 T
2468
Signature Networks PLUS, Inc.
187 W Orangethorpe Ave, Ste H
Placentia CA 92870
Signature Networks PLUS Sterling
MPN
Entity that
provides
physician
network
services 5/5/2016 www.snpsterlingmpn.com
2451
Signature Networks PLUS, Inc.
187 W. Orangethorpe Ave, Ste H
Placentia CA 92870 Prime Health Services Inc MPN
Entity that
provides
physician
network
services 2/18/2016 www.PrimeHealthServicesIncMPN.com
2452
Signature Networks PLUS, Inc.
187 W. Orangethorpe Ave, Ste H
Placentia CA 92870 Prime Health Services MPN
Entity that
provides
physician
network
services 2/18/2016 www.PrimeHealthServicesMPN.com
2469
Signature Networks PLUS, Inc.
187 W. Orangethorpe Ave, Ste H
Placentia CA 92870 Signature Networks PLUS Golden MPN
Entity that
provides
physician
network
services 5/5/2016 www.snpgoldenmpn.com
1882
Silver Valley Unified School District
35320 Daggett-Yermo Road, PO Box 847
Yermo CA 92398
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/31/2011 T
1204
Simi Valley Unified School District
875 E. Cochran St.
Simi Valley CA 93065 WellComp Medical Provider Network
Self-Insured
Employer 5/22/2006 T
0064
Simpson Manufacturing Company, Inc.
5956 W. Las Positas Blvd.
Pleasanton CA 94588
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 8/11/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
159
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0825
SKB Corporation
434 W. Levers Place
Orange CA 92867 TRISTAR MPN Insurer 5/3/2005 T
0818
Small Cities Organized Risk Effort, A California
Public Entity
2933 Gold Pan Court, Suite E
Rancho Cordova CA 95670 InterPlan/Kaiser
Joint Powers
Authority 6/30/2005 W
0581
Smart & Final, Inc.
600 Citadel Drive
Commerce CA 90040
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 3/24/2005 T
1807
Smurfit-Stone Container Corporation
6 City Place Dr
Creve Coeur MO 63141 Broadspire Signature MPN
Self-Insured
Employer 3/24/2011 T
1194
Solano Concrete Corporation
1501 Belvedere Road
West Palm Beach FL 33406 CorVel HCO
Self-Insured
Employer 4/10/2006 T
0636
Solano County
675 Texas Street Courthouse
Fairfield CA 94533 Interplan/Kaiser
Self-Insured
Employer 6/14/2005 W
0011
Solar Turbines Incorporated
PO Box 85376
San Diego CA 92186
Solar Medical Provider Network
("SMPN")
Self-Insured
Employer 2/4/2005 T
3077
Sompo America Insurance Company
11405 N Community House Rd Suite 600
Charlotte NC 28277
Sompo/Global Risk Solutions GBMCS
KOJ MPN Insurer 12/19/2017 www.talispoint.com/cvty/gbkoj
1688
SOMPO JAPAN FIRE & MARINE INSURANCE
COMPANY OF AMERICA
11405 N. Community House Road, Ste. 600
Charlotte NC 28277 Broadspire Signature MPN Insurer 8/19/2010 T
1306
Sompo Japan Ins. Co. of America
Two World Financial Center, 43rd Floor, 225
Liberty Street
New York NY 10281 Broadspire MPN Insurer 10/9/2007 T
1687
Sompo Japan Insurance Company Of America
2 WFC 43rd Flr 225 Liberty St
New York NY 10281 Broadspire Signature Network Insurer 8/19/2010 T
0495
Sompo Japan Insurance Company of America
225 Liberty Street, 43rd Floor
New York NY 10281 Sompo - Crawford Primary Insurer 6/16/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
160
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0496
Sompo Japan Insurance Company of America
225 Liberty Street, 43rd Floor
New York NY 10281 Sompo - Crawford Select Insurer 6/16/2005 W
0330
Sompo Japan
Two World Financial Center, 43rd Floor
225 Liberty Street
New York City NY 10281 CorVel MPN Insurer 3/7/2005 T
2417
Sony Electronics Inc.
16530 Via Esprillo
San Diego CA 92127 Athens MPN
Self-Insured
Employer 11/6/2015 www.medexhco.com
1108
Sony Electronics Inc., San Diego
16530 Via Esprillo
San Diego CA 92127
Self-Insured
Employer 3/8/2007 T
1521
South Bay Union School District
601 Elm Ave
Imperial Beach CA 91932
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 3/26/2009 T
0223
South Orange County Community College District
28000 Marguerite Parkway
Mission Viejo CA 92692 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
0020
Southern California Edison Company
PO Box 5038
Rosemead CA 91770 SCE Select
Self-Insured
Employer 12/30/2004 www.talispoint.com/sce/external
1694
Southern California Permanente Medical Group (a
partnership)
1800 Harrison St, 20th Floor
Oakland CA 94612 Kaiser Permanente/Harbor Net MPN
Self-Insured
Employer 12/29/2010 T
0977
Southern California Permanente Medical Group
1800 Harrison St., 20th Floor
Oakland CA 94612 Kaiser Permanente MPN
Self-Insured
Employer 7/25/2005 T
1704
Southern California Presbyterian Homes
516 Burchett St.
Glendale CA 91203 SCPH MPN
Self-Insured
Employer 11/4/2010 scph.employermpn.com
1152
Southern California Presbyterian Homes
516 Burchett Street
Glendale CA 91203
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 5/4/2006 T
1703
Southern Insurance Company
5525 LBJ Freeway
Dallas TX 75240 Athens MPN Insurer 9/29/2010 www.medexhco.com W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
161
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1797
Southern Insurance Company
5525 LBJ Freeway
Dallas TX 75240 CorVel MPN Insurer 3/10/2011 W
1825
Southern Insurance Company
5525 LBJ Freeway
Dallas TX 75240
Southern Insurance Company GBMCS
MPN Insurer 5/3/2011 T
1929
Southern Insurance Company
5525 LBJ Freeway
Dallas TX 75240
Southern Insurance Company/US
Administrator Claims/First Health
Select Insurer 5/15/2012 T
1930
Southern Insurance Company
5525 LBJ Freeway
Dallas TX 75240
Southern Insurance Company/US
Administrator Claims/First Health
Primary Insurer 5/15/2012 T
2260
Southern Insurance Company
P O Box 809076
Dallas TX 75380 The Rising MPN Insurer 1/9/2014 http://midwest.risingms.com/ T
2224
Southern Insurance Company
P.O. Box 809076
Dallas TX 75380 The Rising Medical Solutions MPN Insurer 12/20/2013 T
1396
Southern Insurance Company
P.O. Box 809076
Dallas TX 75380-0976 Rising MPN Insurer 9/11/2008 https://www.markelfirstcomp.com/injured-workers T
0964
Southwest Gas Corporation
PO Box 98510
Las Vegas NV 89193 TRISTAR MPN
Self-Insured
Employer 9/30/2005 T
0199
Southwestern Community College District
900 Otay Lakes Road
Chula Vista CA 91910 Prime Advantage Medical Network
Self-Insured
Employer 3/2/2005 T
2384
Space Exploration Technologies Corp.
1 Rocket Road
Hawthorne CA 90250 CorVel MPN
Self-Insured
Employer 4/23/2015 www.corvel.com
1786
Sparta American Insurance Company
185 Asylum St - City Plaza II
Hartford CT 06103 Wellcomp Medical Provider Network Insurer 2/24/2011 T
1787
Sparta American Insurance Company
185 Asylum St - City Plaza II
Hartford CT 06103 Wellcomp Medical Provider Network Insurer 5/24/2011 T
1765
SPARTA American Insurance Company
City Place II 185 Asylum St
Hartford CT 06103 Sedgwick CMS MPN Insurer 2/2/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
162
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1749
SPARTA American Insurance Company
City Place II 185 Asylum St.
Hartford CT 06103
MedInsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 1/12/2011 T
1755
SPARTA American Insurance Company
City Place II
185 Asylum St.
Hartford CT 06103 CorVel MPN Insurer 1/12/2011 T
1752
SPARTA American Insurance Company
City Place II, 185 Asylum St.
Hartford CT 06103
SPARTA American/Gallagher
Bassett/First Health MPN Insurer 1/12/2011 T
1754
SPARTA American Insurance Company
City Place II, 185 Asylum St.
Hartford CT 06103 SPARTA American GBMCS MPN Insurer 1/12/2011 T
1767
SPARTA American Insurance Company
City Place II, 185 Asylum St.
Hartford CT 06103 Sedgwick CMS Extended MPN Insurer 2/2/2011 T
1753
SPARTA American Insurance Company
City Place II, 185 Asylum St.
Hartford CT 06103
SPARTA American/Gallagher
Bassett/Coventry MPN Insurer 2/24/2011 T
1813
SPARTA American Insurance Company
City Place II, 185 Asylum Street
Hartford CT 06103 The ACM/SPARTA MPN Insurer 4/12/2011 http://mpn.acmclaims.com/sparta T
1527
Sparta Insurance Company
185 Asylum St City Plaza II
Hartford CT 06103 WellComp Medical Provider Network Insurer 5/8/2009 T
1488
Sparta Insurance Company
185 Asylum Street City Plaza II
Hartford CT 06103 WellComp Medical Provider Network Insurer 1/27/2009 T
1435
Sparta Insurance Company
185 Asylum Street
Philadelphia PA 19106 SPARTA GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn T
1599
Sparta Insurance Company
5 Batterson Park Rd, 3rd Floor
Farmington CT 06032 CorVel MPN Insurer 3/1/2010 www.corvel.com
1586
SPARTA Insurance Company
City Place II 185 Asylum St
Hartford CT 06103 Sedgwick CMS MPN Insurer 2/10/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
163
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1587
SPARTA Insurance Company
City Place II 185 Asylum St
Hartford CT 06103 Sedgwick CMS Extended MPN Insurer 2/10/2010 T
1341
SPARTA Insurance Company
City Place II, 185 Asylum Street
Hartford CT 06103
SPARTA Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 3/18/2008 T
1342
SPARTA Insurance Company
City Place II, 185 Asylum Street
Hartford CT 06103
SPARTA Insurance
Company/Gallagher Bassett/First Health
MPN Insurer 3/18/2008 T
1371
SPARTA Insurance Company
City Place II, 185 Asylum Street
Hartford CT 06103 Prudent Buyer HCO Insurer 9/19/2008 W
1814
SPARTA Insurance Company
City Place II, 185 Asylum Street
Hartford CT 06103 The ACM/SPARTA MPN Insurer 4/12/2011 http://mpn.acmclaims.com/sparta T
1601
Special District Risk Management Authority
1112 I St., Ste 300
Sacramento CA 95814 WellComp Medical Provider Network
Joint Powers
Authority 2/24/2010 T
0848
Special District Risk Management Authority
1112 I Street Suite 300
Sacramento CA 95814 Interplan/Kaiser MPN
Joint Powers
Authority 6/28/2005 T
0045
Springfield Insurance Company
874 S. Village Oaks Drive
Covina CA 91724 Unified Grocery Employers Insurer 1/11/2005 T
0588
SSA Containers, Inc.
1131 S.W. Klickitat Way
Seattle WA 98134 CorVel MPN
Self-Insured
Employer 3/24/2005 www.corvel.com
1040
St. Paul Fire and Casualty Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Fire and Casualty Insurance
Company, Crawford Primary Insurer 9/28/2005 W
1046
St. Paul Fire and Casualty Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Fire and Casualty Insurance
Company, Crawford Select Insurer 9/28/2005 W
0604
St. Paul Fire and Marine Insurance Co.
385 Washington St.
St. Paul MN 55102
The Hartford/SRS- First Health
CompAmerica SM Primary (or "First
Health Primary") Insurer 3/29/2005 T
1728
St. Paul Fire And Marine Insurance Company
1 Tower Square, Mail Stop 12
Hartford CT 06183 Broadspire Signature MPN Insurer 12/21/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
164
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0253
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102 FOCUS Astrasano HCO Insurer 3/17/2005 W
0601
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102
The Hartford/SRS- First Health
CompAmerica SM Select HCO
Network (or "First Health Select") Insurer 3/29/2005 W
0644
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102 Broadspire MPN Insurer 3/29/2005 T
1028
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Fire and Marine Cambridge
MPN Insurer 8/9/2005 T
1045
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Fire and Marine Insurance
Company, Crawford Select Insurer 9/28/2005 W
1047
St. Paul Fire and Marine Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Fire and Marine Insurance
Company, Crawford Primary Insurer 9/28/2005 W
0632
St. Paul Fire and Marine Insurance Company
387 Washington St.
St. Paul MN 55102 Travelers ESIS MPN Insurer 3/28/2005 T
0254
St. Paul Fire and Marine Insurance Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
1727
St. Paul Guardian Insurance Company
1 Tower Square, Mail Stop 12
Hartford CT 06183 Broadspire Signature MPN Insurer 12/21/2010 T
0602
St. Paul Guardian Insurance Company
385 Washington St.
St. Paul MN 55102
The Hartford/SRS- First Health
CompAmerica SM Select HCO
Network (or "First Health Select") Insurer 3/29/2005 T
0603
St. Paul Guardian Insurance Company
385 Washington St.
St. Paul MN 55102
The Hartford/SRS- First Health
CompAmerica SM Primary (or "First
Health Primary") Insurer 3/29/2005 T
0940
St. Paul Guardian Insurance Company
385 Washington St.
St. Paul MN 55102 Broadspire MPN Insurer 7/7/2005 T
1030
St. Paul Guardian Insurance Company
385 Washington St.
St. Paul MN 55102 St. Paul Guardian Cambridge MPN Insurer 8/9/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
165
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0622
St. Paul Guardian Insurance Company
386 Washington St.
St. Paul MN 55102 St. Paul Travelers ESIS MPN Insurer 3/28/2005 T
0256
St. Paul Guardian Insurance Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
0258
St. Paul Medical Liability Insurance Company
One Tower Square, MS05A
Hartford CT 06183 First Health CompAmerica Select Insurer 3/17/2005 W
0624
St. Paul Mercury Insurance Company
385 Washington St.
St. Paul MN 55102 St. Paul ESIS MPN Insurer 3/28/2005 T
1043
St. Paul Mercury Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Mercury Insurance Company,
Crawford Select Insurer 9/28/2005 W
1044
St. Paul Mercury Insurance Company
385 Washington St.
St. Paul MN 55102
St. Paul Mercury Insurance Company,
Crawford Primary Insurer 9/28/2005 W
0255
St. Paul Mercury Insurance Company
One Tower Sq, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
1041
St. Paul Property and Casualty Insurance
Company
385 Washington St.
St. Paul MN 55102
St. Paul Property and Casualty
Insurance Company, Crawford Select Insurer 9/28/2005 W
1042
St. Paul Property and Casualty Insurance
Company
385 Washington St.
St. Paul MN 55102
St. Paul Property and Casualty
Insurance Company, Crawford Primary Insurer 9/28/2005 W
0616
St. Paul Protective Insurance Company
385 Washington St.
St. Paul MN 55102 St. Paul Travelers Network Insurer 4/8/2005 T
0263
St. Paul Protective Insurance Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
0347
Stanley Works
1000 Stanley Drive
New Britain CT 06053
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 3/8/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
166
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0561
Star Insurance Company
26255 American Drive
Southfield MI 48034 Star/Gallagher Bassett/Coventry MPN Insurer 3/24/2005 T
1538
Star Insurance Company
P.O. Box 2054
Southfield MI 48037 Rising Interplan MPN Insurer 7/28/2009 T
1848
Star Insurance Company
PO Box 2054
Southfield MI 48037
Star Insurance Co. - Harbor-
HealthSmart MPN Insurer 6/17/2011 www.harborsys.com/meadowbrook T
2159
Star Transport L.L.C.
9500 S. De Wolfe
Selma CA 93622 Risico TMC Star Transport MPN
Self-Insured
Employer 5/6/2013 http://www.risico.com
2087
StarNet Insurance Company
9797 Aero Drive, Suite 200
San Diego CA 92123 Preferred Select MPN Insurer 1/10/2013 www.peiwc.com
1921
Starr Indemnity & Liability Company
399 Park Ave
New York NY 10022 STARR INDEMNITY/GBMCS Insurer 5/2/2012 T
3009
Starr Indemnity & Liability Company
399 Park Ave.
New York NY 10022 CorVel MPN Insurer 1/9/2017 www.corvel.com
2049
Starr Indemnity & Liability Company
399 Park Ave., 8th Floor
New York NY 10022 WellComp Medical Provider Network Insurer 9/14/2012 T
2280
Starr Indemnity & Liability Company
399 Park Avenue, 8th floor
New York NY 10022 Sedgwick/Harbor MPN Insurer 1/30/2014 www.harborsys.com/Sedgwick T
2281
Starr Indemnity & Liability Company
399 Park Avenue, 8th Floor
New York NY 10022 Sedgwick/Harbor 2 MPN Insurer 1/30/2014 www.harborsys.com/Sedgwick2 T
2178
Starr Indemnity and Liability Company
399 Park Avenue 24th Floor
New York NY 10022 Broadspire Signature MPN Insurer 6/18/2013 T
2288
Starstone National Insurance Company
Harborside Financial Ctr, Plaza 5 Ste. 2600
Jersey City NJ 07311 Starstone MPN Insurer 5/13/2014 www.paladinmc.com
0104
State Compensation Insurance Fund
333 Bush St., 8th Floor
San Francisco CA 94104 State Fund Medical Provider Network Insurer 1/20/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
167
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0612
State Compensation Insurance Fund
333 Bush St., 8th Floor
San Francisco CA 94104 State Fund Medical Provider Network State 6/9/2005 T
2133
State National Insurance Company, Inc
1900 L. Don Dodson Drive
Bedford TX 76021
WellComp Medical Provider Network
(SNIC/Plymouth MPN) Insurer 3/29/2013 T
1927
State National Insurance Company, Inc.
1900 L Don Dodson Drive
Bedford TX 76021
SNIC/US Administrator Claims/First
Health Select Insurer 5/31/2012
www.usadminclaims.com/workers-
compensation.aspx
1931
State National Insurance Company, Inc.
1900 L Don Dodson Drive
Bedford TX 76021
SNIC/US Administrator Claims/First
Health Primary Insurer 5/31/2012 T
3011
State National Insurance Company, Inc.
1900 L. Dodson Drive
Bedford TX 76021
State National Insurance Company
GBMCS KOJ MPN Insurer 2/23/2017 http://www.talispoint.com/cvty/gbkoj
0325
State Of California
1515 S Street, North Building Suite 400
Sacramento CA 95811 State Fund Medical Provider Network State 8/29/2005 T
0436
Steadfast Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0835
Steadfast Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 5/31/2005 T
0813
Stockton Unified School District
55 South Madison Street
Stockton CA 95203 San Joaquin MPN
Self-Insured
Employer 6/28/2005 T
2204
Stonington Insurance Company
5801 Tennyson Pkwy, Ste. 600
Plano TX 75024 CorVel MPN Insurer 7/15/2013 T
1957
Stonington Insurance Company
5801 Tennyson Parkway, Ste. 600
Plano TX 75024
Stonington Insurance Company
GBMCS MPN Insurer 5/2/2012 T
2145
Stonington Insurance Company
5801 Tennyson Parkway, Suite 600
Plano TX 75024 Sedgwick CMS Extended MPN Insurer 3/29/2013 T
2162
Stonington Insurance Company
5801 Tennyson Parkway, Suite 600
Plano TX 75024 Sedgwick/ Harbor MPN Insurer 5/6/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
168
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2163
Stonington Insurance Company
5801 Tennyson Parkway, Suite 600
Plano TX 75024 Sedgwick/Harbor 2 MPN Insurer 5/10/2013 T
1562
Sulphur Springs Union School District
27000 Weyerhaeuser Way
Canyon Country CA 91351
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/13/2009 T
1331
Sun Valley Group
3160 Upper Bay Road
Arcata CA 95521 WellComp Medical Provider Network
Self-Insured
Employer 12/28/2007 T
0880
Sunline Transit Agency
32-505 Harry Oliver Trail
Thousand Palms CA 92276 TRISTAR-CompAmerica Primary HCO
Joint Powers
Authority 5/3/2005 T
0884
Superior Ready Mix Concrete, L.P.
1508 W. Mission Road
Escondido CA 92029 Tristar MPN
Self-Insured
Employer 5/3/2005 T
1611
Sussex Insurance Company
221 Dawson Road
Columbia SC 29223 Sussex MPN Insurer 3/25/2010 www.talispoint.com/intermed/sussexmpn
2010
Sutter Central Valley Hospitals
1800 Coffee Rd. Suite 116
Modesto CA 95355
Self-Insured
Employer 6/7/2012 T
0693
Sutter Tracy Community Hospital (STCH)
1420 N. Tracy Blvd.
Tracy CA 95376 Medical Partners @ Work (MPN)
Self-Insured
Employer 6/6/2005 W
3070
Swift Transportation Co. Of Arizona, LLC
2200 S 75th Avenue
Phoenix AZ 85043 CorVel MPN
Self-Insured
Employer 12/1/2017 www.corvel.com
3071
Swift Transportation Services, LLC
2200 S 75th Avenue
Phoenix AZ 85043 CorVel MPN
Self-Insured
Employer 12/1/2017 www.corvel.com
0957
T&R Painting and Drywall
7116 Valjean Ave.
Van Nuys CA 91406 CorVel MPN
Self-Insured
Employer 7/11/2005 T
0582
Target Corporation
1000 Nicollet Mall, TPN 1301
Minneapolis MN 55403 Target Medical Provider Network
Self-Insured
Employer 5/11/2005 T
1537
Target Corporation
1000 Nicollet Mall, TPN 1301
Minneapolis MN 55403 Sedgwick CMS/Harbor Net-Target
Self-Insured
Employer 6/16/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
169
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0775
Tarzana Treatment Centers, Inc.
18646 Oxnard St
Tarzana CA 91356 Tarzana/Concentra MPN
Self-Insured
Employer 5/12/2005 W
1840
Technology Insurance Company, Inc
59 Maiden Lane, 6th Floor
New York NY 10038 Medex MPN Insurer 6/1/2011 T
2132
Technology Insurance Company, Inc
98 Spit Brook Road, Suite #402
Nashua NH 03062
Sedgwick CMS Medical Provider
Network Insurer 4/18/2013 T
2320
Teichert Land Co.
3500 American River Dr.
Sacramento CA 95851 WellComp Medical Provider Network
Self-Insured
Employer 7/22/2014 www.WellComp.com T
2326
Teichert Pipelines, Inc.
3500 American River Dr
Sacramento CA 95851 WellComp Medical Provider Network
Self-Insured
Employer 7/22/2014 www.WellComp.com T
2321
Teichert, Inc.
3500 American River Dr.
Sacramento CA 95851 WellComp Medical Provider Network
Self-Insured
Employer 7/22/2014 www.WellComp.com T
2033
Temecula Valley Unified School District
31350 Rancho Vista Rd.
Temecula CA 92592 Athens MPN
Self-Insured
Employer 9/25/2012 T
0545
Tenet Healthcare Corporation
13737 Noel Road Ste 100
Dallas TX 75240
First Health CompAmerica Primary
HCO Network (or "First Health
Primary")
Self-Insured
Employer 3/22/2005 T
2150
Tenet Healthcare Corporation
1445 Ross Ave., Suite 1400
Dallas TX 75202 Sedgwick/Harbor MPN - Tenet
Self-Insured
Employer 4/4/2013 T
1675
Textron Inc.
40 Westminster St, 14th Floor
Providence RI 02903 Broadspire Signature MPN
Self-Insured
Employer 8/10/2010 T
0192
Textron, Inc.
40 Westminster 21st Floor
Providence RI 02903 Broadspire MPN
Self-Insured
Employer 6/30/2005 T
1123
The 99 Cents Only Stores
4000 E. Union Pacific Ave.
City of Commerce CA 90025 The 99 Cents Only Stores MPN
Self-Insured
Employer 2/24/2006 T
0276
The American Insurance Company
33 W. Monroe Street, Ste 1100
Chicago IL 60603
The American Insurance Company
ESIS MPN Insurer 2/1/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
170
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0618
The American Insurance Company
777 San Marin Dr.
Novato CA 94998 First Health Select Insurer 2/14/2005 www.agcs.allianz.com/usclaims
1428
The American Insurance Company
777 San Marin Drive
Novato CA 94998 Sedgwick CMS MPN Insurer 11/10/2008 T
1429
The American Insurance Company
777 San Marin Drive
Novato CA 94998 Sedgwick CMS Extended MPN Insurer 11/10/2008 T
1642
The American National Red Cross
2025 E. St. NW-RiskMgmt 3rd Flr
Washington DC 20006 Sedgwick CMS MPN
Self-Insured
Employer 6/1/2010 T
0698
The American Red Cross
2025 E. St, NW, Risk Management Div., 7th Fl.
Washington DC 20006 CA Red Cross MPN
Self-Insured
Employer 4/19/2005 T
1271
The Cities Group
P.O. Box 111
Burlingame CA 94011 The Cities Group
Joint Powers
Authority 3/21/2007 W
1070
The Cities Group
PO Box 111
Burlingame CA 94011
The Cities Group Medical Provider
Network
Joint Powers
Authority 8/23/2005 W
1231
The City of Redding
777 Cypress Ave
Redding CA 96001 City of Redding/CorVel MPN
Self-Insured
Employer 8/29/2006 W
1769
The Continental Insurance Company
333 South Wabash Avenue
Chicago IL 60604 Broadspire Signature MPN Insurer 2/2/2011 T
0096
The County of Fresno
2220 Tulare Street, 21st Floor
Fresno CA 93721 Status MPN - County of Fresno
Self-Insured
Employer 3/1/2005 W
0025
The County of Riverside
PO Box 1120
Riverside CA 92502 First Health Comp America Select
Self-Insured
Employer 3/7/2005 T
1803
The Dentists Insurance Company
1201 K Street, 17th Floor
Sacramento CA 95814 Sedgwick CMS Extended MPN Insurer 3/15/2011 T
3046
The Eggo Company
One Kellogg Square
Battle Creek MI 49017 CorVel MPN
Self-Insured
Employer 8/25/2017 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
171
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0048
The Explorer Insurance Company
11455 El Camino Real
San Diego CA 92130 Medex MPN Insurer 12/3/2004 T
1981
The Explorer Insurance Company
11455 El Camino Real
San Diego CA 91230 ICW Group Premier MPN Insurer 5/25/2012 T
0087
The First Liberty Insurance Corporation
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
1820
The Hanover American Insurance Company
440 Lincoln Street
Worcester MA 01615 CorVel/Kaiser Select MPN Insurer 4/22/2011 www.Corvel.com
1816
The Hanover Insurance Company
440 Lincoln St
Worcester MA 01615 CorVel/Kaiser Select MPN Insurer 4/22/2011 www.corvel.com
1588
The Hanover Insurance Company
440 Lincoln St.
Worcester MA 01615 First Health Select MPN Insurer 1/20/2010 T
1785
The Harker School
3800 Blackford Ave.
San Jose CA 95117 WellComp Medical Provider Network
Self-Insured
Employer 2/24/2011 www.wellcomp.com
0028
The Herrick Corporation
3003 E. Hammer Lane
Stockton CA 95212 First Health CompAmerica Select HCO
Self-Insured
Employer 3/24/2005 T
1343
The Hershey Company
100 Crystal A Drive
Hershey PA 17033 Sedgwick CMS CA MPN
Self-Insured
Employer 1/18/2008 T
0978
The HON Company
2323 E. Firestone Blvd.
South Gate CA 90280 Interplan through CompPartners
Self-Insured
Employer 7/20/2005 T
1378
The HON Company
2323 East Firestone Blvd.
South Gate CA 90028
First Health CompAmerica Primary
HCO Network
Self-Insured
Employer 5/13/2008 W
1417
The Hon Company
408 East Second Street
Muscatine IA 52761
First Health CompAmerica Select HCO
Network
Self-Insured
Employer 10/8/2008 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
172
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0629
The Insurance Company of the State of
Pennsylvania
175 Water St - 18th Flr.
New York NY 10038
Ins Co of ST of PA/Longs Drug
Stores/Bunch MPN Insurer 7/19/2005 T
1959
The Insurance Company of the State of
Pennsylvania
175 Water St - 18th Flr.
New York NY 10038 Liberty Mutual Group MPN Insurer 5/16/2012 T
1641
The Insurance Company Of The State Of
Pennsylvania
175 Water St 18th Flr
New York NY 10038 Broadspire Signature MPN Insurer 5/26/2010 www.broadspireppo.com T
0580
The Insurance Company of the State of
Pennsylvania
175 Water St
New York NY 10038 Chartis-Cambridge MPN Insurer 3/24/2005 W
1761
The Insurance Company Of The State Of
Pennsylvania
175 Water St., 18th Floor
New York NY 10038 AIG Select MPN Insurer 1/19/2011 www.talispoint.com/aig/mpnselect
0118
The Insurance Company Of The State Of
Pennsylvania
175 Water Street - 18th Floor
New York NY 10038 AIG Primary MPN Insurer 2/17/2005 www.talispoint.com/aig/com
0654
The Insurance Company of the State of
Pennsylvania
175 Water Street 18th Floor
New York NY 10038
The Insurance Company of the State of
Pennsylvania/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 www.talispoint.com/cvty/gbcvtympn T
0365
The Insurance Company of the State of
Pennsylvania
175 Water Street - 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/28/2005 T
0369
The Insurance Company of the State of
Pennsylvania
175 Water Street - 18th Floor
New York NY 10038
Sedgwick First Health CompAmerica
Primary HCO Network Insurer 3/28/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
173
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0617
The Insurance Company of the State of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038 AIG ESIS MPN Insurer 3/28/2005 T
0522
The Insurance Company of the State of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038 TCT CA MPN Insurer 4/12/2005 www.mywcinfo.com T
0761
The Insurance Company Of The State Of
Pennsylvania
175 Water Street 18th Fl
New York NY 10038
The Insurance Company Of The State
Of Pennsylvania/Gallagher
Bassett/CorVel MPN Insurer 5/5/2005 www.corvel.com
1022
The Insurance Company of the State of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038
The Insurance Company of the State of
Pennsylvania/Gallagher Bassett/First
Health MPN Insurer 8/5/2005 www.talispoint.com/cvty/gbfhmpnselect T
0869
The Insurance Company Of The State Of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038 Chartis/Northrop Grumman MPN Insurer 9/23/2005 www.talispoint.com/chartis/norgr
1318
The Insurance Company of the State of
Pennsylvania
175 Water Street, 17th Floor
New York NY 10038 Medex B Insurer 9/6/2007 T
1319
The Insurance Company of the State of
Pennsylvania
175 Water Street, 17th Floor
New York NY 10038 Medex MPN Insurer 9/6/2007 T
1403
The Insurance Company Of The State Of
Pennsylvania
175 Water Street - 18th Floor
New York NY 10038 CorVel MPN Insurer 8/6/2008 www.corvel.com
1492
The Insurance Company of the State of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038 Wellcomp Medical Provider Network Insurer 1/30/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
174
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1519
The Insurance Company of the State of
Pennsylvania
175 Water Street 18th Floor
New York NY 10038 Walmart-Medex ISOP MPN Insurer 4/1/2009 www.medexhco.com
1451
The Insurance Company of the State of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038
The Insurance Company of the State of
Pennsylvania GBMCS MPN Insurer 5/7/2009 www.talispoint.com/cvty/gbmpn T
1977
The Insurance Company of the State of
Pennsylvania
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor MPN Insurer 5/25/2012 T
1985
The Insurance Company of the State of
Pennsylvania
175 Water Street – 18th Floor
New York NY 10038 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
2347
The Insurance Company Of The State Of
Pennsylvania
175 Water Street -18th Floor
New York NY 10038 Deseret Signature MPN
Entity that
provides
physician
network
services 9/25/2014 www.deseretsignaturempn.com
2418
The Insurance Company Of The State Of
Pennsylvania
175 Water Street, 18th Floor
New York NY 10038 Chartis/EP MPN Insurer 10/30/2015 www.talispoint.com/aig/EP
1298
The Insurance Company of the State of
Pennsylvania
300 S. Riverside Plaza
Chicago IL 60606 Medex Insurer 7/9/2007 W
1425
The Insurance Company of the State of
Pennsylvania
70 Pine St
New York NY 10270
CCMSI/ AIG/ First Health Comp
America Select HCO Network Insurer 1/7/2009 T
0504
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270
Sedgwick CMS Extended Medical
Provider Network Insurer 3/10/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
175
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0494
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270
Sedgwick CMS Medical Provider
Network Insurer 3/16/2005 T
0468
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270 Broadspire MPN Insurer 4/26/2005 T
0917
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270
Medinsights Medical Provider Network
accessing Prudent Buyer PPO Insurer 5/19/2005 T
0613
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270 INTRACORP-Gates McDonald MPN Insurer 6/2/2005 T
0863
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270
The Insurance Company of the State of
Pennsylvania, Crawford Select Insurer 10/5/2005 W
1524
The Insurance Company of the State of
Pennsylvania
70 Pine Street
New York NY 10270 Athens/Insurance Co. of PA MPN Insurer 5/6/2009 T
0395
The Insurance Company of the State of
Pennsylvania
80 Pine Street, 10th Floor
New York NY 10005 ESIS INTRACORP Insurer 4/29/2005 T
0853
The Insurance Company of the State of
Pennsylvania
AIG 70 Pine Street
New York NY 10270
The Insurance Company of the State of
Pennsylvania-Crawford Primary Insurer 7/1/2005 W
2333
The Kroger Co.
1014 Vine Street
Cincinnati OH 45202 Sedgwick/Harbor MPN - Kroger
Self-Insured
Employer 9/5/2014 www.harborsys.com/kroger
1534
The Kroger Co.
P.O. Box 54143
Los Angeles CA 90054 CorVel/Kroger Select MPN
Self-Insured
Employer 6/29/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
176
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0286
The Kroger Company
PO Box 54143
Los Angeles CA 90054 CorVel MPN/Kroger
Self-Insured
Employer 2/18/2005 T
1556
The Netherlands Insurance Company
62 Maple Ave
Keene NH 03431 Liberty Mutual Group MPN Insurer 6/29/2009 T
1210
The North River Insurance Company
110 William Street
New York NY 10038 Medex Insurer 6/12/2006 www.medexhco.com
2240
The North River Insurance Company
1100 Town And Country Road, Ste. 550
Orange CA 92868 Broadspire Signature MPN Insurer 11/19/2013 T
2250
The North River Insurance Company
305 Madison Ave
Morristown NJ 07962 Crum & Forster Primary MPN Insurer 12/6/2013 T
2253
The North River Insurance Company
305 Madison Ave
Morristown NJ 07962 Crum & Forster Select MPN Insurer 12/6/2013 T
1310
The North River Insurance Company
305 Madison Ave. P.O. Box 1973
Morristown NJ 07962 PRIME Advantage MPN for HealthCare Insurer 8/6/2007 T
1214
The North River Insurance Company
305 Madison Ave.
Morristown NJ 07962
GENEX HCO/First Health Comp
America HCO Select Network Insurer 6/22/2006 T
0122
The North River Insurance Company
305 Madison Avenue
Morristown NJ 07962 Crum&Forster-Concentra MPN Insurer 12/20/2004 T
0993
The North River Insurance Company
305 Madison Avenue
Morristown NJ 07962 Concentra Broad Based Insurer 7/25/2005 T
1217
The North River Insurance Company
305 Madison Avenue
Morristown NJ 07962 GENEX/Interplan MPN Insurer 6/19/2006 T
1529
The North River Insurance Company
305 Madison Avenue
Morristown NJ 07962
First Health CompAmerica HCO
Primary Network Insurer 5/12/2009 T
2368
The North River Insurance Company
305 Madison Avenue
Morristown NJ 07962 CorVel/C&F Select MPN Insurer 4/2/2015 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
177
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3080
The Pep Boys Manny Moe & Jack Of California
3111 West Allegheny Avenue
Philadelphia PA 19132 CorVel MPN
Self-Insured
Employer 12/14/2017 www.corvel.com
1713
The Pep Boys Manny Moe and Jack of California
3111 W. Allegheny Ave.
Philadelphia PA 19132 TCT CA MPN
Self-Insured
Employer 11/10/2010 www.mywcinfo.com
1272
The Pictsweet Company
10 Pictsweet Drive
Bells TN 38006 Liberty Mutual Group MPN
Self-Insured
Employer 2/5/2007 T
2081
The Procter & Gamble Paper Products Company
6300 Center Hill Rd.
Cincinnati OH 45224 Sedgwick/Harbor 2 MPN
Self-Insured
Employer 11/15/2012 W
2199
The Procter & Gamble Paper Products Company
6300 Center Hill Rd.
Cincinnati OH 45224 Sedgwick/ Harbor MPN - PG
Self-Insured
Employer 7/9/2013 T
2198
The Procter and Gamble Manufacturing Company
6300 Center Hill Rd.
Cincinnati OH 45224 Sedgwick/ Harbor MPN- PG
Self-Insured
Employer 7/9/2013 T
0874
The Roman Catholic Bishop of San Diego (a sole
corporation)
3888 Paducah Drive
San Diego CA 92117 Tristar MPN
Self-Insured
Employer 5/3/2005 T
0513
The Salvation Army
180 E. Ocean Blvd.
Long Beach CA 90802 Red Shield MPN
Self-Insured
Employer 5/9/2005 T
0242
The Standard Fire Insurance Company (FH)
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0241
The Standard Fire Insurance Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
0257
The Travelers Casualty Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/17/2005 www.mywcinfo.com T
3081
The Travelers Indemnity Company Of Connecticut
One Tower Square Main South, 12
Hartford CT 06183 CorVel MPN Insurer 1/9/2018 www.corvel.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
178
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0234
The Travelers Indemnity Company of Connecticut
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0233
The Travelers Indemnity Company of Connecticut
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
2493
The Travelers Indemnity Company
One Tower Square, GS02A
Hartford CT 06183 TravNet MPN
Entity that
provides
physician
network
services 7/26/2016 www.mywcinfo.com
2443
The Travelers Indemnity Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 4/25/2016 www.mywcinfo.com T
0815
The Walt Disney Company
500 South Buena Vista St.
Burbank CA 91521 The Liberty Mutual Group MPN
Self-Insured
Employer 10/21/2005 T
2449
The Zurich Services Corporation
1299 Zurich Way
Schaumburg IL 60196 ZSC Select MPN
Entity that
provides
physician
network
services 3/10/2016 www.zurichna.com
0544
Thomson, Inc.
10330 N. Meridian Street INH 330
Indianapolis IN 46290
First Health CompAmerica Select HCO
Network (or "First Health Select")
Self-Insured
Employer 3/22/2005 R
0699
Thor Industries West, Inc.
419 W. Pike Street
Jackson Center OH 45334 Thor Industries West, Inc. MPN
Self-Insured
Employer 5/20/2005 T
1236
TIMEC Holdings Inc.
2751 E. El Presidio St.
Carson CA 90810 Liberty Mutual Group MPN
Self-Insured
Employer 9/18/2006 W
1953
TNUS Insurance Company
230 Park Ave
New York NY 10169 Coventry MPN Insurer 5/2/2012 T
1954
TNUS Insurance Company
290 Park Ave.
New York NY 10169 First Health CompAmerica Select HCO Insurer 5/2/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
179
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1955
TNUS Insurance Company
499 Washington Blvd. Suite 1500
Jersey City NJ 07310 Primary MPN Insurer 5/2/2012 www.coventrywcs.com
1966
TNUS Insurance Company
800 East Colorado Blvd., Ste. 600
Pasadena CA 91101 Medex MPN Insurer 5/16/2012 T
1461
Tokio Marine & Nichido Fire Insurance Co Ltd
230 Park Ave
New York NY 10169 Sedgwick CMS MPN Insurer 11/10/2008 T
1781
Tokio Marine & Nichido Fire Insurance Co., LTD
230 Park Ave.
New York NY 10169 TMNF-ESIS MPN Insurer 2/10/2011 T
1463
Tokio Marine & Nichido Fire Insurance Co., Ltd.
230 Park Ave
New York NY 10169 Sedgwick CMS Extended MPN Insurer 11/10/2008 T
1948
Tokio Marine & Nichido Fire Insurance Co., Ltd.
230 Park Ave
New York NY 10169 Coventry MPN Insurer 5/2/2012 T
0773
Tokio Marine & Nichido Fire Insurance Co., Ltd.
230 Park Avenue
New York NY 10169
First Health Comp America Primary
HCO Network Insurer 4/28/2005 W
0774
Tokio Marine & Nichido Fire Insurance Co., Ltd.
230 Park Avenue
New York NY 10169
Sedgwick First Health Comp America
Select HCO Network Insurer 4/28/2005 T
0170
Tokio Marine & Nichido Fire Insurance Co., Ltd.
230 Park Avenue
New York NY 10169
First Health CompAmerica Select HCO
Network Insurer 9/23/2005 T
1949
Tokio Marine & Nichido Fire Insurance Co., Ltd.
290 Park Ave.
New York NY 10010 Primary MPN Insurer 5/2/2012 T
0333
Tokio Marine & Nichido Fire Insurance Co., Ltd.
800 East Colorado Blvd., Ste 600
Pasadena CA 91101 Medex Insurer 2/12/2005 T
1301
Tokio Marine & Nichido Fire Insurance Co., Ltd.
8000 East Colorado Blvd., Ste 600
Pasadena CA 91101 Medex Insurer 7/9/2007 T
2272
Tokio Marine America Insurance Company
230 Park Ave
New York NY 10169
Sedgwick First Health Comp America
Select HCO Network Insurer 1/9/2014 www.talispoint.com/srs/login T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
180
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2269
Tokio Marine America Insurance Company
230 Park Ave
New York NY 10169 Coventry MPN Insurer 1/10/2014 www.coventrywcs.com T
2270
Tokio Marine America Insurance Company
230 Park Ave
New York NY 10169
First Health CompAmerica Select HCO
Network Insurer 1/10/2014 www.coventrywcs.com T
2273
Tokio Marine America Insurance Company
230 Park Ave
New York NY 10169 Sedgwick CMS Extended MPN Insurer 1/10/2014 www.coventrywcs.com T
2277
Tokio Marine America Insurance Company
230 Park Ave
New York NY 10169 TMAIC ESIS MPN Insurer 1/22/2014 http://www.esis.com/awcmpn T
2276
Tokio Marine America Insurance Company
230 Park Avenue
New York NY 10169 Medex MPN Insurer 1/10/2014 T
2271
Tokio Marine America Insurance Company
499 Washington Blvd. Suite 1500
Jersey City NJ 07310 Primary MPN Insurer 1/10/2014 www.coventrywcs.com
0697
Topa Insurance Company
PO Box 67810
Los Angeles CA 90067
Topa Insurance Company/GENEX
MPN Insurer 5/17/2005 www.genexservices.com
1067
Torrance Health Associates, Inc.
3330 Lomita Blvd.
Torrance CA 90505
PRIME Advantage Medical Network
for HealthCare Medical Provider
Network, accessing selected physicians
Blue Cross of California Prudent Buyer
PPO
Self-Insured
Employer 8/12/2005 W
0277
Torrance Unified School District
2335 Plaza Del Amo
Torrance CA 90509 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
1384
Tower Energy Group
1983 West 190th Street
Torrance CA 90504 CorVel MPN
Self-Insured
Employer 6/24/2008 http://www.corvel.com/ T
1827
Tower Insurance Company of New York (DBA -
Tower Select Insurance Company)
120 Broadway 31st Floor
New York NY 10271 ACM/Tower MPN Insurer 5/3/2011 http://mpn.acmclaims.com/zurich/ T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
181
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1393
Tower Insurance Company of New York dba
Tower Select Insurance Company
777 E. Tahquitz Canyon Way Suite 200-27
Palm Springs CA 92262 WellComp MPN Insurer 7/24/2008 T
1499
Tower Insurance Company of New York dba
Tower Select Insurance Company
777 E. Tahquitz Canyon Way
Palm Springs CA 92262 Tower Care MPN Insurer 4/3/2009 T
1333
Tower Insurance Company of New York
120 Broadway, 31st Floor
New York NY 10271 Rising Interplan MPN Insurer 12/28/2007 T
1630
Tower Select Insurance Company
120 Broadway, 31st Floor
New York NY 10271 Tower Group Companies MPN Insurer 5/20/2010 T
1951
Trans Pacific Insurance Company
230 Park Ave.
New York NY 10169 Coventry MPN Insurer 5/2/2012 T
1952
Trans Pacific Insurance Company
230 Park Ave.
New York NY 10169 First Health CompAmerica Select HCO Insurer 5/2/2012 T
0771
Trans Pacific Insurance Company
230 Park Avenue
New York NY 10169
First Health CompAmerica Primary
HCO Network Insurer 4/28/2005 W
0772
Trans Pacific Insurance Company
230 Park Avenue
New York NY 10169
First Health Comp America Select HCO
Network Insurer 4/28/2005 W
1950
Trans Pacific Insurance Company
499 Washington Blvd. Suite 1599
Bew Herset NJ 07310 Primary MPN Insurer 5/2/2012 www.coventrywcs.com
1967
Trans Pacific Insurance Company
800 East Colorado Blvd., Ste. 600
Pasadena CA 91101 Medex MPN Insurer 5/16/2012 T
1771
Transportation Insurance Company
333 South Wabash Avenue
Chicago IL 60604 Broadspire Signature MPN Insurer 2/2/2011 T
0248
Travelers Casualty & Surety Company of America
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
182
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0240
Travelers Casualty & Surety Company
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0247
Travelers Casualty and Surety Company of
America
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
0239
Travelers Casualty and Surety Company
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
0252
Travelers Casualty Company of Connecticut
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0251
Travelers Casualty Company of Connecticut
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
2034
Travelers Casualty Insurance Company of
America
c/o Travelers National Accounts Unbundled, 5
Batterson Park Rd.
Farmington CT 06032
WellComp Medical Provider Network -
(TRV-NAU-York) Insurer 8/30/2012 T
0244
Travelers Casualty Insurance Company of
America
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 T
0243
Travelers Casualty Insurance Company of
America
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
0249
Travelers Commercial Insurance Company
One Tower Square
Hartford CT 06183 First Health CompAmerica Select Insurer 3/2/2005 W
0250
Travelers Commercial Insurance Company
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 W
1794
Travelers Property Casualty Company of America
5 Batterson Park Rd
Farmington CT 06032
Travelers Property Casualty Company
of America/Gallagher Bassett/First
Health MPN Insurer 3/10/2011 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
183
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1793
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032
Travelers Property Casualty Company
of America/Gallagher Bassett/Coventry
MPN Insurer 3/15/2011 T
1868
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032
Sedgwick CMS Medical Provider
Network Insurer 7/28/2011 T
1870
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032
Sedgwick CMS Extended Medical
Provider Network Insurer 8/4/2011 T
2109
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032
Sedgwick/Harbor MPN-Travelers
PCCA Express Insurer 1/15/2013 T
2121
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor MPN Insurer 1/31/2013 T
2122
Travelers Property Casualty Company of America
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor 2 MPN Insurer 2/1/2013 T
1783
Travelers Property Casualty Company of America
5 Batterson Park
Farmington CT 06032 Travelers/Bunch/Barnes Group MPN Insurer 2/10/2011 T
1828
Travelers Property Casualty Company of America
5 Batterson Park
Farmington CT 06032 Discover Re/TIL/ESIS MPN Insurer 5/3/2011 T
1859
Travelers Property Casualty Company of America
c/o Traveler's National Accounts Unbundled, 5
Batterson Park Rd.
Farmington CT 06032 Wellcomp Medical Provider Network Insurer 7/20/2011 T
1795
Travelers Property Casualty Company of America
One Tower Square MS-12
Hartford CT 06183
Travelers Property Casualty Company
of America GBMCS MPN Insurer 3/10/2011 T
1925
Travelers Property Casualty Company of America
One Tower Square MS-12
Hartford CT 06183
Sedgwick/Harbor MPN-Travelers NAU
UHG Insurer 3/20/2012 T
2442
Travelers Property Casualty Company of America
One Tower Square MS-12
Hartford CT 06183 MEDEX Advantage Plus Insurer 1/21/2016 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
184
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
3039
Travelers Property Casualty Company Of America
One Tower Square Main South, 12
Hartford CT 06183 CorVel/Express MPN Insurer 6/29/2017 www.corvel.com
0236
Travelers Property Casualty Company Of America
One Tower Square
Hartford CT 06183 CorVel CorCare Insurer 3/9/2005 www.corvel.com
0235
Travelers Property Casualty Company of America
One Tower Square, MS05A
Hartford CT 06183 TCT CA MPN Insurer 3/2/2005 www.mywcinfo.com T
1940
Travelers Property Casualty Company Of America
One Tower Square, Mail Stop 12
Hartford CT 06183 DRe TIL Broadspire Signature MPN Insurer 4/20/2012 T
2246
Travelers Property Casualty Company Of America
One Towers Square
Hartford CT 06183 Coventry Medical Provider Network Insurer 4/18/2014 www.talispoint.com/cvty/matrix
0879
Tri-city Healthcare District
4002 Vista Way
Oceanside CA 92056 TRISTAR MPN
Self-Insured
Employer 5/3/2005 W
2400
Trindel Insurance Fund
P.O.Box 2069
Weaverville CA 96093 EIA Medical Provider Network
Joint Powers
Authority 7/6/2015 www.eiampn.csac-eia.org
2398
TRINET GROUP, INC
1100 San Leandro Blvd., Ste. 400
San Leandro CA 94577 TRINET SOI MPN
Entity that
provides
physician
network
services 6/17/2016 https://www.risingms.com T
0110
Trinity Health Corporation
34605 W. Twelve Mile
Farmington Hills MI 48152
First Health CompAmerica Primary
HCO
Self-Insured
Employer 4/13/2005 T
2502
TRISTAR Managed Care, Inc.
P.O. Box 10220
Santa Ana CA 92711 TRISTAR PLUS MPN
Entity that
provides
physician
network
services 8/25/2016 www.tristarmanagedcare.com
0312
Truck Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Select HCO
Network (First Health Select Network) Insurer 3/9/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
185
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0320
Truck Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010
First Health CompAmerica Primary
HCO Network (First Health Primary
Network) Insurer 3/9/2005 T
1745
Truck Insurance Exchange
4680 Wilshire Blvd
Los Angeles CA 90010 Liberty Mutual Group MPN Insurer 6/16/2011 T
1595
Truck Insurance Exchange
6301 Owensmouth Ave.
Woodland Hills CA 91367 CorVel/Kaiser MPN Insurer 2/11/2010 www.corvel.com
2072
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Trumbull Insurance Company utilizing
First Health CompAmerica Primary
HCO Network Insurer 11/15/2012 T
2073
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Trumbull Insurance Company utilizing
First Health CompAmerica Select HCO
Network Insurer 11/15/2012 T
2074
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Trumbull Insurance Company accessing
Anthem Blue Cross Prudent Buyer PPO Insurer 11/15/2012 www.thehartford.com/ca-workers-compensation T
2155
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Trumbull Insurance Company GBMCS
MPN Insurer 5/6/2013 T
2218
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 9/3/2013 T
2219
Trumbull Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 9/3/2013 T
0203
Tulare County Schools Insurance Group Workers
Compensation JPA
2637 West Burrel
Visalia CA 93291 Prime Advantage Medical Network
Joint Powers
Authority 4/6/2005 T
1176
Turlock Irrigation District
333 East Canal Drive
Turlock CA 95380 Turlock Irrigation District MPN
Self-Insured
Employer 5/4/2006 secure.simon-companies.com/TID/
0713
Tustin Unified School District
300 South "C" Street
Tustin CA 92780 Prime Advantage Medical Network
Self-Insured
Employer 4/19/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
186
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1245
Twin City Fire Insurance Company
690 Asylum Ave
Hartford CT 06115
Frank Gates SVC Co/Hartford/Corvel
MPN Insurer 9/29/2006 W
0065
Twin City Fire Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Primary
HCO Network Insurer 1/12/2005 T
0066
Twin City Fire Insurance Company
690 Asylum Avenue
Hartford CT 06115
First Health CompAmerica Select HCO
Network Insurer 1/12/2005 T
1135
Twin City Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Twin City Fire Insurance Company
accessing Anthem Blue Cross Prudent
Buyer PPO Insurer 3/17/2006 www.thehartford.com/ca-workers-compensation T
1934
Twin City Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155
Sedgwick CMS Extended Medical
Provider Network Insurer 4/18/2012 T
1936
Twin City Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick CMS Insurer 4/18/2012 T
1972
Twin City Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor MPN Insurer 5/24/2012 T
1988
Twin City Fire Insurance Company
One Hartford Plaza (HO-1-09)
Hartford CT 06155 Sedgwick/Harbor 2 MPN Insurer 5/29/2012 T
1647
Twin City Fire Insurance Company
One Hartford Plaza [HO 1-09]
Hartford CT 06155 Athens MPN-TCFIC Insurer 6/10/2010 www.medexhco.com
1440
Twin City Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
Wellcomp Medical Provider Network-
York-TCFIC Insurer 1/20/2009 T
1609
Twin City Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
TCFIC Redwoods First Health
CompAmerica Insurer 3/17/2010 T
1636
Twin City Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155
RISICO TMC Twin City Fire Insurance
Company MPN Insurer 6/1/2010 www.risico.com
1634
Twin City Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 TCFIC/ESIS MPN Insurer 6/20/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
187
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1956
Twin City Fire Insurance Company
One Hartford Plaza [HO-1-09]
Hartford CT 06155 Twin City Fire GBMCS MPN Insurer 5/2/2012 T
1154
Twin City Fire Insurance Company
One Hartford Plaza
Hartford CT 06155
Twin City Fire./Gallagher
Bassett/Coventry MPN Insurer 3/20/2006 T
1853
Twin City Fire Insurance Company
One Hartford Plaza, HO-1-09
Hartford CT 06155 TCFIC/Broadspire Signature MPN Insurer 7/15/2011 T
1311
U.S. Fire Insurance Company
305 Madison Ave. P.O. Box 1973
Morristown NJ 07962 PRIME Advantage MPN Insurer 8/6/2007 T
1213
U.S. Fire Insurance Company
305 Madison Ave.
Morristown NJ 07962
GENEX HCO/First Health Comp
America HCO Select Network Insurer 6/22/2006 T
1772
U.S. Fire Insurance Company
305 Madison Ave.
Morristown NJ 07962 Broadspire Signature Network Insurer 2/2/2011 T
1216
U.S. Fire Insurance Company
305 Madison Avenue
Morristown NJ 07962 GENEX/Interplan MPN Insurer 6/19/2006 T
1528
U.S. Fire Insurance Company
305 Madison Avenue
Morristown NJ 07962
First Health CompAmerica HCO
Primary Network Insurer 5/12/2009 T
0660
U.S. Foodservice, Inc.
300 Lawrence Dr.
Livermore CA 94551 MedInsights/Prudent Buyer HCO
Self-Insured
Employer 4/1/2005 W
1315
Ulico Casualty Company
PO Box 5131
Chino CA 91708 Insurer 9/10/2007 T
1598
Ullico Casualty Company
1625 Eye St N.W.
Washington DC 20006 Athens MPN Insurer 1/25/2010 T
1922
Ullico Casualty Company
1625 Eye Street N.W.
Washington DC 20006 Medex MPN Insurer 3/15/2012 T
1575
Ullico Casualty Company
1625 Eye Street, NW
Washington DC 20006
Patriot Risk Services-Ullico Casualty
MPN Insurer 2/17/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
188
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1379
ULLICO Casualty Company
c/o Delaware Ins Dept, 704 N. King St., Ste. 602,
Wilmington DE 19801
ULLICO/Gallagher Bassett/Coventry
MPN Insurer 8/5/2008 T
0050
United Airlines, Inc.
PO Box 66100
Chicago IL 60666 CorVel/UAL/Kaiser MPN
Self-Insured
Employer 2/2/2005 www.corvel.com T
0801
United Cerebral Palsy of Los Angeles and Ventura
Counties
1660 L St. NW Ste 700
Washington DC 20036 UCPLA Cambridge MPN
Self-Insured
Employer 5/16/2005 T
1866
United Cerebral Palsy/Spastic Children's
Foundation of Los Angeles and Ventura Counties
6430 Independence Avenue
Woodland Hills CA 91367
Sedgwick CMS Extended Medical
Provider Network
Self-Insured
Employer 8/4/2011 T
2242
United Cerebral Palsy/Spastic Children's
Foundation of Los Angeles and Ventura Counties
6430 Independence Avenue
Woodland Hills CA 91367 WellComp Medical Provider Network
Self-Insured
Employer 12/24/2013 T
2038
United Rentals (North America), Inc.
PO Box 4366
Modesto CA 95352 Liberty Mutual Group MPN
Self-Insured
Employer 8/2/2012 T
1498
United Rentals Inc.
P.O. Box 4366
Modesto CA 96352 United Rentals ESIS MPN
Self-Insured
Employer 2/26/2009 T
1681
United States Fidelity And Guaranty Company
1 Tower Square- MS 12
Hartford CT 06183 Broadspire Signature Network/USF&G Insurer 8/18/2010 T
0400
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Discover Re Cambridge MPN Insurer 2/24/2005 T
0500
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick CMS Extended MPN Insurer 3/10/2005 T
0489
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032
Sedgwick CMS Medical Provider
Network Insurer 3/15/2005 T
0425
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
189
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0553
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032
SRS First Health CompAmerica Select
HCO Network (or "SRS First Health
Select") Insurer 3/22/2005 W
0554
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032
SRS First Health CompAmerica
Primary HCO Network (or "SRS First
Health Primary") Insurer 3/22/2005 W
0594
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Discover Re/USF&G/GAB-MedInsights Insurer 3/22/2005 T
0442
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032
Frank Gates/DRE/First Health
CompAmerica Select HCO Network Insurer 5/11/2005 W
0809
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 CorVel MPN/USF&G/Frank Gates Insurer 5/18/2005 W
0829
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Intracorp - Dre GatesMcDonald MPN Insurer 6/2/2005 T
2113
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor MPN Insurer 2/1/2013 T
2114
United States Fidelity and Guaranty Company
5 Batterson Park Road
Farmington CT 06032 Sedgwick/Harbor 2 MPN Insurer 2/1/2013 T
0190
United States Fidelity and Guaranty Company
C/o Discover Re 5 Batterson Park Road
Farmington CT 06032 Discover Re ESIS MPN Insurer 2/2/2005 T
0878
United States Fidelity and Guaranty Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
First Health CompAmerica Primary
HCO Insurer 5/3/2005 W
0665
United States Fidelity and Guaranty company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
United States Fidelity and Guaranty
Company-Crawford Select Insurer 6/16/2005 W
0968
United States Fidelity and Guaranty Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
United States Fidelity and Guaranty
Company - Crawford Primary Insurer 6/16/2005 W
1082
United States Fidelity and Guaranty Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
First Health Network - DRe Matrix
MPN Insurer 12/7/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
190
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1367
United States Fidelity and Guaranty Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032
SCRMA-WellComp Medical Provider
Network Insurer 5/27/2008 W
1432
United States Fidelity and Guaranty Company
c/o Discover Re 5 Batterson Park Road
Farmington CT 06032 USF & G Company GBMCS MPN Insurer 5/7/2009 T
0291
United States Fidelity And Guaranty Company
C/o Discover Re, 5 Batterson Park Road
Farmington CT 06032 CorVel MPN/USF&G/ LWP Insurer 2/18/2005 www.corvel.com
0406
United States Fidelity And Guaranty Company
C/O The Travelers Companies, Inc. National
Accounts UnbundledOne Tower Square MS-12
Hartford CT 06183 CorVel MPN Insurer 2/28/2005 www.corvel.com
1386
United States Fidelity and Guaranty Company
c/o Traveler's National Accounts Unbundled, 5
Batterson Park Rd
Farmington CT 06032 Wellcomp Medical Provider Network Insurer 6/20/2008 T
0988
United States Fidelity and Guaranty Company
c/o Travelers National Accounts Unbundled One
Tower Square, 12-MS
Hartford CT 06183 Liberty Mutual Group MPN Insurer 7/28/2005 T
0515
United States Fidelity and Guaranty Company
One Tower Square MS-12
Hartford CT 06183
United States Fidelity and Guaranty
Company/Gallagher Bassett/Coventry
MPN Insurer 4/27/2005 T
0537
United States Fidelity and Guaranty Company
One Tower Square MS-12
Hartford CT 06183
United States Fidelity and Guaranty
Company/Gallagher Bassett/ First
Health MPN Insurer 5/13/2005 T
1626
United States Fire Insurance Company
305 Madison Ave
Morristown NJ 07962 Crum & Forster ESIS MPN Insurer 6/24/2010 T
2173
United States Fire Insurance Company
305 Madison Ave
Morristown NJ 07962 LWP Signature MPN Insurer 5/6/2013 http://www.lwpsignaturempn.com
2252
United States Fire Insurance Company
305 Madison Ave
Morristown NJ 07962 Crum & Forster Select MPN Insurer 12/6/2013 T
1212
United States Fire Insurance Company
305 Madison Ave.
Morrison NJ 07962 Medex Insurer 6/12/2006 www.medexhco.com
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
191
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2251
United States Fire Insurance Company
305 Madison Ave.
Morristown NJ 07962 Crum & Forster Primary MPN Insurer 12/6/2013 T
0179
United States Fire Insurance Company
305 Madison Avenue
Morristown NJ 07962 Crum&Forster-Concentra MPN Insurer 1/24/2005 T
0994
United States Fire Insurance Company
305 Madison Avenue
Morristown NJ 07962 Concentra Broad Based Insurer 7/25/2005 T
2370
United States Fire Insurance Company
305 Madison Avenue
Morristown NJ 07962 CorVel/C&F Select MPN Insurer 4/2/2015 www.corvel.com
1583
United Wisconsin Insurance Company
200 N. Grand Avenue
Lansing MI 48933
United Heartland Medical Provider
Network Insurer 1/28/2010 T
0294
Universal Underwriters Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 4/6/2005 T
1574
University of Southern California
3434 S. Grand Ave CAL-120
Los Angeles CA 90089 USC/Harbor MPN
Self-Insured
Employer 12/16/2009 www.harborsys.com/usc T
0396
University of Southern California
851 Downey Way, HSH 300
Los Angeles CA 90089
University of Southern California
Medical Provider Network
Self-Insured
Employer 2/24/2005 T
0033
University of the Pacific
3601 Pacific Avenue
Stockton CA 95211
UOP First health CompAmerica Select
and Limited KOJ MPN
Self-Insured
Employer 4/7/2005 T
2381
Upland Unified School District
390 North Euclid Ave
Upland CA 91786 EIA Medical Provider Network
Self-Insured
Employer 4/1/2015 www.wellcomp.com
0805
US Concrete
2925 Briar Park Drive, Ste 1050
Houston TX 77042 CorVel MPN
Self-Insured
Employer 5/18/2005 T
0262
USF&G Specialty Company
111 Schilling Road
Hunt Valley MD 21031 TCT CA MPN Insurer 3/17/2005 W
0659
USS-POSCO Industries
PO Box 471
Pittsburg CA 94565 USS-POSCO MPN
Self-Insured
Employer 5/5/2005 https://secure.simon-companies.com/UPI/
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
192
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0753
Utility Trailer Manufacturing Company
17295 E. Railroad St
City of Industry CA 91748 Liberty Mutual Group MPN
Self-Insured
Employer 4/28/2005 T
1897
Val Verde Unified School District
975 West Morgan St
Perris CA 92570 PRIME Plus Medical Provider Network
Self-Insured
Employer 12/20/2011 T
0150
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0216
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
FirstHealth CompAmerica Select HCO
Network Insurer 4/18/2005 T
0673
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Valiant Insurance Company, Crawford
Select Insurer 7/1/2005 W
1001
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Valiant Insurance Company - Crawford
Primary Insurer 7/1/2005 W
0845
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 T
1147
Valiant Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer HCO Insurer 5/5/2006 T
1353
Valiant Insurance Company
1400 American Lane Tower 1-13th Floor
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
1774
Valley Forge Insurance Company
333 South Wabash Avenue
Chicago IL 60604 Broadspire Signature MPN Insurer 2/2/2011 T
0826
Valley Harvesting & Packing, Inc.
101 East Main Street
Heber CA 92249 TRISTAR MPN
Self-Insured
Employer 5/3/2005 T
3016
Valley Harvesting & Packing, Inc.
101 East Main Street
Heber CA 92249 First Health Comp America HCO Select
Self-Insured
Employer 7/3/2017 https://www.talispoint.com/cvty/mandb
1060
Valley Insurance Program (VIP)
170 W. San Jose Ave
Claremont CA 91711 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
193
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0737
ValleyCrest Companies
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
0734
ValleyCrest Golf Course Maintenance
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
0736
ValleyCrest Landscape Development, Inc.
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
0735
ValleyCrest Landscape Maintenance, Inc.
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
0733
ValleyCrest Tree Company
24151 Ventura Blvd
Calabasas CA 91302 First Health CompAmerica Select MPN
Self-Insured
Employer 6/9/2005 W
2421
Vanliner Insurance Company
3250 Interstate Drive
Richfield OH 44826 Vanliner MPN Insurer 12/28/2015 www.vanlinermpn.com
0225
Ventura County Community College District
333 Skyway Drive
Camarillo CA 93010 Prime Advantage Medical Network
Self-Insured
Employer 3/7/2005 T
0849
Ventura County Schools Self-Funding Authority
5189 Verdugo Way, Ste A
Camarillo CA 93012 WellComp Medical Provider Network
Self-Insured
Employer 8/4/2005 www.wellcomp.com
0453
Viacom International Services Inc.
1515 Broadway
New York NY 10036
First Health Comp America HCO Select
Network
Self-Insured
Employer 4/21/2005 https://www.talispoint.com/cvty/mandb
1282
VIAD CORP
1850 N. Central Ave Suite 800
Phoenix AZ 85004 CorVel MPN
Self-Insured
Employer 3/15/2007 www.corvel.com
0586
Victor Valley Community College District
18422 Bear Valley Road
Victorville CA 92395 Prime Advantage Medical Network
Self-Insured
Employer 3/22/2005 T
1312
Victor Valley Union High School District
16350 Mojave Drive
Victorville CA 92395
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 8/6/2007 T
1105
Victory Comp, Inc.
2452 Lakewest Dr
Chico CA 95928 CorVel/Victory Comp
Self-Insured
Employer 1/17/2006 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
194
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2065
Victory Comp, Inc.
255 Great Valley Parkway, Ste 255
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 10/26/2012 www.monumentllc.com T
1485
Victory Comp, Inc.
255 Great Valley Pkwy Ste 200
Malvern PA 19355 Monument MPN
Group of
Self-Insured
Employers 3/17/2009 T
0268
Vigilant Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel MPN Insurer 2/17/2005 www.corvel.com
1471
Vigilant Insurance Company
15 Mountain View Road
Warren NJ 07059 CorVel/Chubb Kaiser Select MPN Insurer 12/24/2008 mpn.corvel.com/chubbkaiser
1198
Vintners and Independent Producers Self-
Insurance Program
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/25/2006 T
0329
Virginia Surety Company Inc.
175 W Jackson, Ste 1100
Chicago IL 60604 Virginia Surety Cambridge MPN Insurer 2/16/2005 W
1558
Virginia Surety Company, Inc.
175 West Jackson Blvd, 11th Floor
Chicago IL 60604 Rising MPN Insurer 8/17/2009 https://www.markelfirstcomp.com/injured-workers T
1139
Virginia Surety Company, Inc.
175 West Jackson Blvd.
Chicago IL 60604 CPG/VSC/Coventry MPN Insurer 3/16/2006 T
0634
Virginia Surety Company, Inc.
175 West Jackson Blvd., Suite 1100
Chicago IL 60604 Rising Interplan MPN Insurer 3/24/2005 T
1399
Vista Paint Corporation
2020 East Orangethorpe Ave., Ste. 210
Fullerton CA 92831 Vista Paint Corporation MPN
Self-Insured
Employer 9/25/2008 VistaPaint.EmployerMPN.com
1740
Vista Unified School District
1234 Arcadia Ave.
Vista CA 92084
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 12/22/2010 T
2140
Vista Unified School District
1234 Arcadia Avenue
Vista CA 92074 Prime Plus Medical Provider Network
Self-Insured
Employer 3/27/2013 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
195
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1893
Walt Disney Parks And Resorts U.S., Inc.
1313 Harbor Blvd.
Anaheim CA 92802
Walt Disney Parks And Resorts U.S.,
Inc. MPN
Self-Insured
Employer 12/13/2011 www.harborsys.com/WDPR
1287
Walt Disney World Co (The Disneyland Resort
Division)
1313 South Harbor Blvd
Anaheim CA 92803
Disneyland Resort Medical Provider
Network
Self-Insured
Employer 8/22/2007 T
0600
Washington Township Healthcare District
2000 Mowry Avenue
Fremont CA 94538 First Health CompAmerica HCO
Self-Insured
Employer 3/18/2005 W
1074
Watkins Manufacturing
1280 Park Center Drive
Vista CA 92081 TRISTAR MPN
Self-Insured
Employer 8/12/2005 T
0093
Wausau Business Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
0090
Wausau General Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 W
0092
Wausau Underwriters Insurance Company
175 Berkeley Street
Boston MA 02116 Liberty Mutual Group MPN Insurer 2/3/2005 T
1612
Wendy's International, Inc.
1155 Perimeter Center West
Atlanta GA 30338
First Health CompAmerica Primary
HCO Network
Self-Insured
Employer 3/26/2010 T
1839
Wesco Insurance Company
59 Maiden Lane, 6th Floor
New York NY 10038 Medex MPN Insurer 6/1/2011 T
1815
West Hills Community College District
9900 Cody Street
Coalinga CA 93210
PRIME Advantage Medical Provider
Network
Self-Insured
Employer 5/5/2011 T
0680
Westchester Fire Insurance Company
1601 Chestnut Street
Philadelphia PA 19103
Westchester Fire Insurance Company -
Crawford Primary Insurer 6/16/2005 W
0353
Western Digital Corporation
20511 Lake Forest Drive
Lake Forest CA 92630
First Health CompAmerica Select HCO
Network (or First Health Select)
Self-Insured
Employer 3/7/2005 W
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
196
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1115
Western Independent Bankers Self Insurance
Group
2600 Michelson Dr., Suite 1620
Irvine CA 92612 Medex
Group of
Self-Insured
Employers 4/27/2006 T
1392
Western Oilfields Supply Company
3404 State Rd.
Bakersfield CA 93308
Western Oilfields Supply Company
ESIS MPN
Self-Insured
Employer 9/23/2008 T
2380
Western Orange County Self-Funded Workers'
Compensation Agency
200 Kalmus Dr.
Costa Mesa CA 92626 WellComp Medical Provider Network
Joint Powers
Authority 3/20/2015 www.wellcomp.com W
3020
Westlake Services, LLC
4751 Wilshire Blvd Ste 100
Los Angeles CA 90010 Hankey Group MPN
Self-Insured
Employer 4/27/2017 www.intermedccs.com/HankeyGroupMPN
0948
Westport Insurance Corporation
5200 Metcalf Ave
Overland Park KS 66202
Westport Insurance
Corporation/Gallagher Bassett/First
Health MPN Insurer 7/1/2005 T
1690
Westview Services, Inc.
10522 Katella Ave
Anaheim CA 92804 WellComp Medical Provider Network
Self-Insured
Employer 8/19/2010 T
1201
Westview Services, Inc.
10522 Katella Avenue
Anaheim CA 92804 CorVel HCO
Self-Insured
Employer 5/3/2006 T
1255
Westview Services, Inc.
10522 Katella Avenue
Anaheim CA 92804 Broadspire MPN
Self-Insured
Employer 12/11/2006 T
0891
Whittier Area Schools Insurance Authority
10800 Benavon Street
Whittier CA 90606 WellComp Medical Provider Network
Joint Powers
Authority 8/4/2005 T
1072
Whittier Union High School District
9401 S. Painter Ave.
Whittier CA 90605 WellComp Medical Provider Network
Self-Insured
Employer 9/12/2005 T
0559
Williamsburg National Insurance Company
26255 American Drive
Southfield MI 48034
Williamsburg National/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 T
1539
Williamsburg National Insurance Company
26255 American Drive
Southfield MI 48034 Rising Interplan MPN Insurer 7/28/2009 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
197
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1842
Williamsburg National Insurance Company
26255 American Drive
Southfield MI 48034
Williamsburg Co. - Harbor-HealthSmart
MPN Insurer 6/17/2011 www.harborsys.com/meadowbrook T
1061
WinCo Holdings, Inc.
PO Box 5756
Boise ID 83705 Liberty Mutual Group MPN
Self-Insured
Employer 8/9/2005 T
0227
Wiseburn Elementary School District
13530 Aviation Blvd
Hawthorne CA 90250 Prime Advantage Medical Network
Self-Insured
Employer 3/1/2005 T
1199
Wm. Bolthouse Farms
7200 East Brundage Lane
Bakersfield CA 93307
Wm. Bolthouse Farms/TMC Medical
Provider Network
Self-Insured
Employer 6/12/2006 T
1640
Wm. Bolthouse Farms, Inc.
One Campbell Place
Camden NJ 08103 Broadspire Signature MPN
Self-Insured
Employer 5/26/2010 T
1714
Wonderful Citrus LLC
11444 West Olympic Blvd 5th Flr
Los Angeles CA 90064 Broadspire Signature MPN
Self-Insured
Employer 11/4/2010 T
1716
Wonderful Orchards LLC
11444 W. Olympic Blvd. 5th FL
Los Angeles CA 90064 Broadspire Signature MPN
Self-Insured
Employer 11/4/2010 T
1717
Wonderful Pistachios & Almonds LLC
11444 W. Olympic Blvd. 5th FL
Los Angeles CA 90064 Broadspire Signature MPN
Self-Insured
Employer 11/4/2010 T
2302
XL Insurance America, Inc.
1201 N. Market Street Suite 501
Wilmington DE 19801 Medex Insurer 9/5/2014 www.medexhco.com
2441
XL Insurance America, Inc.
200 Liberty St., 22nd Floor
New York NY 10281 CorVel/Select Staffing MPN Insurer 3/16/2016 www.corvel.com
2209
XL Insurance America, Inc.
200 Liberty Street, 22nd Floor
New York NY 10281 CorVel MPN Insurer 8/1/2013 www.corvel.com
2221
XL Insurance America, Inc.
70 Seaview Ave.
Stamford CT 06902 Tractor/XLGroup/Bunch MPN Insurer 9/17/2013 T
2456
XL Insurance America, Inc.
70 Seaview Avenue
Stamford CT 06902 Agri1 MPN Insurer 4/14/2016 www.intermedccs.com/Agri1MPN
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
198
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2216
XL Insurance America, Inc.
One World Financial Center, 200 Liberty St
New York NY 10281 Sedgwick CMS MPN Insurer 8/23/2013 T
2217
XL Insurance America, Inc.
One World Financial Center, 200 Liberty St
New York NY 10281 Sedgwick CMS Extended MPN Insurer 8/23/2013 T
2329
XL Insurance America, Inc.
One World Financial Center/200 Liberty St
New York NY 10281 Sedgwick/Harbor MPN Insurer 9/5/2014 www.harborsys.com/harborone T
2330
XL Insurance America, Inc.
One World Financial Center/200 Liberty Street
New York NY 10281 Sedgwick/Harbor 2 MPN Insurer 9/5/2014 www.harborsys.com/harborone T
3055
XL Insurance America, Inc.
Seaview House 70 Seaview Ave
Stamford CT 06902 Agricultura MPN Insurer 10/30/2017 http://www.talispoint.com/intermed/agriculturampn
0974
XL Specialty Insurance Company
200 Liberty Street, 21st Floor
New York NY 10281
XL Specialty Insurance
Company/Gallagher Bassett/Coventry
MPN Insurer 12/7/2006 www.talispoint.com/cvty/gbcvtympn T
1118
XL Specialty Insurance Company
1 World Financial Center 200 Liberty St 27th
Floor
New York NY 10281 XL Insurance Cambridge MPN Insurer 12/9/2005 W
1679
XL Specialty Insurance Company
100 Catlin Constitution Plaza
Hartford CT 06103 Broadspire Signature Network MPN Insurer 8/18/2010 T
1571
XL Specialty Insurance Company
100 Constitution Plaza
Hartford CT 06103
First Health CompAmerica Select
Network Insurer 10/8/2009
1756
XL Specialty Insurance Company
200 Liberty St 21st Floor
New York NY 10281
CCMSI/XL Specialty Insurance
Company/First Health Comp American
Select HCO Network Insurer 1/12/2011 T
1550
XL Specialty Insurance Company
200 Liberty St.
New York NY 10281 WellComp MPN Insurer 9/17/2009 T
2013
XL Specialty Insurance Company
200 Liberty St.
New York NY 10281 Insurer 6/7/2012 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
199
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1433
XL Specialty Insurance Company
200 Liberty Street 21st Floor
New York NY 10281 XL Specialty GBMCS MPN Insurer 5/7/2009 T
0984
XL Specialty Insurance Company
200 Liberty Street, 21st Floor
New York NY 10281
XL Specialty Insurance
Company/Gallagher Bassett/First Health
MPN Insurer 7/11/2005 www.talispoint.com/cvty/gbfhmpnselect T
1668
XL Specialty Insurance Company
200 Liberty Street, 21st Floor
New York NY 10281 XL/ACS/GENEX Insurer 9/29/2010 www.genexservices.com T
0955
XL Specialty Insurance Company
200 Liberty Street, 22nd Floor
New York NY 10281
CorVel MPN/XL Specialty Insurance
Company Insurer 7/11/2005 www.corvel.com
1469
XL Specialty Insurance Company
200 Liberty Street, 22nd Floor
New York NY 10281 CorVel MPN Insurer 12/2/2008 www.corvel.com
0909
XL Specialty Insurance Company
520 Eagleview Blvd
Exton PA 19434
MedInsights Medical Provider Network
accessing Prudent Buyer HCO Insurer 6/1/2005 W
2089
XL Specialty Insurance Company
70 Seaview Avenue DEPT: Regulatory
Stamford CT 06902
Carl Warren and Company Medical
Provider Network Insurer 12/7/2012 T
0943
XL Specialty Insurance Company
One World Financial Center 200 Liberty St.
New York NY 10281
Sedgwick First Health CompAmerica
Primary HCONetwork Insurer 6/16/2005 T
0944
XL Specialty Insurance Company
One World Financial Center 200 Liberty St
New York NY 10281
Sedgwick First Health CompAmerica
Select HCO Medical Provider Network Insurer 6/16/2005 T
1804
XL Specialty Insurance Company
One World Financial Center 200 Liberty Street
New York NY 10281 XL Specialty ESIS MPN Insurer 1/19/2012 T
1974
XL Specialty Insurance Company
One World Financial Center 200 Liberty St.
New York NY 10281 Sedgwick/Harbor MPN Insurer 5/24/2012 T
0953
XL Specialty Insurance Company
One World Financial Center, 100 Liberty Street
New York NY 10281 Broadspire MPN Insurer 7/12/2005 T
1617
XL Specialty Insurance Company
One World Financial Center, 200 Liberty Street
New York NY 10281 WellComp Medical Provider Network Insurer 4/28/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
200
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
2012
XL Specialty Insurance Company
One World Financial Center, 200 Liberty St.
New York NY 10281 Sedgwick/Harbor 2 MPN Insurer 6/1/2012 T
1164
XL Specialty Insurance Company
One World Financial Center-200 Liberty St.
New York NY 10281
Sedgwick CMS Extended Medical
Provider Network Insurer 2/24/2006 T
1165
XL Specialty Insurance Company
One World Financial Center-200 Liberty St.
New York NY 10281
Sedgwick CMS Medical Provider
Network Insurer 2/24/2006 T
1914
XL Specialty Insurance Company
One World Financial Cntr-200 Liberty St.
New York NY 10281 Roth Staffing Companies MPN Insurer 3/27/2012 T
2344
XL Specialty Insurance Company
Seaview House, 70 Seaview Avenue
Stamford CT 06902 Reiter Affiliated Companies MPN Insurer 9/30/2014 www.intermedccs.com/reitermpn
1219
Yellow Cab Cooperative
1200 Mississippi Street
San Francisco CA 94107 WellComp Medical Provider Network
Self-Insured
Employer 6/19/2006 T
1107
Yellow Transportation, Inc.
10990 Roe Avenue
Overland Park KS 66211 CorVel MPN
Self-Insured
Employer 12/29/2005 T
1413
Yellow Transportation, Inc.
10990 Roe Avenue
Overland Park KS 66211 First Health CompAmerica Select MPN
Self-Insured
Employer 8/26/2008 T
2192
Yellow Transportation, Inc.
10990 Roe Avenue
Overland Park KS 66211 Yellow Transportation GBMCS MPN
Self-Insured
Employer 7/19/2013 T
0599
YMCA of Metropolitan Los Angeles
625 S. New Hampshire Ave.
Los Angeles CA 90005 YMCA MPN
Self-Insured
Employer 4/27/2005 T
0477
YMCA of San Diego County
4715 Viewridge Ave., Suite 100
San Diego CA 92123 TRISTAR CompAmerica Primary HCO
Self-Insured
Employer 3/18/2005 W
1085
Yolo County Public Agency Risk Management
Insurance Authority
77 West Lincoln Ave.
Woodland CA 95695 YCPARMIA MPN
Joint Powers
Authority 9/21/2005 http://ycparmia.org/mpn
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
201
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1540
Young Men's Christian Association of
Metropolitan Los Angeles
625 So. New Hampshire Ave
Los Angeles CA 90005 YMCA ESIS MPN
Self-Insured
Employer 5/19/2009 T
0484
Youngs Market Company LLC
2164 N. Batavia Street
Orange CA 92865 Coventry MPN
Self-Insured
Employer 3/16/2005 T
1750
Zacky & Sons Poultry, LLC
2020 So. East Ave
Fresno CA 93721 Zacky Farms Custom CorVel MPN
Self-Insured
Employer 1/12/2011 www.corvel.com
0024
Zenith Insurance Company
21255 Califa Street
Woodland Hills CA 91367
Zenith Medical Provider Network
(ZMPN) Insurer 12/30/2004 www.thezenith.com
0373
ZNAT Insurance Company
21255 Califa Street
Woodland Hills CA 91367 Zenith Medical Provider Network Insurer 1/6/2005 W
0209
Zurich American Insurance Company Of Illinois
1299 Zurich Way 3W
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 4/18/2005 www.zurichna.com
1148
Zurich American Insurance Company Of Illinois
1299 Zurich Way 3W
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 www.zurichna.com
0437
Zurich American Insurance Company of Illinois
1299 Zurich Way
Schaumburg IL 60196 Broadspire-Concentra Standard MPN Insurer 3/21/2005 T
0136
Zurich American Insurance Company of Illinois
1299 Zurich Way
Schaumburg IL 60196 Zurich ESIS MPN Insurer 4/18/2005 T
1349
Zurich American Insurance Company Of Illinois
1299 Zurich Way
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 6/30/2008 T
1692
Zurich American Insurance Company Of Illinois
1299 Zurich Way
Schaumburg IL 60196 Broadspire Signature Network MPN Insurer 8/18/2010 T
1823
Zurich American Insurance Company of Illinois
1299 Zurich Way
Schaumburg IL 60196 ACM/Zurich American of Illinois MPN Insurer 5/3/2011 http://mpn.acmclaims.com/zurich T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
202
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0148
Zurich American Insurance Company of Illinois
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0671
Zurich American Insurance Company of Illinois
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich American Insurance Company of
IL, Crawford Select Insurer 7/1/2005 W
0999
Zurich American Insurance Company of Illinois
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich American Insurance Company of
IL - Crawford Primary Insurer 7/1/2005 W
0847
Zurich American Insurance Company of Illinois
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health Comp America Primary
HCO Network Insurer 8/11/2005 T
0208
Zurich American Insurance Company
1299 Zurich Way 3W
Schaumburg IL 60196
FirstHealth CompAmerica Select HCO
Network Insurer 4/18/2005 www.zurichna.com
0846
Zurich American Insurance Company
1299 Zurich Way 3W
Schaumburg IL 60196
First Health CompAmerica Primary
HCO Network Insurer 8/2/2005 www.zurichna.com
0355
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick First Health Comp America
Primary HCO Network Insurer 3/7/2005 T
0357
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick First Health CompAmerica
Select HCO Network Insurer 3/7/2005 T
0174
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 TCT CA MPN Insurer 3/8/2005 www.mywcinfo.com T
0301
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 CorVel MPN Insurer 3/14/2005 www.corvel.com
0124
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 First Health Comp America Select HCO Insurer 3/17/2005 T
0648
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Zurich American/Gallagher
Bassett/Coventry MPN Insurer 3/24/2005 www.talispoint.com/cvty/gbcvtympn T
0645
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Zurich/Ward North America Prudent
Buyer Medical Provider Network,
accessing Prudent Buyer HCO Insurer 3/29/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
203
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0138
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Zurich ESIS MPN Insurer 4/18/2005 T
0833
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 TRISTAR MPN Insurer 5/3/2005 T
0490
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick CMS Medical Provider
Network Insurer 5/7/2005 T
0485
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Sedgwick CMS Extended Medical
Provider Network Insurer 5/23/2005 T
1270
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
Zurich American/Gallagher
Bassett/First Health MPN Insurer 1/31/2007 www.talispoint.com/cvty/gbfhmpnselect
1362
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
First Health CompAmerica Primary
Network Insurer 5/13/2008 T
1347
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Zurich Kaiser MPN Insurer 7/9/2008 T
1391
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196
CCMSI/Zurich/First Health Comp
America Network Insurer 8/19/2008 T
1533
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Insurer 4/30/2009 www.genexservices.com T
1526
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Roth Staffing Companies MPN Insurer 5/8/2009 T
1530
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Zurich GBMCS MPN Insurer 5/8/2009 www,talispoint.com/cvty/gbmpn
1686
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Broadspire Signature Network MPN Insurer 8/18/2010 T
1693
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Medex Insurer 8/19/2010 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
204
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
1822
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 ACM/American Zurich MPN Insurer 5/3/2011 http://mpn.acmclaims.com/zurich T
1947
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Patriot Risk Services Insurer 5/2/2012 T
2099
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Sedgwick/Harbor MPN Insurer 12/27/2012 T
2100
Zurich American Insurance Company
1299 Zurich Way
Schaumburg IL 60196 Sedgwick/Harbor 2 MPN Insurer 12/27/2012 T
1883
Zurich American Insurance Company
1400 American Lane - Tower 1, 13th Floor
Schaumburg IL 60196
Sedgwick CMS / Harbor MPN - Zurich
SUMC Insurer 9/7/2011 W
0308
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Zurich Cambridge MPN Insurer 2/16/2005 T
0140
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 3/8/2005 T
0557
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
MedInsights Medical Provider Network,
MPN accessing Prudent Buyer HCO Insurer 3/22/2005 T
0531
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Broadspire-First Health CompAmerica
Select HCO MPN Insurer 3/24/2005 T
0342
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 FARA-CVTY Insurer 4/21/2005 T
0377
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Broadspire-Concentra Standard MPN Insurer 4/26/2005 T
0765
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health Comp America HCO Select
Network Insurer 5/5/2005 T
0834
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
First Health CompAmerica Select HCO
Network Insurer 5/31/2005 T
Medical Provider Networks Approved by DWC (Sorted by Name of Applicant)
NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 04/02/2018. However, changes may have been made
since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN.
Approved MPN Applications: 2402
*MPN Approval Status Legend
BLANK = MPN status has not changed after approval; = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after
approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval
205
MPN
ID # Name of Applicant with Mailing Address Name of MPN
Type of
Applicant
Date of
Approval Internet Website Address of MPN
MPN
Approval
Status *
0667
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich American Insurance Company,
Crawford Select Insurer 7/1/2005 W
1006
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196
Zurich American Insurance Company -
Crawford Primary Insurer 7/1/2005 W
1055
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Mezzo Forte Medical Provider Network Insurer 8/5/2005 W
1071
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Intracorp-Gates McDonald MPN Insurer 9/26/2005 T
1395
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Zurich/Harrah's Bunch CA MPN Insurer 7/1/2008 T
1497
Zurich American Insurance Company
1400 American Lane - Tower 2 - 6th Floor
Schaumburg IL 60196 Medex Insurer 2/25/2009 T
1241
Zurich American Insurance Company
1400 American Lane - Tower 2-6th Floor
Schaumburg IL 60196 First Health/Tribune Company MPN Insurer 9/25/2006 T
1541
Zurich American Insurance Company
1400 American Lane 6th Flr
Schaumburg IL 60196 Intracorp Insurer 7/28/2009 T
2048
Zurich American Insurance Company
1400 American Lane T2-6th Floor
Schaumburg IL 60196 WellComp Medical Provider Network Insurer 9/14/2012 T
1748
Zurich American Insurance Company
1400 American Lane
Schaumburg IL 60196 Zurich GBMCS KOJ MPN Insurer 1/12/2011 T
1140
Zurich American Insurance Company
1400 American Lane, Tower 2, 6th Floor
Schaumburg IL 60196
Zurich Services Corporation Prudent
Buyer Insurer 5/5/2006 www.zurichna.com
