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10/26/2022 document.xlsx Cover Page State of New York Department of Health Delivery System Reform Incentive Payment (DSRIP) Program Project Design Grant Application There will be no extensions for this application. Any application submitted past the due date will not be considered. Section Lead Applicant Info & Project Point of Contact Section 6 List of Vendors Section Partner Organization - Contact Info Section 7 Design Grant Timeline Section Partner Organizations & Service Area Section 8 Data Request Section Project Program Overview & Description Section 9 Design Grant Budget Section Community Needs Assessment & Stakeholder Engagem ** Section 10 Special Terms & Conditions Attachment I Attachment J (Recommend) - PowerPoint/Webinar DSRIP LINK: Application Due on: June 17, 2014 Project Advisory Committee (PAC) Form - (RELOCATED) ^ Due to changes, this section has been RELOCATED and made as a separate form which still needs to be filled out and can be found on the DSRIP website under "DSRIP Project Design Grant Application". To understand the Project Design Grant Application, carefully and thoroughly read through the Instructions before completing this application. As a reminder and an addition to the instructions, you MUST read through the following state documents which are provided on the DSRIP website (see link below). https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

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Cover Page

State of New York Department of HealthDelivery System Reform Incentive Payment (DSRIP) Program

Project Design Grant Application

There will be no extensions for this application. Any application submitted past the due date will not be considered.

Section 1 Lead Applicant Info & Project Point of Contact Section 6 List of VendorsSection 2 Partner Organization - Contact Info Section 7 Design Grant TimelineSection 3 Partner Organizations & Service Area Section 8 Data RequestSection 4 Project Program Overview & Description Section 9 Design Grant BudgetSection 5 Community Needs Assessment & Stakeholder Engagement ** Section 10

Special Terms & Conditions Attachment I Attachment J

(Recommend) - PowerPoint/Webinar

DSRIP LINK:

Application Due on: June 17, 2014

Project Advisory Committee (PAC) Form - (RELOCATED)

^ Due to changes, this section has been RELOCATED and made as a separate form which still needs to be filled out and can be found on the DSRIP website under "DSRIP Project Design Grant Application".

To understand the Project Design Grant Application, carefully and thoroughly read through the Instructions before completing this application.

As a reminder and an addition to the instructions, you MUST read through the following state documents which are provided on the DSRIP website (see link below).

https://www.health.ny.gov/health_care/medicaid/redesign/delivery_system_reform_incentive_payment_program.htm

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NYS DOH DSRIP_Project Design Grant Application Page 1 Applicant Info_Project Contact_Partner Organizations

Lead Applicant Information

1.1) Organization Name:Operating Certificate # (Opcert): NA

Provider Type:Provider Type - OTHER: Accountable Care Organization

MMIS: 1.4)Billing Entity ID:

NPI #1: NPI #2:

Federal Employer ID (FEIN):

1.2) Please provide a brief statement as to why the lead organization is qualified to serve in this capacity. ( Restricted to 3000 characters)

Characters used: 2999

1.3)

OR

#1 Is the lead applicant one of the following providers? Select One

OR

%A. 2A

Select One

B. 2B

OR

#3 Select One 3

For Safety-net definition, please see link:

Catholic Medical Partners-Accountable Care IPA INC

Catholic Medical Partner’s Accountable Care organization (CMP-AC) was incorporated in 2012 to implement and govern the Shared Saving ACO contract with CMS. CMP-AC is a related entity to CIPA WNY IPA dba Catholic Medical Partners (CMP) and has common governance and clinical improvement structure. CMP-AC goals are to achieve the vision of the Triple Aim, namely better care at a lower cost with improved population health. CMP-AC performance over the past 8 quarters has shown continued success in all key indicators including: reductions in hospital admissions and readmissions per 1000, reductions in emergency visits per 1000 and CT scans per 1000, as well as a 13% reduction in ambulatory care sensitive conditions. CMP-AC infrastructure is designed around the Idealized Design of the Clinical Office and the Patient Centered Medical Home. CMP-AC’s guiding principles and practices are based on team driven care, optimal use of health information technology, use of clinical registries and process improvement to enhance coordination of care and care transitions. CMP-AC network includes over 900 physicians, Catholic Health Systems, Mount St.Mary’s Hospital, a behavioral health network and ancillary provider group including ambulatory surgery centers, free standing radiology, dental services and other service providers. CMP-AC envisions a future state in which provider networks are accountable for cost, quality and the patient experience and have a well developed population health value driven business model. CMP has 7 managed care contracts that are performance based with risk sharing and an insurance captive to support the risk based contracting. Over the past six (6) years CMP has shown success in its risk based contracts. CMP-AC infrastructure includes a web site and an effective communication system, MedInsight data warehouse and analytics, PCMH-level 3 certified practices for 65% of the patients, electronic health record in all practices with over 50% interoperable. We have an extensive network of embedded care coordinators in the clinical office who are working with the population that has the highest burden of illness. We have consistently demonstrated our ability to perform and to adapt to the complex needs of patients, providers, health plans and government sponsored initiatives .CMP-AC is able to measure quality and cost at the practice level and regularly conducts patient experience of care surveys. Our governing board has training in all aspect of board governance with a focus on clinical integration, financial integrity and effective board decision making on strategy and policy. The NYS DSRIP is aligned with our population health objective and mission and our infrastructure has capacity to support the performance requirements set forth by NYS in its vision of transformation. (Note: If CMP-AC is not approved through the VAP exception process, Sisters of Charity Hospital will assume the lead.)

Based on the lead applicant provider type, please fill out the applicable section below to verify that you meet the DSRIP safety- net definition (Either Hospital OR Non-hospital based) :

Hospital: A hospital must meet one of the three following criteria to participate in a performing provider system:

#2 - Must pass both A & B test (Please indicate what % for both tests)

At least 35 percent of patient volume in their outpatient lines of business must be associated with Medicaid, uninsured, and Dual Eligible individualsAt least 30 percent of inpatient treatment associated with Medicaid, uninsured, and Dual Eligible individuals

Must serve at least 30 percent of all Medicaid, uninsured and Dual Eligible members in the proposed county or multi-county community. (The state will use Medicaid claims and encounter data as well as other sources to verify this claim. The state reserves the right to increase this percentage on a case by case basis so as to ensure that the needs of each community's Medicaid members are met.(Please indicate what %)

https://www.health.ny.gov/health_care/medicaid/redesign/docs/safety_net_definitions.pdf

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NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

2.1) Partner Organizations - Contact Information

1 Organization Name: 2 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip Code

Organization Address: Organization Address:Contact Person: Contact Person:

Contact Phone Number: Extension: Contact Phone Number: Extension:Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

3 Organization Name: 4 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

5 Organization Name: 6 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

7 Organization Name: 8 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

9 Organization Name: 10 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

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Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

11 Organization Name: 12 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

13 Organization Name: 14 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

15 Organization Name: 16 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

17 Organization Name: 18 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

19 Organization Name: 20 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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21 Organization Name: 22 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

23 Organization Name: 24 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

25 Organization Name: 26 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

27 Organization Name: 28 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

29 Organization Name: 30 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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31 Organization Name: 32 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

33 Organization Name: 34 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

35 Organization Name: 36 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

37 Organization Name: 38 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

39 Organization Name: 40 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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41 Organization Name: 42 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

43 Organization Name: 44 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

45 Organization Name: 46 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

47 Organization Name: 48 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

49 Organization Name: 50 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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51 Organization Name: 52 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

53 Organization Name: 54 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

55 Organization Name: 56 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

57 Organization Name: 58 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

59 Organization Name: 60 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

61 Organization Name: 62 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

63 Organization Name: 64 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

65 Organization Name: 66 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

67 Organization Name: 68 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

69 Organization Name: 70 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

71 Organization Name: 72 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

73 Organization Name: 74 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

75 Organization Name: 76 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

77 Organization Name: 78 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

79 Organization Name: 80 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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81 Organization Name: 82 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

83 Organization Name: 84 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

85 Organization Name: 86 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

87 Organization Name: 88 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

89 Organization Name: 90 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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NYS DOH DSRIP_Project Design Grant Application Section 2 Partner Organizations' - Contact Info

91 Organization Name: 92 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

93 Organization Name: 94 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

95 Organization Name: 96 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

97 Organization Name: 98 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

99 Organization Name: 100 Organization Name:Qualified Under Safety Net Definition? Select One (Please select Yes or No) Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City State Zip Code Address City State Zip CodeOrganization Address: Organization Address:

Contact Person: Contact Person:Contact Phone Number: Extension: Contact Phone Number: Extension:

Contact Email: Contact Email:Provider Type: Select One Provider Type: Select One

Provider Type - OTHER: MMIS: Provider Type - OTHER: MMIS:Operating Certificate Number (OPCERT): Billing/Provider Entity ID: Operating Certificate Number (OPCERT): Billing/Provider Entity ID:

NPI #1: NPI #1: NPI #2: NPI #2:

Federal Employer ID (FEIN): Federal Employer ID (FEIN):

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NYS DOH DSRIP_Project Design Grant Application Section 3 Partner Organizations Service Area

Partner Organizations

3.1)Yes

Provide explanation (Restricted to 2000 characters):

Characters used: 1962

Service Area3.2) Briefly describe the proposed service area for your entire emerging Performing Provider System below. (e.g. general overview, geographic location, any notable characteristics specific to your population, etc.) ( Restricted to 3000 characters)

Characters used: 2943

Do any regulations need to be waived to accomplish a DSRIP partnership within your emerging Performing Provider System?

CMP-AC PPS has identified the following areas where regulatory flexibility is needed and expects additional regulatory barriers will become apparent as the PPS develops new & innovative approaches to system transformation.• Rules regarding management contracts & revenue sharing will need to be waived. • Definitive anti-trust protections are required -broad state action immunity is necessary. • Need a centralized system-wide credentialing authority—involving facilities licensed by multiple state agencies to include all practitioners throughout PPSs. • NYS will need to waive CON regulations • Co-location restrictions need to be eliminated for services that integrate behavioral & physical health care especially for Article 28 providers. • Need consistent set of operational standards & recordkeeping requirements for co-located behavioral & physical health services across all state licensing agencies. • Substantial workforce flexibility must be enabled, especially as care provider roles change & staff transition to new roles • Widespread use of nurse-driven protocols utilizing evidence-based strategies for disease management. • Impediments to smooth & rapid transition of patients between care levels need to be waived. • Hospice need requirements & geographic limitations will need to be waived or eliminated—previous Public Health & Health Planning Council recommendation.• Nursing home regulations, interpreted to protect the safety of other residents that compel nursing homes to transfer patients (especially behavioral patients) to hospitals, need to be modified to allow for appropriate therapeutic interventions within the nursing home. • Home care ordering authority should be broadened to allow for medical directors, nurse practitioners, & physician assistants to sign orders for home care. • A broader range of clinicians should be able to perform home health aide supervision, including utilizing methods other than on-site supervision.

The population of Erie, Niagara, Cattaraugus, Chautauqua and Orleans Counties in WNY is 1,390,861. Urban Erie is 78% White, 14% Black, 5% Hispanic, 3% Asian/Pacific. Though outlying counties tend to be less diverse, African-Americans are 6.1% of the Orleans population, among the highest in rural NY. Cattaraugus’s 3.1% Native American percent is 2nd-highest in the State. In Erie and Niagara, health disparities are prevalent. Hispanic pediatric asthma admissions in Erie are 3x the rate for Whites (36.9/10,000, versus 12.1). Access to medical resources is both an urban issue with most of the city designated as a HPSA and an MUA, and a rural one. In both cases, the impact is extreme, with the RWJ Foundation placing all 5 counties in NYS’s bottom 10. Age-adjusted mortality for all 5 exceeds NYS’s rate of 658.1/100,000, ranging from 774.3 (Chautauqua) to 822.3 (Cattaraugus). Education in all 5 lags NYS, where 33.4% hold bachelor’s degrees or higher; WNY ranges from 30.7% (Erie) to 15.3% (Orleans). Severe poverty areas exist; Buffalo is the 3rd-poorest major US city, and all 5 counties report lower median household income than NYS ($55,972), from $48,473 (Erie) to $40,711 (Chautauqua). The age-adjusted effect on WNY health is outlined below. Cardiovascular: NYS’s CHF death rate per 100,000 is 11.2. WNY’s county with the lowest CHF mortality is Cattaraugus (15.7), with Erie at 19.5. Stroke mortality, (26.9 statewide), varies from 37.0 in Cattaraugus to 41.6 in Erie. Tobacco: Lung cancer incidence in all 5 counties (from 74.3 in Cattaraugus to 89.1 in Orleans) exceeds NYS’s rate of 63.6/10,000. Chronic lower respiratory mortality is 31.0 statewide, but 38.5 (Erie) to 61.5 (Chautauqua) in WNY. Chronic Renal Failure: Causes include diabetes and obesity. Chautauqua’s adult admission rate for short-term diabetes complications is 5.7/10,000, near the NYS average; it ranges up to 9.3 in Niagara. In the 3 rural counties, 64% of adults are overweight, compared to 58-60% in Erie-Niagara and 57% statewide. Behavioral Health: Suicides exceed the NYS rate (7.2 per 100,000) in all 5 counties (10.1 Erie -12.8 Orleans). Drug hospitalizations in Erie (27.4/10,000) and Niagara (30.5) surpass the State rate of 26.1. Rural people experience their own challenges; far less likely to have access to mental health care, they use these services less frequently. Telemed: Rural WNY has a doctor shortage, with population-to-primary care ratios of 1,976:1 (Chautauqua), 2,158:1 (Cattaraugus) and 4,262:1 (Orleans) vs 1,216:1 for NYS. Isolation from urban health resources is made worse by WNY’s severe winter weather, including frequent storms leaving roads impassable. Home Care: WNY is significantly older than the rest of NYS, with median ages of 40.4 (Erie) to 41.9 (Niagara), compared to 38.0 statewide. The non-institutionalized disabled population is also higher, from 12.8% (Niagara) to 15.0% (Orleans), versus 10.8% for NYS.

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NYS DOH DSRIP_Project Design Grant Application Section 3 Partner Organizations Service Area

3.3) Check off with a "X" of all the counties that are within your emerging Performing Provider System proposed service area.

Albany Herkimer Richmond (Staten Island)Allegany Jefferson RocklandBronx Kings (Brooklyn) Saint LawrenceBroome Lewis Saratoga

x Cattaraugus Livingston SchenectadyCayuga Madison Schoharie

x Chautauqua Monroe SchuylerChemung Montgomery SenecaChenango Nassau SteubenClinton New York (Manhattan) SuffolkColumbia x Niagara SullivanCortland Oneida TiogaDelaware Onondaga TompkinsDutchess Ontario Ulster

x Erie Orange WarrenEssex x Orleans WashingtonFranklin Oswego WayneFulton Otsego WestchesterGenesee Putnam WyomingGreene Queens YatesHamilton Rensselaer

Please type in the letter "X" OR you can use the drop down menu:

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NYS DOH DSRIP_Project Design Grant Application Section 4 Project Program Overview/Description

Project Program Overview

DSRIP Projects - Must choose a Minimum of 5, Maximum of 10:

Domain 2 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list B or C.Domain 3 - Must select 2 projects, Maximum of 4 - At least 1 from sub list A, and 1 from sub list A, B, C, D, E, F, G or H.Domain 4 - Must select 1 project, Maximum of 2 - At least 1 from sub list A, B, C or D.** Please see Appendix B in the Instructions for details of each Domain. For further information, see link below for the DSRIP Project Toolkit**

DSRIP Project Toolkit:

4.1)

Project #1- Sub-list A I.S.

2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

Project #2- Sub-list B or C I.S.

2.B.I Ambulatory ICUs 36

Project #3 I.S.

2.B.VIII Hospital-Home Care Collaboration Solutions 45

Project #4 I.S.

2.C.II Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services 31

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 2 (Restricted to 4000 characters)

Characters used: 3982

4.2)

Project #1- Sub-list AI.S.

3.A.I Integration of primary care services and behavioral health 39

Project #2- Sub-list A - HI.S.

3.B.I Evidence based strategies for disease management in high risk/affected populations (adult only) 30

https://www.health.ny.gov/health_care/medicaid/redesign/docs/dsrip_project_toolkit.pdf

Domain 2 (System Transformation) - Applicants must select a minimum of two projects, maximum of 4 from this domain (one of which must be from sub-list A and one of which must be from sub-list B or C)

(REQUIRED) Must choose 1 from sub list A-->

(REQUIRED) Must choose 1 from sub list B or C-->

(NOT REQUIRED) Can choose 1 from sub list A, B or C-->

(NOT REQUIRED) Can choose 1 from sub list A, B or C-->

2.a.i Working with modest resources CMP-AC built a high performing IDS that is the foundation of our successful population health business model. Key components are: effective medical leadership and the use of best practices and evidenced based medicine, effective network communication, clinical & technical HIT support for meaningful use & interoperability, ability to extract & store claims & EMR data for performance reports and clinical data to guide improvement, financial systems to manage budgets & clinical integration transactions, education & training to bring population health competencies to the workforce. This project will enable CMP-AC to create an expanded delivery network to bring more effective and efficient medical care and social & behavioral health services to our Medicaid and high need populations. There is continuous need to adapt to changes in the following areas: evidence based medicine, EMR upgrades and interfacing, PCMH and meaningful use standards, quality & utilization metrics, educational needs of clinical teams, care management protocols for a dynamic provider network, coordination with community services and specific needs of target populations. The IDS structure & processes will be adapted to support the PPS team in providing better care with a clear focus on achieving all performance targets.2.b.i CMP-AC/PPA selected this improvement domain for a several key reasons. Chronic illness and complex medical problems require patients to cope with a heavy burden of illness that impacts all aspects of an individual’s life. Complex medical, behavioral, and social morbidities have high associated medical costs & utilization and require effective coordination of services with active follow up. Intervention studies as well as our data suggest that overall quality & utilization can be improved by integrating care coordinators into primary care practices and other key services. Care coordinators enabled more timely post hospital primary care and higher quality discharge information yielding greater improvements in mental health and patient activation. This initiative is foundational to our entire strategy & improvement agenda.2.b.viii CMP-AC/PPA selected this domain due to the high cost of providing care to patients with chronic physical and behavioral health conditions in a hospital setting, who can be treated at home more cost effectively and with a better quality of life. Home care agencies are in a strong position to develop high risk screening and transfer tools, standardized education disease management materials to avoid urgent care and hospital admissions. Telemedicine can also be utilized for early identification, rapid assessment and communication of patient changes for providers. A multi-disciplinary care team, providing care management at home will support patient’s medical and social needs and provides linkage to community based services, so that patients can have a higher quality of life at home for as long as possible.2.c.ii All CMP-AC acute care PPS partners have high speed secure broadband network infrastructure. CMP-AC PPS proposes the establishment of a telemedicine program designed to meet the specific needs of acute care partners & rural providers outside the metropolitan Buffalo region. Bertrand Chaffee, Medina Memorial, and WCA hospitals each identified specialty physician services that, if provided in a telehealth fashion, would improve clinical outcomes and reduce cost of care. Currently, there is insufficient specialty physician capacity to support the staffing of a timely and reliable telehealth program serving multiple remote facilities in a scheduled &/or episodic, emergent manner. Cost savings will result thru the earlier diagnosis & treatment of medical conditions, avoiding patient transfer to higher cost urban providers and elimination of related transportation costs. Home-based telemonitoring and medical intervention will be a component of this project.

Domain 3 ( Clinical Improvement) – Applicants must select at least two projects from this domain (one of which must be A. Behavioral Health), but can submit up to 4 projects from Domain 3 for scoring purposes

(REQUIRED) Must choose 1 from sub list A-->

(REQUIRED) Must choose 1 from sub list A, B, C, D, E, F, G or H-->

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NYS DOH DSRIP_Project Design Grant Application Section 4 Project Program Overview/Description

Project #3- Sub-list A - H I.S.

3.G.I IHI “Conversation Ready” model 29

Project #4- Sub-list A - H I.S.

3.H.I Specialized Medical Home from Chronic Renal Failure 29

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 3 (Restricted to 4000 characters)

Characters used: 3908

4.3)

Project #1- Sub-list A-D I.S.

4.A.III Strengthen Mental Health and Substance Abuse Infrastructure across Systems 20

Project #2- Sub-list A-D I.S.

4.B.I Promote tobacco use cessation, especially among low SES populations and those with poor mental health 23

Provide reasoning regarding why your emerging Performing Provider System has selected the projects listed above from Domain 4 (Restricted to 4000 characters)

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(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or

H-->

(NOT REQUIRED) Can choose 1 from sub list A, B, C, D, E, F, G or

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3ai: CMP estimates that in about 8%-12% of office visits practitioners are identifying significant behavioral health needs. Our data shows that depression and alcohol and substance abuse are two of the highest need areas and that nationally about 60% of all depression medication is initiated by primary care providers. Our claims analysis show depressive disorders are the number one reason for psychiatric admission. CMP-AC has successful experience in addressing this and in integrating behavioral health into primary care practices. CMP participated in a Heal 17 initiative focused on establishing standardized screening for depression using the PHQ -9 and establishing coordinated care between our psychiatrists and primary care practices. Results showed increased screening and identification of patients who were experiencing an episode of depression benefitted from more targeted evidence-based interventions. To address the over 2500 visits to our ER sites involving behavioral health we are developing a mobile behavioral health team to support the emergency service sites. This team will improve assessment, enable rapid access to outpatient behavioral health services and reduce ER and hospital admissions. Our primary care physicians report major gaps in access to behavioral health treatment and even greater concern regarding the availability of psychiatric practitioners to evaluate the medication needs of patients. Our selection of this domain is based upon our desire to make behavioral health care and treatment readily available in a more normalized setting and in doing so bring greater adherence to evidence-based care and more effective and efficient utilization of services.3.g.i CMP-AC leadership has conducted an internal analysis of our services to patients with serious and advanced illnesses and end of life care. In general patients are often not aware nor are they presented with treatment options regarding the choices they have in directing their medical care. The result is underutilization of hospice care and observable hospital mortality for patients that meet the medical criteria for palliative care. Palliative care offers better care at lower cost but the decision making must be made based on individual patient/families wants, needs and values. CMP-AC has developed with CHS a palliative home care program that will be expanded & embedded in primary care sites with linkage and referral agreements with HHC providers and SNF providers. Spreading the option of palliative care to patients and families in WNY will requires that providers are comfortable with the option and that they have a trusting and open relationship with their patient. Patients and families need to be aware of the palliative option and that all community stake holders particularly religious leaders and clergy understand that palliative care is not a giving up decision but on that is value based for the individual.3.h.i Chronic Renal Failure is a major contributor to morbidity and mortality among the Medicaid population. It also represents one of the highest costs per patient of any chronic disease state. As an integrated delivery system we believe the development of a comprehensive care team for these patients is essential to impact the overall population health goals. This comprehensive care team requires primary care practices to provide prevention, early detection and slowing of progression of the disease, Nephrologists to support primary care physicians & assist in the management of more complex patients, use of modalities beyond traditional office based dialysis, including home dialysis, and nutrition, social work, pharmacy and behavioral health support. Nationally approved evidence based guidelines will then be rolled out to our entire network .This initiative would be lead by a nephrologist champion whom we have already identified within our community.

Domain 4 (Population-wide Strategy Implementation) – Applicants must select at least one project from this domain, but can submit up to 2 projects from Domain 4 for scoring purposes.

(REQUIRED) Must choose 1 from sub list A, B, C, or D-->

(NOT REQUIRED) Can choose 1 from sub list A, B, C, or D-->

4aiii CMP-AC PPS network includes a behavioral health network with specialized services for children and adolescents and a high volume maternal and child health program. Our plan is to make effective interventions for children with two over arching objectives. First is to prevent child maltreatment by using the Early Childhood Home Visitation Program and secondly to accelerate early childhood home visitation to promote effective parenting during the first two years of life and in some instances, during the prenatal period . This initiative is highly innovative in that it teams together the high volume Catholic Health System Maternal and Child programs with the services of Spectrum Behavioral Health and Child and Adolescent Treatment Services(CATS) to identify high risk patients and to promote health and supportive parenting . CATS has developed an innovative Parent Child Interaction Therapy and evidenced based practice that is office based but could be linked to a home based program and Catholic Health has developed a Baby Café to support new working parents and their infants/children. This expertise and partnerships will help CMP-AC PPS to accelerate interventions in this area and will ensure that our intervention teams are experienced, well trained and culturally competent. Our Buffalo Urban League representation on the PPS will also provide us with the ability to identify high risk patients in the community who benefit from intervention services.4.b.i Through this project and in working with all the members and participants in the CMP-AC PPS we will systemize the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use and Dependence which recommends that all health care providers and health delivery systems address tobacco use at each visit with tobacco using patients utilizing unique tools such as the Opt-to-Quit™ (OTQ™) program. OTQ™ has been developed by the Roswell Park Cancer Institute Cessation Services. This policy-driven system-wide patient referral model supports hospitals, clinics and office health care settings to provide tobacco using patients with access to stop smoking support and treatment once they leave the health care setting. OTQ™ also automatically refers tobacco users to the New York State Smokers Quit Line. This project will increase the number of health-care provider organizations that have a system to screen all patients for tobacco use, deliver brief advice to quit at all visits, and provide assistance to help patients quit successfully. Evidence demonstrates that brief advice to quit smoking from a primary health-care provider significantly increases the odds that a smoker will quit.One of the keys to population based behavior change is changing social norms. This can be achieved through public policy and adoption of health promoting polices by private and non-government organizations. This project involves implementation of policies addressing smoking access in multi-unit dwellings (MUD) and other indoor and outdoor locations. Roswell Park researchers have proven that second hand smoke (SHS) affects the neighboring units by unavoidably drifting from the smoker’s unit. Education and advocacy will be the chief tactics with public housing officials, owners of MUD that obtain HUD and other types of rent subsidies as well as owners of market-rate MUD. Lastly, this project will utilize an incentive based program for Medicaid recipients to quit smoking. A similar program is currently being piloted. The adoption of healthy behaviors by Medicaid beneficiaries who participate in prevention programs and demonstrate changes in health risk and outcomes will be provided financial incentives.

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NYS DOH DSRIP_Project Design Grant Application Section 4 Project Program Overview/Description

Project Description

4.4)

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4.5)

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4.6)

Provide a brief executive summary of your emerging Performing Provider System's vision and goals and how your emerging Performing Provider System hopes to sustain these achievements beyond the DSRIP program timeframe. (Restricted to 3000 characters)

CMP-AC/PPS vision is to continue our work as a high performing integrated health care network that meets the needs of our population and specifically the Medicaid population in WNY. Better care at lower price trend is our objective and specifically a reduction of at least 25% in unnecessary hospital admissions while demonstrating improvements in preventive and chronic care and overall health to the population. This vision is aligned with the CMP-AC high performing health care system model . Catholic Medical Partners vision and work effort for the past 6-8 years has focused on the following:1. Reducing medical services that do not bring value or that are not necessary2. Improving care and treatment to patients with highest burden of illness.3. Improving preventive care4. Increasing patient engagement and empowerment5. Integrating health care providers with community services and specialized care providers7. Creating an effective digital infrastructure to improve access to information and reporting 8. Creating new methods of payment and reimbursement based on a population health business model9. Providing care in the least restrictive and lowest cost settingThe Delivery System Reform Incentive Program will enable CMP-AC /PPS to accelerate work with the Medicaid population and to take a big step forward by expanding our provider network and integration of the all important community based services into our delivery network.

Why does your emerging Performing Provider System, as a whole, feel uniquely qualified to participate in DSRIP and serve the area you have proposed? (Restricted to 3000 characters)

CMP-AC has extensive experience in delivery system reform and is a Shared Savings ACO with CMS. We have the medical and board leadership needed to achieve success and an existing information system infrastructure including data warehouse, web site and data and analytical capabilities to support population based measurement and process improvement. CMP-AC has a mobile practice improvement team of health information staff and professional nurses trained in meaningful use, PCMH and process improvement and care coordination. This team supports the network and our high performing health care system model and risk based contracting. CMP-AC is qualified as a PPS because of our transforming work in strengthening primary care practice capacity, our work in embedding care management in the clinical office, our success in accelerating the use of health information technology - over 65% of patients are treated in a PCMH level 3 practice. CMP-AC designed and implemented a care transitions hospital to home program in 2009 that has shown success and currently is working to develop a mobile behavioral health team to support an emergency service team. CMP-AC has been using the principle and practices of clinical integration and public health for over 10 years and understands the DSRIP goals and the challenges ahead. We are an organization that has incorporated the Institute of Medicine’s guidelines for transformation and we believe we have the leadership, vision and the supportive infrastructure to be successful. The DSRIP model is aligned with our mission, vision and values and with our expanding group of community providers, will enable us to continue our population health improvement agenda.

What specific challenges does your emerging Performing Provider System foresee that could hinder the implementation of its DSRIP Project Plan? (Restricted to 3000 characters)

We anticipate a number of challenges including: 1. designing the right interventions in the right settings to get results, 2. internalizing the key PPS goals among all providers 3.organizing heath information technology capabilities and data governance to enhance communication and reporting 4. integration of community services and health care delivery 5.training of community health workers and integrating them into care teams and workflow redesign. 6. developing the business model and internal incentive programs. CMP-AC and our PPS will use best clinical practices and best science plus our experience in reducing unnecessary hospitalizations to overcome the challenges of implementing the right interventions in the right settings with the greatest potential to achieve our performance goals. CMP-AC has strong medical leadership that will enable the CMP-AC to gain consensus and move forward without unnecessary delay.The internalization of the key goals presents another challenge for a virtual organization like PPS. CMP- AC will develop and shape performance oriented teams and provide to the practice the appropriate education and training and trending reports to keep a clear focus on our target goals. CMP-AC has a mobile practice improvement team that will be expanded for the PPS to provide the necessary clinical and operational support needed.CMP-AC providers will need to use information technology capabilities effectively and efficiently to improve coordination of care. Our plan is to conduct a comprehensive assessment of the EHR systems that are being used within our PPS and to establish interoperability using the direct method with secure e-mail. In addition we will work with HEALTHeLINK, the local RHIO, to ensure that our providers are accessing available information including hospital discharge data, laboratory and radiology results. We will also use the GSI capabilities of HEALTHeLINK for our care coordination and health home. Integration of supportive community services and health care providers will require that we augment our broad urban and rural relationships and develop effective and timely referral and follow up procedures. Training of community health workers and care coordinators will require clear job descriptions and proper training and supervision. We have on our team the Buffalo Urban League that is a leader in the use of community health workers to overcome the social and economic barriers that impact health care utilization. CMP-AC is also experienced in training practices in the PCMH model and these two assets will enable us to mitigate the challenges of team based care using community health workers.The PPS business model is performance based and contingent upon both process and outcome measures. After identifying the target population and assessing their needs we will develop an internal policy to guide incentive based payment that is fair and understandable and is consistent with who is driving the results.

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NYS DOH DSRIP_Project Design Grant Application Section 4 Project Program Overview/Description

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

Community Needs Assessment

Examples of items to include in the descriptions can be found in the instructions.

Description

5.1)

Planning and Organizing

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Description - Each box is restricted to 5000 characters.

~ Keep in mind, the description box will expand as you type ~

The organizations deemed emerging PPS’s in Western New York have plan to work together on elements of the DSRIP Design process to achieve economies of scale, reduce cost and avoid duplication of work effort. This joint work includes the completion of a comprehensive community needs assessment organized, contracted and overseen by the PPS group. It is expected that an external vender with expertise in collecting and analyzing community needs assessment data will be utilized. The Catholic Medical Partners-AC PPS will utilize its Project Advisory Committee to identify an initial focus for information collection and provide this to a regional PPS community needs assessment task group. The CMP-AC PAC consists of project leads for each of the ten projects it has chosen across the 3 domains plus additional representation from select groups (i.e. academia, workforce, payers, other CBOs). Working through subcommittees consisting of individuals most experienced &/or educated in each project area (behavioral health, palliative care, etc) the CMP-AC PPS PAC will provide the information to guide the initial determination of data. Due to the very short timeframe for assessment, the emerging PPS’s and CMP-AC PAC expect to begin work in July 2014, immediately following submission of the DSRIP Design application. Work goals and objectives will be set at the subcommittee level under the leadership of the PAC member. The committee of all PPSs in WNY will develop a summary dashboard of domains/projects that will then drive the discussion around what and how best to collect community input on those domains. Part of the CMP-AC PPS committee work will be to review the extensive population health data available already (WNY hospital CNA’s, John Snow Inc PC survey, Medicaid data on DOH website, CMP-AC data, CBO generated survey data, BRFSS, etc) and determine the gaps in information.At this time, the P2 Collaborative of WNY, is a vendor of choice to conduct a community needs assessment. P2 has provided community needs assessments for the past four years. They designed and conducted community needs assessments in six of eight WNY counties in support of the Prevention Agenda activities in 2013 designing and compiling data from surveys, conducting focus groups, providing training in and facilitation of community conversations and facilitation of group meetings with community based organizations.For DSRIP, P2 would be working with the collective PPSs for WNY to design and conduct community needs assessments. The specific activities would be:• Assistance with determination of specific outreach efforts for each geographic area• Outreach and convening of community based organizations and/or community members• Conducting surveys and compilation of survey data• Facilitation of focus groups and/or community conversations • Development of reports back to the WNY PPSs regarding input from the community on specific domains and/or other DSRIP related topics

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

Description

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Description

5.3)

Data Collection

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Description

Needs Assessment Methodology

The methodology to assess the community’s needs will vary based on the project specific information required. For example, different data and qualitative community information will be needed for the palliative care project versus the integration of behavioral health and primary care. The CMP-AC PPS PAC will determine the information needed and will recommend the type of measures to be used. Our basic assessment methodology will use county level data or zip code level data within the county focusing mainly on the five counties identified in our proposed service area (Orleans, Niagara, Erie, Chautauqua, and Cattaraugus). Whenever possible, we will benchmark our data against statewide, region-wide or national use rates. We will focus our attention on the metrics outlined by the State within Domains 2, 3 and 4 and gain an understanding of where our counties stand in relation to the State as a whole. We also will be assessing the health care resources available by county as well as the community-based resources available by county. For both types of resources, we will ascertain their capacity, service area, Medicaid status, areas of expertise, accessibility, affordability, acceptability, hours of operation, transportation, sliding fee scales, etc.

We anticipate using multiple methods to collect the data necessary for our community needs assessment. We plan to use any and all methods of primary data collection based on the unique needs of the communities we are assessing. For example, one of our rural communities may be better assessed by a small community focus group while one of our urban communities may be more comfortable with a phone, paper or electronic survey tool. For seniors, having a community conversation at a senior center or local easy to use community gathering place is a good way to collect specific information and set priorities around goals. For providers and higher level personnel (executives at local employers for example), having a focus group session can be more effective as it is a concentrated time period and the questions can be asked and answered in the limited amount of time available.The proposed vender has used an advanced survey monkey license to develop and disseminate surveys in a unique way, which we have under consideration. They sent surveys to our local health departments, who in turn used provider offices, community based organization outreach (at senior centers etc.), partnered with local businesses (markets, grocery stores etc) and used social media to communicate via electronic means to drive people to a survey. In this process our PPS PAC committees would set goals for a targeted number of survey responses per county. CMP-AC also plans to “mine” the extensive claims/EMR data we have archived as well as all available secondary data sets at our disposal. We will be sure to gather the most recently prepared Community Health Needs Assessments completed by the local health departments, community providers/groups and hospitals in conjunction with the New York State Prevention Agenda. Additionally, the Department of Health is providing unprecedented access to all payer and Medicaid specific data that can be pulled and analyzed for “hot spots” of service utilization, PPRs, PPVs, PQIs, PDIs, population health metrics, etc. We also expect to use other sources of data such as the behavioral health risk assessment, transportation studies, local academic studies that may have been done, etc.

CMP-AC PPS plans to gather resource data elements by developing a survey tool to use across all the providers in the counties in our services area and/or asking these questions in a 1:1 interview if a community has a limited number of providers to be surveyed. Additionally, narrative information, tables and maps will be used to gather and share the description of the community to be served by our CMP-AC PPS. Basic demographics of the population as well as health status metrics inclusive of leading causes of death, ambulatory sensitive conditions, obesity risk factors, provider availability, and disease management and preventive care resources will be gathered and understood.

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

5.4)

Reporting

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Whenever possible, we will convert our data into understandable narrative, tables and charts to share among CMP-AC PPS partners, stakeholders and the community, customizing the presentations to each audience and purpose. CMP-AC has individuals skilled in data analytics who will summarize the data into concise reports that share the needs, strengths and service gaps of the 5 county areas we plan to serve. CMP-AC PPS will also use the resources of some of its larger partners, such as the Catholic Health System, who have professional staff skilled in marketing, staff training, and community education and programming. For community needs assessment work completed by an external contractor, data compilation and presentation to various parties will be set out contractually. Qualitative and quantitative information will also be communicated throughout the planning process using our CMP-AC PPS website and the social media sites of our PPS partners.

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

Stakeholder Engagement

5.5) As an emerging Performing Provider System, please explain the process on how you plan to engage the key stakeholders to develop your DSRIP Project Plan? (Restricted to 3000 characters)

(Key stakeholders should not be a part of the emerging Performing Provider System) - See instructions for examples of key stakeholders

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The CMP-AC PPS will engage community stakeholders using the relationships established through our partnering with local county health departments and through interaction with the personnel at hospitals & community providers that were involved in the Community Service Plan development process. This will help CMP-AC PPS to develop a specific list of stakeholder organizations and the best people to reach out to at each of those organizations. CMP-AC PPS membership also represents a broad section of the communities it serves, with a diverse network of organizations ranging from school based health centers, academic outreach collaborative (spanning elementary through college programs/institutions), charter schools, faith community nursing programs, workforce training, housing & community development, etc. Additionally CMP-AC PPS will develop and implement a targeted outreach campaign. Local organizations will be asked who needs to be at the table to assist in identifying the local experts, and hopefully earn their participation. Community meetings will be facilitated based on the community conversation or focus group methodology, or more informal gatherings such as lunches or morning/afternoon meetings with snacks or early evening with light dinner to ensure participation. Where possible, CMP-AC PPS will have political and or strong community advocates involved to also help bring more people to the conversation. CMP-AC PPS will be using its website as a resources for both community needs assessment, stakeholder engagement and community wide information and education.

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NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

List of Vendors

6.1)

1 Organization Name P2 Collaborative of WNY 2 Organization NameAddress City State Zip Code Address City State Zip Code

Organization Address 355 Harlen Road, Building C 2nd Floor West Seneca NY 14224 Organization AddressContact Person Kate Ebersole Contact Person

Contact Phone Number (716) 499-0963 Extension: Contact Phone Number Extension:

Contact Email [email protected] Contact Email

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Address City State Zip Code Address City State Zip Code

Organization Address Organization AddressContact Person Contact Person

Contact Phone Number Extension: Contact Phone Number Extension:

Contact Email Contact Email

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Address City State Zip Code Address City State Zip Code

Organization Address Organization AddressContact Person Contact Person

Contact Phone Number Extension: Contact Phone Number Extension:

Contact Email Contact Email

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Applicant must list contact information of any vendor they plan to contract with to assist in their DSRIP planning efforts. **The state maintains the right to approve any vendor used in the DSRIP program.**

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

The P2 Collaborative of WNY has provided community needs assessments for the past four years. We designed and conducted community needs assessments in six of eight WNY counties in support of the Prevention Agenda activities in 2013, designing and compiling data from surveys, conducting focus groups, providing training in and facilitation of community conversations and facilitation of group meetings with community based organizations.For DSRIP, P2 would be working with the collective PPSs for WNY to design and conduct community needs assessments. The specific activities would be:• Determination of specific outreach efforts for each geographic area• Outreach and convening of community based organizations and/or community members• Development of surveys and compilation of survey data• Facilitation of focus groups and/or community conversations • Development of reports back to PPSs regarding input from the community on specific domains and/or other DSRIP related topics

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

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NYS DOH DSRIP_Project Design Grant Application Section 7 Design Grant Timeline

Design Grant Timeline7.1)

Date (MM/DD/YYYY) Action/Decision/Milestone8/15/2014 Milestone Establish a planning-phase work structure for the PPS.

8/15/2014 Action

8/15/2014 Action8/15/2014 Action Identify/hire/ appoint a project manager and staff to facilitate each project group.

8/15/2014 Action

8/5/2014 ActionDevelop standard format for describing the improvement initiatives: who, what, where, when, why and how

11/30/2014 Milestone Complete comprehensive workplans for each initiative.

8/1/2014 Action

11/15/2014 Milestone

3/30/2015 Action

11/15/2014 Action

3/30/2015 Milestone

8/1/2014 Action Appoint HIT/operations leadership team, and complete HIT assessment.

10/31/2014 Milestone

10/31/2014 Milestone10/31/2014 Milestone Complete an assessment of workforce requirements and capacity.

8/5/2014 Decision Determine scope of Community Needs Assessment, evaluate & contract with vendor(s).

8/5/2014 Action11/15/2014 Milestone Community needs assessment complete.

9/30/2014 Action

11/30/2014 Action

11/30/2014 Milestone

11/30/2014 Milestone11/30/2014 Decision Analyze attributed members and stratify using HCC coding for provider systems.

11/30/2014 Action

Description (Up to 1200 characters)

Review initial Project Advisory Committee membership and identify & recruit additional PAC leadership as appropriate.

Assure Project Advisory Committee has all necessary resources to function effectively and to accomplish tasks including development of specific sets of focused milestones & metrics for all projects.

Set meeting times and establish deadlines to complete final improvement plans for each of the initiatives selected. Include dates for 1st, 2nd and final drafts with goals, operational requirements, training needs, metrics, communication and BUDGET and ROI projections.

Identify and engage legal services to assist with partnership agreements and compliance with all applicable laws and regulations, including HIPPA, BAA, anti-kickback statute (sections 1128B(b)(1) and (2) of the Act); the physician self-referral prohibition (section 1903(s) of the Act); the gainsharing civil monetary penalty (CMP) provisions (sections 1128A(b)(1) and (2) of the Act); and the beneficiary inducement CMP (section 1128A(a)(5) of the Act).

Establish a clear business relationship between the PPS partners, including joint budgeting and funding distribution plan that specifies the methodology for funds distribution.

Develop a data agreement to share and manage patient level data on system-wide performance consistent with all relevant HIPAA rules and regulations.

Establish policies and procedures for the PPS including reporting, decision-making, change management, and dispute resolution on performance and incentive payments.

Develop and execute PPS participating provider agreement with all necessary business and regulatory requirements.

Complete HIT assessment for all participants and identify current technology, connectivity, address gaps, and budget to close gaps. CMP's health information technology team will work closely with HEALTHeLINK.

Complete an assessment of all data requirements, and sources of data and ETL to aggregate data for reporting. Assess Medinsight capabilities to support reporting.

Conduct community needs assessment, include analysis of CMP population health data for our Medicaid risk contracts, including assessment of utilization and quality, using Milliman MedInsight.

Conduct Stakeholder engagment to address gaps in Community Needs Assessment and to identify project specific community input.

Review project selections within domains to assure alignment with community/stakeholder needs and goal of system transformation. Make changes as necessary.

Set metrics for each project and determine annual performance goals (milestones) for each metric.i. Overall project progress metrics (Domain 1)ii. System transformation metrics (Domain 2)iii. Clinical improvement metrics (Domain 3)iv. Population-wide metrics (Domain 4)

Analyze WNY Medicaid utilization data using Milliman benchmarking (loose, moderate and well managed) and set annual goals.

Develop quarterly performance reporting format and data sources including access to claims for attributed members from the 4 major health plans.

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NYS DOH DSRIP_Project Design Grant Application Section 7 Design Grant Timeline

3/30/2015 Action8/5/2014 Action Assess CMP web site capabilities to support the PPS. Upgrade & develop website as needed.

11/30/2014 Milestone Electronic communication established for the PPS.

3/30/2015 Milestone Estabish bank account/ accounting and auditing relationships.

9/30/2014 Milestone

11/30/2014 Action11/30/2014 Action Develop project specific education & training, for PPS partners and community-wide education.

9/30/2014 Action Provide training and education to PPS Project Advisory Committee3/30/2015 Milestone Establish mobile training and operations team to support all providers.

12/16/2014 Milestone Develop and submit DSRIP Project Plan application for CMP-AC PPSSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

Select OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

Develop 5 year budget for DSRIP based on attributed members with performance requirements and cash flow.

Define process to establish PPS governance and anticipated governance powers including how decisions will be made, what corporate structure will be used throughout the life of the project and how the Performing Provider System will address management of lower performing providers in the Performing Provider System network.

Develop clinical, business model and population health education and training programs (including rapid cycle improvement, data analysis, integrated delivery system models,

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NYS DOH DSRIP_Project Design Grant Application Section 8 Data Request

Data Request

8.1) Please identify any additional data that would be helpful in completing your DSRIP Project Plan. For additional help, please see link below.

Type of Data Explanation of why this additional data will be helpful (Up to 1500 characters in each line)

Data specific to the Medicaid beneficiaries attributed to our PPS including: the PPS provider that beneficiary was attributed to, beneficiary demographics, chronic health conditions identified through 3M Clinical Risk Group software, number of inpatient admissions, number of avoidable inpatient admissions (PQIs and PDIs), number of potentially preventable readmissions (PPRs), number of emergency room visits, number of avoidable emergency room visits (PPVs).

This information will enable us to set accurate baselines for all attributed members and assist us in focusing our care management efforts in a timely manner.

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NYS DOH DSRIP_Project Design Grant Application Section 8 Data Request

This information will enable us to focus efforts for project and population health overall .

DSRIP Resources Link:See pages 87-92

Summary data for all providers that are members of our PPS including: number of Medicaid beneficiaries attributed to the provider, number of beneficiaries with each of the chronic health conditions identified through 3M Clinical Risk Group software, number of inpatient admissions, number of avoidable inpatient admissions (PQIs and PDIs), number of potentially preventable readmissions (PPRs), number of emergency room visits, number of avoidable emergency room visits (PPVs).

This information will enable us to set accurate baselines to assist us in focusing our care management efforts in a timely manner.

Baseline metrics and targets for the PPS attributed population for all metrics in Domains 2, 3, and 4.

https://www.health.ny.gov/health_care/medicaid/redesign/docs/waiver_amendment_update_present.pdf

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NYS DOH DSRIP_Project Design Grant Application Section 9 Design Grant Budget

Design Grant Budget9.1)

* Only include direct expenses related to developing your DSRIP Project Plan application.

Budget Cost Category Amount

Community Needs Assessment Costs:Contractors/Vendors $ 35,000 Data Analysis $ 30,000

Other: Milliman ConsultingUniversity School of Public HealthPatient SurveysHEDIS AnalysisHospital Based Community Needs AssesmentNYS DOH Medicaid Data Files

Total Community Needs Assessment Costs: $ 65,000

Stakeholder Engagement Costs:Advertising $ 20,000 Website Design $ 40,000 Meeting Costs $ 40,000

Other: Travel $ 15,000 Work Group Stipends $ 50,000 Staffing -project development/Facilitation $ 75,000 Meeting/Training/Education Materials $ 10,000

Total Stakeholder Engagement Costs: $ 250,000

Application Development Costs:Other: ADT- HEALTHeLINK $ 40,000

PPS reporting development $ 10,000 Milliman Actuarial Services $ 50,000 Legal Services-Bylaws changes, PPS agreements, etc $ 50,000 Data Warehousing Design- claims, EMR, etc $ 20,000 GSI Care Management $ 50,000

Total Application Development Costs: $ 220,000

Other Category:Manpower Training Assessment $ 10,000 Population Health Risk Stratification using HCC Scores $ 10,000

Total $ 20,000

Other Category:

Total $ -

Grand Total $ 555,000

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NYS DOH DSRIP_Project Design Grant Application Section 9 Design Grant Budget

Capital Needs

9.2) Yes

If so, how much ? (Estimate): $ 163,500,000

If you selected 'Yes' or 'Maybe' in 9.2, please answer questions 9.3 and 9.4:

9.3)

Category Dollar Amount ($) Category Dollar Amount ($)IT/EMR $ 120,000,000 Telemonitoring Equipment (diagnostic, r $ 10,000,000 Dark fiber/T1 lines/Managed Ethernet $ 1,000,000 Telehealth software $ 500,000 Ultrasound equipment $ 2,000,000 Construction $ 15,000,000 Renovation $ 15,000,000

9.4)

Characters used: 2268

Does your emerging Performing Provider System anticipate needing capital funding to achieve the goals of your DSRIP Project Plan?

Please use the grid to state which types of costs the capital funds would be utilized for (e.g. construction, renovation) as well as approximately how much funding would be needed for each potential category.

Please describe which DSRIP projects these capital funds would be applied to and how the capital funds will help the emerging Performing Provider System achieve its project specific DSRIP objectives. (Restricted to 3500 characters)

IT system and EHR related capital expenditures are critical to support most, if not all, of the ten proposed DSRIP projects and essential to the creation of a successful integrated delivery system. The results of a preliminary poll of CMP-AC partners indicate a broad range of electronic readiness from providers with no EHR capacity to those with complex but unique IT systems. Significant IT related funding will be needed to accomplish care coordination among disparate providers and community based organizations. IT infrastructure will also need to be enhanced to accomplish expanded data management for evidenced based medicine evaluation and population health management.

Capital to create IT, diagnostic & reporting infrastructure for telemedicine and telehealth will be needed for Project 2.c.ii Expand Usage of telemedicine in underserved areas to provide access to scarce resources, Project 4.a.iii Strengthen mental health and substance abuse infrastructure across systems and for components of several other projects to facilitate communication & training/education. Some of the capital needs are: basic computer/monitor/camera mobile units, peripheral instrumentation (digital stethoscope, otoscope, ophthalmoscope, full exam cameras), advanced diagnostic equipment (i.e. portable ultrasound, digital imaging), technology to obtain, store, transmit and archive images for review & consultation and inclusion in an EHR, enhanced real-time videoconferencing to provide access to medical specialists and behavioral health providers. This capital will promote access to care, timely treatment, and improved quality for the patient. It will also support providers by providing access to specialty consults for improved decision making, experts in many specialties, educational & mentoring opportunities, improved efficiency and improved patient outcomes.

Capital funding is also needed to achieve Project 3ai Integration of primary care and behavioral health services and 4aiii Strengthen mental health and substance abuse infrastructure across systems. It is expected that service locations will need to be modified or constructed to accommodate the co-location of services and the relocation or expansion of services to previously unserved locations.

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

State of New York Department of Health

Delivery System Reform Incentive Payment (DSRIP) Program

** Please read instructions for ease of use **

1 2 3 4 5 6 7 8 9 10

Organization Name Address City State Zip Person Phone # Extension Email

1 Able2 NO 1118 Charles St. Elmira NY 14904 Mark Peters 60773471072 Absolut Care of Dunkirk YES 447 Lakeshore Dr. West Dunkirk NY 14048 Matthew J. Hriczko, LNHA 71636667103 Absolut Care of Eden YES 2806 George St. Eden NY 14057 Matthew J. Hriczko, LNHA 71636667104 Absolut Care of Orchard Brooke NO 6060 Armor Rd. Orchard Park NY 14127 Jennifer May 71666267535 Absolut Care of Orchard Park YES 6060 Armor Rd. Orchard Park NY 14127 Daniel Detor 71666244336 Absolut Care of Salamanca YES 451 Broad St. Salamanca NY 14779 Kevin Kennedy 71694518007 Absolut Center for Nursing & Rehab at Allegany, LLC YES 2178 North 5th St. Allegany NY 14706 Karen Randolph, LNHA 71637322388 Absolut of Houghton YES 9876 Luckey Drive Houghton NY 14744 Heather A. Morin/LNHA 58556727709 Absolute Care of Westfield YES 26 Cass St. Westfield NY 14787 Charlene Youknut, LNHA 7163264646

10 Aspire YES 2356 North Forest Road Getzville NY 14068 Tom Sy/ Honor Martin (honor.m716838004711 Autumn View Healthcare facility YES S-4650 Southwestern Blvd Hamburg NY 14075 Stephen Mercurio 7168262010 1124 [email protected] Baker Victory Services NO 780 Ridge Road Lackawanna NY 14218 Jeffrey Almeter 7168289751 [email protected] Bertrand Chaffee Hospital NO 224 East Main Street Springville NY 14141 Nils Gunnersen, CEO 7165922871 1200 [email protected]

19 Brooks Memorial Hospital YES 529 Central Avenue Dunkirk NY 14048 Jeffrey Morgan, Interim VP of F 7163637212 [email protected] BryLin Hospitals, Inc. NO 1263 Delaware Avenue Buffalo NY 14209 Paul Hettich 7168868200 [email protected]

Cantalician Center for Learning YES 2049 George Urban Blvd. Depew NY 14043 Melissa Acquard21 Catholic Charities YES 741 Delaware Avenue Buffalo NY 14209 Denis Walczyk, CEO 7162181400 [email protected]

Catholic Charities YES 741 Delaware Avenue Buffalo NY 14209 Denis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 76 West Humboldt Parkway Buffalo NY 14214 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 76 West Humboldt Parkway Buffalo NY 14214 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 20 Rich Street Buffalo NY 14211 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 20 Rich Street Buffalo NY 14211 Dennis Walczyk, CEO 7162181400 [email protected] Charities - Monsignor Carr Institute YES 1581 Bailey Avenue Buffalo NY 14212 Dennis Walczyk, CEO 7162181400 [email protected]

2.1) Partner Organizations - Contact Information General Provider Types

Fill out this form for the specific provider types we have listed in columns L & M

For all "Other" provider types, use the 2nd tab - Section 2.2_Partner Org_"Other".

SN Qualified (Y/N)

[email protected]@[email protected]@[email protected]@[email protected]@[email protected]@aspirewny.org

[email protected]

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24 Catholic Charities - Monsignor Carr Institute YES 1581 Bailey Avenue Buffalo NY 14212 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 170 Fulton Street Buffalo NY 14204 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 170 Fulton Street Buffalo NY 14204 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 3719 Union Road Cheektowaga NY 14225 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 3719 Union Road Cheektowaga NY 14225 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 3370 Delaware Avenue Kenmore NY 14217 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 3370 Delaware Avenue Kenmore NY 14217 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 33 Wilkesbarre Avenue Lackawanna NY 14218 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 33 Wilkesbarre Avenue Lackawanna NY 14218 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 620 Tronolone Place Niagara Falls NY 14302 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 620 Tronolone Place Niagara Falls NY 14302 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 1465 Payne Avenue N Tonawanda NY 14120 Dennis Walczyk, CEO 7162181400 [email protected]

Catholic Charities - Monsignor Carr Institute YES 1465 Payne Avenue N Tonawanda NY 14120 Dennis Walczyk, CEO 7162181400 [email protected] Catholic Charities - Monsignor Carr Institute YES 300 Bewely Building Lockport NY 14094 Dennis Walczyk, CEO 7162181400 [email protected]

24 Catholic Charities - Monsignor Carr Institute YES 300 Bewely Building Lockport NY 14094 Dennis Walczyk, CEO 7162181400 [email protected]

27 Chautauqua Co. Chapter NYSARC Inc, dba The Resource Center YES 200 Dunham Avenue Jamestown NY 14701 Heather Brown 7166611042 [email protected]

28 Chautauqua Co. Department of Health & Human Services YES 7 North Erie Street Mayville NY 14757 Christine Schuyler 7167534590 [email protected] Child & Adolescent Treatment Services YES 301 Cayuga Rd., Suite 200 Cheektowaga NY 14225 Bonnie Glazer 7168193420 10130 Community Concern of Western New York Inc. YES 6722 Erie Rd. Derby NY 14047 Jerry S. Barone MA MBA 7169475025

31 Community Services for the Developmentally Disabled YES 2118 Delaware Ave. Buffalo NY 14216 Mark Foley 7168838888

32 Community Services for the Developmentally Disabled YES 585 West Utica Buffalo NY 14213 Mark Foley 7168838888

33 Community Services for the Developmentally Disabled YES 110 Lorelee Dr. Tonawanda NY 14150 Mark Foley 7168838888

34 Community Services for the Developmentally Disabled YES 24 Eagan Drive Lackawanna NY 14218 Mark Foley 7168838888

35 Community Services for the Developmentally Disabled YES 248-252 Parkridge Buffalo NY 14215 Mark Foley 7168838888

36 Community Services for the Developmentally Disabled YES 181 East Hazeltine Kenmore NY 14217 Mark Foley 7168838888

38 Community Services for the Developmentally Disabled YES 1377 Abbott Rd. Lackawanna NY 14218 Mark Foley 7168838888

39 Community Services for the Developmentally Disabled YES 24 Victoria Kenmore NY 14217 Mark Foley 7168838888

40 Community Services for the Developmentally Disabled YES 162 Heritage Rd. Tonawanda NY 14150 Mark Foley 7168838888

41 Community Services for the Developmentally Disabled YES 30 Persia Buffalo NY 14211 Mark Foley 7168838888

42 Community Services for the Developmentally Disabled YES 11 Abbott Rd. Buffalo NY 14220 Mark Foley 7168838888

43 Community Services for the Developmentally Disabled YES 506 Delaware St. Tonawanda NY 14150 Mark Foley 7168838888

[email protected]@communityconcern.org

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

44 Community Services for the Developmentally Disabled YES 98 Lafayette Buffalo NY 14213 Mark Foley 7168838888

45 Community Services for the Developmentally Disabled YES 260 Victory Lackawanna NY 14218 Mark Foley 7168838888

46 Community Services for the Developmentally Disabled YES 1835 Niagara St. Buffalo NY 14207 Mark Foley 7168838888

47 Community Services for the Developmentally Disabled YES 590 Kenmore Buffalo NY 14216 Mark Foley 7168838888

48 Community Services for the Developmentally Disabled YES 256 Parkridge Buffalo NY 14215 Mark Foley 7168838888

49 Community Services for the Developmentally Disabled YES 4590 Lake Ave. Blasdell NY 14219 Mark Foley 7168838888

50 Community Services for the Developmentally Disabled YES 198 Bakos Buffalo NY 14211 Mark Foley 7168838888

51 Community Services for the Developmentally Disabled YES 4799 Harlem Rd. Amherst NY 14226 Mark Foley 7168838888

52 Community Services for the Developmentally Disabled YES 333 Robert Drive N. Tonawanda NY 14120 Mark Foley 7168838888

53 Community Services for the Developmentally Disabled YES 275 Brookside Tonawanda NY 14150 Mark Foley 7168838888

54 Community Services for the Developmentally Disabled YES 1588 Sheridan Dr. Tonawanda NY 14150 Mark Foley 7168838888

55 Community Services for the Developmentally Disabled YES 158 Thorndale West Seneca NY 14224 Mark Foley 7168838888

56 Community Services for the Developmentally Disabled YES 695 Parkside Buffalo NY 14216 Mark Foley 7168838888

57 Community Services for the Developmentally Disabled YES 283 Overbrook Tonawanda NY 14150 Mark Foley 7168838888

58 Community Services for the Developmentally Disabled YES 4365 Bayview Hamburg NY 14075 Mark Foley 7168838888

59 Community Services for the Developmentally Disabled YES 509 Dodge Rd. Getzville NY 14086 Mark Foley 7168838888

60 Community Services for the Developmentally Disabled YES 54 Continental Grand Island NY 14072 Mark Foley 7168838888

61 Community Services for the Developmentally Disabled YES 3 Geary St. Buffalo NY 14210 Mark Foley 7168838888

62 Community Services for the Developmentally Disabled YES 205 Willowgrove Tonawanda NY 14150 Mark Foley 7168838888

63 Community Services for the Developmentally Disabled YES 179 Syracuse Tonawanda NY 14150 Mark Foley 7168838888

64 Community Services for the Developmentally Disabled YES 8071 Southwestern Blvd. Angola NY 14006 Mark Foley 7168838888

65 Community Services for the Developmentally Disabled YES Fletcher St. N. Tonawanda NY 14120 Mark Foley 7168838888

66 Community Services for the Developmentally Disabled YES 44 North Drive Lackawanna NY 14218 Mark Foley 7168838888

67 Community Services for the Developmentally Disabled YES 5329 Armor Duells Orchard Park NY 14127 Mark Foley 7168838888

68 Community Services for the Developmentally Disabled YES 76-78 Rosemary Buffalo NY 14216 Mark Foley 7168838888

69 Community Services for the Developmentally Disabled YES 510 Leydecker West Seneca NY 14224 Mark Foley 7168838888

70 Community Services for the Developmentally Disabled YES 98 Lafayette Buffalo NY 14213 Mark Foley 7168838888

[email protected]

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

71 Community Services for the Developmentally Disabled YES 526 Leydecker West Seneca NY 14224 Mark Foley 7168838888

72 Community Services for the Developmentally Disabled YES Commerce Court Wheatfield NY 14120 Mark Foley 7168838888

73 Community Services for the Developmentally Disabled YES 52 Dixon Dr. Tonawanda NY 14150 Mark Foley 7168838888

74 Community Services for the Developmentally Disabled YES 2180 Genesee Buffalo NY 14211 Mark Foley 7168838888

75 Community Services for the Developmentally Disabled YES 180 Oak St. Buffalo NY 14203 Mark Foley 716883888876 DePaul Adult Care Communities, Inc. - Glenwell ALP NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Adult Care Communities, Inc. - Horizons ALP NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Adult Care Communities, Inc. - Kenwell ALP NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Adult Care Communities, Inc. - Woodcrest ALP NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Community Services, Inc. - Care Mangement (HH) NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Community Services, Inc. - Community Residences NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] DePaul Community Services, Inc. - PROS YES 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] Elderwood at Amherst YES 4559 Bailey Avenue Amherst NY 14226 Larry Piselli 7168352543 [email protected] Elderwood at Cheektowaga YES 225 Bennett Road Cheektowaga NY 14227 Scott West 7166819480 [email protected] Elderwood at Grand Island YES 2850 Grand Island Blvd Grand Island NY 14072 Colleen Krauss 7167735900 [email protected] Elderwood at Hamburg YES 5775 Maelou Drive Hamburg NY 14075 Deborah Urbank 7166482820 [email protected] Elderwood at Lancaster YES 1818 Como Park Blvd Lancaster NY 14086-2824 Denise Bothwell 7166836165 [email protected] Elderwood at Liverpool YES 4800 Bear Road Liverpool NY 13088 Kristin Russell 2128027600 [email protected]

Elderwood at Waverly YES 37 North Chemung Street Waverly NY 14892-1211 Maria Landy 6075656314 [email protected] at Wheatfield YES 2600 Niagara Falls Blvd Wheatfield NY 14304 Anthony DePinto 7162158000 [email protected]

91 Elderwood at Williamsville YES 200 Bassett Road Williamsville NY 14221 Rich McCune 7166896681 [email protected] EPIC- Every Peson Influences Children NO 1000 Main St. Buffalo NY 14202 Vito J. Borrello 7163324116

96 EPIC- Every Peson Influences Children NO 1000 Main St. Buffalo NY 14202 Vito J. Borrello 716332411697 Erie County Department of Health YES 95 Franklin Street, 9th Floor Buffalo NY 14202 Cheryll Moore 7168587695 [email protected] Father Baker Manor Yes 6400 Powers Road Orchard Park NY 14127 Rachael Nees 7168283812 [email protected] Garden Gate Healthcare Facility YES 2365 Union Road Cheektowaga NY 14227 Stephen Mercurio 7168262010 1124 [email protected]

101 Gateway-Longview, Inc. NO 10 Symphony Circle Buffalo NY 14201 Al Dirschberger PhD 7167833314

102 NO 120 Gardenville Parkway W Seneca NY 14224 Teresa Dancy 7166564042 [email protected] Harris Hill Nursing Facility YES 2699 Wehrle Drive Williamsville NY 14221 Stephen Mercurio 7168262010 1124 [email protected] Heritage Christian Services Yes 349 West Commercial St. E. Rochester NY 14445 Marisa Geitner105 Hillside Family of Agencies Yes 1183 Monroe Ave. Rochester NY 14620 Dennis Richardson 5852567500106 Holy Childhood YES 100 Groton Parkway Rochester NY 14623 Donna Dedee 5853593710107 Horizon Health Serivces YES 1750 Pine Avenue Niagara Falls NY 14303 Herbert Weiss, Chief Quality & 7168311800 [email protected]

108 Horizon Health Services YES 6301 Inducon Drive East Sanborn NY 14132 Herbert Weiss, Chief Quality & 7168318100 [email protected]

109 Horizon Health Services YES 11 Summer Street Buffalo NY 14209 Herbert Weiss, Chief Quality & 7168318100 [email protected]

110 Horizon Health Services YES 3297 Bailey Avenue Buffalo NY 14215 Herbert Weiss, Chief Quality & 7168311800 [email protected]

111 Horizon Health Services YES 3045 & 3085 Southwestern Blvd Orchard Park NY 14127 Herbert Weiss, Chief Quality & 7168318100 [email protected]

112 Horizon Health Services YES 2563 Union Road Cheektowaga NY 14227 Herbert Weiss, Chief Quality & 7168311800 [email protected]

113 Horizon Health Services YES 6495 Transit Road E Amherst NY 14051 Herbert Weiss, Chief Quality & 7168318100 [email protected]

114 Horizon Health Services YES 699 Hertel Avenue, Suite 350 Buffalo NY 14207 Herbert Weiss, Chief Quality & 7168311800 [email protected]

[email protected]

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[email protected]

[email protected] Valley Group Health association dba Lifetime Health (4 sites total)

[email protected]@holychildhood.org

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

115 Horizon Health Services YES 1370 Niagara Falls Blvd Tonawanda NY 14150 Herbert Weiss, Chief Quality & 7168318100 [email protected] Horizon Health Services YES 2157 Main Street, Suite 100 Buffalo NY 14214 Herbert Weiss, Chief Quality & 7168311800 [email protected] Horizon Health Services YES 3020 Bailey Avenue Buffalo NY 14215 Herbert Weiss, Chief Quality & 7168318100 [email protected] Horizon Health Services YES 6520 Niagara Falls Blvd Niagara Falls NY 14304 Herbert Weiss, Chief Quality & 7168318100 [email protected] Horizon Health Services YES 60 East Amherst Street Buffalo NY 14215 Herbert Weiss, Chief Quality & 7168311800 [email protected] Horizon Health Services YES 620 Tenth Street, 7th Floor Niagara Falls NY 14301 Herbert Weiss, Chief Quality & 7168311800 [email protected]

124 Horizon Village, Inc. NO 251 Elm Street Buffalo NY 14203 Herbert Weiss, Chief Quality & 7168311800 [email protected]

125 Kenmore Mercy Hospital NO 2950 Elmwood Avenue Kenmore NY 14217 Rachael Nees 7168283812 [email protected] Woerner, Inc. dba HCR YES 85 Metro Park Rochester NY 14623 Elizabeth Zicari, RN, BSN, CENP 5852956481

126 L Woerner, Inc. dba HCR NO 211 East Main St., Suite 3 Batavia NY 14020 Elizabeth Zicari, RN, BSN, CENP 5852956481130 Lake Shore Behavioral Health YES 255 Delaware Avenue, Suite 300 Buffalo NY 14202 Howard Hitzel, PsyD, President 7168420440 112 [email protected]

131 Lake Shore Behavioral Health YES 255 Delaware Avenue, Suite 300 Buffalo NY 14202 Howard Hitzel, PsyD, President 7168420440 112 [email protected]

132 Lifetime Assistance Inc. YES 425 Paul Road Rochester NY 14624 Jamie Branciforte 5854264120134 Living Opportunities of DePaul, Inc. - Community Residences/HH NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected] Lutheran Home & Rehab Center / Luteran Retirement Home Yes 715 Falconer Street Jamestown NY 14701 Tom Holt 7166658128 [email protected] McAuley Seton Home Care NO 2875 Union Road Cheektowaga NY 14227 Rachael Nees 7168283812 [email protected] Medina Memorial Hospital NO 200 Ohio Street Medina NY 14103 Delores Horvath, CEO 5857988100 [email protected] Mercy Home Care dba Niagara Home Makers NO 2875 Union Road Cheektowaga NY 14214 Rachael Nees 7168283812 [email protected]

139 Mercy Hospital of Buffalo NO 565 Abbott Road Buffalo NY 14220 Rachael Nees 7168283812 [email protected] Mercy Skilled Nursing Facility YES 55 Melroy Avenue Lackawanna NY 14218 Rachael Nees 7168283812 [email protected] Mid Erie Counseling & Treatment Svcs YES 125 Martin Road Lackawanna NY 14218 Elizabeth Mauro 7168956700 4051 [email protected] Mid Erie Counseling & Treatment Svcs YES 650 Ridge Road Lackawanna NY 14218 Elizabeth Mauro 7168956700 4051 [email protected] Mid Erie Counseling & Treatment Svcs YES 1500 Broadway Buffalo NY 14212 Elizabeth Mauro 7168956700 4051 [email protected] Mid Erie Counseling & Treatment Svcs YES 5360 Genesee Street, Suite 200 Bowmansville NY 14026 Elizabeth Mauro 7168956700 4051 [email protected] Mid-Erie Counseling & Treatment Services YES 1526 Walden Avenue, Suite 400 Cheektowaga NY 14225 Elizabeth Mauro, Executive Dire7168956700 4051 [email protected] Mid-Erie Counseling & Treatment Services YES 1526 Walden Avenue, Suite 400 Cheektowaga NY 14225 Elizabeth Mauro, Executive Dire7168956700 4051 [email protected]

162 Mount St. Mary's Hospital & Health Center YES 5300 Military Road Lewiston NY 14092 Bernadette Franjione 7162982198 [email protected]

164 Niagara Co. Department of Health NO 5467 Upper Mountain Road, Suite 10Lockport NY 14094 Daniel Stapleton 7164397435 [email protected] Northgate Healthcare Facility YES 77264 Nash Road N Tonawanda NY 14120 Stephen Mercurio 7168262010 1124 [email protected] Odd Fellow & Rebekah Rehab & Healthcare Center, LLC YES 104 Old Niagara Road Lockport NY 14094 Eugene Urban 7164346324 [email protected] Orleans County Department of Mental Health YES 14014 Route 31 W Albion NY 14411 Mark O'rien, LCSW-R, Director 5855893292 mark.o'[email protected] Father Baker Manor YES 5285 Lewiston Road Lewiston NY 14092 Thomas LoStracco 7162982900 [email protected] Pathways Inc. Yes 33 Denison Parkway West Corning NY 14830 Ed Lukomski 6079373293172 People Inc. Yes 1219 North Forest Rd. Williamsville NY 14221 Jim Boles 7168177400173 Roswell Park Cancer Institute NO Elm & Carlton Streets Buffalo NY 14263 Lisa Damiani 7168453079 [email protected] Seneca Healthcare Center YES 2987 Seneca Street W Seneca NY 14224 Stephen Mercurio 7168262010 1124 [email protected]

176 Sisters Long Term Home Health Care Program YES 2157 Main Street Buffalo NY 14214 Rachael Nees 7168283812 [email protected]

177 Sisters of Charity Hospital of Buffalo YES 2157 Main Street Buffalo NY 14214 Rachael Nees 7168283812 [email protected]

178 Southern Tier Health Home NO 7 North Erie Street Mayville NY 14757 Patricia Brinkman 7167534104 [email protected]

[email protected]@hcrhealth.com

[email protected]

[email protected]@people-inc.org

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

180 Southern Tier Health Home NO 7 North Erie Street Mayville NY 14757 Patricia Brinkman 7167534104 [email protected] Southern Tier Health Home NO 7 North Erie Street Mayville NY 14757 Patricia Brinkman 7167534104 [email protected]

182 Southern Tier Health Home NO 7 North Erie Street Mayville NY 14757 Patricia Brinkman 7167534104 [email protected] Spectrum Human Services NO 227 Thorn Avenue Orchard Park NY 14127 Bruce Nisbet 7165978336 [email protected] St Francis Williamsville NO 147 Reist Street Williamsville NY 14221 Rachael Nees 7168283812 [email protected] St. Catherine Laboure YES 2157 Main Street Buffalo NY 14214 Rachael Nees 7168283812 [email protected]

192 Suburban Adult Services Inc. YES 960 Maple Rd. Elma NY 14059 Anthony Annunziato 7168051555193 The McAuley Residence Yes 1503 Military Road Kenmore NY 14217 Rachael Nees 7168283812 [email protected]

194 TLC Health Network YES 845 Routes 5 & 20 Irving NY 14081 Scott Butler 7169517041 [email protected]

195 Westfield Memorial Hospital NO 189 East Main Street Westfield NY 14787 Patty Ballman 7167932201 [email protected] Winship Community Residences, Inc. - Community Residences NO 1931 Buffalo Road Rochester NY 14624 James M. Whalen, CFO 5857193170 [email protected]

197 Women's Christian Association Hospital dba WCA Hospital YES 207 Foote Avenue, PO Box 840 Jamestown NY 14702 Dan Tota 7166648445 [email protected]

[email protected]

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

Assisted Living Facility OASAS (Article 32) Provider

OMH (Article 31) Provider

Critical Access Hospital (CAH) OPWDD (Article 16) provider

Public Hospital

Skilled Nursing Facility

Nursing Home

"OTHER" Providers - Fill out Section 2.2 11 12 13 15 16

Provider Type MMIS OPCERT NPI #1 NPI #2

OPWDD (Article 16) providerSkilled Nursing Facility 1058759 601303 1063549889Skilled Nursing Facility 1058777 1461302 1508993320Assisted Living Facility 240-F-878Nursing Home 335507 1435303N 1518094333Nursing Home 01660902 0433303N 1144357963Nursing Home 33561001 0420302 1881721611Skilled Nursing Facility 1561311 0226301N 1235266057Skilled Nursing Facility 335683 0675302N 1528195344OPWDD (Article 16) provider 00474924 1401204R 1346337011Skilled Nursing Facility 764181 1430301N 1568459725OMH (Article 31) provider 3007009 7577120A 1669695391Public Hospital 354150 1427000H 1275553521

381439 0601000H 1215917224OMH (Article 31) provider 358058 1499000H 1194728691 1528400249OPWDD (Article 16) provider 1174789242OMH (Article 31) provider 2998227 6770100 1962596718

OASAS (Article 32) Provider2998227 6770100 1962596718

OMH (Article 31) Provider 2998227 6770100A 1962596718

OASAS (Article 32) Provider2998227 6770100A 1962596718

OMH (Article 31) Provider 2998227 6770100B 1962596718

OASAS (Article 32) Provider2998227 6770100B 1962596718

OMH (Article 31) Provider 2998227 6770100C 1962596718

Provider Type: ONLY choose from the following:

Certified Home Health Agency

Diagnostic & Treatment Center (Non FQHC)

Federally Qualified Healthcare Center (FQHC)

Long Term Home Health Care Provider

Sole Community Provider (SCP)

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Voluntary Hospital (Non CAH, Non Sole Community Provider)

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

OASAS (Article 32) Provider2998227 6770100C 1962596718

OMH (Article 31) Provider 2998227 6770100D 1962596718

OASAS (Article 32) Provider2998227 6770100D 1962596718

OMH (Article 31) Provider 2998227 6770100E 1962596718

OASAS (Article 32) Provider2998227 6770100E 1962596718

OMH (Article 31) Provider 2998227 6770100F 1962596718

OASAS (Article 32) Provider2998227 6770100F 1962596718

OMH (Article 31) Provider 2998227 6770100G 1962596718

OASAS (Article 32) Provider2998227 6770100G 1962596718

OMH (Article 31) Provider 2998227 6770120A 1962596718

OASAS (Article 32) Provider2998227 6770120A 1962596718

OMH (Article 31) Provider 2998227 6770120B 1962596718

OASAS (Article 32) Provider2998227 6770120B 1962596718

OMH (Article 31) Provider 2998227 6770120C 1962596718

OASAS (Article 32) Provider2998227 6770120C 1962596718

3004955 0602201R 1982682639 1538223110

02995279 0622200R 1336291640OMH (Article 31) Provider 00357855 6769100A 1225180052 1851557656OMH (Article 31) Provider Licensed Home Care 671807 6755100A 1497828461

OPWDD (Article 16) provider02253496 8083-0160 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0161 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0162 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0163 2253496 2704350

OPWDD (Article 16) provider02253487 8083-0164 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0165 2253496 2704350

OPWDD (Article 16) provider02704350 8083-0166 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0167 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0168 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0169 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0170 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0172 2253496 2704350

Diagnostic & Treatment Center (Non FQHC)

Diagnostic & Treatment Center (Non FQHC)

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

OPWDD (Article 16) provider02253487 8083-0173 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0174 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0175 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0176 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0177 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0178 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0179 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0180 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0181 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0182 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0183 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0184 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0185 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0186 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0187 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0188 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0189 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0442 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0443 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0444 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0445 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0446 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0448 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0449 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0450 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0451 2253496 2704350

OPWDD (Article 16) provider02253496 8083-0452 2253496 2704350

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

OPWDD (Article 16) provider02253496 8083-0453 2253496 2704350

OPWDD (Article 16) provider02704350 8083-0651 2253496 2704350

OPWDD (Article 16) provider03561906 8083-0800 2253496 2704350

OPWDD (Article 16) provider02704350 8083-0840 2253496 2704350

OPWDD (Article 16) provider2253496 2704350

Assisted Living Facility 02253001 240-E-146 1689745275Assisted Living Facility 02253001 530-E-051 1689745275Assisted Living Facility 02253001 240-E-843 1912071044Assisted Living Facility 02253001 370-E-198 1689745275OMH (Article 31) Provider 02189628 17600 1942374368OMH (Article 31) Provider 02994241 17600 1134293541OMH (Article 31) Provider 00357557 17600 1780756114Nursing Home 2084839 1451307N 1467725101Nursing Home 1243512 1455303N 130619078Nursing Home 1148136 1464302N 1013280759Nursing Home 872028 1430303N 1205109949Nursing Home 1542621 1406303N 1053684720Nursing Home 870677 3331301N 1285907980Nursing Home 362689 5320302N 1891068565Nursing Home 1615021 3121304N 1891068532Nursing Home 1287874 1421307N 1467725168OMH (Article 31) Provider

OASAS (Article 32) Provider

Diagnostic & Treatment Center (non-FQHC) 474846 1401202R 1447282199 1215183421Skilled Nursing Facility 01487076 1435302N 1861487498Skilled Nursing Facility 475232 1455300N 1295722460OMH(Article 31) Provider MLT 7850009A 20195148 1710158134

3001856 2701218R 1295751261Skilled Nursing Facility 1323793 1406301N 1013904283OPWDD (Article 16) provider 2247276 1700077443OPWDD (Article 16) provider 1639267933OPWDD (Article 16) provider 1023270824 1265509491OMH (Article 31) Provider 2993786 6034105C 1043387152

OASAS (Article 32) Provider2993786 141011812 1043387152

OASAS (Article 32) Provider2993786 141110815 1043387152

OASAS (Article 32) Provider2993786 150210811 1043387152

OASAS (Article 32) Provider2993786 151011772 1043387152

OASAS (Article 32) Provider2993786 160111680 1043387152

OASAS (Article 32) Provider2993786 160211714 1043387152

OASAS (Article 32) Provider2993786 161210814 1043387152

Diagnostic & Treatment Center (Non FQHC)

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

OASAS (Article 32) Provider2993786 170210812 1043387152

OMH (Article 31) Provider 2993786 6034005C 1043387152OMH (Article 31) Provider 2993786 6034103A 1043387152OMH (Article 31) Provider 2993786 6034105A 1043387152OMH (Article 31) Provider 2993786 6034303A 1043387152OMH (Article 31) Provider 1043387152

OASAS (Article 32) Provider2890077 E140611819 1730256231

3001618 1404000H 1770598104Certified Home Health Agency 01102432 2701603 1649285354Certified Home Health Agency 01102432 2701603 1649285354OMH (Article 31) provider 671765 06783101A 1508868407

OASAS (Article 32) Provider671765 06783101A 1508868407

OPWDD (Article 16) provider7041450 7041440 1356554406 1518170679

OMH (Article 31) Provider 02997726 10450 1861564221Skilled Nursing Facility 314618 0602308N 1235116286Certified Home Health Agency 01080735 1455600N 1699772343Public Hospital 30000846 3622000H 1609873520Certified Home Health Agency 00887976 0054L001 146742200

354412 1401008H 1164464921Skilled Nursing Facility 00475301 1401008H 1144262908OMH (Article 31) Provider 02994796 160310875 1225095201OMH (Article 31) Provider 02994796 160310875 1225095201OMH (Article 31) Provider 02994796 6791021A 1225095201OMH (Article 31) Provider 02994796 6791120H 1225095201OMH (Article 31) Provider 2994796 160310875 1225095201OMH (Article 31) Provider 2994796 6791100A 1225095201

1746616 3121001H 1043394745

03575940 3101200R 1417292020Skilled Nursing Facility 688546 3160301N 1659368827Skilled Nursing Facility LTC 335500 3101305N 1194857292OMH (Article 31) provider 2993759 6943100A 1043345713Skilled Nursing facility 2415507 3121303N 1720073539OPWDD (Article 16) provider 1851571038OPWDD (Article 16) provider 518974 6310442 1093997454Public Hospital 354518 1401010H 1548315401Skilled Nursing Facility 475365 1474301N 1003803271

00354563 1401903L 1053319756

3001705 1401013H 1790727543

OASAS (Article 32) Provider02997928 150610712 1902897374

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Diagnostic & Treatment Center (Non FQHC)

Long Term Home Health Care Provider

Voluntary Hospital (Non CAH, Non Sole Community Provider)

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

OASIS (ARTICLE 31) Provider 02997928 6854101A 1902897374OASIS (ARTICLE 31) Provider 02997928 6854102A 1902897374

OASAS (Article 32) Provider02997928 C141210711 1902897374

OMH (Article 31) Provider 1143599 6845102A 1962684316Skilled Nursing facility 00475383 1421300N 1821084492Skilled Nursing Facility 00346754 1401324N 1043259997

OPWDD (Article 16) provider02824784 7051357 1528081734

Skilled Nursing facility 00475287 1404000N 1013903657

2995848 0427000H 1487738886

354614 0632000H 1942236427OMH (Article 31) Provider 01326943 50000 1467524801

3001750 1770573222 1063498889

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Voluntary Hospital (Non CAH, Non Sole Community Provider)

Voluntary Hospital (Non CAH, Non Sole Community Provider) 0602001H

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

State of New York Department of HealthDelivery System Reform Incentive Payment (DSRIP) Program

1 2 3 4 5 6 7 8 9 10

Organization Name Address City State Zip Person Phone # Extension Email

1 Buffalo Prenatal Perinatal Network YES 625 Delaware Ave. Buffalo NY 14202 Connie Schweitzer, CEO 7168846711 2112 Buffalo Psychiatric Center YES 400 Forest Avenue Buffalo NY 14213 Celia Spacone, PhD 7168162011 [email protected] Buffalo Psychiatric Center YES 400 Forest Avenue Buffalo NY 14213 Celia Spacone, PhD 7168162011 [email protected] Buffalo Psychiatric Center YES 400 Forest Avenue Buffalo NY 14213 Celia Spacone, PhD 7168162011 [email protected] Buffalo Psychiatric Center YES 400 Forest Avenue Buffalo NY 14213 Celia Spacone, PhD 7168162011 [email protected]

Buffalo Urban League YES 14 Genesee St. Buffalo NY 14203 Grace Tate 71625024006 Catholic Health System, Inc. NO 2121 Main Street, Suite 300 Buffalo NY 14214 Joseph D. McDonald, CEO 7168622410 [email protected] Catholic Medical Partners NO 1083 Delaware Avenue Buffalo NY 14209 Michael Edbauer, DO 7168621260 [email protected]

8 Chautauqua County Health Network NO 200 Harrison St. , Suite 200 Jamestown NY 14701 Ann Abdella 71633800109 Chautauqua Region Associated Medical Partners (AMP) NO 200 Harrison Street, Suite 200 Jamestown NY 14701 Ann Abdella 7163380010 [email protected]

10 D'Youville College NO 320 Porter Avenue Buffalo NY 14201 Dr. Arup Sen, VP for Academic Af7168298144 [email protected] Erie Co. Department of Mental Health YES 95 Franklin Street Buffalo NY 14202 Deborah Goldman, Assistant Co 7168588538 [email protected] Erie Niagara Community-Based Integrated Care Network YES 95 Franklin St., 13th Floor Buffalo NY 14202 Randall A. Hoak 716858852613 Family & Childrens Services of Niagara YES 1522 Main Street Niagara Falls NY 14305 Kenneth A. Sass 7162856984 [email protected] Family Help Center NO 60 Dingens Street Buffalo NY 14206 Deborah A. Merrifield, Executive7168220919 [email protected] Health Home Partners of WNY, LLC YES 227 Thorn Avenue Orchard Park NY 14127 Bruce Nisbet 7165978336 [email protected] Independent Health Association, Inc. NO 511 Farber Lakes Drive Buffalo NY 14221 Anthony Montagna, VP Network7166353639 anthony.montagna@independenthea17 Innovative Health Svcs of America, dba MASH Care Network NO 6 Fountain Plaza Buffalo NY 14215 Paul Snyder III 7163324214 [email protected] Living Independent for Elders (LIFE) NO 55 Melroy Avenue Lackawanna NY 14218 Rachael Nees 7168283812 [email protected] MedFirst Urgent Care, PLLC dba MASH Urgent Care NO 6 Fountain Plaza Buffalo NY 14202 Mark Pundt, MD 7165801801 [email protected] Lake Shore Behavioral Health YES 255 Delaware Avenue, Suite 300 Buffalo NY 14202 Howard Hitzel, PsyD, President 7168420440 112 [email protected] National Kidney Foundation NO 310 Packetts Landing Fairport NY 14450 Diana Jason 585598396322 New Directions Youth & Family Services, Inc. NO 6395 Old Niagara Road Lockport NY 14094 James Coder 7163595830 [email protected] Niagara County Community College NO 3111 Saunders Settlement Road Sanborn NY 14132 Cherie Mavissakalian, MS, RN - 7166145941 [email protected] Niagara County Department of Mental Health YES 5467 Upper Mountain Road Lockport NY 14094 Michael A. White 716439741025 Niagara County Department of Mental Health YES 1001 Eleventh St. Niagara Falls NY 14301 Michael A. White 716278194026 Niagara University NO 5795 Lewiston Road Niagara Univ NY 14109 Frances Crosby, PhD 7162868155 [email protected] PLS III LLC dba We Care NO 401 East Amherst Street Buffalo NY 14215 Paul Snyder, IV 7168987917 [email protected] Restoration Society, Inc. NO 66 Englewood Avenue Buffalo NY 14214 Jack Guastaferro 7168322141 29 [email protected] Southern Tier Health Home NO 7 North Erie Street Mayville NY 14757 Patricia Brinkman 7167534104 [email protected] St. Elizabeth's Home NO 5539 Broadway Lancaster NY 14086 Rachael Nees 7168283812 [email protected] St. Vincent's Home NO 319 Washington Avenue Dunkirk NY 14048 Rachel Nees 7168283812 [email protected] SUNYAB School of Nursing NO 3435 Main Street, 104 Beck Hall Buffalo NY 14214 Marsha Lewis, PhD, RN, FAAN 7168292566 [email protected] Trocaire College NO 360 Choate Avenue Buffalo NY 14220 Mary Ann Deb 7168272448 [email protected] UB Family Medicine NO 77 Goodell St, Gateway Bldg Suite 22Buffalo NY 14203 John Taylor, Executive Director 7168167277 [email protected]

2.2) Partner Organizations - Contact Information"OTHER" Provider Types

SN Qualified (Y/N)

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]@niagaracounty.com

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35 NO Buffalo NY 14225 Daniel Porreca, Executive Direct7162060993 [email protected] Cattaraugus County Health Department YES 1 Leo Moss Drive, Suite 4010 Olean NY 14760 Debra Lacher 716701339837 Buffalo Hearing & Speech YES 50 East North St. Buffalo NY 14203 Joe Sonnenberg 7168858871

Western New York Clinical Information Exchange, Inc d/b/a HEALTHeLINK

2568 Walden Ave, Suite 107

[email protected]@askbhsc.org

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

11 12 15 16

"OTHER"- Provider Type MMIS NPI #1 NPI #2

Other Key Community AgencyOther NYS Psychiatric Facility 476628 1740344647 1922162197Other NYS Psychiatric Facility 476628 1740344647 1922162197Other NYS Psychiatric Facility 476628 1740344647 1922162197Other NYS Psychiatric Facility 476628 1740344647 1922162197OtherOther Integrated Health NetworkPhysician IPA

Other Rural Health NetworkOther ACOOther Academic InstitutionOther Local Government Unit 1053656694Other CBOOther 1164158 1447398755Other Community Based OrganizationOther Health Home 3465001 1760742548Other Payer 1033255278Other Urgent Care ProviderOther PACE Program 03072740 1124268305Other Urgent Care Provider 1447298401Other Health Home 671765 1508868407Other Non-Profilt Org.Other CBO 353553Other Nursing EducationOther Mental Health 618786 1285774083Other Mental Health 618786 1891832879Other Academic InstitutionOther 1047158 1720147010 1000055467Other Peer Operated Recovery Ctr & Rehab SvcOther Rural Health Network 03520990 1477807097Other Adult HomeOther Adult HomeOther UniversityOther Academic InstitutionOther Ambulatory Provider 1739220 1942294467

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DSRIP Project Design Grant Application Updated Section 2 Form Partner Organization Contact Info

Other RHIOOtherOther

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Elaine Clutterbuck Certified_Nurse_Midwife Individual Yes 1124081070 466393 223 Erie 397 Louisiana St. Buffalo NY 14204 716-847-6610Sarah Worrell Certified_Nurse_Midwife Individual Yes 1437114709 1474675 F000206-1 Erie 397 Louisiana St. Buffalo NY 14204 716-847-6610Ameneh Habir Nurse_Practitioner Individual No 1568645810 F420854-1 Erie 515 Abbott Rd., Suite 302 Buffalo NY 14220 716-706-2034Christine Hatem Nurse_Practitioner Individual No 1861423584 380147 Erie 397 Louisiana St. Buffalo NY 14204 716-828-3520Asmahan Korach Nurse_Practitioner Individual No 1528099298 380521 Erie 397 Louisiana St. Buffalo NY 14204 716-847-6610Danielle Leach-Minazzi Nurse_Practitioner Individual Yes 1689909020 F335624-1 Erie 227 Ridge Rd. Buffalo NY 14218 716-822-5944Kathleen McCarthy Nurse_Practitioner Individual No 1649292855 380270 Erie 515 Abbott Rd. Buffalo NY 14220 716-828-2775Kristine Sabatino Certified_Nurse_Midwife Individual No 1497706303 8494418 F0010231 Erie 565 Abbott Rd. Buffalo NY 14220 716-828-2600Sharon Nisengard Certified_Nurse_Midwife Individual No 1043232002 1041 Erie 565 Abbott Rd. Buffalo NY 14220 716-828-2568Joan Osswald Nurse_Practitioner Individual No 1588686307 330889 Erie 397 Louisiana St. Buffalo NY 14204 716-847-6610Najmul Khan Physician Individual No 1417276726 No License- student Erie 1240 Delaware Ave. Buffalo NY 14209 203-570-5667Evette Hernandez Physician Individual Yes 1730460593 28001481 Erie 289 Summer St. Buffalo NY 14222 716-885-2229Indea King Nurse_Practitioner Individual Yes 1275802084 336596 Erie 2157 Main St. Buffalo NY 14214 716-862-1984Louise Tomczak Nurse_Practitioner Individual No 1255357851 420385 Erie 2157 Main St. Buffalo NY 14214 716-862-1984Lana Pasek Nurse_Practitioner Individual No 1770507758 F303465-1 Erie 2157 Main St. Buffalo NY 14214 716-862-1196Mary Schumer Nurse_Practitioner Individual No 1821012683 360114 Erie 515 Abbott Rd., Suite 304 Buffalo NY 14220 716-828-3520Avtar Samra MD Physician Individual Yes 1427078138 189530 Erie 300 Two Mile Creek Road Tonawanda New York 14150 716-706-2034Ayesha Butt MD Physician Individual No 1164669651 254106 Erie 300 Two Mile Creek Road Tonawanda New York 14150 716-447-6450Gloria Wang MD Physician Individual Yes 1275568958 2496371 229449 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610James M. Fitzpatrick MD Physician Individual Yes 1326093089 1364841 NY135497 Erie Kenmore New York 14217 716-876-8760James Matthews MD Physician Individual Yes 1114964988 131142 Erie 227 Ridge Road Lackawanna New York 14218 716-822-5944James Stephen MD Physician Individual Yes 1821009911 241259 Erie 1595 Bailey Avenue Buffalo New York 14212 716-893-8550Ji Young Lee MD Physician Individual No 1477796092 268466 Erie 407 Darwin Dr. Amherst New York 14226 716-862-1492Katherine Frachetti MD Physician Individual Yes 1508028531 253449 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610Kent Lieber MD Physician Individual No 1265455109 1192474 170279-1 Erie 227 Ridge Road Lackawanna New York 14218 716-822-5944Lynn Aronica MD Physician Individual Yes 1952374050 2496371 229449-1 Erie 515 Abbott Road-Suite 302 Buffalo New York 14220 716-828-3520Michael S Gough MD Physician Individual Yes 1477661486 243206 Erie 2950 Elmwood Ave Kenmore New York 14217 716-949-3449Nadezhda Polataiko MD Physician Individual Yes 1013936137 233447 Erie 300 Two Mile Creek Road Tonawanda New York 14150 716-447-6450Nicholas Cromwell MD Physician Individual Yes 1790708626 1768914 191190-1 Erie 515 Abbott Road-Suite 302 Buffalo New York 14220 716-828-3520Nicole DeLuca MD Physician Individual Yes 1811167448 242817 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610Nirisha Kalakada MD Physician Individual Yes 1760647945 003888 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610Patrick Siaw MD Physician Individual Yes 1922039213 211163 Erie 1595 Bailey Avenue Buffalo New York 14212 716-893-8550Paul Updike MD Physician Individual Yes 1073544755 211389 Erie 1595 Bailey Avenue Buffalo New York 14212 716-893-8550Philip J Rados MD Physician Individual Yes 1326073008 197182 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610Qamrunnisa Rahman MD Physician Individual Yes 1922091685 1988581 213653 Erie 300 Two Mile Creek Road Tonawanda New York 14150 716-447-6450Rania Ahmed Karam-Bayoumi MD Physician Individual Yes 1851546097 259233 Erie 227 Ridge Road Lackawanna New York 14218 716-822-5944Shahid Banday MBBS Physician Individual Yes 1154656031 3503959 004108 Erie 397 Louisiana Street Buffalo New York 14204 716-847-6610Brian Snyder MD Physician Individual 1437148087 1131951 177885 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911Calogero Ippolito MD Physician Individual 1205803509 220843 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750Charles Yates MD Physician Individual 1134112691 1991262 211440 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750David Farrugia MD Physician Individual 1891998563 257310 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750Eileen Reilly MD Physician Individual 1871586420 2212779 219574 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911Elizabeth Kyger MD Physician Individual 1548241177 754036 143470 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911Elizabeth M Love MD Physician Individual 1063400521 1761820 200473 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750Joseph M. Mylotte MD Physician Individual 1356380612 1150852 120404 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911Katherine Gaines MD Physician Individual 1376529164 776650 153168 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750Leroy W. McCune MD Physician Individual 1497741391 903104 158075 Erie 1026 Union Road West Seneca New York 14224 716-725-1956Michael J. Pelechaty, Jr. MD Physician Individual 1235228552 1702634 206551-1 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911Steven Evans MD Physician Individual 1730172776 1173293 177137 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750

Kenmore Mercy Hosp, Second Floor 2950 Elmwood Avenue

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Subrato Ghosh MD Physician Individual 1083607055 2317664 226537 Erie 50 Lakefront Blvd, Suite 130 Buffalo New York 14202 716-849-8750Teresa Chau MD Physician Individual 1841286747 1075727 169818 Erie 2875 Union Road, Suite 8 Cheektowaga New York 14227 716-651-0911. Zulkharnain MD Physician Individual 1124195649 1614204 206334 Erie 136 Sobieski Street Buffalo New York 14212 716-447-6096

A. Kamil Alpsan MD Physician Individual 1427013879 648128 136056 Niagara 415 Tremont Street New York 14120 716-694-6884Aaron M. Powell MD Physician Individual 1427259688 3338534 260279 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000

Abdallah Rimawi MD Physician Individual 1831239508 243059 Erie Buffalo New York 14220 716-828-2434

Abeer Eddib MD Physician Individual 1215954102 227498 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Abul Islam MD Physician Individual 1215901749 204776 Erie 100 High St., Room E324 Buffalo New York 14203 716-859-2360Adam Kotowski MD Physician Individual 1992813828 3413467 249101 Erie 199 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-3340Adam Radolinski MD Physician Individual 1629078431 898215 151288 Erie 888 Center Road West Seneca New York 14224 716-675-3530

Adel Chouchani MD Physician Individual 1255325650 765962 148116 Erie 30 North Union Road, Suite 101 Williamsville New York 14221 716-633-6363

Adel Sulaiman MD Physician Individual 1255432944 1827210 208908 Erie Buffalo New York 14220 716-828-2578Afshan Samad MD Physician Individual 1275844540 256923-1 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Agnes Quebral MD Physician Individual 1861553349 3038671 250185 Erie 1900 Ridge Road Suite 130 West Seneca New York 14224 716-675-0707Aislinn Scarbinsky DO Physician Individual 1427288463 270461 Erie 310 Sterling Drive, Suite 105 Orchard Park New York 14127 716-675-7730Ajay Panchal MD Physician Individual 1053573444 267266 Erie 350 Alberta Dr., Suite 205 Amherst New York 14226 716-833-7112

Akram Talhouk MD Physician Individual 1346215167 1530547 153555 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-857-8800

Alain Eluard MD Physician Individual 1710941661 658044 137063 Erie 1412 Sweet Home Road Suite 5 Amherst New York 14228 716-875-4500Alan Kuritzky MD Physician Individual 1316067499 774016 134741 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Alan W. Meholick MD Physician Individual 1912973025 170851 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966

Albert Diaz-Ordaz MD Physician Individual 1588735203 162503 Erie Orchard Park New York 14127 716-677-9220Albert J Addesa MD Physician Individual 1609804368 725315 144992 Erie 1616 Kensington Avenue Buffalo New York 14215 716-683-5252Alberto Benedicto MD Physician Individual 1679506117 3024155 226297 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Alessandra Palma MD Physician Individual 1730120304 1771273 207323-1 Erie 4899 Transit Road Depew New York 14043 716-558-5437

Alexander B Gelfer MD Physician Individual 1689638462 1083825 166540-2 Erie 100 College Parkway, Suite 110 Williamsville New York 14221 716-631-8863

Alexander K. Mandych MD Physician Individual 1053362103 191510 Erie Orchard Park New York 14127 716-675-0616Alexander Rovner MD Physician Individual 1326097403 2798570 238610-1 Erie 4772 North French Road East Amherst New York 14051 716-404-2604Alfredo Rodes MD Physician Individual 1477539823 1670020 207147 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Ali Ghomi MD Physician Individual 1639196520 2533324 229501 Erie 2157 Main Street Buffalo New York 14214 716-862-1965

Alka Chatrath MD Physician Individual 1164459681 2494113 222458-1 Erie Buffalo New York 14220 716-828-2434Allyn Norman DO Physician Individual 1568420925 153492 Erie 1825 Maple Road, Suite LLB Williamsville New York 14221 716-204-4532Alok D. Gupta MD Physician Individual 1801836507 239786 Erie 9 Limestone Drive Williamsville New York 14221 716-631-2517Alvin M. Panahon MD Physician Individual 1912953571 776756 115312-1 Erie 45 Spindrift Dr Williamsville New York 14221 716-298-1635Amar J.S. Atwal MD Physician Individual 1356346795 503466 131796 Erie 3095 Harlem Road Cheektowaga New York 14225 716-896-8831

Amarjit Singh MD Physician Individual 1710936463 648251 119393-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-630-1050

Amy J. Burke MD Physician Individual 1952563439 3013590 248781 Erie Orchard Park New York 14127 716-362-3909

Amy Wnek-Hassenfratz MD Physician Individual 1871547463 2312783 225912-1 Erie Orchard Park New York 14127 716-972-0279Anandaram Herle MD Physician Individual 1043295868 111776 Erie 3675 Southwestern Blvd Orchard Park New York 14127 716-558-7555

North Tonawanda

565 Abbott Road, 8th floor-room 632

Mercy Hospital - Dept of Medicine 565 Abbott Rd

3065 Southwestern Blvd, Suite 100

3075 Southwestern Boulevard #102

565 Abbott Road, 8th floor-room 632

3065 Southwestern Blvd, Suite 102

3671 Southwestern Boulevard, Suite 101

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Andrew Green MD Physician Individual 1427050301 124074-2 Erie 3615 Seneca Street West Seneca New York 14224 716-675-2660Andrew J. Harbison DO Physician Individual 1114941267 203914 Erie 30 North Union Williamsville New York 14221 716-839-8000Andrew Luisi, Jr. MD Physician Individual 1467428599 2619643 219185 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050Andrew Siedlecki MD Physician Individual 1417939802 1558621 178042-8 Erie PO Box 1068 Getzville New York 14068 716-634-8500Andrew Soh MD Physician Individual 1649276189 1218271 172437 Erie 2950 Elmwood Ave Kenmore New York 14217 716-871-0171Andrew Stoeckl MD Physician Individual 1942269964 231925-1 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999

Andrew W. Halsdorfer DO Physician Individual 1376500157 2238342 221778-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 (716) 630-1465Andrew Warner MD Physician Individual 1215967880 1885203 209530 Erie 1616 Kensington Avenue Buffalo New York 14215 716-835-3097

Anees Ahmad MD Physician Individual 1881760049 237483 Erie Buffalo New York 14220 716-828-2434Anil Mathur MD Physician Individual 1811061104 647383 111426 Erie 5285 Main Street Williamsville New York 14221 716-631-9477

Ann Schapiro MD Physician Individual 1063459006 2739095 239071-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Annaliese Noack DO Physician Individual 1750510418 3487625 262019 Erie 6255 Sheridan Drive Suite 108 Williamsville New York 14221 716-677-6060

Anthony Buscaglia DO Physician Individual 1598828733 2208506 215967 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Anthony F. Perna MD Physician Individual 1568429330 148393 Erie 1430 Colvin Boulevard Tonawanda New York 14223 716-874-4060

Anthony Freundel MD Physician Individual 1881658672 1423289 1892041 Erie 100 College Parkway, Suite 110 Williamsville New York 14221 716-631-8863Anthony J Buscaglia MD Physician Individual 1265579536 604595 112703 Erie 515 Abbott Road Suite 102 Buffalo New York 14220 716-824-0266Anthony Pivarunas DO Physician Individual 1134197650 182660-1 Erie 2157 Main Street Buffalo New York 14214 716-862-1965Anthony Ricottone MD Physician Individual 1134114051 1732609 1996071 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Anthony Vetrano MD Physician Individual 1982636650 1191877 171758 Erie 2625 Harlem Road, Suite 210 Cheektowaga New York 14225 716-893-7337Aravind Herle MD Physician Individual 1851327951 2146972 220336 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243

Arif S. Syed MD Physician Individual 1508068628 262199 Niagara Lewiston New York 14092 716-284-3278Arooj Shaikh MD Physician Individual 1194784892 203091 Niagara 5300 Military Road Lewiston New York 14092 716-298-2356

Arthur G. Ostrum Jr DO Physician Individual 1376596841 1272059 186766 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Arundathi Namassivaya MD Physician Individual 1790807410 2098662 217755 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Arvind K. Wadhwa MD Physician Individual 1629077391 1075516 168079 Niagara 273 Division Street N Tonawanda New York 14120 716-693-3344Ashish Bhatia MD Physician Individual 1104034545 229275 Erie 100 High Street Buffalo New York 14203 716-859-1400

Ashok Kaushal MD Physician Individual 1871546572 1010773 157200 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Ashok Singh MD Physician Individual 1326046343 2071016 232523 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Ashraf Henry MD Physician Individual 1033147400 2490119 236106 Erie 4227 Maple Rd Amherst New York 14226 716-832-1107Ashvani Gulati MD Physician Individual 1245228642 1241950 180207 Erie 3750 Delaware Avenue Kenmore New York 14217 716-874-2455Ashwina Sheth MD Physician Individual 1073572475 172538 Erie 85 Wehrle Drive Cheektowaga New York 14225 716-832-0618

August Bruno, Jr. MD Physician Individual 1013996131 1572816 190949-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-857-8800Ayman Farghaly MD Physician Individual 1760489975 1167817 195041 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454Baljinder Singh MD Physician Individual 1356539415 249213 Erie 46 Golden Pheasant Drive Getzville New York 14068 716-909-6718

Barbara Stefanick MD Physician Individual 1730150384 210770-1 Erie Amherst New York 14228 716-250-9235Barbara Stouter MD Physician Individual 1073568358 8494418 183576 Erie 515 Abbott Road, Suite 304 Buffalo New York 14220 716-995-8801Barry Fitzgerald DPM Physician Individual 1629140587 004522 Erie 843 McKinley Avenue Buffalo New York 14220 716-822-0118

Bashir Attuwaybi MD Physician Individual 1578791992 253606 Erie 4955 N Bailey Ave, Suite 201 Amherst New York 14226 716-630-1081Bela Ajtai MD Physician Individual 1316155500 002751 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Bellamkonda Raghu MD Physician Individual 1922050012 1843232 194173 Erie P.O. Box 580 East Amherst New York 14051 716-632-5450Benjamin J Schaus DO Physician Individual 1891982450 259127 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501

565 Abbott Road, 8th floor-room 632

Attn: Finance Dept - Patty Hanna 5300 Military Road

20 Northpointe Parkway, Suite 100

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Benjamin Rueda MD Physician Individual 1891767786 1191684 181946 Niagara Lewiston New York 14092 716-284-3278Bennett Myers MD Physician Individual 1437211414 2389724 224146-1 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Bertrand P. Roche MD Physician Individual 1639134174 125258 Erie 61 Maple Road Williamsville New York 14221 716-565-1234

Bhavansa Padmanabha MD Physician Individual 1841264587 109999 Erie Kenmore New York 14217 716-447-6629Bohdan J. Kawinski MD Physician Individual 1598700650 00722409 151074 Erie 625 Hopkins Rd. Williamsville New York 14221 716-913-2610Bradley Ertel MD Physician Individual 1932360773 263500 Erie 565 Abbott Rd Buffalo New York 14220 716-828-2860Breeann N. Wilson DPM Physician Individual 1255573887 006328 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983Brenda Perez MD Physician Individual 1902864234 2675872 232452 Niagara 5290 Military Road, Suite 8 Lewiston New York 14092 716-298-3000Brian Block MD Physician Individual 1528066214 602906 114629 Niagara 5300 Military Road Lewiston New York 14092 716-298-2356Brian Cromwell MD Physician Individual 1548231541 1268706 169198 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Brian Karaszewski MD Physician Individual 1255478376 213340 Erie 400 International Drive Williamsville New York 14221 716-631-3555Brian Matier MD Physician Individual 1942484159 267289 Erie 85 High Street Buffalo New York 14203 716-857-8800Brian McGrath MD Physician Individual 1801862776 1442786 193700 Erie 4949 Harlem Rd Amherst New York 14226 716-204-3257

Brian Rambarran MD Physician Individual 1235391244 258163 Niagara 3850 Saunders Settlement Rd Cambria New York 14132 716-898-2800Brian Smith MD Physician Individual 1528051596 1397951 1846081 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Bruce Naughton MD Physician Individual 1740241918 1477696 195956 Erie 4498 Main Street, Suite 23 Buffalo New York 14226 716-961-9900

Bruce Platt MD Physician Individual 1083611610 569282 1373181 Erie 1616 Kensington Avenue Buffalo New York 14215 716-834-3278Bruce Rodgers MD Physician Individual 1174544860 150203 Erie 2157 Main Street Buffalo New York 14214 716-862-1506Budder Siddiqui MD Physician Individual 1366670051 266169 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-531-3480Cara M. Fininzio DO Physician Individual 1992948475 255865 Erie 30 North Union Road Williamsville New York 14221 716-839-8000Carl A. Todoro MD Physician Individual 1881699221 615196 134051 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-8300Carlo M Perfetto MD Physician Individual 1568457182 1088453 1611227 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Carlos Martinez MD Physician Individual 1366476897 1036382 160093 Erie 2291 Union Road West Seneca New York 14224 716-668-6146Carlos Santos MD Physician Individual 1275526246 989919 1601631 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Carmen Alvarez MD Physician Individual 1508828906 238588 169624 Erie 297 Spindrift Drive Williamsville New York 14221 716-635-0688Carmen M. Todoro MD Physician Individual 1245223437 1188738 1712911 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222

Carola E. Bagnarello MD Physician Individual 1053488247 242466 Erie 30 North Union Road, Suite 101 Williamsville New York 14221 716-633-6363Cary Vastola DO Physician Individual 1619901170 142631 Erie 30 North Union Williamsville New York 14221 716-839-8000Catalina Ionita MD Physician Individual 1568439222 2731262 002531 Erie 515 Abbott Rd, Suite 25 Buffalo New York 14220 716-828-3123Catherine Falkner MD Physician Individual 1174679880 2621901 232327 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Catherine Tota-Thurn DO Physician Individual 1417987694 212504 Erie 30 North Union Williamsville New York 14221 716-839-8000Celestino Pietrantoni DO Physician Individual 1689658312 2560901 223235 Erie 6460 Main Street Williamsville New York 14221 716-634-5100

Chad E. Szymanski DO Physician Individual 1336148709 2396665 224175 Niagara 3799 Commerce Court, Suite 100 New York 14120 716-839-8000Chad Strittmatter MD Physician Individual 1184692816 Pending 210727 Erie 2157 Main Streeet Buffalo New York 14214 716-862-1984Chad Tyler DO Physician Individual 1942534581 259454 Erie 1491 Sheridan Drive Tonawanda New York 14217 716-332-4476Charles Niles MD Physician Individual 1053378109 1021452 158661 Erie 6333 Main Street Williamsville New York 14221 716-632-3545

Charles Rice MD Physician Individual 1457332827 136299 Niagara Lewiston New York 14092 716-298-3000Chee Kim MD Physician Individual 1013974245 1592869 180360 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050Chelsie Bax DO Physician Individual 1942443015 169921 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Cheng Shung Fu MD Physician Individual 1730132366 592003 118876 Erie 6636 Main Street, Suite 1 Williamsville New York 14221 716-633-0541

Christian Chouchani MD Physician Individual 1881858702 266351 Erie 30 North Union Road, Suite 101 Williamsville New York 14221 716-633-6363

Christian Krawczyk DO Physician Individual 1205881547 2550278 228690-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Attn: Finance Dept - Patty Hanna 5300 Military Road

2950 Elmwood Avenue, Room 5022

North Tonawanda

Attn: Finance Dept - Patty Hanna 5300 Military Road

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Christopher Bartolone MD Physician Individual 1548246788 1658415 183549 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Christopher Hamill MD Physician Individual 1164495446 200675 Erie 4949 Harlem Rd Amherst New York 14226 716-204-3257Christopher Karkut MD Physician Individual 1922208453 264903 Erie 1616 Kensington Avenue Buffalo New York 14215 716-834-3278Christopher Kopp MD Physician Individual 1679568596 1380643 1773681 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Christopher Ritter MD Physician Individual 1093788432 2564047 213291 Erie 4949 Harlem Road Amherst New York 14226 716-898-3106

Christopher Skomra MD Physician Individual 1841297496 1566072 199193 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Christopher Springer MD Physician Individual 1093706657 2166287 214979-1 Erie 515 Abbott Road, Suite 304 Buffalo New York 14220 716-995-8801Cindy Romanowski MD Physician Individual 1952338873 202177 Erie 4510 Main Street Buffalo New York 14226 716-839-0632Claude Sy MD Physician Individual 1437135381 1590849 208192 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Claudia D. Fosket MD Physician Individual 1194765933 2775253 177506 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000

Corine Cicchetti MD Physician Individual 1639339716 2476171 Erie 100 College Parkway, Suite 100 Williamsville New York 14221 716-626-0093Corstiaan Brass MD Physician Individual 1487619946 711000 143124-1 Erie 6255 Sheridan Dr, Suite 210 Williamsville New York 14221 716-857-8603

Courtenay Watt MD Physician Individual 1841233442 1647685 2026711 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Craig Fetterman MD Physician Individual 1922038785 2246591 214954 Erie 2950 Elmwood Aveune Kenmore New York 14217 716-447-6100Craig MacLean DO Physician Individual 1588667893 1092020 154802 Erie 3040 Amsdell Rd. Hamburg New York 14075 716-646-6700Craig S. Chertack MD Physician Individual 1811979487 169890 Erie 8750 Transit Road Suite 105 East Amherst New York 14051 716-636-1470Cynthia Ferrelli DPM Physician Individual 1710970108 1215118 BF2072976 Erie 330 Harris Hill Road, Suite B Williamsville New York 14221 716-631-1133Dale L Deahn MD Physician Individual 1871573378 711064 150120 Wyoming 401 Main Street Arcade New York 14009 585-492-5088Dale Wheeler MD Physician Individual 1366448367 964021 163873 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Dalip Khurana MD Physician Individual 1578534368 139722 Erie 15 Commerce Drive Springville New York 14141 716-592-4166Dan Weitzenkorn MD Physician Individual 1730238288 1274653 266853 Erie 3095 Harlem Road Cheektowaga New York 14225 716-896-8831Dana Jandzinski MD Physician Individual 1598879801 2775253 236988 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000

Dang Tuan Pham MD Physician Individual 1831146125 251073 Erie 2625 Harlem Road, Suite 160 Cheektowaga New York 14225 716-893-0333

Daniel A. Castellani MD Physician Individual 1669459368 151648-1 Erie 6245 Sheridan Drive, Suite 216 Williamsville New York 14221 716-626-2647Daniel B Keating DPM Physician Individual 1639192156 1009030 N0039411 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983Daniel Cotter MD Physician Individual 1003018102 233935 Erie 1 Hopkins Road Williamsville New York 14221 716-631-8888Daniel J Patterson DO Physician Individual 1831193580 2555228 232298 Erie 310 Sterling Drive, Suite 105 Orchard Park New York 14127 716-675-7730Daniel Kassavin MD Physician Individual 1144428103 260157 Erie 2121 Main Street, Suite 316 Buffalo New York 14214 716-837-2400Daniel Leary MD Physician Individual 1497758064 797737 143061 Erie 3030 Orchard Park Rd, Suite B West Seneca New York 14224 716-671-8393Daniel Molloy MD Physician Individual 1215255781 271846 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-828-2437Daniel Murak MD Physician Individual 1407844145 1132874 164660 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Daniel S. Camara MD Physician Individual 1235121732 139374 Erie 2625 Harlem Road #240 Cheektowaga New York 14225 716-895-4400Daniel Schaefer MD Physician Individual 1285699744 982283 151623 Erie 4590 Main Street Amherst New York 14226 716-839-3535Daniel Trock MD Physician Individual 1639134885 2174050 222142 Erie 1150 Youngs Road, Suite 104 Williamsville New York 14221 716-636-7979Daniel Wild MD Physician Individual 1295755395 137730-1 Erie 6255 Sheridan Dr, Suite 210 Williamsville New York 14221 716-631-1117

Daniel Zorich MD Physician Individual 1770581993 214961 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Danielle Conley MD Physician Individual 1497818173 2836446 2422551 Erie 560 Franklin Street Buffalo New York 14202 716-332-4472Darla Lane DO Physician Individual 1225057037 227580 Erie 30 North Union Williamsville New York 14221 716-839-8000Darlene Dzik MD Physician Individual 1558318949 1833590 201886 Erie 4899 Transit Road Depew New York 14043 716-558-5437

Darren Caparaso MD Physician Individual 1699731588 1885143 204934 Erie 3671 Southwestern Blvd #213 Orchard Park New York 14127 716-662-7008

Darren Huffman MD Physician Individual 1396058012 269468 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Daryl Ehlenfield MD Physician Individual 1033117809 1856573 209031 Erie 560 Franklin Street Buffalo New York 14202 716-332-4472

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

David A. Sherris MD Physician Individual 1689646739 178951 Erie 1237 Delaware Ave Bufalo New York 14209 716-884-5102David A. Silverstein MD Physician Individual 1881687358 758347 144649 Erie 2914 Elmwood Avenue Kenmore New York 14217 716-875-6700

David Avino MD Physician Individual 1710944632 1735400 199233 Erie Orchard Park New York 14127 716-667-2062David B. Lillie MD Physician Individual 1952306201 607167 145776 Erie 3800 Delaware Ave Kenmore New York 14217 716-873-3828David C Dean MD Physician Individual 1144283425 594770 079703 Erie 65 Huxley Drive Amherst New York 14226 716-839-3085David Carlson MD Physician Individual 1710942859 661027 190642 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050David Clifford MD Physician Individual 1386604775 1597039 196229-1 Erie 256 Center Road West Seneca New York 14224 716-677-4159David Cuthbert MD Physician Individual 1346599495 3504556 266407 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5500David F. Pfalzer MD Physician Individual 1588623714 1086424 163300 Erie 2914 Elmwood Avenue Kenmore New York 14217 716-875-6700David F. Ratliff MD Physician Individual 1740569805 262236 Erie 8750 Transit Road Suite 105 East Amherst New York 14051 716-636-1470David Fisher MD Physician Individual 1083711170 2429472 2109341 Erie S3673 Southwestern Blvd Orchard Park New York 14127 716-662-4827

David Gunther MD Physician Individual 1962483156 754201 139495 Erie 1026 Union Road West Seneca New York 14224 716-712-0851David Hartman MD Physician Individual 1790775575 1091661 154572 Erie 6000 N. Bailey Ave Suite 1D Amherst New York 14226 716-834-4266David J Novelli MD Physician Individual 1093776445 617294 128300-1 Erie 256 Center Road West Seneca New York 14224 716-677-4178David J. Durante MD Physician Individual 1902842040 98869 Erie 1900 Ridge Road, Suite 130 West Seneca New York 14224 716-677-0850

David J. Serra MD Physician Individual 1912938390 2300769 223702 Erie 5670 Glen Iris Drive Clarence Center New York 14032David L Capaccio DO Physician Individual 1457355364 206544 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-828-2437David Lawton MD Physician Individual 1194799494 1787315 191961 Erie 112 Olean Road, Suite 220 East Aurora New York 14052 716-805-1072David Marchetti MD Physician Individual 1528042835 844688 146548-1 Erie 45 Spindrift Dr, Suite 102 Williamsville New York 14221 716-689-8398David Martinke DO Physician Individual 1083638027 186542 Erie 30 North Union Williamsville New York 14221 716-839-8000David Montesanti MD Physician Individual 1386636389 2282846 215803 Erie 1 Hopkins Road Williamsville New York 14221 716-631-8888David N. Johnson MD Physician Individual 1053370908 693563 139434 Erie 2914 Elmwood Avenue Kenmore New York 14217 716-875-6700

David O. Scamurra MD Physician Individual 1427015221 149164 Erie Amherst New York 14228 716-250-9235David O'Neil MD Physician Individual 1811926249 BB4911 172109 Erie 3755 Abbott Road Orchard Park New York 14127 716-649-4454

David P. Kowalski MD Physician Individual 1881699312 204975 Erie Orchard Park New York 14127 716-677-3065David P. Nichols MD Physician Individual 1346240314 1654631 132972 Niagara 5320 Military Rd, #107 Lewiston New York 14092 716-297-1701David Pawlowski MD Physician Individual 1033174958 2334403 224404 Erie 1150 Youngs Road, Suite 104 Williamsville New York 14221 716-564-1111David R Conti MD Physician Individual 1619904612 705702 119688 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243

David R. Dougherty DO Physician Individual 1235196189 1503039 190466-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-630-1050

David Rowland MD Physician Individual 1619991445 664604 1130771 Erie Amherst New York 14226 716-633-8675David S. Bevilacqua MD Physician Individual 1437169547 854059 134662 Erie 3673 Southwestern Blvd Orchard Park New York 14127 716-662-8087David S. Garson MD Physician Individual 1457337388 1241487 166788 Erie 60 Maple Road Williamsville New York 14221 716-626-5250David Wolf MD Physician Individual 1154311157 1200251 169834 Erie 55 Spindrift Dr. Williamsville New York 14221 716-631-2500Dawn A. Gais MD Physician Individual 1225095003 2039247 187958-2 Erie 6255 Sheridan Drive Williamsville New York 14221 716-677-6060Deborah Raiken MD Physician Individual 1245221274 764392 149970 Erie 560 Franklin Street Buffalo New York 14202 716-332-4472Debra Ehrig MD Physician Individual 1952397283 2560763 232604 Erie 25 E Main Street Springville New York 14141 716-592-2832Deirdre Bastible MD Physician Individual 1821091794 164517 Erie 20 Losson Road, Suite 105 Cheektowaga New York 14227 716-558-7727Dennis Chugh MD Physician Individual 1184695058 206531 Erie 5530 Sheridan Drive Suite 2 Williamsville New York 14221 716-580-3810Deolindo Ocampos MD Physician Individual 1043251903 591662 117719 Erie 310 Sterling Drive, Suite 100 Orchard Park New York 14127 716-677-6800

Dhiren K. Shah MD Physician Individual 1427011782 1619878 200420-3 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5500Diana Pomakova MD Physician Individual 1982846952 251039 Erie 565 Abbott Road Buffalo New York 14220 716-828-2578

Diana Vakante-Jankovic MD Physician Individual 1457330623 2082593 217457 Erie Orchard Park New York 14127 716-972-0279

3671 Southwestern Boulevard - Suite 107

20 Northpointe Parkway, Suite 100

3065 Southwestern Boulevard, Suite 104

3730 Sheridan Drive Attn: Patricia Winker

3671 Southwestern Boulevard, Suite 101

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Diane J. Sutter MD Physician Individual 1447291703 186895 Erie 3800 Delaware Ave, Suite 102 Kenmore New York 14217 716-650-5548

Diane Sanfilippo MD Physician Individual 1104819952 195197-1 Erie West Seneca New York 14224 716-771-1995Dilara Samadi MD Physician Individual 1821047010 1567959 188431-1 Erie 6255 Sheridan Dr, Suite 210 Williamsville New York 14221 716-630-2507Dilip Patel MD Physician Individual 1437177425 113684 Erie 65 Wehrle Drive Cheektowaga New York 14225 716-837-1090Domonic Falsetti MD Physician Individual 1093710576 083525 Niagara 723 Main Street Niagara Falls New York 14301 716-285-2244Donald Gullickson DO Physician Individual 1124080056 1295587 186403 Erie 1783 Colvin Boulevard Buffalo New York 14223 716-874-2150

Donald Michael Slate MD Physician Individual 1003872854 214562 Erie Amherst New York 14228 716-250-9235Donald P. Copley MD Physician Individual 1245296557 589973 109170-1 Erie 760 Millersport Highway Amherst New York 14226 716-874-1772Dorene Zerfas MD Physician Individual 1427299973 270530 Erie 310 Sterling Drive, Suite 105 Orchard Park New York 14127 716-675-7730Dorothy Trubish MD Physician Individual 1295817369 186192 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Douglas Hage MD Physician Individual 1538113873 1530221 188832 Erie 7020 Erie Road, Suite 3 Derby New York 14047 716-947-4545

Douglas Hickox MD Physician Individual 1396799698 1816513 204790-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Douglas Moreland MD Physician Individual 1942285739 161777-1 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-839-9402Douglas Roberts MD Physician Individual 1811931066 614219 106412 Erie 310 Sterling Drive, Suite 100 Orchard Park New York 14127 716-677-6800Eddie E. Mas MD Physician Individual 1154315554 1331722 187156 Erie 172 Slade Aveune West Seneca New York 14224 716-823-3300Edgardo F. Salvador MD Physician Individual 1528080306 178811 Erie 3140 Sheridan Drive Suite 201 Amherst New York 14226 716-832-2920Edmund Juncewicz DO Physician Individual 1104069525 269563 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278

Edward Cosgrove MD Physician Individual 1639123433 1760214 202079-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Edward Fitzpatrick DPM Physician Individual 1972664449 006292 Erie 3980 Sheridan Drive, Suite 308 Amherst New York 14226 716-839-3930Edward K. Bartels MD Physician Individual 1538100755 146718 Erie 3834 Delaware Avenue Kenmore New York 14217 716-877-1221Edward R. Niemiec MD Physician Individual 1902923923 153301-1 Erie 315 Alberta Drive Amherst New York 14226 716-833-5100Edward Simmons MD Physician Individual 1457399883 177174 Erie 235 North Street Buffalo New York 14201 716-882-0035Edward Stehlik MD Physician Individual 1245292192 647470 138324 Erie 1783 Colvin Boulevard Buffalo New York 14223 716-874-2150Edward Ventresca MD Physician Individual 1154395648 1419974 191202 Niagara 6941 Elaine Drive, Suite 2 Niagara Falls New York 14304 716-298-8133Edwin Heidelberger MD,PhD Physician Individual 1821070970 1458795 190805 Erie 224 East Main Street Springville New York 14141 716-592-8140Elizabeth Davis MD Physician Individual 1538125869 1250875 178881 Erie 5330 Genesee Street Bowmansville New York 14026 716-684-6140

Elizabeth Hatton MD Physician Individual 1609979038 1078220 167630 Erie 646 North French Rd, Suite 3 West Amherst New York 14228 716-691-9365Elizabeth Weingarten MD Physician Individual 1508820242 2845032 257093 Erie 112 Olean Road, Suite 220 East Aurora New York 14052 716-805-1072Elvin Witmer MD Physician Individual 1356384382 1886039 2104211 Erie 9630 West Hill Road Boston New York 14025 716-941-6085

Emilia Phillips MD Physician Individual 1235195058 209348 Erie 3140 Sheridan Drive, Suite 219 Amherst New York 14226 716-834-5517Emily Williams MD Physician Individual 1174563191 2775235 231305 Erie 4575 Main Street Snyder New York 14226 716-633-4575Emmekunla Nylander MD Physician Individual 1952499204 2298800 224648 Erie 4575 Main Street Snyder New York 14226 716-633-4575Ephraim S. Atwal MD Physician Individual 1194915371 1000540 260573 Erie 3095 Harlem Road Cheektowaga New York 14225 716-896-8831Eric J Koch MD Physician Individual 1053373456 2630748 229921 Erie 2950 Elmwood Avenue Kenmore New York 14217 716-983-0974Eric Sickels MD Physician Individual 1700827110 898233 157752 Erie 4899 Transit Road Depew New York 14043 716-558-5437Eric Southard MD Physician Individual 1306825153 1355022 184767 Erie 6000 N. Bailey Ave Suite 1D Amherst New York 14226 716-834-4266

Erik Diringer DO Physician Individual 1376799783 245104 Erie Kenmore New York 14217 716-447-6100

Erik Peterson MD Physician Individual 1700040672 174771 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Ernesto Diaz-Ordaz MD Physician Individual 1114965738 1442699 160661 Erie 180 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-7350Erzsebet A. Mazepa MD Physician Individual 1801845516 1590881 Erie 1900 Ridge Road Suite 130 West Seneca New York 14224 716-675-0707Eugene Kalmuk MD Physician Individual 1114912367 891832 1613451 Erie 2625 Harlem Rd #180 Cheektowaga New York 14225 716-893-4797Faraj Touchan MD Physician Individual 1184887853 267669 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Farid Berenji MD Physician Individual 1699783324 2589164 232746 Erie 45 Spindrift Drive Suite 100 Williamsville New York 14221 716-565-0355

550 Orchard Park Road, Suite A104

20 Northpointe Parkway, Suite 100

Kenmore Mercy Hosptial 2950 Elmwood Ave

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Fazalur C. Rehman MD Physician Individual 1518930965 1185097 167690-1 Erie Mercy Hospital - 565 Abbott Rd Buffalo New York 14220 716-828-2173

Fernando Domondon Jr MD Physician Individual 1013969492 1610939 196197-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Frances Ilozue MD Physician Individual YES 1013036706 243530 Erie 2200 Main Street Buffalo New York 14214 716-200-4122Francis Augustine MD Physician Individual 1659343010 Erie 531 Center Road West Seneca New York 14224 716-675-0445

Franco E Vigna MD Physician Individual 1760489736 225427-1 Niagara 6932 Williams Road, Suite 1600 Niagara Falls New York 14304 716-629-3338Frank B. Perillo DPM Physician Individual 1891860128 668997 NY002894 Erie 1431 Hertel Avenue Buffalo New York 14216 716-838-1131

Frank Laurri MD Physician Individual 1326115304 1112963 166897 Niagara 5290 Military Road; Suite 10 A/B Lewiston New York 14092 716-205-0170

Frank Lee MD Physician Individual 1831143734 2084375 213144 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Frank Schlehr MD Physician Individual 1982605499 196979-1 Erie 15 South Forest Road Williamsville New York 14221 716-626-1824

Frank Schreck MD Physician Individual 1730126400 756785 149296-1 Erie 3725 North Buffalo Rd, Suite A Orchard Park New York 14127 716-662-2300

Frederick C Gass MD Physician Individual 1699726745 209113 Erie Orchard Park New York 14127 716-675-0616Frederick Hong MD Physician Individual 1366436198 1129386 159131 Erie 45 Spindrift Drive Suite 100 Williamsville New York 14221 716-565-0355

Frederick McAdam MD Physician Individual 1831148840 1080060 161215 Erie 100 College Parkway, Suite 100 Williamsville New York 14221 716-626-0093Frederick Piwko MD Physician Individual 1639196421 1956481 213857 Niagara 3805 Lockport-Olcott Rd Lockport New York 14094 716-439-4248Frederick Poynton MD Physician Individual 1679554117 189519 Niagara 5300 Military Road Lewiston New York 14092 716-298-2356

Frida Gelfer MD Physician Individual 1740240019 176547 Erie Amherst New York 14228 716-250-9235Friedrich Albrecht MD Physician Individual 1801865340 191753 Erie 831 Maple Rd. Williamsville New York 14221 716-565-1978Fuad Sheriff MD Physician Individual 1609855477 1771631 207082 Erie 6000 N. Bailey Ave Suite 1D Amherst New York 14226 716-834-4266

Gabriel E. Chouchani MD Physician Individual 1629062013 613507 117387 Erie 30 North Union Road, Suite 101 Williamsville New York 14221 716-633-6363

Gail Goodman MD Physician Individual 1568442465 1477605 194330 Erie Orchard Park New York 14127 716-972-0279

Gale O'Connor MD Physician Individual 1750398160 1505182 1767201 Erie Orchard Park New York 14127 716-712-0490Gary Nelson DO Physician Individual 1245209634 164038 Erie 3320 North Benzing Road Orchard Park New York 14127 716-825-0300Gary Stern MD Physician Individual 1700812633 1420593 174275 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243Gary Wang MD Physician Individual 1053382051 2119762 216631 Erie 2121 Main Street, Suite 210 Buffalo New York 14214 716-832-1000Geemson Oo MD Physician Individual 1841283629 2411594 226696 Erie 3775 Seneca Street West Seneca New York 14224 716-712-0920

Geoffrey A. Bernas MD Physician Individual 1780757641 244299 Erie Orchard Park New York 14127 716-204-3200George Albert MD Physician Individual YES 1205890126 Erie 2157 Main Street Buffalo New York 14214 716-862-1271

George Blessios MD Physician Individual 1669472080 2162334 219980 Erie Buffalo New York 14220 716-822-2400George Haddad MD Physician Individual 1154488351 189835 Erie 3800 Delaware Ave Kenmore New York 14217 716-876-3737George Kalonaros MD Physician Individual 1396703583 1122774 155226 Erie 2950 Elmwood Avenue Kenmore New York 14127 716-447-7260George Marinides MD Physician Individual 1912029653 1842819 157085 Erie 4233 Maple Road Amherst New York 14226 716-838-3188George Vasiliadis DPM Physician Individual 1376518548 1195573 NY004647 Erie 190 Main Street Tonawanda New York 14150 716-693-1050Gerald J Joyce MD Physician Individual 1336113596 1197626 156569 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Gerald Jeyapalan MD Physician Individual 1801092937 264196 Erie 518 Abbott Road, Suite 210 Buffalo New York 14220 716-823-4962Giuseppina Kenyon-Savard DO Physician Individual 1023278082 245534 Niagara 7350 Porter Rd Niagara Falls New York 14304 716-332-1644Gordon Tussing DO Physician Individual 1750323291 212802 Erie 4643 Main Street Snyder New York 14226 716-839-9113Gracie M. Lin MD Physician Individual 1144273004 1343508 184536 Erie 6636 Main Street, Suite 1 Williamsville New York 14221 716-633-0541

3075 Southwestern Boulevard #102

20 Northpointe Parkway, Suite 100

3671 Southwestern Boulevard, Suite 101

3075 Southwestern Boulevard Suite 100

3671 Southwestern Blvd, Suite 207

Marian Professional Center 515 Abbott Road Suite 310

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Grant S. Golden MD Physician Individual 1992712301 1257010 1456351 Erie Amherst New York 14226 716-633-8675Gregory Adornetto DPM Physician Individual 1013027846 897585 2891-1 Erie 179 Buffalo Street Hamburg New York 14075 716-649-2892Gregory Castiglia MD Physician Individual 1003891896 1934587 1982201 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-839-9402Gregory D. Sambuchi MD Physician Individual 1942203112 1550361 197485 Niagara 4600 Military Road, Suite B Niagara Falls New York 14305 716-297-8709Gustavo Diaz-Reyes MD Physician Individual 1588652168 2634339 234797-1 Erie 897 Delaware Avenue Buffalo New York 14209 716-883-6800

Guy Whalen MD Physician Individual 1629052667 1140472 178512 Erie Orchard Park New York 14127 716-972-0279Hanaw Adham MD Physician Individual 1427112291 2842588 242668 Erie PO Box 911 Getzville New York 14068 716-580-3764Hani Abdel Nabi MD Physician Individual 1083679435 1176627 179081 Erie 1616 Kensington Ave Buffalo New York 14215 716-836-5500

Harold Reubens MD Physician Individual 1164420378 1529473 190711 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Harriette Hogan MD Physician Individual 1922083989 1398705 191621 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Harry Eugene McCrea III MD Physician Individual 1689786477 254591 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243

Hartwig Boepple MD Physician Individual 1568426344 788207 1313091 Erie 100 College Parkway, Suite 110 Williamsville New York 14221 716-631-8863

Heather Pleskow MD Physician Individual 1871757914 246011 Niagara 6930 Williams Road, Suite 3700 Niagara Falls New York 14304 716-298-3541Heather Wheat MD Physician Individual 1972705978 229254 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Henna M Sheikh MD Physician Individual 1477887560 3154056 250826 Erie 7060 Erie Rd, Suite 100 Derby New York 14047 716-947-0408Henri T. Woodman MD Physician Individual 1437107232 128449 Erie 5430 Main Street Williamsville New York 14221 716-998-9043Henry Meltser MD Physician Individual 1497796304 2689123 208132 Erie 310 Sterling Drive, Suite 100 Orchard Park New York 14127 716-677-6800Hongyu Wen MD Physician Individual 1205867546 2273187 251943 Erie 10 Homewood Court Williamsville New York 14221 (716) 630-1465Horacio A. Capote MD Physician Individual 1053475939 1731731 190556 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Howard Lippes MD Physician Individual 1750343141 1088802 1353871 Erie 297 Spindrift Drive Williamsville New York 14221 716-635-0688Howard Penn DPM Physician Individual 1366424848 N004270 Erie 1271 Ridge Road Lackawanna New York 14218 716-824-9835

Ichabod Jung MD Physician Individual 1497784789 2163913 220355 117 Foote Ave, Suite 100 Jamestown New York 14071 716-338-9200Ihab M. Shafik MD Physician Individual 1225038581 1657414 199994 Erie 18 Limestone Dr, Suite 5 Williamsville New York 14221 716-632-1400Irfan Khan MD Physician Individual 1326141342 2831827 242356 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Iris Danziger MD Physician Individual 1902887102 1272288 177744 Erie 1026 Union Road West Seneca New York 14221 716-712-0855Irshad Ali MD Physician Individual 1639256548 452680 133793 Erie 357 Englewood Avenue Buffalo New York 14223 716-835-5869Isosceles D. Garbes MD Physician Individual 1427050590 149522 Erie 3612 Seneca Street West Seneca New York 14224 716-674-3104J. William Canavan MD Physician Individual 1639165772 602828 126376 Erie 25 E Main Street Springville New York 14141 716-592-2832J.K. Bhattacharyya MD Physician Individual 1154480242 111156 Erie 534 Abbott Road Buffalo New York 14220 716-822-8078Jack Lawler MD Physician Individual 1669493334 1295032 1758651 Erie 2157 Main Street Buffalo New York 14214 716-862-1506Jacqueline Dombrowski MD Physician Individual 1205893591 2173233 219856 Erie 268 Main Street East Aurora New York 14052 716-652-8606Jae Sung Lee MD Physician Individual 1689646259 589579 130958 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Jafar W Siddiqui MD Physician Individual 1023202355 3116167 248830 Erie 180 Park Club Lane, Suite 250 Williamsville New York 14221 716-580-3380Jahangir Koleini MD Physician Individual 1689687857 1013670 167700 Erie 3457 Clinton Street West Seneca New York 14224 716-668-8226Jaime Obst DO Physician Individual 1548496847 271504 Erie 2157 Main Street Buffalo New York 14214 716-862-1965

Jamal Zohur MD Physician Individual 1326005430 2574798 225678 Niagara 5290 Military Road; Suite 10 A/B Lewiston New York 14092 716-205-0170James B Fitzgerald MD Physician Individual 1386615987 1280102 170760 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000James Burruano DPM Physician Individual 1356523062 1198594 N004668 Erie 80 Delaware Road Kenmore New York 14217 716-874-5540James Conley MD Physician Individual 1083611982 713259 129057 Erie 100 High Street Buffalo New York 14203 716-859-2981James Conway MD Physician Individual 1952367252 1050375 148610 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050

James Cumella MD Physician Individual 1093725665 140792 Erie 333 International Drive, Suite B1 Williamsville New York 14221 716-633-5277James F. Twist MD Physician Individual 1316929169 834639 1465021 Erie 2156 Sheridan Drive Kenmore New York 14223 716-873-7227James G Egnatchik MD Physician Individual 1699751990 686833 1432671 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-839-9402

3730 Sheridan Drive Attn: Patricia Winker

3671 Southwestern Boulevard, Suite 101

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

James G Lampasso MD Physician Individual 1902889090 1236497 178138 Erie 6460 Main Street Williamsville New York 14221 716-634-5100James J Czyrny MD Physician Individual 1598726804 843747 150393 Erie 4949 Harlem Road Amherst New York 14226 716-898-3106

James J. Piscatelli MD Physician Individual 1790734093 1627141 18403-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-631-2517

James Keefe MD Physician Individual 1548410020 263895 Erie Buffalo New York 14220 716-828-2434James Kelly DO Physician Individual 1871593053 1438013 189303 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999

James M. Wopperer MD Physician Individual 1861498990 155653 Niagara Lewiston New York 14092 716-297-1701

James McEntee MD Physician Individual 1285878512 262055 Erie Buffalo New York 14220 716-828-2434James Panzarella DO Physician Individual 1518964204 178714 Erie 1208 Niagara Falls Boulevard Tonawanda New York 14150 716-833-2200James Ryan, III MD Physician Individual 1467574194 1842864 165614 Erie 4233 Maple Road Amherst New York 14226 716-838-3188James Rycyna MD Physician Individual 1770556631 982807 162368-1 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243James Slough MD Physician Individual 1477546034 188540 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999James Swiencicki MD Physician Individual 1366568420 243772 Erie 1829 Maple Road, Suite 202 Williamsville New York 14221 716-204-5933Jamie Streicher DO Physician Individual 1982847331 262975 Erie 1491 Sheridan Drive Tonawanda New York 14217 716-332-4476Jane D. Kraft MD Physician Individual 1376530105 1478211 187358 Erie 21 East Main Street Springville New York 14141 716-592-8931

Janice Errick MD Physician Individual 1104874205 191601 Erie Amherst New York 14228 716-250-9235Jason Dunleavy MD Physician Individual 1316084726 261325 Erie 55 Spindrift Dr. Williamsville New York 14221 716-631-2500Jason Matuszak MD Physician Individual 1427186410 238059 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Jay Hassenfratz DPM Physician Individual 1992856397 2324532 N005872-1 Erie 1026 Union Road West Seneca New York 14224 716-712-0851

Jay Newman MD Physician Individual 1073567954 178413 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Jayanta Chaudhuri MD Physician Individual 1497716492 2519139 256566 Niagara 4525 Witmer Road Niagara Falls New York 14305 716-298-0230Jean Haar MD Physician Individual 1144256892 795461 Erie 1083 Delaware Avenue Buffalo New York 14209 716-882-1023Jeannie Koenig MD Physician Individual 1851356810 2273398 221343-1 Erie PO Box 563 Getzville New York 14068 716-861-3364Jeffrey B. Rockoff MD Physician Individual 1902873839 1048255 170657 Erie 2540 Sheridan Drive Tonawanda New York 14150 716-874-8980Jeffrey Brewer MD Physician Individual 1508930363 3214362 256387 Erie 462 Grider St, DKM-3rd floor Buffalo New York 14215 716-898-5269

Jeffrey Carrel DPM Physician Individual 1831158435 588610 N002175 Erie 3980 Sheridan Drive, Suite 308 Amherst New York 14226 716-839-3930Jeffrey Constantine MD Physician Individual 1467431429 1660700 194347-1 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Jeffrey dePerio MD Physician Individual 1841252111 1604553 196887-1 Erie 571 Terrace Boulevard Depew New York 14043 716-683-6737Jeffrey Frost MD Physician Individual 1083662043 1348374 195675 Erie 1829 Maple Road, Suite 202 Williamsville New York 14221 716-204-5933Jeffrey Martinez MD Physician Individual 1801866868 252402 Erie 1829 Maple Road, Suite 202 Williamsville New York 14221 716-204-5933Jeffrey Parker DO Physician Individual 1205085305 3202288 254212 Erie c/o Marcare 1191 Bowen Rd. Elma New York 14059 716-479-5761Jeffrey R Neu MD Physician Individual 1184608911 1233090 185150 Erie 6460 Main Street Williamsville New York 14221 716-634-5100Jeffrey Schratz MD Physician Individual 1649222134 1263547 176168 Niagara 160 East Ave Lockport New York 14094 716-434-6141

Jeffrey Steinig MD Physician Individual 1376547026 1561499 179037 Erie 3030 Orchard Park Road Suite B West Seneca New York 14224 716-671-8393

Jeffrey Visco MD Physician Individual 1902885601 2588374 229881-1 Erie 4955 Bailey Avenue, Suite 201 Amherst New York 14226 716-857-8751

Jehad Miqdadi MD Physician Individual 1396724357 481838 E001764-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-857-8800

Jennifer Brown MD Physician Individual 1710957063 2173181 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Jennifer Erickson DO Physician Individual 1609832914 172415 Erie 3671 Southwestern Blvd #213 Orchard Park New York 14127 716-662-7008Jennifer Gurske-dePerio MD Physician Individual 1972768042 251338 Erie 4180 Abbott Rd Orchard Park New York 14127 716-648-1128

Jennifer J. Adamson MD Physician Individual 1851366017 2574798 229948 Niagara Lewiston New York 14092 716-284-3278Jennifer L. Rojek MD Physician Individual 1568602209 260852 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222

565 Abbott Road, 8th floor-room 632

Attn: Finance Dept - Patty Hanna 5300 Military Road

565 Abbott Road, 8th floor-room 632

20 Northpointe Parkway, Suite 100

Attn: Finance Dept - Patty Hanna 5300 Military Road

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Jennifer Matier MD Physician Individual 1891926663 3361882 262061 Erie 1026 Union Road West Seneca New York 14224 716-712-0851

Jennifer McVige MD Physician Individual 1649596495 257529 Erie 3980 Sheridan Drive, Suite 600 Amherst New York 14226 716-250-2000Jennifer Ray MD Physician Individual 1508871930 2686377 231784 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Jennifer Roller MD Physician Individual 1912936121 229568 Erie 2625 Harlem Road, Suite 210 Cheektowaga New York 14225 716-893-7337Jennifer Teeter DO Physician Individual 1497075410 250143 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101Jennifer Wisnoski MD Physician Individual 1790740637 230380-1 Erie 61 Maple Road Williamsville New York 14221 716-565-1234Jeon Lee MD Physician Individual 1588603054 824768 144341-1 Erie 45 Spindrift Dr Williamsville New York 14221 716-634-6503

Jerome Andres MD Physician Individual 1063410108 826137 150366 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Jerome Ulatowski MD Physician Individual 1790783355 1167817 159192 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454Jessica E. Ogorchock MD Physician Individual 1720221229 264071 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084

Jesus Santiano MD Physician Individual 1679526909 1945220 207522-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Jia Zhao MD Physician Individual 1619934536 222966 Erie Amherst New York 14228 716-250-9235

Jihad Abialmouna MD Physician Individual 1396793782 187463 Erie 2800 Sweethome Road, Suite 6 West Amherst New York 14228 716-691-1300Joan Vivona MD Physician Individual 1558379297 1842846 164969-1 Erie 400 Northrup Road Elma New York 14059 716-879-0830John A. Brach MD Physician Individual 1992735344 1971851 165369 Erie 2605 Harlem Rd Cheektowaga New York 14225 716-891-2536John A. Leone DO Physician Individual 1871558825 177161 Erie 61 Maple Road Williamsville New York 14221 716-565-1234

John A. Moscato MD Physician Individual 1700852837 656015 124571 Erie 3552 Southwestern Boulevard Orchard Park New York 14127 716-662-1221

John Asirwatham MD Physician Individual 1417913708 137762 Erie Amherst New York 14228 716-250-9235John B. Wiles MD Physician Individual 1750371985 645432 132618 Erie 2625 Harlem Road #140 Cheektowaga New York 14225 716-893-0221John Bell-Thomson MD Physician Individual 1053344648 121353 Erie 22 Cazenovia Street Buffalo New York 14220 716-828-1410John Bodkin MD Physician Individual 1609831536 131001 Erie 1150 Youngs Road, Suite 104 Williamsville New York 14221 716-636-7979John C. Karpie MD Physician Individual 1972705408 264292 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101John Callahan MD Physician Individual 1952338048 192324 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999

John Carter MD Physician Individual 1881653988 220563 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247John Dzik MD Physician Individual 1659346948 1642020 198388 Erie 4899 Transit Road Depew New York 14043 716-558-5437John G Fahrbach IV MD Physician Individual 1205045424 2904781 243524 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-839-9402John Hall MD Physician Individual 1912969304 1703924 193183 Erie 297Spindrift Drive Williamsville New York 14221 716-635-0688John Hellriegel MD Physician Individual 1528064136 0137338 Erie 449 Brantwood Road Amherst New York 14226 716-875-2904John Huebschmann MD Physician Individual 1750309977 239936 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278John Hurley DPM Physician Individual 1164481446 004498-1 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999John J. Cai MD Physician Individual 1225099419 2733324 238954 Erie 515 Abbott Rd, Suite 310 Buffalo New York 14220 716-844-8754John Kavcic MD Physician Individual 1992708754 202290 Erie 20 Losson Road, Suite 105 Cheektowaga New York 14227 716-558-7727John Krzan MD Physician Individual 1821035593 1336070 171487 Erie 4390 Quinby Drive, Suite E Hamburg New York 14075 716-312-7400John L. O'Donnell MD Physician Individual 1245208446 1414882 189230 Erie 3673 Southwestern Bvd Orchard Park New York 14127 716-662-8083

John Leddy MD Physician Individual 1043286651 1132250 174724 Erie Buffalo New York 14240 716-204-3200John M. Aquino DPM Physician Individual 1508964693 N003211 Erie 2047 Clinton Street Buffalo New York 14206 716-827-0100John M. Fitzgerald MD Physician Individual 1649232059 2648786 218039-1 Erie 3040 Amsdell Road Hamburg New York 14075 716-828-2399John Menchini MD Physician Individual 1801871843 652882 101753-1 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230John P Ward DO Physician Individual 1891772836 1367028 1714051 Erie 7531 Seneca Street East Aurora New York 14052 716-655-5019John Pollina MD Physician Individual 1740266048 2141977 2015031 Erie 3980A Sheridan Drive Amherst New York 14226 716-218-1000John Raabe MD Physician Individual 1689677726 252069 Erie 825 Wehrle Dr Williamsville New York 14221 716-677-6800John Repicci MD Physician Individual 1003852989 092382-1 Erie 4510 Main Street Buffalo New York 14226 716-839-0632

20 Northpointe Parkway, Suite 100

20 Northpointe Parkway, Suite 100

3435 Main Street, 160 Farber Hall

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

John Roehmholdt MD Physician Individual 1801886965 167540 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000

John Rutkowski MD Physician Individual 1902061914 264603 Niagara 3850 Saunders Settlement Rd Cambria New York 14132 716-898-2800

John Santillo MD Physician Individual 1447437876 257053 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247John Sauret MD Physician Individual 1225000268 1688288 208903 Niagara 3101 9th Street Niagara Falls New York 14305 716-284-8917John Stanievich MD Physician Individual 1851333892 607974 143100 Erie 180 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-7350

John V. Pinski MD Physician Individual 1316911779 1482177 160669-1 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Johnny Yap MD Physician Individual 1790766269 238060 Niagara 810 Davison Road Lockport New York 14094 716-438-5486

Jonathan Coolidge MD Physician Individual 1942515994 261155 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Jonathan Edelson MD Physician Individual 1548225097 2658964 225271-1 Erie 100 College Parkway, Suite 110 Williamsville New York 14221 716-631-8863

Jonathan Vogan MD Physician Individual 1487605382 217257 Erie Orchard Park New York 14127 716-675-0616Jose de Perio III MD Physician Individual 1023016417 199774-1 Erie 571 Terrace Blvd Depew New York 14043 716-683-4196

Jose Perez-Brache MD Physician Individual 1033162144 172187-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Joseph A. Ralabate MD Physician Individual 1992761035 641474 107317 Erie 2450 Elmwood Avenue Kenmore New York 14217 716-873-7335Joseph Bax MD Physician Individual 1316093412 143785-1 Niagara 700 Park Place Niagara Falls New York 14301 716-285-7366Joseph Buran MD Physician Individual 1740293893 1074340 142458 Erie 2733 Wehrle Drive, Suite 400 Williamsville New York 14221 716-639-8358

Joseph Corigliano DO Physician Individual 1144286485 1656679 199242-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 (716) 630-1465Joseph DiPirro MD Physician Individual 1013905801 2082406 213542 Erie 2625 Harlem Rd #180 Cheektowaga New York 14225 716-893-4797Joseph Fasanello MD Physician Individual 1366769796 270385 Erie 1150 Youngs Road, Suite 104 Williamsville New York 14221 716-564-1111Joseph G Rusnak MD Physician Individual 1326010216 1248315 184871 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Joseph Gelormini MD Physician Individual 1790790442 167995 155314 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966

Joseph Grisanti MD Physician Individual 1093825721 1652741 Erie Orchard Park New York 14127 716-675-2500Joseph Kita MD Physician Individual 1982619433 2898960 243024 Erie 24 Carrow Steet Orchard Park New York 14127 716-662-3443Joseph Kowalski MD Physician Individual 1043285786 1955155 210558 Erie 4949 Harlem Road Amherst New York 14226 716-898-3106

Joseph L. Muscarella DO Physician Individual 1457302366 1166178 155405 Erie 180 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-7350Joseph M Anain Jr DPM Physician Individual 1215958830 1253438 004701 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983Joseph M Anain Sr MD Physician Individual 1235100041 686993 98379 Erie 2121 Main Street, Suite 316 Buffalo New York 14214 716-837-2400

Joseph M. Greco MD Physician Individual 1487650016 1417541 125081 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Joseph Maddi MD Physician Individual 1992761266 1024840 149577-1 Erie 4225 Maple Road Amherst New York 14226 716-834-0221Joseph Nasca DPM Physician Individual 1023170719 945377 N003878 Erie 369 Kenmore Avenue Buffalo New York 14223 716-833-0225Joseph P. Falcone DO Physician Individual 1366449332 210531 Erie 55 Spindrift Drive, Suite 120 Williamsville New York 14221 716-632-1212

Joseph P. Leberer MD Physician Individual 1740248855 1075772 159681 Erie Amherst New York 14226 716-834-4237Joseph Polcaro MD Physician Individual 1598716920 8878102 198470 Erie 515 Abbott Road, Suite 204 Buffalo New York 14220 716-828-3650

Joseph R. Berardi MD Physician Individual 1497723688 112531 Erie 3580 Sheridan Drive, Suite 150 Amherst New York 14226 716-839-4949Joseph Riccione DO Physician Individual 1932335155 263674 Erie 3680 Eggert Road Orchard Park New York 14127 716-662-5357

3075 Southwestern Boulevard #102

3055 Southwestern Blvd, Suite 100

4955 North Bailey Avenue, Suite 200

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Joseph Testa MD Physician Individual 1518935584 154759 Erie 2155 Sheridan Drive Buffalo New York 14223 716-447-0590Josephine Welliver MD Physician Individual 1942232632 161363 Erie 2625 Harlem Road, Suite 210 Cheektowaga New York 14225 716-893-7337Joshua Jones MD Physician Individual 1417119355 261726 Erie 4949 Harlem Rd Amherst New York 14226 716-204-3257

Joshua Usen DO Physician Individual 1447257399 211359 Erie 1416 Sweet Home Road, Suite 12 Amherst New York 14228 716-636-7800

Juan Diego Mazariegos MD Physician Individual 1629036454 176502 Erie Amherst New York 14228 716-250-9235Jude S. Violante DPM Physician Individual 1093778565 N006111 Niagara 1 Columba Drive, Suite 6 Niagara Falls New York 14305 716-205-0181Judine Davis MD Physician Individual 1487622148 Pending 204770 Erie 2157 Main Street Buffalo New York 14214 716-862-1589Judith Ortman-Nabi MD Physician Individual 1699731141 184711 Erie 6095 Transit Road E. Amherst New York 14051 716-634-9303

Judy Wesolowski MD Physician Individual 1528042108 1736025 202730-1 Niagara Lewiston New York 14092 716-298-3000JudyAnn Joy-Pardi MD Physician Individual 1568477214 1560663 183358 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966

Julia Melanson DO Physician Individual 1982605879 267511 Erie 6245 Sherdan Drive, Suite 316 Williamsville New York 14221 716-630-1150

Julie A. Gavin MD Physician Individual 1700083276 243652 Erie Kenmore New York 14217 716-873-9115Julie Thomas DO Physician Individual 1114168499 2624481 Erie 3680 Eggert Road Orchard Park New York 14127 716-662-5357Juliette Nwachkwu MD Physician Individual 1609838002 2711360 225486-1 Erie 297 Spindrift Drive Williamsville New York 14221 716-635-0688Julio A Alvarez-Perez MD Physician Individual 1306840046 1031272 170358 Erie 3030 Orchard Park Rd, Suite B West Seneca New York 14224 716-671-8393

Justin D Miller MD Physician Individual 1134142185 257426 Niagara Lewiston New York 14092 716-298-3000Jyotsna Rajeswary MD Physician Individual 1639141633 254377 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Kamal Singhal MD Physician Individual 1720036031 185819 Erie 2157 Main Street Buffalo New York 14214 716-862-1271Kandala Chary MD Physician Individual 1356335194 611532 119189 Erie 45 Spindrift Drive Suite 100 Williamsville New York 14221 716-565-0355Karen Krutchick MD Physician Individual 1619962560 1608002 160926 Erie 3615 Seneca Street West Seneca New York 14224 716-675-7376Karen Snell-Garus MD Physician Individual 1043262827 217525 Niagara 57 Davison Court Lockport New York 14094 716-439-9183Katherine O'Donnell MD Physician Individual 1912996133 1956376 198782 Erie 55 Spindrift Dr, Suite 220 Williamsville New York 14221 716-626-6300

Kathleen Dyson-Budzinski MD Physician Individual 1356388029 2273274 2095481 Erie Orchard Park New York 14127 716-662-2300Keith C. Stube MD Physician Individual 1053377325 200037 Erie 180 Park Club Lane Suite 225 Williamsville New York 14221 716-839-5858

Keith Kaplan MD Physician Individual 1285852566 259982 Erie Buffalo New York 14220 716-828-2399Kenneth Anthone MD Physician Individual 1427040294 673547 1364173 Erie P.O. Box 807 Getzville New York 14068 716-634-6100Kenneth Eckhert III MD Physician Individual 1427026327 2685918 237123 Erie 310 Sterling Drive, Suite 105 Orchard Park New York 14127 716-675-7730Kenneth Halliwell MD Physician Individual 1639338429 248880 Niagara 7731 Porter Road Niagara Falls New York 14304 716-575-0075Kenneth J Guth MD Physician Individual 1194745281 1143833 177472 Erie 3320 North Benzing Road Orchard Park New York 14127 716-825-0300Kenneth Murray MD Physician Individual 1265594733 1078266 159871 Erie 200 Sterling Drive Orchard Park New York 14127 716-250-2000

Kent K Chevli MD Physician Individual 1215934781 1482255 195675 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Keun Yong Lee MD Physician Individual 1750379269 612684 130040 Erie 897 Delaware Avenue Buffalo New York 14209 716-883-6800

Kevin Barlog MD Physician Individual 1174520696 1018015 168798 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000

Kevin G. Cleary MD Physician Individual 1831156447 1657083 200751 Erie 4893 Transit Road Depew New York 14043 716-608-7040Kevin McMahon MD Physician Individual 1528032695 1816673 203121 Erie 112 Olean Road, Suite 220 East Aurora New York 14052 716-805-1072Kevin O'Gorman MD Physician Individual 1083677231 699409 140567 Erie 8600 Depot Street Eden New York 14057 716-992-4999Kevin Robillard MD Physician Individual 1356436489 2207716-1 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Kevin Shiley MD Physician Individual 1154486454 256525 Erie 565 Abbott Road Buffalo New York 14220 716-828-2578Khalid S. Mahran MD Physician Individual 1336253210 1774038 207970 Erie 2121 Main Street, Suite 216 Buffalo New York 14214 716-833-1511

20 Northpointe Parkway, Suite 100

Attn: Finance Dept - Patty Hanna 5300 Military Road

3800 Delaware Avenue, Suite 108

Attn: Finance Dept - Patty Hanna 5300 Military Road

3725 North Buffalo Street, Suite A

565 Abbott Road Attn: Denise Sobczynski

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Kimberly Prise MD Physician Individual 1205813680 20521904 209492 Erie 4711 Transit Road, Suite 1 Depew New York 14043 716-668-5331Kishor Phadke MD Physician Individual 1205840162 197824 Erie 5530 Sheridan Drive Suite 2 Williamsville New York 14221 716-580-3810Komal Chandan MD Physician Individual 1508896457 1371553 189392-1 Niagara 4600 Military Road, #A Niagara Falls New York 14305 716-298-4050Kristen L. Smyers MD Physician Individual 1063652972 260229 Erie 3834 Delaware Avenue Kenmore New York 14217 716-877-1221Kristen Robillard MD Physician Individual 1508800491 2273036 211538 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084Kristin Matteson DO Physician Individual 1063532125 2422071 215890 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Kunwardeep Sohal MD Physician Individual 1043416407 270349 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Kyu H. Shin MD Physician Individual 1881692804 1388141 184546 Niagara 810 Davison Road Lockport New York 14094 716-438-5486Lakshmanan Rajendran MD Physician Individual 1316040686 145271 Erie 3649 Harlem Road Cheektowaga New York 14215 716-835-9192LaQuita King MD Physician Individual 1316180508 266003 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Laszlo Mechtler MD Physician Individual 1710978598 1134427 171164 Erie 3980 Sheridan Drive Suite 300 Amherst New York 14226 716-250-2000

Laura Ford Mukkamala DO Physician Individual 1306950001 265258 Erie 3345 Southwestern Blvd Orchard Park New York 14127 716-656-4825

Lauren Kuwik MD Physician Individual 1912160573 266661 Erie Orchard Park New York 14127 716-712-0490Laurie Kasnicki MD Physician Individual 1649202342 1052120 141845 Erie 515 Abbott Road, Suite 304 Buffalo New York 14220 716-995-8801

Lawrence Gugino MD Physician Individual 1770586372 1182425 174516-1 Erie Buffalo New York 14220 716-828-2567Lawrence Krol MD Physician Individual 1407822125 1842777 154463 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Lawrence Rand MD Physician Individual 1942282207 1086268 134789 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Lawrence Sinatra MD Physician Individual 1942200209 715375 149630 Erie 18 Limestone Dr, Suite 5 Williamsville New York 14221 716-632-1400Lee C. Ruotsi MD Physician Individual 1376504605 175439 Erie 2625 Harlem Road, #120 Cheektowaga New York 14225 716-891-2570Lee Guterman MD,PhD Physician Individual 1780600718 1651876 187667 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-803-1504Leo Michalek, Jr. MD Physician Individual 1003801366 601643 94920 Erie 550 Center Road West Seneca New York 14224 716-677-0100Leonard Gurevich MD Physician Individual 1548228190 1843365 203313 Erie 1176 Main Street Buffalo New York 14209 716-677-6500

Leonard Kaplan DO Physician Individual 1982653697 2259281 223649 Erie 100 College Parkway, Suite 100 Williamsville New York 14221 716-626-0093Les A. Zakrzewski MD Physician Individual 1467431577 806973 154880-1 Erie 721 Center Road West Seneca New York 14224 716-677-4070

Linda Burns DO Physician Individual 1205082666 253950 Erie Orchard Park New York 14127 716-675-2500Linda Cardone MD Physician Individual 1790751501 978267 149862 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Lindsey Clark MD Physician Individual 1003147323 247954 Erie 4180 Abbott Rd Orchard Park New York 14127 716-648-1128Lisa Daye MD Physician Individual 1083673693 196266 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Lisa Forehand MD Physician Individual 1538127113 2461392 228952 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084Lisa Gelman-Koessler MD Physician Individual 1518163419 2899690 240887 Erie 4575 Main Street Snyder New York 14226 716-633-4575Lisa Hoffman MD Physician Individual 1679550412 1505206 190033 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Lisa Mendonza MD Physician Individual 1538128764 2109713 213141 Erie 2914 Elmwood Avenue Kenmore New York 14217 716-875-6700Lisette A D'Eon MD Physician Individual 1437115482 1345179 185096 Erie 224 East Main Street Springville New York 14141 716-592-8140Liveleen Gill MD Physician Individual 1427042647 845643 152871 Erie 45 Spindrift Drive Suite 100 Williamsville New York 14221 716-674-4006Lixin Zhang MD,PhD Physician Individual 1154482859 2505920 227642-1 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000

Lloyd W. Brown MD Physician Individual 1043261779 1617252 177594 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Lori Bowman MD Physician Individual 1528034261 2273283 221190-1 Erie 3725 North Buffalo Rd, Suite A Orchard Park New York 14127 716-662-2300

Lorianne E. Avino DO Physician Individual 1306898762 237910 Erie Orchard Park New York 14127 716-667-2064

Loubert Suddaby MD Physician Individual 1609869783 193722 Erie 3775 Southwestern Blvd, Suite A Orchard Park New York 14127 716-667-1980Louis Antonucci MD Physician Individual 1548227275 625356 98883 Erie 6333 Main Street Williamsville New York 14221 716-632-3545Louis Baumann MD Physician Individual 1851387419 1380703 1777792 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Luis Melgar MD Physician Individual 1497701965 1616348 190379 Erie 5893 Camp Road, Suite 3 Hamburg New York 14075 716-648-7401

3075 Southwestern Boulevard Suite 100

Marian Professional Building 565 Abbott Road

3055 Southwestern Blvd, Suite 100

3671 Southwestern Blvd, Suite 107

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Luisa Rojas MD Physician Individual 1326247594 263398 Erie 3980 Sheridan Drive, Suite 200 Amherst New York 14226 716-250-2000LuJean Jennings MD,PhD Physician Individual 1194780692 1420488 192121 Niagara 1 Colomba Drive, #2 Niagara Falls New York 14305 716-285-3464Lynda Stidham MD Physician Individual 1386600765 1051481 171500 Erie 25 E Main Street Springville New York 14141 716-592-2832

Lyudmila Nikolaychook MD Physician Individual 1578794533 246017 Niagara Lewiston New York 14092 716-285-3464M Steven Piver MD Physician Individual 1932176807 108937-1 Erie 2157 Main Street Buffalo New York 14214 716-862-1965M Yousuf Fazili MD Physician Individual 1265477491 657034 123086 Erie 3469 Harlem Road Cheektowaga New York 14225 716-833-3008M. Sadiqur Rahman MD Physician Individual 1316049554 1861912 220619 Erie 4985 Harlem Road Suite 2 Amherst New York 14226 716-839-0500M. Yusuf Siddiqui MD Physician Individual 1376698936 746901 136544 Erie 2178 Main Street Buffalo New York 14214 716-838-8488

Madeline Lillie MD Physician Individual 1962482711 614475 145777 Erie Amherst New York 14226 716-631-0380

Madga Osman MD Physician Individual 1518916196 2771424 239349 Erie 3345 Southwestern Blvd Orchard Park New York 14127

Madga Osman MD Physician Individual 1518916196 2771424 239349 Erie 6245 Sherdan Drive, Suite 316 Williamsville New York 14221

Magdi Sayegh MD Physician Individual 1013901412 1139679 174733 Erie 30 North Union Road, Suite 101 Williamsville New York 14221 716-633-6363Maithridevi Rasalingam MD Physician Individual 1295803294 677601 128730 Erie 725 Orchard Park Rd, Suite D West Seneca New York 14224 716-677-0038

Malti Patel MD Physician Individual 1144381831 1566123 199107-1 Erie 3980 Sheridan Drive, Suite 200 Amherst New York 14226 716-250-2000Malvina Khozina MD Physician Individual 1063473288 2595004 233926 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-828-2437Marc Fineberg MD Physician Individual 1083670962 200743 Erie 4949 Harlem Rd Amherst New York 14226 716-204-3257

Marc Frost MD Physician Individual 1841256336 186981-1 Erie 3980 Sheridan Drive, Suite 200 Amherst New York 14226 716-250-2000

Marc K. Klementowski MD Physician Individual 1134196728 1795308 188748 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Marcus Romanowski MD Physician Individual 1265469126 206361-1 Erie 4510 Main Street Buffalo New York 14226 716-839-0632Margaret McDonnell MD Physician Individual 1972691210 1093865 160095-1 Erie 2157 Main Street Buffalo New York 14214 716-862-1500Margaret Novotony MD Physician Individual 1962472787 1586281 195021 Niagara 57 Davison Court Lockport New York 14094 716-439-9183Maria DelCastillo MD Physician Individual 1467572537 1778147 192766 Erie 4233 Maple Road Amherst New York 14226 716-838-3188

Maria Jereva-Simeonova MD Physician Individual 1285616425 239958 Niagara 5290 Military Road; Suite 10 A/B Lewiston New York 14092 716-205-0170

Maria Komin MD Physician Individual 1508864505 1023752 170669 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Maria Matala-Sullivan MD Physician Individual 1912940214 1874813 210175 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084Maria Rita Andaya MD Physician Individual 1639102874 1918950 207380 Erie 1344 McKinley Pkwy Lackawanna New York 14218 716-821-0170Marie Iacona MD Physician Individual 1649294430 1105215 176737 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Marie-Eve Thoman MD Physician Individual 1861654584 254981 Erie 3095 Harlem Road Cheektowaga New York 14225 716-896-8831Mark A C Hoeplinger MD Physician Individual 1831154384 857630 156731 Erie 3626 Seneca Street West Seneca New York 14224 716-675-5711Mark A. Weissman MD Physician Individual 1003875691 186417 Erie 3834 Delaware Avenue Kenmore New York 14217 716-877-1221Mark Bezbatchenko MD Physician Individual 1710942818 887027 161315 Erie 5330 Genesee Street Bowmansville New York 14026 716-684-6140Mark Burke MD Physician Individual 1730341074 3229334 244867 Erie 1083 Delaware Avenue Buffalo New York 14209 716-882-1023

Mark D. Chazen MD Physician Individual 1518931989 1739899 191198-1 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000

Mark E. Swetz MD Physician Individual 1013918879 194104 Erie Orchard Park New York 14127 716-674-1414Mark Falvo MD Physician Individual 1699966242 245495 Erie 1150 Youngs Road Williamsville New York 14221 716-636-9004Mark J. Doerr MD Physician Individual 1477560738 255209 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Mark Jajkowski MD Physician Individual 1073628244 2414840 210052 Erie 439 Brantwood Drive Amherst New York 14226 716-632-0006

Attn: Finance Dept - Patty Hanna 5300 Military Road

500 Corporate Parkway, Suite 100

3065 Southwestern Boulevard, Suite 206

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Mark R. Podlas MD Physician Individual 1437117264 1223069 175742 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Mark S. Mieth MD Physician Individual 1497721336 200346 Niagara 1 Colomba Drive, Suite 1 Niagara Falls New York 14305 716-297-7207Mark Schulte MD Physician Individual 1093973471 251630 Erie 3615 Seneca Street West Seneca New York 14224 716-675-7376Mark St Marie MD Physician Individual 1629150792 136312 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Marsilia Seiwell Cloud MD Physician Individual 1043257462 228524 Erie 3834 Delaware Avenue Kenmore New York 14217 716-877-1221Martin A. Casey MD Physician Individual 1205890308 1358974 190108 Erie 290 Center Road West Seneca New York 14224 716-675-7693Martina Taylor MD Physician Individual 1932335924 262578 Erie 4671 Mosey Lane Blasdell New York 14218 716-875-2904Mary Alice Kelly MD Physician Individual 1053361816 1568631 Erie 1900 Ridge Road Suite 130 West Seneca New York 14224 716-675-0707Mary Elizabeth Roehmholdt MD Physician Individual 1972772838 481021 128036-1 Erie 300 Essjay Road Williamsville New York 14221 716-634-6357Mary Jo McDonell MD Physician Individual 1821095118 1167817 178523 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454Mary Louise Lenahan MD Physician Individual 1144216953 153446 Erie 6507 Transit Road East Amherst New York 14051 716-689-4377

Mary Margaret O'Neil MD Physician Individual 1598790818 1316201 188049-1 Erie Orchard Park New York 14127 716-675-2500Mary Rykert Wolf MD Physician Individual 1023012853 2047143 209496 Erie 7060 Erie Rd, Suite 100 Derby New York 14047 716-947-0408Mary Turkiewicz MD Physician Individual 1255302345 1371613 187899 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Matthew Antalek DO Physician Individual 1023066065 1091923 170215-1 Erie 1829 Maple Road, Suite 202 Williamsville New York 14221 716-204-5933

Matthew Cywinski MD Physician Individual 1639136682 1843425 206063 Erie Amherst New York 14226 716-834-4237Matthew McClure MD Physician Individual 1407063241 264513 Erie 310 Sterling Drive, Suite 100 Orchard Park New York 14127 716-677-6800Matthew Missert DO Physician Individual 1942437652 265123 Erie 114 Amberwood Drive Grand Island New York 14072 716-447-6100

Matthew Smith MD Physician Individual 1982653630 2383195 224904 Erie 85 High Street Buffalo New York 14203 716-857-8800Matthew Zinno DO Physician Individual 1831316447 261740 Erie 15 South Forest Road Williamsville New York 14221 716-626-1824Maurice Hourihane MD Physician Individual 1326109083 1752969 207113 Erie 200 Sterling Drive, Suite 200 Orchard Park New York 14127 716-250-2000Megan Farrell MD Physician Individual 1609812635 1375075 117917 Erie 225 Como Park Blvd Cheektowaga New York 14227 716-686-1900Mekdess Abebe MD Physician Individual 1316266711 264601 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Meliton Silva MD Physician Individual 1255588521 260900 Erie 4231 Maple Road Amherst New York 14226 716-837-9111

Melvin Dyster MD Physician Individual 1093713141 603223 074185 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Melvin Mangulabnan MD Physician Individual 1871540484 189425 Erie 3918 Seneca Street West Seneca New York 14224 716-675-4433

Michael A Pell MD Physician Individual 1710987128 1651981 1988781 Erie 700 Michigan Avenue, Suite 110 Buffalo New York 14203 716-840-3385Michael A. Meyer MD Physician Individual 1518933498 3079047 219413 Erie 515 Abbott Rd, Suite 25 Buffalo New York 14220 716-828-3123

Michael A. Vasquez MD Physician Individual 1841231511 1564438 198880 Niagara 415 Tremont Street N. Tonawanda New York 14120 716-690-2691Michael Aquino DPM Physician Individual 1720046253 762881 N003686 Erie 929 Brighton Road Tonawanda New York 14150 716-837-1500

Michael Baggett MD Physician Individual 1437102712 224783 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Michael Banas MD Physician Individual 1447283288 222237 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Michael Butler DPM Physician Individual 1710908348 1034413 N0037071 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983Michael C Geraci Jr MD Physician Individual 1760431068 1039101 162259 Erie 57 Darwin Drive Amherst New York 14226 716-247-5320Michael C. Moore MD Physician Individual 1700957727 124157 Erie 2943 Seneca Street West Seneca New York 14224 716-825-3601Michael C. Snyderman MD Physician Individual 1760401236 679727 115814 Erie 515 Abbott Road, Suite 102 Buffalo New York 14220 716-824-5588

Michael Cicchetti MD Physician Individual 1164644183 3110469 251201 Erie 100 College Parkway, Suite 100 Williamsville New York 14221 716-626-0093Michael Cipolla MD Physician Individual 1841450137 265808 Erie 3626 Seneca Street West Seneca New York 14224 716-675-5711Michael D. Calabrese MD Physician Individual 1992782601 839318 148092 Erie 656 Elmwood Ave Buffalo New York 14222 716-883-0515Michael D. DiBella MD Physician Individual 1760471072 189249 Erie 2950 Elmwood Ave Suite 2034 Kenmore New York 14217 716-828-2389

Michael Duff MD Physician Individual 1083648646 2776790 239329 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5500

3055 Southwestern Blvd, Suite 100

4955 North Bailey Avenue, Suite 200

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Michael F Pusatier DO Physician Individual 1699723353 2149911 219447 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 (716) 630-1465

Michael Ferguson MD Physician Individual 1790728673 1661343 202619 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Michael Grisanti MD Physician Individual 1851326177 1164525 178231 Erie Orchard Park New York 14127 716-675-2500Michael Haar MD Physician Individual 1144258641 168852 Erie 1083 Delaware Avenue Buffalo New York 14209 716-882-1023Michael Hanzly DPM Physician Individual 1871598326 669750 2793 Erie 2267 Seneca Street Buffalo New York 14210 716-823-0049Michael Hocko MD Physician Individual 1043271646 1071136 162862 Erie 1616 Kensington Avenue Buffalo New York 14215 716-893-3835Michael J Hong MD Physician Individual 1760595771 1456046 158623 Erie 3091 William Street Cheektowaga New York 14227 716-819-1807

Michael J. Chaskes MD Physician Individual 1215971395 1144852 164089 Erie 3980 Sheridan Drive, 6th Floor Amherst New York 14226 716-961-9900Michael J. Pietrusik DPM Physician Individual 1356368864 845978 N0036341 Erie 3277 South Park Avenue Lackawanna New York 14218 716-822-3411Michael Kane MD Physician Individual 1790728004 2273045 215824-1 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084

Michael Kozower MD Physician Individual 1396721551 614122 103470 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Michael Krabak MD Physician Individual 1578557302 2129082 218067 Erie 45 Spindrift Drive Suite 100 Williamsville New York 14221 716-565-0355Michael Kreymer DO Physician Individual 1720220023 255183 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Michael LaCivita DPM Physician Individual 1285651018 2676171 N006026-1 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983Michael Landi MD Physician Individual 1437116308 1623490 201459 Erie 400 International Drive Williamsville New York 14221 716-631-3555Michael Licata MD Physician Individual 1306814579 1528734 184241 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Michael Merletti DPM Physician Individual 1952377285 1205669 N004636 Niagara 616 Pine Avenue Niagara Falls New York 14301 716-284-2242

Michael Merrill MD Physician Individual 1649205782 2515277 212164 Erie Buffalo New York 14220 716-828-2434Michael Mitchell MD Physician Individual 1750371746 1669992 1918411 Niagara 620 10th Street, Suite 715 Niagara Falls New York 14301 716-282-0349Michael Ostempowski MD Physician Individual 1447262209 223550 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101Michael P. Rade MD Physician Individual 1891763587 633743 128302 Erie 310 Sterling Drive, Suite 105 Orchard Park New York 14127 716-675-7730Michael Parentis MD Physician Individual 1821054057 219537 Erie 180 Park Club Lane Suite 225 Williamsville New York 14221 716-839-5858Michael Peyser MD Physician Individual 1881671238 3470353 217155 Erie 55 Spindrift Dr, Suite 220 Williamsville New York 14221 716-626-6300Michael Rabice MD Physician Individual 1235195769 1716774 198242-1 Erie 5330 Genesee Street Bowmansville New York 14026 716-684-6140

Michael Rauh MD Physician Individual 1205985645 2142487 219352 Erie Orchard Park New York 14127 716-204-3200

Michael S. Albert MD Physician Individual 1386602118 170621 Erie Amherst New York 14228 716-250-9235Michael Sansano, Jr. MD Physician Individual 1649232497 1139899 168353 Erie 515 Abbott Road #206 Buffalo New York 14220 716-828-3460Michael Stoffman MD Physician Individual 1003847484 239975 Erie 400 International Drive Williamsville New York 14221 716-631-3555Michael Terranova MD Physician Individual 1376509976 877569 157125 Erie 5330 Genesee Street Bowmansville New York 14026 716-684-6140Michael Weingarten MD Physician Individual 1750590253 256155 Erie 3615 Seneca Street West Seneca New York 14224 716-675-7376Michael Wood MD Physician Individual 1740374032 176691 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Michele H Frech DO Physician Individual 1093800476 195207 Erie 9300 Back Creek Road Boston New York 14025 716-875-2904

Michelle Rainville MD Physician Individual 1447206222 2568174 231407-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Mikhail Choubmesser MD Physician Individual 1669651758 245213 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Minsoo Kang MD Physician Individual 1780681569 2548516 252105 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Mohamad Shafi MD Physician Individual 1043389620 11195398 168148 Erie 3469 Harlem Road Cheektowaga New York 14225 716-836-0016

Mohamed Ahmed MD,PhD Physician Individual 1679667463 247436 Niagara 2931 Military Road Niagara Falls New York 14304 716-298-4869

Mohamed Zeid MD Physician Individual 1457317752 163627 Erie Amherst New York 14228 716-250-9235Mohammad Khan MD Physician Individual 1033183231 001389-1 Niagara 6941 Elaine Drive, Suite 2 Niagara Falls New York 14304 716-298-8133

Mohammad Qasaymeh MD Physician Individual 1528074341 248736 Erie 3980 Sheridan Drive, Suite 200 Amherst New York 14226 716-250-2000

3055 Southwestern Blvd, Suite 100

565 Abbott Road, 8th floor-room 632

3671 Southwestern Blvd, Suite 207

20 Northpointe Parkway, Suite 100

20 Northpointe Parkway, Suite 100

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Mohammad Reza Samie MD Physician Individual 1811969926 232136 Erie 515 Abbott Road, Suite 400 Buffalo New York 14220 716-828-3400

Mohammed Fayyaz MD Physician Individual 1992731616 1610186 204462-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-631-2517Mohan Madhusudanan MD Physician Individual 1548308463 255870 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Molly J. Zittel DO Physician Individual 1295709137 184251 Erie 530 Main Street East Aurora New York 14052 716-652-5499Moneer Khalil MD Physician Individual 1043276850 159170 Erie 295 Essjay Rd., Suite 7 Williamsville New York 14221 716-630-1288

Monique Mirshak MD Physician Individual 1962628016 248875 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Morris Cavalieri MD Physician Individual 1114921947 1632562 208623 Erie 7060 Erie Rd, Suite 100 Derby New York 14047 716-947-0408

Mrinalini Meesala MD Physician Individual 1972826816 259110 Erie 1616 Kensington Avenue Buffalo New York 14215 716-834-3278Muzamil Rana MD Physician Individual 1578586251 237704 Erie 5530 Sheridan Drive Suite 2 Williamsville New York 14221 716-580-3810Nadeem U L Haq MD Physician Individual 1790729820 1805274 208881 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243Nady Shehata MD Physician Individual 1811926124 959462 163910 Erie 1616 Kensington Avenue Buffalo New York 14215 716-835-3097Naim Dawli MD Physician Individual 1174586614 678340 133835 Erie 2121 Main Street, Suite 207 Buffalo New York 14214 716-862-1066Naima A. Mian DO Physician Individual 1609066224 230486 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Najat Turaif MD Physician Individual 1669438446 2185977 217475 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Nalini J Namassivaya MD Physician Individual 1003892134 2087290 218610 Erie 6460 Main Street Williamsville New York 14221 716-634-5100Nancy Peters MD Physician Individual 1932137122 1357060 155764 Erie 1616 Kensington Avenue Buffalo New York 14215 716-835-3097Narayana S. Shenoy MD Physician Individual 1871545665 943471 145153 Erie 66 Weiss Avenue West Seneca New York 14224 716-674-6612

Naren Kansal MD Physician Individual 1407897333 1065374 173996-1 Erie 725 Orchard Park Road Suite B West Seneca New York 14224 716-675-5010Naresh Jain MD Physician Individual 1285633032 958970 157035 Niagara 620 10th Street, Suite 710 Niagara Falls New York 14301 716-285-1133Narhari M. Panchal MD Physician Individual 1184637894 616073 1114841 Erie 350 Alberta Drive Amherst New York 14226 716-833-7112

Nashat Rabadi MD Physician Individual 1669421970 1479309 188923-3 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-630-1050Natalka Stachiw MD Physician Individual 1619058989 262465 Erie 3626 Seneca Street West Seneca New York 14224 716-675-5711

Nathan Billings MD Physician Individual 1396991923 258316 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Naureen Jaffri DO Physician Individual 1487605333 239323 Erie 2800 Sweet Home Road, Suite 8 Amherst New York 14228 716-691-0639

Naveed Shahid MD Physician Individual 1578736336 253224 Erie Buffalo New York 14220 716-828-2434Nicholas Naples DO Physician Individual 1962417394 1377820 1763801 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Nicholas Violante DO Physician Individual 1215193800 266159 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Nicolas Saikali MD Physician Individual 1821228511 254089 Erie 200 Sterling Drive Orchard Park New York 14127 716-250-2000Nikolaos Botsoglou MD Physician Individual 1225015621 1820411 Erie 2475 Harlem Road Cheektowaga New York 14225 716-896-5922Nitza Ellis MD Physician Individual 1740266451 1029556 137951-1 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Noor Shah MD Physician Individual 1437451150 137655 Erie 2695 Harlem Road Cheektowaga New York 14225 716-891-5991Norbert J. Szymula MD Physician Individual 1205833548 611445 124226 Niagara 6941 Elaine Drive Niagara Falls New York 14304 716-282-2041Norman Fiorica MD Physician Individual 1043312093 1047772 164425-1 Niagara 5320 Military Road, Suite 105 Lewiston New York 14092 716-297-0001

Norman Sfeir MD Physician Individual 1972567741 892851 1466391 Erie 100 College Parkway, Suite 110 Williamsville New York 14221 716-631-8863Ognian Pomakov MD Physician Individual 1366583767 2897607 244049 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Omar Kass-Hout MD Physician Individual 1861631590 270463 Erie 515 Abbott Rd, Suite 25 Buffalo New York 14220 716-828-3123Orville Hendricks MD Physician Individual 1700889573 202444 Erie 20 Losson Road, Suite 105 Cheektowaga New York 14227 716-558-7727Oscar Llugany MD Physician Individual 1336117860 673643 115761 Erie 55 Stonybrook Lane Williamsville New York 14221 716-828-2399Oscar Lopez MD Physician Individual 1558315879 594876 098285 Erie 42 Brookshire Court East Amherst New York 14051Owen Moy MD Physician Individual 1457358780 1194421 155630 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999P Jeffrey Lewis MD Physician Individual 1417933706 1123633 1768721 Erie 550 Orchard Park Road, A-105 West Seneca New York 14224 716-677-6000Pamela Khurana MD Physician Individual 1740381235 1643810 196875 Erie 5 Hidden Meadows Orchard Park New York 14127 716-632-5450Pankaj K. Singhal MD Physician Individual 1437361037 228743 Erie 626 Frankhauser Road Amherst New York 14221 716-276-9162

565 Abbott Road, 8th floor-room 632

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Parmanand K. Parikh MD Physician Individual 1487603783 854224 159050 Niagara Lewiston New York 14092 716-298-3000Patricia O'Donnell DO Physician Individual 1316012560 2876713 238555-1 Erie 297 Spindrift Drive Williamsville New York 14221 716-635-0688Patrick Chan-lam MD Physician Individual 1205807575 209313 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243Patrick Hlubik MD Physician Individual 1588895189 254201 Erie 36 North Union Rd Williamsville New York 14221 716-636-1470Patrick J. Hughes MD Physician Individual 1205962982 590189 105387 Erie 240 Redtail Dr., Suite 10 Orchard Park New York 14127 716-677-6700Paul Anain MD Physician Individual 1003887811 1981933 206152 Erie 2121 Main Street, Suite 316 Buffalo New York 14214 716-837-2400Paul Biddle MD Physician Individual 1073558557 227659-1 Erie 200 Sterling Drive, Suite 202 Orchard Park New York 14127 716-649-1613Paul D. Paterson MD Physician Individual 1235114349 2047092 193064 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Paul J Wopperer MD Physician Individual 1346219847 145086 Erie 5214 Main St, Suite 100 Williamsville New York 14221 716-565-3620Paul Lapoint DO Physician Individual 1790782761 202933 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101Paul Mason MD Physician Individual 1598762320 2261741 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101

Paul Meade MD Physician Individual 1356344279 150240 Niagara Lewiston New York 14092 716-298-3000

Paul Nasca DPM Physician Individual 1639192677 N0036331 Erie 2562 Walden Avenue, Suite 105 Cheektowaga New York 14225 716-683-3330Paul Pizzella MD Physician Individual 1225045685 2641183 235477 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Paul Young MD Physician Individual 1184858458 268372 Erie 4955 N. Bailey Ave, Suite 202 Amherst New York 14226 716-832-8500Pedro G. Joven MD Physician Individual 1134133127 104946 Erie 162 George Urban Boulevard Cheektowaga New York 14225 716-895-6826Peter Adrian MD Physician Individual 1831154525 1650531 163675 Erie 565 Abbott Rd Buffalo New York 14220 716-208-1825

Peter Campione MD Physician Individual 1801851803 693949 136093-2 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-823-4962Peter D. Bloom MD Physician Individual 1316923253 2697414 237590 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Peter Ferin MD Physician Individual 1639157571 1210571 150416 Niagara 5300 Military Road Lewiston New York 14092 716-298-2356Peter Forgach MD Physician Individual 1427051515 630873 117465 Erie 405 International Drive Williamsville New York 14221 716-633-7386Peter Gambacorta DO Physician Individual 1700089596 256227 Erie 8750 Transit Road Suite 105 East Amherst New York 14051 716-636-1470

Peter Janes MD Physician Individual 1720012834 2277365 215603 Erie Buffalo New York 14220 716-828-2434Peter Shields MD Physician Individual 1841259108 145078 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999

Peter Walter MD Physician Individual 1992735377 1518827 195224 117 Foote Ave, Suite 100 Jamestown New York 14071 716-338-9200Peterkin Lee-Kwen MD Physician Individual 1811966880 1721420 206950 Erie 3775 Seneca Street West Seneca New York 14224 716-712-0890

Philip Aliotta MD Physician Individual 1760455356 1030515 1518481 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Philip Fu MD Physician Individual 1285877050 265202 Erie 6636 Main Street, Suite 1 Williamsville New York 14221 716-633-0541

Philip G Lauria MD Physician Individual 1134122773 664535 1853181 Erie 4154 McKinley Pkwy, Suite 1200 Blasdell New York 14219 716-649-6500

Philip M. Dvoretsky MD Physician Individual 1851467757 137783-1 Erie Amherst New York 14228 716-250-9235Philip Penepent Jr MD Physician Individual 1265499008 751193 144089 Erie 5196 Genesee Street Bowmansville New York 14026 716-681-1895

Philip Sauvageau MD Physician Individual 1609852714 2147780 205478-1 Niagara Lewiston New York 14092 716-298-3000Philip Seereiter Jr MD Physician Individual 1447429576 247709 Erie 500 Sterling Drive Orchard Park New York 14127 716-677-2273Philip Sullivan MD Physician Individual 1538234661 815581 143103-1 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Phillip C. Culliton DPM Physician Individual 1629018734 687590 N003003 Erie 2700 Sheridan Drive Tonawanda New York 14150 716-835-2617Pirouz Fakhraei MD Physician Individual 1659514990 269353 Niagara 5290 Military Road, Suite 8 Lewiston New York 14092 716-298-3000Prama Luther MD Physician Individual 1164524708 1830322 181906 Erie 2671 Harlem Road Cheektowaga New York 14225 716-894-5610Pramod Luthra MD Physician Individual 1184677056 146263 Erie 2075 Kensington Avenue Amherst New York 14226 716-839-3717Prashant Pendyala MD Physician Individual 1801842844 2212706 241265 Niagara 670 Davison Road Lockport New York 14094 716-650-0373

Attn: Finance Dept - Patty Hanna 5300 Military Road

Attn: Finance Dept - Patty Hanna 5300 Military Road

565 Abbott Road, 8th floor-room 632

20 Northpointe Parkway, Suite 100

Attn: Finance Dept - Patty Hanna 5300 Military Road

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Qasim Jaffri DO Physician Individual 1447469416 252014 Erie 2800 Sweet Home Road, Suite 8 Amherst New York 14228 716-691-0639R Keith Felstead DO Physician Individual 1487673281 208135 Erie 30 North Union Williamsville New York 14221 716-839-8000

Rachel Weselak MD Physician Individual 1598905390 254352 Niagara 5300 Military Road, Second Floor Lewiston New York 14092 716-298-2224Rafael Medina MD Physician Individual 1265416598 2110983 212374 Erie 6044 Main St. Suite 106 Williamsville New York 14221 716-635-0230Raghu Ram MD Physician Individual 1639138597 1574923 196890 Erie 30 North Union Road Williamsville New York 14221 716-839-8000Ragupathy Varavenkataraman MD Physician Individual 1518949833 1300870 180886 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Raja Cheruvu MD Physician Individual 1942247945 2533677 231856 Erie 55 Spindrift Dr. Williamsville New York 14221 716-631-2500Rajinder S. Sachar MD Physician Individual 1114943719 620457 108861 Erie 2848 William Street Cheektowaga New York 14227 716-893-0900Rajiv K Jain MD Physician Individual 1568436004 2165277 221199 Erie 1491 Sheridan Drive Tonawanda New York 14217 716-332-4476Rama Bojedla MD Physician Individual 1417908419 973111 166504 Niagara 120 Lockport St Youngstown New York 14174 716-745-7724Ramesh Luther MD Physician Individual 1437141991 149576 Erie 2625 Harlem Road #240 Cheektowaga New York 14225 716-895-4400Ramesh Shastri MD Physician Individual 1598760944 643201 113789 Erie 1900 Ridge Road, Suite 8B West Seneca New York 14224 716-674-5966

Randy L. Hobbs MD Physician Individual 1134153596 2364249 226819 Erie Buffalo New York 14220 716-828-2434

Ranjan Bhayana MD Physician Individual 1366407173 1419410 192011 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050Ranjana Luthra MD Physician Individual 1780637694 159445 Erie 2075 Kensington Avenue Amherst New York 14226 716-839-3717Raquel G. Martin DO Physician Individual 1902851256 1059594 157556 Erie 8199 Fern Leaf Court Williamsville New York 14221 716-697-8332Rashida Khanam MD Physician Individual 1932153004 1557937 235325-1 Erie 4985 Harlem Road Suite 2 Amherst New York 14226 716-839-0500Raymond Paolini MD Physician Individual 1609837863 1766581 186332 Erie 6645 Main Street Williamsville New York 14221 716-634-6224Raymond Tuoti MD Physician Individual 1255317343 705862 135189 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Rexford Thomas Jr MD Physician Individual 1629063235 1977417 191725 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Richard A Jennings MD Physician Individual 1306800552 256054 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Richard Bloomberg MD Physician Individual 1770577330 2591862 241414 Erie 550 Orchard Park Road, A103 West Seneca New York 14224 716-677-5500Richard Carlson, Jr. MD Physician Individual 1740246735 1226122 183745 Erie 1491 Sheridan Drive Tonawanda New York 14217 716-332-4476Richard Curran MD Physician Individual 1659338580 724841 139621-1 Erie 85 High Street Buffalo New York 14203 716-857-8800Richard D. Kaplan MD Physician Individual 1184600975 1178638 168072 Erie 60 Maple Road Williamsville New York 14221 716-626-5250

Richard Elman MD Physician Individual 1851345698 653567 141975 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Richard Ferguson MD Physician Individual 1467420638 1575644 184240 Erie 771 Main Street East Aurora New York 14052 716-655-5454Richard J Buckley Jr MD Physician Individual 1316005614 670640060 125872 Erie 4231 Maple Road Amherst New York 14226 716-837-9111

Richard Kessler MD Physician Individual 1366466195 1821407 148270 Erie Amherst New York 14226 716-633-8675

Richard N. Gilbert MD Physician Individual 1336146984 1504636 195757 Erie 3085 Harlem Road, Suite 200 Cheektowaga New York 14225 716-844-5000Richard Ruh MD Physician Individual 1073535449 1843085 187034-1 Erie 3680 Eggert Road Orchard Park New York 14127 716-662-5357Richard Sawicki DPM Physician Individual 1598846941 740565 N003284-1 Niagara 8657 Buffalo Avenue Niagara Falls New York 14304 716-283-3338Richard Steinacher DO Physician Individual 1629198700 224049-1 Erie 4233 Maple Road Amherst New York 14226 716-838-3188Rita Sloan MD Physician Individual 1386646230 172835 Erie 3615 Seneca Street West Seneca New York 14224 716-675-2660Robbert J. Salis MD Physician Individual 1215238258 259122 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454Robbie D. Wall DO Physician Individual 1053433243 255942 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243Robbin Hansen MD Physician Individual 1841287687 1018524 169858 Erie 25 E Main Street Springville New York 14141 716-592-2832Robert Dukarm MD Physician Individual 1609833508 198906 Erie 2157 Main Street Buffalo New York 14214 716-862-1271Robert E. Kaprove MD Physician Individual 1134114234 689258 108951 Erie 3615 Seneca Street West Seneca New York 14224 716-675-7376Robert Erickson DO Physician Individual 1093771396 175824 Erie 3671 Southwestern Blvd #213 Orchard Park New York 14127 716-662-7008

Robert F. Glover MD Physician Individual 1164466298 1057423 147477 Erie Amherst New York 14226 716-961-9900Robert G. Fugitt MD Physician Individual 1104821453 653136 120597 Erie 3800 Delaware Ave Kenmore New York 14217 716-873-3828Robert Gadawski MD Physician Individual 1649277930 1167817 201617 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454

565 Abbott Road, 8th floor-room 632

3730 Sheridan Drive Attn: Patricia Winker

Dent Tower, 6th Floor 3980 Sheridan Drive

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Robert Gianfagna MD Physician Individual 1386650943 1072191 159354 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Robert Hodge MD Physician Individual 1215989173 1449485 1847367 Niagara 160 East Ave Lockport New York 14094 716-434-6141Robert J. Neufeld MD Physician Individual 1336102458 1086497 173864 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Robert J. Powalski, Jr. MD Physician Individual 1134160872 167611 Erie 3834 Delaware Avenue Kenmore New York 14217 716-877-1221

Robert LaDuca MD Physician Individual 1144295056 111366 Erie Orchard Park New York 14127 716-662-2595Robert R. Conti MD Physician Individual 1750322947 1524029 1818401 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Robert Roche' DO Physician Individual 1063459394 2479505 226915-1 Erie 1026 Union Road West Seneca New York 14224 716-712-0851Robert S. LaMantia MD Physician Individual 1700949914 481278 120482-1 Erie 3911 Main Street Eggertsville New York 14226 716-833-3366Robert Schulman MD Physician Individual 1518944990 682206 126079 Erie 2875 Union Road, Suite 21 Cheektowaga New York 14227 716-706-2034

Robert Smolinski MD Physician Individual 1619949963 1244857 173912 Erie Buffalo New York 14240 716-204-3200

Robert W. Williams MD Physician Individual 1902856420 1851858 166690-1 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-823-4962

Robert Zielinski MD Physician Individual 1043260664 1209778 168200 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050Roger Walcott MD Physician Individual 1992962302 3138965 2545321 Erie 2121 Main Street, Suite 316 Buffalo New York 14214 716-837-2400Roland Honeine MD Physician Individual 1285817841 2936285 296685 Erie 3615 Seneca Street West Seneca New York 14224 716-675-2660Romel Bertulfo MD Physician Individual 1194915116 245363-1 Erie 2605 Harlem Rd Cheektowaga New York 14225 716-891-2536Ronald B Boersma MD Physician Individual 1003850876 589886 104448 Erie 825 Wehrle Dr Williamsville New York 14221 716-677-6800Ronald Bauer MD Physician Individual 1215935952 1498315 188498 Erie 199 Park Club Lane, Suite 100 Williamsville New York 14221 716-332-6834Rosalba Mucciarella MD Physician Individual 1497717888 1683783 212681 Erie 297 Spindrift Drive Williamsville New York 14221 716-635-0688Rosann Lana MD Physician Individual 1144422296 2887805 243709 Erie 4575 Main Street Snyder New York 14226 716-633-4575Rositsa Byers MD Physician Individual 1245494574 267360 Erie 2605 Harlem Rd Cheektowaga New York 14225 716-891-2536Ross Sherban DO Physician Individual 1972705077 260619 Erie 2914 Elmwood Ave Kenmore New York 14217 716-447-6310Roy R. DeFrancis DPM Physician Individual 1346275351 N002491-1 Erie 570 French Road Cheektowaga New York 14227 716-668-1610Rurik Johnson MD Physician Individual 1760495824 2877796 229457 Erie 550 Orchard Park Road, A103 West Seneca New York 14224 716-677-5500Russell E. Carlson MD, FACS, FCCP Physician Individual 1821103029 2212417 189175 Erie 210 Ellicott Street #706 Buffalo New York 14203 716-632-0006Ryan DenHaese MD Physician Individual 1356563381 2453525 Erie 19 Limestone Drive #11 Williamsville New York 14221 716-438-2973Ryan Weber DO Physician Individual 1942434824 247407 Erie 9900 Main Street Clarence New York 14031 716-759-8815

Ryan White MD Physician Individual 1912932799 2581822 231146 117 Foote Ave, Suite 100 Jamestown New York 14071 716-338-9200Ryan Wilkins MD Physician Individual 1427286699 266111 Erie 4510 Main Street Buffalo New York 14226 716-839-0632S. Ray Ogra MD Physician Individual 1275581431 1843287 197304 Erie 85 High Street Buffalo New York 14203 716-857-8800

Sachin Wadhawan MD Physician Individual 1700023579 004013 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Saif Soniwala MD Physician Individual 1982620027 209645 Erie 199 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-3340Salvatore M Calandra MD Physician Individual 1659307528 1456082 164085 Erie 825 Wehrle Drive Williamsville New York 14221 716-634-3243Saman Chubineh MD Physician Individual 1861654980 251164 Erie 2625 Harlem Road #240 Cheektowaga New York 14225 716-895-4400Sameer Mamnoon MD Physician Individual 1881663144 229765 Erie 6645 Main St., Suite A Williamsville New York 14221 716-276-8726Sami A. Raphael MD Physician Individual 1790871846 1541620 197756 Niagara 5290 Military Road, Suite 8 Lewiston New York 14092 716-298-3000Samuel F. Ruggiero DPM Physician Individual 1376542704 N3433 Erie 2507 Harlem Road Cheektowaga New York 14225 716-896-6262Samuel Reyes MD,PhD Physician Individual 1598976391 253206 Erie 180 Park Club Lane, Suite 200 Williamsville New York 14221 716-634-7350Samuel Shatkin, Jr. MD Physician Individual 1134122682 168299 Erie 2500 Kensington Avenue Amherst New York 14226 716-839-1700

Samuel Sirianni MD,PhD Physician Individual 1508933581 1114290 167653 Niagara 5290 Military Road; Suite 10 A/B Lewiston New York 14092 716-205-0170Sandra A. Block MD Physician Individual 1205806627 216425 Erie 4955 N Bailey Ave, Suite 201 Amherst New York 14226 716-630-1081Sanford R. Pleskow MD Physician Individual 1447224407 130091 Erie 79 Heritage East Williamsville New York 14221 716-631-3555Sanjay Gupta MD Physician Individual 1740238906 1570974 1825061 Erie 3980 Sheridan Drive Amherst New York 14226 716-250-2000Sanjeev Ahuja MD Physician Individual 1770762015 199847 Erie 12845 Broadway Alden New York 14004 716-937-3255Sara Koritz MD Physician Individual 1326041799 1032379 170019-1 Erie 133 St. James Place Buffalo New York 14222 716-675-5222

3671 Southwestern Boulevard, Suite 209

3435 Main Street, 160 Farber Hall

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05/05/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Sara R. Sirkin MD Physician Individual 1225033236 631714 104165 Erie 2441 Sheridan Drive Tonawanda New York 14150 716-836-8700Sarah Cook MD Physician Individual 1740401918 2882837 243153-1 Erie 4855 Camp Road, Suite 100 Hamburg New York 14075 716-646-1084Sarah H. Spillman DO Physician Individual 1033343173 257205 Erie 30 North Union Road Williamsville New York 14221 716-839-8000

Sarita Kansal MD Physician Individual 1073556825 1619612 175096-1 Erie 725 Orchard Park Road,Suite B West Seneca New York 14224 716-674-0101Sarwat Khawar MD Physician Individual 1558396325 221514 Erie 8987 Hickory Meadows Road Boston New York 14025 585-492-3000

Sateesh Satchidanand MD Physician Individual 1023078359 125273 Erie Amherst New York 14228 716-250-9235Satish Arora MD Physician Individual 1215962808 1488637 141571 Erie 2095 Kensington Avenue Snyder New York 14226 716-893-3755Saurin Popat MD Physician Individual 1073569877 2070799 226844 Erie 1083 Delaware Avenue Buffalo New York 14209 716-882-1023Sayeed Nabi MD Physician Individual 1306899380 611885 126606 Erie 6645 Main Street Williamsville New York 14221 716-634-6224

Scott Cholewinski MD Physician Individual 1467558056 2058111 2021561 Erie Amherst New York 14226 716-633-8675Scott R Darling MD Physician Individual 1487691564 2785399 236352 Erie 2950 Elmwood Avenue Kenmore New York 14217 716-304-6585

Scott Zuccala DO Physician Individual 1487657094 1519662 1957851 Erie 4154 McKinley Pkwy, Suite 1200 Blasdell New York 14219 716-649-6500Sean E. Keating DPM Physician Individual 1457372161 674548 N0031511 Erie 2121 Main Street, Suite 214 Buffalo New York 14214 716-838-2983

Sevak Soukiazian MD Physician Individual 1407809742 2554369 232684 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Shabbir Z Hakim MD Physician Individual 1730116344 1185088 159556 Erie Mercy Hospital - 565 Abbott Rd Buffalo New York 14220 716-828-2173Shah Faisal MD Physician Individual 1780832766 3244520 261611 Erie 1135 Youngs Road, Unit H Williamsville New York 14221 716-440-4599Shahid Mehboob MD Physician Individual 1588674428 2396963 248281 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Shahriyar Leilabadi MD Physician Individual 1710062245 242080 Erie 1208 Niagara Falls Boulevard Tonawanda New York 14150 716-833-2200Shaikh Manzoor MD Physician Individual 1053427625 192926 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-826-7000Sharmilee Thota MD Physician Individual 1003082215 003979 Niagara 3101 9th Street Niagara Falls New York 14305 716-284-8917Shashi Lall MD Physician Individual 1730166448 1665021 146834 Erie 725 Orchard Park Road West Seneca New York 14224 716-675-1001Shawn Cotton MD Physician Individual 1003880113 1781593 191738 Erie 112 Olean Road, Suite 220 East Aurora New York 14052 716-805-1072Shawn Ferguson MD Physician Individual 1922071521 1827458 2059211 Niagara 5290 Military Road, Suite 3 Lewiston New York 14092 716-297-0052

Shehla Haque MD Physician Individual 1063466340 913891 151604-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Sheila Pieczonka DO Physician Individual 1720071780 225 2238251 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Shirley Anain MD Physician Individual 1891755708 1382636 187404 Erie 4949 Harlem Road, Suite 302 Amherst New York 14226 716-838-1333Siddhartha Shah MD Physician Individual 1841276763 1339624 179451 Erie 60 Maple Road Williamsville New York 14221 716-626-5250

Song Yi Han MD Physician Individual 1104060375 268592 Niagara 5300 Military Road Lewiston New York 14092 716-284-3278Sonjoy Singh MD Physician Individual 1063410066 1543333 197421 Niagara 7300 Porter Road Niagara Falls New York 14304 716-298-5862Soosaipillai Jeyapalan MD Physician Individual 1992779284 128590 Erie 1900 Ridge Road Suite 130 West Seneca New York 14224 716-675-0707Sridhar Rachala MD Physician Individual 1326279597 52337 Erie 100 High Street Buffalo New York 14203 716-859-1470Stanley Michalski MD Physician Individual 1386649721 108355 Erie 400 International Drive Williamsville New York 14221 716-631-3555Stanley Pietrak MD Physician Individual 1396794939 845969 143423 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Stephanie Soehnlein MD Physician Individual 1144558057 3572492 264892 Erie 565 Abbott Road Buffalo New York 14220 716-828-2399Stephen Chrzanowski MD Physician Individual 1013966647 2100441 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-828-2437Stephen D. Rycyna MD Physician Individual 1477512739 1237671 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Stephen Downing MD Physician Individual 1104861178 224769 Erie 515 Abbott Road, Suite 101 Buffalo New York 14220 716-923-9650Stephen Scrivani MD Physician Individual 1720088081 840455 152190 Erie 18 Limestone Dr, Suite 5 Williamsville New York 14221 716-632-1400Stephen Sobie MD Physician Individual 1770571358 1065714 157305 Erie 897 Delaware Avenue Buffalo New York 14209 716-883-6800Stephen Sorrentino MD Physician Individual 1366522310 1881814 204750 Erie 2605 Harlem Rd Cheektowaga New York 14225 716-891-2536Steve B. Dofitas MD Physician Individual 1780704189 2422448 226829 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Steven Barone MD Physician Individual 1447407036 250038 Erie 1150 Youngs Road Williamsville New York 14221 716-636-9004Steven Becker MD Physician Individual 1992706485 886402 161094 Erie 539 Cleveland Drive Cheektowaga New York 14225 716-834-9486Steven Buck MD Physician Individual 1932197449 601189 122352-1 Erie 897 Delaware Avenue Buffalo New York 14209 716-883-6800

20 Northpointe Parkway, Suite 100

3730 Sheridan Drive Attn: Patricia Winker

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Steven Gasiewicz MD Physician Individual 1457303521 1908841/RA0570 211527-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Steven Grabiec MD Physician Individual 1184634735 109038 Niagara 6930 Williams Road, Suite 3700 Niagara Falls New York 14304 716-298-3541

Steven Gregoritch MD Physician Individual 1841290772 1436126 159170 Erie West Seneca New York 14224 716-674-6800Steven Horn MD Physician Individual 1457324469 2220041 Erie 5530 Sheridan Drive Suite 2 Williamsville New York 14221 716-580-3810

Steven Lakomy MD Physician Individual 1427002302 1126952 184087 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Steven Lana MD Physician Individual 1043296759 963722 160967-1 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Steven P. Herman MD Physician Individual 1447214903 156114 Erie 5893 Camp Road, Suite 4 Hamburg New York 14075 716-649-7722Steven Stone MD Physician Individual 1629068408 862042 139305 Erie 6000 N. Bailey Ave Suite 1D Amherst New York 14226 716-834-4266Steven Weiss MD Physician Individual 1255393708 1044673 141284 Erie 24 Carrow Steet Orchard Park New York 14127 716-662-3443

Su Zhan MD Physician Individual 1164722054 257677 Erie West Seneca New York 14224 716-677-2700Subramanya Shastri MD Physician Individual 1073527594 135351-1 Erie 17 Limestone, Suite 1 Williamsville New York 14221 716-565-3390Sujatha Addagatla MD Physician Individual 1720168198 1630735 190795 Niagara 2900 Military Rd Niagara Falls New York 14304 716-298-1868Sunita Chadha MD Physician Individual 1013176692 1994834 215479 Erie 1825 Maple Rd, Suite 2A Williamsville New York 14221 716-810-9292Susan Fischbeck MD Physician Individual 1598752438 1083912 162726 Erie 25 E Main Street Springville New York 14141 716-592-2832Susan Littler MD Physician Individual 1265502546 505307 01 190730 Erie 3050 Orchard Park Road West Seneca New York 14224 716-675-5222Suzette LaJeunesse MD Physician Individual 1881600609 229652 Erie 68 Foxboro Lane E. Amherst New York 14051 716-634-9303

Syed Bukhari MD Physician Individual 1447203633 02112127 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Syed Haq MD Physician Individual 1467431296 606506 119740 Erie 474 Niagara Falls Boulevard Tonawanda New York 14223 716-833-3697

Syed Jaffri MD Physician Individual 1053369199 613570 1108101 Erie 2800 Sweet Home Road, Suite 8 Amherst New York 14228 716-691-0639Syed S. Husain MD Physician Individual 1902827769 207679 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966

Tajinder Singh MD Physician Individual 1124289558 263416 Erie Buffalo New York 14220 716-828-2434

Tanvir Dara MD Physician Individual 1366409906 1613065 197036 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

Tara Manteghi DO Physician Individual 1518134196 249460 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Tara Reimer MD Physician Individual 1295763670 2563968 231912 Erie 24 Carrow Steet Orchard Park New York 14127 716-662-3443Tariq A Sheikh MD Physician Individual 1891799656 2564432 233142 Erie 7060 Erie Rd, Suite 100 Derby New York 14047 716-947-0408Tej Kaul MD Physician Individual 1831194513 961582 166453 Niagara 6937 Williams Road Niagara Falls New York 14304 716-298-4454Tejinder Kalra MD Physician Individual 1629015011 2001611 Erie 2671 Harlem Road Cheektowaga New York 14225 716-892-9670

Terence O'Connor MD Physician Individual 1205842184 1283292 1756061 Erie Orchard Park New York 14127 716-712-0490Thaddeus Szarzanowicz MD Physician Individual 1972515740 200802 Erie 192 Park Club Lane, Suite 100 Williamsville New York 14221 716-204-1101Theodore Merletti DPM Physician Individual 1669411864 1220942 N003956-1 Niagara 616 Pine Ave Niagara Falls New York 14301 716-284-2242

Theodore Wells, Jr. MD Physician Individual 1619958816 1772027 194653 Erie 6000 North Bailey Ave, Suite 1D Amherst New York 14226 716-834-6152Theresa Wegman MD Physician Individual 1437117553 1924689 204233 Erie 24 Carrow Steet Orchard Park New York 14127 716-662-3443Thom R. Loree MD Physician Individual 1215927330 156945 Erie 1083 Delaware Avenue Buffalo New York 14209 716-882-1023Thomas Anthony Cumbo MD Physician Individual 1982744504 2664579 226644 Niagara 793 Center St, Unit 482 Lewiston New York 14092 1-866-575-4157

Thomas Brewer DO Physician Individual 1770681777 2628339 231159-1 Erie 11 Red Brick Road Orchard Park New York 14127 716-949-3449Thomas DeGrave DO Physician Individual 1134187537 1789519 173319 Erie 3680 Eggert Road Orchard Park New York 14127 716-662-5357Thomas F. Riley MD Physician Individual 1982644977 199567 Erie 2157 Main Street Buffalo New York 14214 716-862-1271Thomas Gerbasi MD Physician Individual 1457324014 586883 1310771 Niagara 5290 Military Road, Suite 3 Lewiston New York 14092 716-297-0052

550 Orchard Park Road, Suite A 100

550 Orchard Park Rd, Building C, 2nd floor

565 Abbott Road, 8th floor-room 632

3075 Southwestern Boulevard Suite 100

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

Thomas Hassenfratz DPM Physician Individual 1013068410 603287 N002071 Erie 380 Cleveland Drive Buffalo New York 14215 716-836-7156Thomas Helm MD Physician Individual 1881651008 1604833 186385-1 Erie 6255 Sheridan Drive Williamsville New York 14221 716-630-2500Thomas Hughes MD Physician Individual 1518928290 1954810 206866 Erie 1150 Youngs Road, Suite 203 Williamsville New York 14221 716-626-5840Thomas Mason MD Physician Individual 1548365257 3188745 255498 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Thomas Polisoto MD Physician Individual 1891769436 1074657 174476 Erie 550 Orchard Park Rd, Bldg C West Seneca New York 14224 716-558-5153Thomas Raab MD Physician Individual 1023081072 728047 135705 Erie 565 Abbott Road Buffalo New York 14220 716-828-2578Thomas S. Artim MD Physician Individual 1770523342 889592 161110 Erie 539 Cleveland Drive Cheektowaga New York 14225 716-834-9486Thomas S. Branigan MD Physician Individual 1841254281 97648 Erie 15 Briarhill Road Williamsville New York 14221 716-688-2564Thomas Schenk MD Physician Individual 1235115957 2161773 217528-1 Erie 2550 Delaware Avenue Buffalo New York 14216 716-884-0230Thomas Smith Jr MD Physician Individual 1205996980 1479267 179784NY Erie 960 Center Road West Seneca New York 14224 716-674-8502Thomas Summers MD Physician Individual 1063454908 1477903 192681 Erie 55 Spindrift Dr. Williamsville New York 14221 716-631-2500

Thomas Westner MD Physician Individual 1396773826 1273569 163662 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Tiffany Genewick MD Physician Individual 1144278664 2089605 206982 Erie 4731 Transit Road, Suite 1 Depew New York 14043 716-668-1902Timothy Adams MD Physician Individual 1649461401 245531 Erie 1150 Youngs Road Williamsville New York 14221 716-636-9004Timothy Dyster MD Physician Individual 1477534741 1210604 174697 Niagara 5300 Military Road Lewiston New York 14092 716-298-2356Timothy F. Gabryel MD Physician Individual 1124061320 131764 Erie 1900 Ridge Road Suite 130 West Seneca New York 14224 716-675-0707Timothy G. Murphy DO Physician Individual 1194748327 89127GW 256371 Erie 53 Kingsgate Rd Snyder New York 14226 716-828-2437Timothy McGrath MD Physician Individual 1659371862 2683796 236504 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Timothy Rasmusson MD Physician Individual 1538169875 1186516 1696681 Erie 550 Orchard Park Road, A103 West Seneca New York 14224 716-677-5500Timothy Siepel MD Physician Individual 1053348599 114398-1 Erie 224 East Main Street Springville New York 14141 716-592-8140Timothy Wacker MD Physician Individual 1851482038 167448 Erie 260 Redtail Road Orchard Park New York 14127 716-677-6501Todd Lorenc MD Physician Individual 1114103454 246194 Erie 3925 Sheridan Drive Amherst New York 14226 716-250-9999Todd Orszulak DO Physician Individual 1881761864 2273132 216696 Niagara 4515 Military Road Niagara Falls New York 14305 716-236-7880Tomas Holmlund MD Physician Individual 1770644528 1242942 179454 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000Toni Murphy DO Physician Individual 1003862897 1574336 188967 Erie 600 Harlem Road West Seneca New York 14224 716-332-2121Travis Mastroianni DO Physician Individual 1063624468 3283209 260098 Erie 3040 Amsdell Road Hamburg New York 14075 716-649-9000Trudy Baker MD Physician Individual 1639153943 834217 1492771 Erie 45 Spindrift Dr, Suite 102 Williamsville New York 14221 716-689-8398

Usha Chopra MD Physician Individual 1194783928 134250 Erie Amherst New York 14228 716-250-9235

Valerie L. Burkhard MD Physician Individual 1275709164 2476921 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050Venkata Jupudy MD Physician Individual 1285690008 002046 Erie 12845 Broadway Alden New York 14004 716-937-3255Venkateswara Kolli MD Physician Individual 1316940299 198308 Niagara 4525 Witmer Rd. Niagara Falls New York 14305 716-278-0873Vernice Bates MD Physician Individual 1801958202 713819 150028-1 Erie 3980 Sheridan Drive, Suite B Amherst New York 14226 716-250-2000

Victor Yosuico MD Physician Individual 1568523058 2830880 241989 Erie 85 High Street Buffalo New York 14203 716-857-8800Vijay Bojedla MD Physician Individual 1982604468 928890 158437 Niagara 1404 Pine Avenue Niagara Falls New York 14301 716-284-8333Vilasini Shanbhag MD Physician Individual 1326091489 824828 132457-1 Erie 45 Spindrift Dr Williamsville New York 14221 716-634-6503Vinay Mehta MD Physician Individual 1346455755 267644 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966

Vincent J. McGravey MD Physician Individual 1881761559 827385 157102 Erie Buffalo New York 14220 716-828-2568Vito D. Palumbo DO Physician Individual 1700841756 191531 Erie 61 Maple Road Williamsville New York 14221 716-565-1234Vivian Lindfield MD Physician Individual 1356320345 2504772 001986-1 Erie 3915 Sheridan Drive Amherst New York 14226 716-632-7465

Vyjanthanath Gunasingham MD Physician Individual 1912900432 207988064 249369-1 Erie 725 Orchard Park Road, Suite D West Seneca New York 14224 716-748-6002

Waseya Cornell MD Physician Individual 1831344142 251230 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247Wendy Gellman MD Physician Individual 1659359149 1772045 200804 Erie 4711 Transit Road, Suite 1 Depew New York 14043 716-668-5331William B. Cline MD Physician Individual 1528093614 742645 134269 Erie 2605 Harlem Rd Cheektowaga New York 14225 716-891-2536

William Barone DO Physician Individual 1396797064 2678926 236275-1 Erie 1 John James Audubon Parkway Amherst New York 14228 716-881-4247

20 Northpointe Parkway, Suite 100

Department of Pediatrics 565 Abbott Road

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

2.3) IPA/Physicians - Contact Information

Certified_Nurse_Midwife

Dentist State of New York Department of HealthNurse_Practitioner Delivery System Reform Incentive Payment (DSRIP) ProgramPhysician IPA/Physician ListPhysicians Assistant

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

Physician Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension

Physicians Type: ONLY choose from the following:

Physician Type (See Instructions) Individual OR Group Name

SN Qualified (Y/N)

William Belles MD Physician Individual 1346275286 1774761 1774761 Erie 2545 Sheridan Drive Tonawanda New York 14150 716-838-1100William C. Schueler DO Physician Individual 1487655908 1246611 178816 Erie 30 North Union Road Williamsville New York 14221 716-839-8000William Flynn MD Physician Individual 1578586293 1260851 161806 Erie 462 Grider St, DKM-3rd floor Buffalo New York 14215 716-898-5269

William J. Lagaly DO Physician Individual 1356371272 132919003 259734 Erie Orchard Park New York 14127 716-828-2330

William Morris MD Physician Individual 1538127923 891887 140059 Erie 6255 Sheridan Drive, Suite 210 Williamsville New York 14221 716-857-8800William N. Capicotto MD Physician Individual 1356484174 1466581 Erie 135 Linwood Ave Buffalo New York 14209 716-881-0382William R Kuehnling MD Physician Individual 1255337705 1246620 180616 Erie 4893 Transit Road Depew New York 14043 716-608-7040William Stephan MD Physician Individual 1952370173 1528270 171247 Erie 4080 Delaware Avenue Tonawanda New York 14150 716-875-7399William Wind MD Physician Individual 1932179736 2386941 219446 Erie 4949 Harlem Rd Amherst New York 14226 716-204-3257Won Sam Yi MD Physician Individual 1306869417 2777448 240628-1 Niagara 810 Davison Road Lockport New York 14094 716-438-5486

Xiuli Li MD Physician Individual 1720229180 250821 Erie 3980 Sheridan Drive, Suite 200 Amherst New York 14226 716-250-2000Y. R. Kumar MD Physician Individual 1326004649 1902074 225749 Erie 12845 Broadway Alden New York 14004 716-937-3255Yashash Pathak MD Physician Individual 1134370786 264466 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 813-484-7838

Yasmin Pervez MD Physician Individual 1972593903 1795500 209216 Niagara 273 Division St N. Tonawanda New York 14120 716-692-7156Yijun Cheng MD Physician Individual 1013058213 233542 Erie 295 Essjay Rd. Williamsville New York 14221 716-630-1050

Yogesh Maheshwari MD Physician Individual 1972589083 1980872 214449 Erie 60 Maple Road Williamsville New York 14221 716-626-5250Yongzeng Ding MD,PhD Physician Individual 1386917680 265413 Erie 565 Abbott Rd, 5th Floor Buffalo New York 14220 716-828-2437

Young Yu MD Physician Individual 1558335315 654499 113895 Niagara Lewiston New York 14092 716-298-3000

Young Zhou MD Physician Individual 1003874835 218772 Erie Amherst New York 14228 716-250-9235Yubao Wang MD Physician Individual 1306942644 3641018 268689 Erie 45 Spindrift Dr Williamsville New York 14221 716-810-9631Zaki Masud MD Physician Individual 1134237464 687334 127157 Erie 3435 Bailey Avenue Buffalo New York 14215 716-835-2966Zeeshan Qureshi DO Physician Individual 1477748689 270006 Erie 565 Abbott Road Buffalo New York 14220 716-828-2399Zina Hajduczok MD Physician Individual 1104939768 164649 Niagara 5320 Military Rd, Suite 105 Lewiston New York 14092 716-297-1686Southern Tier Pediatrics No Group 1710902200 02366347 Chautauqua 1684 Foote Avenue Extension Jamestown NY 14701 Patricia D'Angelo 7166619730

3669 Southwestern Blvd, Suite 100

Attn: Finance Dept - Patty Hanna 5300 Military Road

20 Northpointe Parkway, Suite 100

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

[email protected]@[email protected]

[email protected]

[email protected]@[email protected]@[email protected]@hotmail.com

[email protected]@[email protected]

[email protected]@buffalomedicalgroup.com

[email protected]

[email protected]@[email protected]@[email protected]@windstream.net

[email protected]

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DSRIP Project Design Grant Application Section 2.4 Pharmacy List

2.4) Pharmacy - Contact Information

State of New York Department of HealthDelivery System Reform Incentive Payment (DSRIP) Program

Pharmacy List

1 2 3 4 5 6 7 8 10 11 12 13 14 15

Pharmacy Name NPI MMIS License # County Address City State Zip Contact Name Phone # Extension EmailSN Qualified (Y/N)

Black Rock Pharmacy, Inc. YES 1568418614 591864 Erie 431 Tonawanda St. Buffalo NY 14207 Bradley J. Arthur (716) 876-3070 [email protected] Ridge Medical Supplies NO 146742200 887976 Erie 6350 Transit Road Depew NY 14043 Rachael Nees 7168283812 [email protected]

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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

Section 10Project Advisory Committee - PAC

10.1) How will the Project Advisory Committee assist the emerging Performing Provider System in the development of its DSRIP Project Plan? (Restricted to 4500 characters)Characters used: 3666

Each emerging Performing Provider System (PPS) is required to form a Project Advisory Committee (PAC). The PAC will advise emerging Performing Provider Systems on all elements of their DSRIP Project Plans and should include representation from each of the emerging PPS partners as well as workers and/or relevant unions. Unless an alternative structure is being proposed. Project Advisory Committee representatives should be determined using the following process:

1. Organizational representatives:a. Emerging PPS partners with more than 50 employees are required to have an organizational (managerial) representative participate in the PAC.b. Emerging PPS partners with less than 50 employees have the option of selecting an organizational (managerial) representative to participate in the PAC.

2. Worker representatives:a. Partner organizations that are not unionized and have over 50 employees must develop a process to elect a worker (non-managerial employee) representative to participate in the PAC. b. For non-unionized partner organizations with less than 50 employees, the employees have the option of electing a worker (non-managerial employee) representative to participate in the PAC if they so choose.

3. Union Representatives:a. Partner organizations that are unionized and have over 50 employees must designate a union representative to participate in the PAC. If a particular union represents workers from multiple emerging PPS partners, one representative from that union is sufficient to satisfy PAC requirements. b. For unionized partner organizations with less than 50 employees, the union has the option of designating a union representative to participate in the PAC if they so choose.

The Project Advisory Committee will be a committee of CMP-AC governance and responsible for leading the planning, implementation and ongoing evaluation of the Performing Provider System. This responsibility includes but is not limited to: evaluation of PPS goals and objectives based on milestones and performance targets, compliance with all reporting requirements with NYS and oversight of all financial transactions, strategic focus, and oversight of all key decisions impacting the performance of the PPS. As described in Question 10.3, the Project Advisory Committee (PAC) is structured to include the lead or co-leads designated for each of the 10 selected projects plus four “floating” Project Advisory Committee members representing academia, workers/unions, payers and community based organizations not represented elsewhere. PAC leadership will organize and direct the work on a specific project through working subcommittees and focus groups consisting of partner organizations and stakeholders important to each initiative. The floating PAC leads will be engaged across the ten project specific PAC subcommittees, providing input and expertise They will maintain membership reflective of their focus, for example, academia will consist of representatives from technical programs, BOCES, colleges & universities, AHEC, BOCES, etc. Union/workers PAC subcommittee will consist of union and worker representatives across the service area. The PAC leads serving on the Project Advisory Committee serve as project experts providing the clinical and operational expertise and leadership required for success. In addition to this focused perspective, the PAC leads will oversee the performance of each initiative and be responsible for the ensuring reliable and valid reporting of process and outcome measures. The leads will also use CMP improvement science model to close performance gaps. PAC leadership will also be working with the CMP mobile technology and practice transformation team to support PPS providers. The PAC leaders will work to ensure that providers in different geographic/county regions are able to customize and adapt the improvement initiatives in their respective communities, addressing workforce & infrastructure capacity. Catholic Medical Partners sees the development of an effective Project Advisory Committee as a long term commitment and investment. Engagement with the initial PAC members is expected to begin in July with educational and training sessions to bring members to a common knowledge platform and to build relationships and trust. PAC members will work together initially to gain knowledge in areas such as the Triple Aim, Integrated Delivery System Models, Population Health, and the basics of Analytics. PAC members will all receive training in teamwork, brainstorming, consensus building, dispute resolution and effective project management. This education and training will support each Project Advisory Committee member’s ability to organize and manage an effective, project focused, working subcommittee(s). During the DSRIP Project Plan development period, the Advisory Committee members and their working subcommittees will conduct critical evaluations of their specific project. This will include thorough consideration of alignment with community need, contribution to DSRIP overall goals, objectives, and deliverables, and availability of the required human, financial & capital resources. Results and recommendations will be shared with the full PAC for DSRIP Plan development. The PAC will use this input to modify or redirect the project work or to elect to change or eliminate a project selection.

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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

Flexibility in the Project Advisory Committee (Q's 10.2 & 10.3)

10.2) Are you proposing an alternative structure for your Project Advisory Committee? Yes

If you answered "Yes" then:

- Answer question 10.3If you answered "No", then please skip 10.3

10.3) Please give an explanation of how your emerging PPS will be structuring your Project Advisory Committee? (Restricted to 5000 characters)~ See instructions for further clarification Characters used: 2776

^ The proposed alternative structure must still represent all key parties(Partner Organization/Union/Worker representatives) within the PPS. ^ Any alternative proposal must be approved by the state during the DSRIP design Grant application process.

For an emerging Performing Provider System with over 20 partnering organizations, qualifying PPS may propose an alternative PAC structure that will allow for a leaner committee as long as the proposed structure is still representative of all key parties within the PPS.

- Your emerging PPS must contain over 20 partnering organizations

The Project Advisory Committee is structured by improvement initiative and by geographic area within the service area as well as by key leadership by academia, labor, health plans and community organizations. The PAC will be results oriented and focused on leading performance based initiatives to achieve the goal of 25% reduction in avoidable hospital admissions and accountability for meeting population health quality metrics. The PAC will work rapidly to (1) establish a culture of accountability that will be a foundational component for future success and (2) establish a formal participating provider agreement. The agreement will set forth the roles and responsibilities of it provider network. In addition the PAC will operate using a consensus decision making model and will be responsible for overall reporting to the CMP board of directors. To date CMP has had multiple meetings with our PPS partners to gain consensus on the initiatives and to explain the business model and deliverables., We have used these meetings to identify the initial PAC leadership group CMP-AC PPS expects as the demands of the DSRIP increase new leaders will emerge and the initial PAC leadership may require changes to ensure accountability and success. THE CMP-AC PPS will operate using the virtual organizational model. This model is used to create an organization of independent providers committed to a business model with common goals, an integrated vision and methods to ensure communication. The overall PAC working structure is as outlined below:

Project Advisory Committee Lead/ Co-lead:This will be the leadership team of project-focused leads and floating leads which will advise the governing body. As a group, project PAC lead/co-leads purpose is to:Organize and direct committee workArticulate overall project specific goalsMonitor performance & progress toward goalsReport & make recommendations to the Governing BodyEstablish work groups as needed

The project PAC lead/co-lead work includes the following: 1. Identify, Recruit, Educate, Train & Mobilize subcommittee members. Subcommittee membership is expected to include partners, floating PAC members, & stakeholders. 2. Set specific Project Goals & Objectives. Agree to start & completion dates, deliverables, measureable outcomes in addition to project specific metrics. 3. Identify and Secure Resources to Achieve Project Goals 4. Seek Knowledge/Experience/Resources from other aligned PPSs & similarly focused groups Form community & other organizational alliances to share ideas & resources 5. Convene focus groups (Targeted population engagement) 6. Develop Project Specific Processes/Programs/Protocols, Test & Implement. 7. Measure Performance 8. Evaluate & Report Results

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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

10.4)List all the worker representatives, union representatives and Performing Provider System partner organization representatives that will be part of the emerging Performing Provider Systems Project Advisory Committee.~ Please see instructions for clarification

(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NamePartner Organization Representative Catholic Health SystemPartner Organization Representative Hospice BuffaloPartner Organization Representative Spectrum Human ServicesPartner Organization Representative Lake Shore Behavior HealthPartner Organization Representative Buffalo Urban LeaguePartner Organization Representative Erie County Department of HealthPartner Organization Representative Chautauqua County Dept of Health & Human ServicesPartner Organization Representative The McGuire GroupPartner Organization Representative St Catherine LabourePartner Organization Representative Mount St. Mary's HospitalPartner Organization Representative WCA HospitalPartner Organization Representative Niagara UniversityPartner Organization Representative SUNYAB School of NursingPartner Organization Representative Person Centered Services of WNYPartner Organization Representative Catholic CharitiesPartner Organization Representative McAuley Seton Home CarePartner Organization Representative Independent Health Association, IncPartner Organization Representative Roswell Park Cancer InstitutePartner Organization Representative Orleans Community HealthPartner Organization Representative

Union Representative Communication Workers of America (CWA)Worker Representative Sisters of Charity Hospital

Partner Organization Representative Child & Adolescent Treatment ServicesSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

Partner Organization Representative/Union Representative*/Worker Representative

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(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NamePartner Organization Representative/Union

Representative*/Worker RepresentativeSelect One

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(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NamePartner Organization Representative/Union

Representative*/Worker RepresentativeSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NamePartner Organization Representative/Union

Representative*/Worker RepresentativeSelect One

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NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(1) (2) (3) (4)

Name Partner Organization Name *Union Organization NamePartner Organization Representative/Union

Representative*/Worker RepresentativeSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect OneSelect One

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INDEX SCOREDomain 2 System Transformation Projects

2A. Create Integrated Delivery Systems (required)2B. Implementation of care coordination and transitional care programs2C. Connecting system

Select One2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

2.A.II Increase certification of primary care practitioners with PCMH certification and/or Advanced Primary Care Models (as developed under the New York State Health Innovation Plan (SHIP)) 372.A.III Health Home At-Risk Intervention Program –Proactive management of higher risk patients not currently eligible for Health Homes through access to high quality primary care and support services. 462.A.IV Create a medical village using existing hospital infrastructure 542.A.V Create a medical village/ alternative housing using existing nursing home 42

Select One2.B.I Ambulatory ICUs 36

2.B.II Development of co-located primary care services in the emergency department (ED) 402.B.III ED care triage for at-risk populations 432.B.IV Care transitions intervention model to reduce 30 day readmissions for chronic health conditions 432.B.V Care transitions intervention for skilled nursing facility residents 41

2.B.VI Transitional supportive housing services 472.B.VII Implementing the INTERACT project (inpatient transfer avoidance program for SNF) 41

2.B.VIII Hospital-Home Care Collaboration Solutions 452.B.IX Implementation of observational programs in hospitals 36

2.C.I Development of community-based health navigation services 372.C.II Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services 31

Select One2.A.I Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 56

2.A.II Increase certification of primary care practitioners with PCMH certification and/or Advanced Primary Care Models (as developed under the New York State Health Innovation Plan (SHIP)) 372.A.III Health Home At-Risk Intervention Program –Proactive management of higher risk patients not currently eligible for Health Homes through access to high quality primary care and support services. 462.A.IV Create a medical village using existing hospital infrastructure 542.A.V Create a medical village/ alternative housing using existing nursing home 422.B.I Ambulatory ICUs 36

2.B.II Development of co-located primary care services in the emergency department (ED) 402.B.III ED care triage for at-risk populations 432.B.IV Care transitions intervention model to reduce 30 day readmissions for chronic health conditions 432.B.V Care transitions intervention for skilled nursing facility residents 41

2.B.VI Transitional supportive housing services 472.B.VII Implementing the INTERACT project (inpatient transfer avoidance program for SNF) 41

2.B.VIII Hospital-Home Care Collaboration Solutions 452.B.IX Implementation of observational programs in hospitals 36

2.C.I Development of community-based health navigation services 372.C.II Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services 31

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Domain 3 Clinical Improvement Projects3A. Behavioral Health (Required)3B. Cardiovascular Health3C. Diabetes Care3D. Asthma3E. HIV3F. Perinatal3G. Palliative Care3H. Renal Care

Select One3.A.I Integration of primary care services and behavioral health 39

3.A.II Behavioral health community crisis stabilization services 373.A.III Implementation of evidence based medication adherence program (MAP) in community based sites for behavioral health medication compliance 293.A.IV Development of withdrawal management (ambulatory detoxification) capabilities within communities 363.A.V Behavioral Interventions Paradigm in Nursing Homes (BIPNH) 403.B.I Evidence based strategies for disease management in high risk/affected populations (adult only) 30

3.B.II Implementation of evidence-based strategies in the community to address chronic disease -- primary and secondary prevention projects (adult only) 263.C.I Evidence-based strategies for disease management in high risk/affected populations (adults only) 30

3.C.II Implementation of evidence-based strategies in the community to address chronic disease – primary and secondary prevention projects (adults only) 263.D.I Development of evidence-based medication adherence programs (MAP) in community settings –asthma medication 28

3.D.II Expansion of asthma home-based self-management program 313.D.III Evidence based medicine guidelines for asthma management 31

3.E.I Comprehensive Strategy to decrease HIV/AIDS transmission to reduce avoidable hospitalizations – development of a Center of Excellence for management of HIV/AIDS 283.F.I Increase support programs for maternal & child health (including high risk pregnancies) (Example: Nurse-Family Partnership) 293.G.I IHI “Conversation Ready” model 29

3.G.II Integration of palliative care into medical homes 223.G.III Integration of palliative care into nursing homes 25

3.H.I Specialized Medical Home from Chronic Renal Failure 29

Domain 4 Population-Wide Projects4A. Promote Mental Health and Prevent Substance Abuse (MHSA)4B. Prevent Chronic Diseases4C. Prevent HIV and STD's4D. Promote Healthy Women, Infants and Children

Select One4.A.I Promote mental, emotional and behavioral (MEB) well-being in communities 23

4.A.II Prevent Substance Abuse and other Mental Emotional Behavioral Disorders 204.A.III Strengthen Mental Health and Substance Abuse Infrastructure across Systems 20

4.B.I Promote tobacco use cessation, especially among low SES populations and those with poor mental health 234.B.II Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings (Note: This project targets chronic diseases that are not included in domain 3.b., such as cancer) 174.C.I Decrease HIV morbidity 19

4.C.II Increase early access to, and retention in, HIV care 194.C.III Decrease STD morbidity 154.C.IV Decrease HIV and STD disparities 18

4.D.I Reduce premature births 24