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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

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

Special Terms & Conditions Attachment I Attachment J

(Recommend) - PowerPoint/Webinar

DSRIP LINK:

Application Due on: June 26, 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".

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 Section 1 Applicant Info_Project Contact_Partner Organizations

Project Point of ContactLead Applicant Information Primary Contact

Contact Person: Phil Hirschhorn, DDS1.1) Organization Name: AMERICAN DENTAL OFFICES PLLC Address City State Zip Code

Operating Certificate # (Opcert): Organization Address: 390 N. BROADWAY, SUITE 110 JERICHO NY 11753Provider Type: Other Contact Phone Number: (516) 822-8700 Extension: 108

Provider Type - OTHER: LARGE DENTAL PROVIDER ACTING AS DENTAL HOSPITAL Contact Email: DRPHIL@AMERICANDENTAL.COM MMIS: 3047418 1.4)

Billing Entity ID: Secondary ContactNPI #1: 1295997724 Contact Person: KATHY BECCARINONPI #2: Address City State Zip Code

Federal Employer ID (FEIN): Organization Address: 390 N. BROADWAY, SUITE 110 JERICHO NY 11753Contact Phone Number: (516) 822-8700 Extension: 249

Contact Email: KBECCARINO@AMERICANDENTAL.COM

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: 2327

1.3)

OR

#1 Is the lead applicant one of the following providers? None of the above %

OR Select One

%A. 2A

Select One

B. 2B

OR

#3 YES 3 37.51

For Safety-net definition, please see link:

We are the largest provider of private dental services in New York State. We have treated over 1 million patients in our 50 years of business! Our dental health delivery system is different and more efficient than a typical dental office. Our facilities are called “dental super-centers” because they are large in size and have a large capacity to see many families at the same time. These facilities are more like dental hospitals where each one has a full complement of general dentists as well as specialists. As the largest Dental care provider organization in the State of NY, American Dental Offices PLLC (ADO) has pioneered the concept of delivering quality care at a reasonable cost while making a profit. We are like a Dental Hospital, however we do not operate like hospitals and do not have any form of inpatient care. Through the use of technology, the inclusion the patients at the center of their care, the use of highly qualified professionals to deliver and manage the care, we have been growing our Medicaid patient volume over the past 5 years to the point we are now the preferred dental organization for a number of Managed Care and TPA in the NY region. Having been such a model of efficiency for 50 years, ADO is best placed to lead the formation of the PPS in our region and truly work towards reducing hospital admissions by 25% over the next 5 years of the program. Being in dentistry, ADO has learned to manage on lower levels of reimbursement and developed protocols, policies and procedures along with the proper governance to ensure success to any PPS. These lessons learned can serve as a basis to model after in all other areas of medical care delivery to ensure a higher level of care and patient satisfaction while keeping cost in line.In order to truly redesign Medicaid and improve care delivery to the recipients while reducing cost, we have to have a new approach and in our opinion, it will have to come from outside of the main stream care delivery system that has been less than fully willing and capable of delivering on the promise of better care at lower cost. American Dental Offices PLLC have successfully demonstrated this is possible and we are willing to take the lead role in the formation of PPS and share our experience with the rest of the care delivery system.

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: Non-Hospital Based Provider - Must meet the following criteria:

Not participating as part of a state-designated Health Home, must have at least 35 percent of all patient volume in their primary lines of business and must be associated with Medicaid, uninsured and Dual Eligible individuals. (Please indicate what %)

#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:Qualified Under Safety Net Definition? Select One (Please select Yes or No)

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

Contact Phone Number:

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

Contact Email:Provider Type: Select One

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:

05/09/2023 document.xlsx

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

Contact Person:Contact Phone Number:

Contact Email:Provider Type: Select One

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

Provider Type - OTHER: MMIS:

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

Operating Certificate Number (OPCERT): Billing/Provider Entity ID:NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

Address City

Organization Address:Contact Person:

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

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:

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

Contact Email:Select One Provider Type: Select One

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

NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

05/09/2023 document.xlsx

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

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

05/09/2023 document.xlsx

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

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

Organization Address:Contact Person:

Extension: Contact Phone Number:Contact Email:

Select One Provider Type: Select OneMMIS: Provider Type - OTHER:

Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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State Zip Code Address

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Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

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Extension: Contact Phone Number:Contact Email:

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Billing/Provider Entity ID: Operating Certificate Number (OPCERT):NPI #1: NPI #2:

Federal Employer ID (FEIN):

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

State Zip Code Address

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State Zip Code Address

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Partner Organizations

3.1)

Provide explanation (Restricted to 2000 characters):

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)

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

Our model: one body one health record (OBOHR) In order to have success in the PPS, ADO strongly feels that at the PPS level, each covered life needs to have a single health record that all providers contribute to and can access on an as needed basis. This is critical for care coordination that will lead to improved quality at lower cost. Since care coordination will be at the core of the PPS operation, we will need our care coordinators to know what is happening with the covered lives as they seek to receive care and NOT after the fact. This will give the PPS the ability to intervene and direct the care so it delivered efficiently at the lowest possible cost. In line with this philosophy, some of the current rules governing carte delivery will need to be relaxed to some extents. The top five are:1. HIPAA – One release form per patient to PPS and all PPS providers have access to health record on an as needed basis as managed by the PPS2. PPS needs to have access to all claims data from all payers for the covered lives3. Relaxing the Starks rules: referrals within the PPS will be managed by the PPS Care Coordination team4. Single patient portal per covered life: when a patient accesses the portal, all treating providers receive credit for patient engagement as required by all government programs such as Medicare ACO, PPS, MU, etc…

ADO PPS proposes to cover the counties of Nassau, and Suffolk. This area is known as “Long Island” although the true definition of Long Island comprises not only Nassau and Suffolk counties, but also Kings (Brooklyn) and Queens Counties. As the name dictates, the Island is stretch of land that is narrow (about 24 miles) and long (about 100 miles).According to the 2010 census Nassau and Suffolk counties have a population of 2,832,882 people; Suffolk County's share at 1,493,350 and Nassau County's at 1,339,532. That population grew by 2.3% in the 2013 Census. Suffolk County has twice the land mass as Nassau. *Owing to economic growth and the suburbanization after World War II, Nassau was the fastest growing county in the United States from the 1950s to the 1970s. In its easternmost sections, Suffolk remains small-town rural, as in Greenport on the North Fork and some of the outward areas of The Hamptons, although summer tourism swells the population in those areas. Western Suffolk, such as the towns of Huntington and Babylon, are becoming increasingly populated and are beginning to resemble towns in Nassau. *According to a 2000 Report on Religion, which asked congregations to respond, Catholics are the largest religious group on Long Island, with non-affiliated in second place. Catholics make up 52% of the population of Nassau and Suffolk, versus 22% for the country as a whole, with Jews at 16% and 7%, respectively, versus 1.7% nationwide. Only a small percentage of Protestants responded, 7% and 8% respectively, for Nassau and Suffolk counties. This is in contrast with 23% for the entire country on the same survey, and 50% on self-identification surveys. Long Island has a substantial Italian-American population. About 26% of total Long Island residents claim Italian ancestry and 28% of Suffolk County residents claim Italian ancestry.*

Today, we are seeing a very different trend as the majority of the new Long Island inhabitants are immigrants enjoying a very different social economic status. Although the change in total population is not very significant (2.3% from 2010 to 2013) the turnover in the makeup of the population is remarkable. The Latino population is the fastest growing on long island claiming largest percentage in a number of areas. Other immigrant groups have made Long Island their new homes as well. *These trends speak very loudly in the number of Long Island residents that are now Medicaid eligible and will be part of the PPS covered lives. With a mix of the wealthiest social-economic classes and some of the poorest living next to each other, the challenges to deliver sensible care is real.We have to have a PPS capable of being sensitive to the changes the Long Island population has been going through and is prepared to embrace such changes and thrive in providing quality care at a the lowest possible cost to the residents. * SOURCE: Wikipedia

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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.

AlbanyAlleganyBronxBroomeCattaraugusCayugaChautauquaChemungChenangoClintonColumbiaCortlandDelawareDutchessErieEssexFranklinFultonGeneseeGreeneHamilton

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 3 Partner Organizations Service Area

Yes

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)

In order to have success in the PPS, ADO strongly feels that at the PPS level, each covered life needs to have a single health record that all providers contribute to and can access on an as needed basis. This is critical for care coordination that will lead to improved quality at lower cost. Since care coordination will be at the core of the PPS operation, we will need our care coordinators to know what is happening with the covered lives as they seek to receive care and NOT after the fact. This will give the PPS the ability to intervene and direct the care so it delivered efficiently at the lowest possible cost. In line with this philosophy, some of the current rules governing carte delivery will need to be relaxed to some extents. The top five are:1. HIPAA – One release form per patient to PPS and all PPS providers have access to health record on an as needed basis as managed by the PPS

3. Relaxing the Starks rules: referrals within the PPS will be managed by the PPS Care Coordination team4. Single patient portal per covered life: when a patient accesses the portal, all treating providers receive credit for patient engagement as required by all government programs such as Medicare ACO, PPS, MU, etc…

ADO PPS proposes to cover the counties of Nassau, and Suffolk. This area is known as “Long Island” although the true definition of Long Island comprises not only Nassau and Suffolk counties, but also Kings (Brooklyn) and Queens Counties. As the name dictates, the Island is stretch

According to the 2010 census Nassau and Suffolk counties have a population of 2,832,882 people; Suffolk County's share at 1,493,350 and Nassau County's at 1,339,532. That population grew by 2.3% in the 2013 Census. Suffolk County has twice the land mass as Nassau. *Owing to economic growth and the suburbanization after World War II, Nassau was the fastest growing county in the United States from the 1950s to the 1970s. In its easternmost sections, Suffolk remains small-town rural, as in Greenport on the North Fork and some of the outward areas of The Hamptons, although summer tourism swells the population in those areas. Western Suffolk, such as the towns of Huntington and Babylon, are becoming increasingly populated and are beginning to resemble towns in Nassau. *According to a 2000 Report on Religion, which asked congregations to respond, Catholics are the largest religious group on Long Island, with non-affiliated in second place. Catholics make up 52% of the population of Nassau and Suffolk, versus 22% for the country as a whole, with Jews at 16% and 7%, respectively, versus 1.7% nationwide. Only a small percentage of Protestants responded, 7% and 8% respectively, for Nassau and Suffolk counties. This is in contrast with 23% for the entire country on the same survey, and 50% on self-identification surveys. Long Island has a substantial Italian-American population. About 26% of total Long Island residents claim Italian ancestry and 28% of Suffolk County residents claim Italian ancestry.*

Today, we are seeing a very different trend as the majority of the new Long Island inhabitants are immigrants enjoying a very different social economic status. Although the change in total population is not very significant (2.3% from 2010 to 2013) the turnover in the makeup of the population is remarkable. The Latino population is the fastest growing on long island claiming largest percentage in a number of areas. Other immigrant groups have made Long Island their new homes as well. *These trends speak very loudly in the number of Long Island residents that are now Medicaid eligible and will be part of the PPS covered lives. With a mix of the wealthiest social-economic classes and some of the poorest living next to each other, the challenges to deliver sensible

We have to have a PPS capable of being sensitive to the changes the Long Island population has been going through and is prepared to embrace such changes and thrive in providing quality care at a the lowest possible cost to the residents.

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

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

Herkimer Richmond (Staten Island)Jefferson RocklandKings (Brooklyn) Saint LawrenceLewis SaratogaLivingston SchenectadyMadison SchoharieMonroe SchuylerMontgomery Seneca

X Nassau SteubenNew York (Manhattan) X SuffolkNiagara SullivanOneida TiogaOnondaga TompkinsOntario UlsterOrange WarrenOrleans WashingtonOswego WayneOtsego WestchesterPutnam WyomingQueens YatesRensselaer

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

Characters used: 1356

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)

In order to have success in the PPS, ADO strongly feels that at the PPS level, each covered life needs to have a single health record that all providers contribute to and can access on an as needed basis. This is critical for care coordination that will lead to improved quality at lower cost. Since care coordination will be at the core of the PPS operation, we will need our care coordinators to know what is happening with the covered lives as they seek to receive care and NOT after the fact. This will give the PPS the ability to intervene and direct the care so it

ADO PPS proposes to cover the counties of Nassau, and Suffolk. This area is known as “Long Island” although the true definition of Long Island comprises not only Nassau and Suffolk counties, but also Kings (Brooklyn) and Queens Counties. As the name dictates, the Island is stretch

According to the 2010 census Nassau and Suffolk counties have a population of 2,832,882 people; Suffolk County's share at 1,493,350 and Nassau County's at 1,339,532. That population grew by 2.3% in the 2013 Census. Suffolk County has twice the land mass as Nassau. *Owing to economic growth and the suburbanization after World War II, Nassau was the fastest growing county in the United States from the 1950s to the 1970s. In its easternmost sections, Suffolk remains small-town rural, as in Greenport on the North Fork and some of the outward areas of The Hamptons, although summer tourism swells the population in those areas. Western Suffolk, such as the towns of Huntington and Babylon, are becoming increasingly populated and are beginning to resemble towns in Nassau. *According to a 2000 Report on Religion, which asked congregations to respond, Catholics are the largest religious group on Long Island, with non-affiliated in second place. Catholics make up 52% of the population of Nassau and Suffolk, versus 22% for the country as a whole, with Jews at 16% and 7%, respectively, versus 1.7% nationwide. Only a small percentage of Protestants responded, 7% and 8% respectively, for Nassau and Suffolk counties. This is in contrast with 23% for the entire country on the same survey, and 50% on self-identification surveys. Long

Today, we are seeing a very different trend as the majority of the new Long Island inhabitants are immigrants enjoying a very different social economic status. Although the change in total population is not very significant (2.3% from 2010 to 2013) the turnover in the makeup of the

These trends speak very loudly in the number of Long Island residents that are now Medicaid eligible and will be part of the PPS covered lives. With a mix of the wealthiest social-economic classes and some of the poorest living next to each other, the challenges to deliver sensible

We have to have a PPS capable of being sensitive to the changes the Long Island population has been going through and is prepared to embrace such changes and thrive in providing quality care at a the lowest possible cost to the residents.

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

Characters used: 2916

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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

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

Project #2- Sub-list B or C

2.B.II Development of co-located primary care services in the emergency department (ED)

Project #3

2.C.I Development of community-based health navigation services

Project #4

2.A.II

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

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-->

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))

ADO selected these projects for domain 2 because they are in line with our philosophy of transforming the system, one provider at a time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all will be the use of our unique technology called ADO Connects®.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS provider has to go through a re-certification process.

With the ADO Connects® technology widely made available across the PPS, the need for standard data collection and reporting becomes critical. PCMH solves that challenge; all primary care providers will receive the necessary help to become PCMH Level III accredited in their first year of participation. Not only will we have access to the standard data set PCMH requires, we will also capitalize off of the concept of a community of providers working together to deliver care centered around the patient.

The Medicaid data shows clearly that non-compliance with primary care orders and a lack of access to primary care has led to a great number of unnecessary hospitalizations. In order to combat this very expensive habit of seeking care in the ER or only when the case has reached a critical stage, PPS participating hospitals will need to help with the development of Primary Care services in the ER and the payers have to support adequate reimbursement and have penalties for PPS providers who do not follow the rules or deliberately break/bend the rules. Hence the need for community based health navigation services to work in conjunction with the PPS and participating providers to engage the Medicaid recipients and educate them where they live, play, work and bring them into the system so they can receive care in primary care settings and remain compliant with their doctor’s orders.

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

4.2)

Project #1- Sub-list A

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

Project #2- Sub-list A - H

3.C.I Evidence-based strategies for disease management in high risk/affected populations (adults only)

ADO selected these projects for domain 2 because they are in line with our philosophy of transforming the system, one provider at a time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all will be the use of our unique technology called ADO Connects®.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS provider has to go through a re-certification process.

With the ADO Connects® technology widely made available across the PPS, the need for standard data collection and reporting becomes critical. PCMH solves that challenge; all primary care providers will receive the necessary help to become PCMH Level III accredited in their first year of participation. Not only will we have access to the standard data set PCMH requires, we will also capitalize off of the concept of a community of providers working together to deliver care centered around the patient.

The Medicaid data shows clearly that non-compliance with primary care orders and a lack of access to primary care has led to a great number of unnecessary hospitalizations. In order to combat this very expensive habit of seeking care in the ER or only when the case has reached a critical stage, PPS participating hospitals will need to help with the development of Primary Care services in the ER and the payers have to support adequate reimbursement and have penalties for PPS providers who do not follow the rules or deliberately break/bend the rules. Hence the need for community based health navigation services to work in conjunction with the PPS and participating providers to engage the Medicaid recipients and educate them where they live, play, work and bring them into the system so they can receive care in primary care settings and remain compliant with their doctor’s orders.

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

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

Project #4- Sub-list A - H

3.D.III Evidence based medicine guidelines for asthma management

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

4.3)

Project #1- Sub-list A-D

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

Project #2- Sub-list A-D

4.B.II

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

(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

H-->

At the center of it all will be the use of our proprietary technology called ADO Connects®. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.

Coupled with the PCMH accreditation for PCP within the first year of participation, ADO will have access to standard data sets through the PCMH reporting process.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below.

It is therefore a normal extension of ADO to be able to jointly develop protocols with the PPS members and code the workflows into the software program to match such protocols for full integration of primary care and behavioral health. For example, the protocol may call for a behavioral health patient seeking services from a behavioral health provider must have a medical exam first and the results of such exam must be made available to the behavioral health provider. ADO Connect® will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health care provider is fully aware that the required medical exam took place and the full set of results is available.

The above approach can be used very effectively to develop evidenced based strategies for all sorts of diseases including cardiovascular, diabetes, asthma and more. The technology is simply the enabler for easy identification, intervention and control. The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State Medicaid Program acting in unison to achieve the goal of Domain 3: clinical improvement.

PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with a single goal: clinical improvement. ADO will conduct in wide-ranging activities such as:• Targeted educational campaigns to increase awareness about heart disease prevention, diabetes control, asthma control and empower patients to take control of their heart health.• Use ADO Connects® technology and quality improvement initiatives to standardize and improve the delivery of care for high blood pressure, high cholesterol, diabetes, and asthma• Community efforts to promote smoke-free air policies; reduce sodium in the food supply; encourage healthy eating habits, regular exercise, and medication adherence• Increase use of effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatment• Support team-based care that improves care coordination by utilizing nurses, nurse practitioners, physician assistants, pharmacists, dietitians, and community health workers to promote medication adherence and patient navigation to free and low-cost drug programs. • Improve access to care through team-based delivery, open scheduling, expanded hours, transportation assistance, and asynchronous contact (e.g., phone visits, secure email access, online patient portals). • Ensure that patient education and self-management are delivered in a culturally and linguistically appropriate manner through patient educators, navigators, coaches, and linkages to community resources• Enter into incentive payment distribution contract with PPS providers that incentivize improvements in clinical quality measures

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-->

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)

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

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below.At the center of it all will be the use of our proprietary technology called ADO Connects®. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State Medicaid Program acting in unison to achieve goal of uncompromised compliance and enhanced reimbursement and bonuses payments to providers.It is therefore a normal extension of ADO to jointly develop protocols with the PPS members and code the workflows into the software program to strengthen Mental Health and Substance Abuse Infrastructure across PPS Systems. For example, the protocol may call for a behavioral health patient upon discharge from a hospital for detoxification must be discharged to a rehabilitation facility which in turn must release the patient to a Primary Care Provider for scheduled follow up and random urine test for the presence of illegal drug(s) or alcohol. ADO Connect® will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health care provider is fully aware that the required medical follow up took place upon discharge and the full set of results must be made available. The payers have a role to play as well as the State Medicaid Program. The Payers should compensate the compliant providers with an enhanced fee and allow for the PPS to enter into Incentive Payment Contract to reward the compliant providers with enhanced bonus payment. Furthermore, the State Medicaid Program should take steps to put immediate and targeted partial holds on the Benefit Cards of non-compliant patients. With the widespread use of ADO Connect® among the PPS members, we will know exactly when and where the patient is seeking services in real time; the Care Navigators and all the providers in the PPS can intervene and direct the patient to the next step in their mandated care in order to reactivate their Benefits Card as they become complaint.

The above approach can be used very effectively to Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings. The technology is simply the enabler for easy identification, intervention and control. PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with a single goal: High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings.ADO will conduct in wide-ranging activities such as: targeted educational campaigns; community fairs, healthy eating habits workshops; regular group exercise sessions where the Medicaid patients live, play or receive care; medication adherence incentive programs; effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatment; ensure that patient education and self-management are delivered in a culturally and linguistically appropriate manner through patient educators, navigators, coaches, and linkages to community resources

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

Project Description

4.4)

4.5)

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)

Our vision is to have any and all current Medicaid providers participate in the PPS as they have been delivering care to the population for a long time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all will be the use of our unique technology called ADO Connects®.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS provider has to go through a re-certification process. The certification is based on

1. The acquisition of the ADO EHR or the working HL7 bridge to another system that carries PPS meaningful use data2. The training of the provider and staff on the effective use of the EHR 3. The ability of provider and staff to pass a simple test on their knowledge about the EHR 4. PCMH accreditation5. Ability to effectively contribute to data aggregation in the ADO cloud6. Maintaining a single record on each PPS member7. Maintaining a single portal for all PPS members8. Commit to work in collaboration with the ADO Connects Operations Center to reduce cost of delivering care to Medicaid recipients and reducing hospitalizations by 25% over 5 years

The ADO staff will train and coach providers every step of the way and make sure they become PPS certified and remain certified. Throughout the two-year certification process, PPS providers will continue to receive score cards and suggestions on steps to take to improve their scores. Hence, it will never be a surprise when a provider loses its PPS certified status as such provider would been given ample opportunities to intervene and correct any and all potentials issues preventing their recertification. This will ensure success and longevity of the program well beyond the first 5 years.

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)

ADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants, including the hospitals. This is our proprietary ADO Connects® technology. Being that we are looking into the current healthcare delivery systems for Medicaid recipients with the eyes of an outsider and we are not hospital owned or affiliated, we have absolutely no biases of any forms. Through the Stakeholders engagement exercise as well as the Community Needs Assessment, we are truly open to learning (as opposed to verifying our assumptions) the needs of both groups. Then and only then will we start to work on solutions to the identified issues as guided by the DSRIP program requirements.Furthermore, upon analyzing data for the last 5 years of the Medicaid program in NYS, we are confident that our predictive analysis tool will unveil many areas for improvement all of our participants should eagerly adopt. More importantly, these models will serve as the solid foundation for our actions in effecting practice transformation. ADO Connects® all care providers in the echo system and allows them to communicate effectively. The solution is designed to put a solid foundation for the PPS system to be built upon. The technology solution will be:o Limited to PPS needs. This is NOT a certified EHR platform for meaningful use purposeso Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reasono Connected to all Hospitals in the Systemo Can be used as a standalone or integrated technology platform o Offered to all community based organization in the PPSo Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.With this solid foundation in place, coupled with our staff and the Operations Center, ADO is in a unique position to effect lasting change that will deliver on the promise of delivering better care, accessible care, at lower possible cost.

Furthermore, because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year.

It is clear that our system along with the experience of all Medicaid providers will work not only in Nassau and Suffolk Counties, but anywhere a commitment is made to effect serious changes through the DSRIP program.

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

4.6)

ADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants, including the hospitals. This is our proprietary ADO Connects® technology. Being that we are looking into the current healthcare delivery systems for Medicaid recipients with the eyes of an outsider and we are not hospital owned or affiliated, we have absolutely no biases of any forms. Through the Stakeholders engagement exercise as well as the Community Needs Assessment, we are truly open to learning (as opposed to verifying our assumptions) the needs of both groups. Then and only then will we start to work on solutions to the identified issues as guided by the DSRIP program requirements.Furthermore, upon analyzing data for the last 5 years of the Medicaid program in NYS, we are confident that our predictive analysis tool will unveil many areas for improvement all of our participants should eagerly adopt. More importantly, these models will serve as the solid foundation for our actions in effecting practice transformation. ADO Connects® all care providers in the echo system and allows them to communicate effectively. The solution is designed to put a solid foundation for the PPS system to be built upon. The technology solution will be:o Limited to PPS needs. This is NOT a certified EHR platform for meaningful use purposeso Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reasono Connected to all Hospitals in the Systemo Can be used as a standalone or integrated technology platform o Offered to all community based organization in the PPSo Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.With this solid foundation in place, coupled with our staff and the Operations Center, ADO is in a unique position to effect lasting change that will deliver on the promise of delivering better care, accessible care, at lower possible cost.

Furthermore, because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year.

It is clear that our system along with the experience of all Medicaid providers will work not only in Nassau and Suffolk Counties, but anywhere a commitment is made to effect serious changes through the DSRIP program.

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

Small offices with few Medicaid providers did not adopt EHR technology; for the most part they welcomed the AIU grant of $21,250 per provider and failed to move forward with the program. To them EHR usage equates to a loss of revenue. The lack of capital to effectively make the transition as it requires not only the acquisition of the EHR software, it also requires training, support personnel and long term relationships with third party consulting companies that specialize in the transformation of practices. The consulting companies keep the providers compliant with the many changes affecting their practices on a daily basis.Based on the current data set made available by NYS about the Medicaid EHR Incentives program, we notice the following:HOSPITAL PAYMENTS: a total of 304 hospital payments have been made. 162 were made in in the first year of the program (2011), 114 in the second year (2012) and 28 in 2013. One can summarize this as 53.29% of the payments in year 1, 37.50% of the payments in year 2 and 9.21% of the payments in year 3. PROVIDER PAYMENTS: A provider being a Physician, Physician Assistant, Nurse Practitioner, or Certified Nurse Midwife. A total of 10,832 have been made of which 7,829 were made in the first year of the program, 2,872 in the second year, and 131 in the third year. One can summarize this as 72.28% of the payments in year 1, 26.51% of the payments in year 2, and 1.21% of the payments in year 3.DENTIST PAYMENTS: A total of 1,038 have been made of which 986 were made in the first year of the program, 50 in the second year, and 2 in the third year. One can summarize this as 95% of the payments in year 1, 4.82% of the payments in year 2, and 0.2 % of the payments in year 3.

* Data set up to March 2014• Long Term Care LTC facilities: mostly did not qualify for EHR Incentives• Nursing Homes NH are not interested in EHR Incentives because most of their doctors are contracted providers and want the incentives for their own office• Mental Health Care Providers MH are for the most part not medical doctors, therefore do not qualify for EHR Incentives• Community based organizations and social services organizations, which are at the core of caring for the Medicaid recipients were not part of the EHR adoption conversation at all as they are not considered care providers.

1. How are we going to have any form of EFFECTIVE PPS with member organizations seamlessly sharing data and working in collaboration with each other without the basic tool called EHR? 2. That is the big elephant in the room that no one is talking about while everyone is trying to take advantage of this funding opportunity to expand their influence and at the same time spend $8 billion of Federal government funds without necessarily showing the results for it.3. We need to build a solid foundation in order to see the short and long term advantages of the DSRIP program.

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

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.

** Please see Appendix B in the Instructions for details of each Domain. For further information, see link below for the DSRIP Project Toolkit**

I.S.

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

I.S.

Development of co-located primary care services in the emergency department (ED) 40

I.S.

Development of community-based health navigation services 37

I.S.

37

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

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

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))

ADO selected these projects for domain 2 because they are in line with our philosophy of transforming the system, one provider at a time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS

With the ADO Connects® technology widely made available across the PPS, the need for standard data collection and reporting becomes critical. PCMH solves that challenge; all primary care providers will receive the necessary help to become PCMH Level III accredited in their first year of participation. Not only will we have access to the standard data set PCMH requires, we will also capitalize off of the concept of a community of providers working together to deliver care centered around the patient.

The Medicaid data shows clearly that non-compliance with primary care orders and a lack of access to primary care has led to a great number of unnecessary hospitalizations. In order to combat this very expensive habit of seeking care in the ER or only when the case has reached a critical stage, PPS participating hospitals will need to help with the development of Primary Care services in the ER and the payers have to support adequate reimbursement and have penalties for PPS providers who do not follow the rules or deliberately break/bend the rules. Hence the need for community based health navigation services to work in conjunction with the PPS and participating providers to engage the Medicaid recipients and educate them where they live, play, work and bring them into the system so they can receive care in primary care settings and remain compliant with their

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

Characters used: 2864

I.S.

Integration of primary care services and behavioral health 39

I.S.

Evidence-based strategies for disease management in high risk/affected populations (adults only) 30

ADO selected these projects for domain 2 because they are in line with our philosophy of transforming the system, one provider at a time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the center of it all

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS

With the ADO Connects® technology widely made available across the PPS, the need for standard data collection and reporting becomes critical. PCMH solves that challenge; all primary care providers will receive the necessary help to become PCMH Level III accredited in their first year of participation. Not only will we have access to the standard data set PCMH requires, we will also capitalize off of the concept of a community of providers working together to deliver care centered around the patient.

The Medicaid data shows clearly that non-compliance with primary care orders and a lack of access to primary care has led to a great number of unnecessary hospitalizations. In order to combat this very expensive habit of seeking care in the ER or only when the case has reached a critical stage, PPS participating hospitals will need to help with the development of Primary Care services in the ER and the payers have to support adequate reimbursement and have penalties for PPS providers who do not follow the rules or deliberately break/bend the rules. Hence the need for community based health navigation services to work in conjunction with the PPS and participating providers to engage the Medicaid recipients and educate them where they live, play, work and bring them into the system so they can receive care in primary care settings and remain compliant with their

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

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

I.S.

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

I.S.

Evidence based medicine guidelines for asthma management 31

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

Characters used: 3955

I.S.

Strengthen Mental Health and Substance Abuse Infrastructure across Systems 20

I.S.

17

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

At the center of it all will be the use of our proprietary technology called ADO Connects®. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.

Coupled with the PCMH accreditation for PCP within the first year of participation, ADO will have access to standard data sets through the PCMH reporting process.

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level

It is therefore a normal extension of ADO to be able to jointly develop protocols with the PPS members and code the workflows into the software program to match such protocols for full integration of primary care and behavioral health. For example, the protocol may call for a behavioral health patient seeking services from a behavioral health provider must have a medical exam first and the results of such exam must be made available to the behavioral health provider. ADO Connect® will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health

The above approach can be used very effectively to develop evidenced based strategies for all sorts of diseases including cardiovascular, diabetes, asthma and more. The technology is simply the enabler for easy identification, intervention and control. The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State

PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with

Targeted educational campaigns to increase awareness about heart disease prevention, diabetes control, asthma control and empower patients to take control of their heart

Use ADO Connects® technology and quality improvement initiatives to standardize and improve the delivery of care for high blood pressure, high cholesterol, diabetes, and

Community efforts to promote smoke-free air policies; reduce sodium in the food supply; encourage healthy eating habits, regular exercise, and medication adherenceIncrease use of effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatmentSupport team-based care that improves care coordination by utilizing nurses, nurse practitioners, physician assistants, pharmacists, dietitians, and community health workers to

Improve access to care through team-based delivery, open scheduling, expanded hours, transportation assistance, and asynchronous contact (e.g., phone visits, secure email

Ensure that patient education and self-management are delivered in a culturally and linguistically appropriate manner through patient educators, navigators, coaches, and linkages

Enter into incentive payment distribution contract with PPS providers that incentivize improvements in clinical quality measures

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

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)

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

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Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level

At the center of it all will be the use of our proprietary technology called ADO Connects®. Once the technology is widely used across the PPS, all the clinical data will finally be in one single location and we will be able to use our proprietary technology to create one single and complete health record per PPS member for the benefit of the PPS as a whole.The true measure of success is in having the PPS, the Care Navigators, the Providers, the Payers and the State Medicaid Program acting in unison to achieve goal of uncompromised

It is therefore a normal extension of ADO to jointly develop protocols with the PPS members and code the workflows into the software program to strengthen Mental Health and Substance Abuse Infrastructure across PPS Systems. For example, the protocol may call for a behavioral health patient upon discharge from a hospital for detoxification must be discharged to a rehabilitation facility which in turn must release the patient to a Primary Care Provider for scheduled follow up and random urine test for the presence of illegal drug(s) or alcohol. ADO Connect® will have the capabilities to recognize when the protocol is not followed so that the ADO staff can intervene and bridge the gap. Furthermore, ADO can facilitate access to the health record of the patient so the behavioral health care provider is fully aware that the required medical follow up took place upon discharge and the full set of results must be made available. The payers have a role to play as well as the State Medicaid Program. The Payers should compensate the compliant providers with an enhanced fee and allow for the PPS to enter into Incentive Payment Contract to reward the compliant providers with enhanced bonus payment. Furthermore, the State Medicaid Program should take steps to put immediate and targeted partial holds on the Benefit Cards of non-compliant patients. With the widespread use of ADO Connect® among the PPS members, we will know exactly when and where the patient is seeking services in real time; the Care Navigators and all the providers in the PPS can intervene and direct the patient

The above approach can be used very effectively to Increase Access to High Quality Chronic Disease Preventive Care and Management in Both Clinical and Community Settings. The technology is simply the enabler for easy identification, intervention and control. PPS proposes to develop programs and engage the patients, providers, payers, State Medicaid Program and other stakeholders in a number of ways in order to ensure success with a single goal: High Quality Chronic Disease Preventive Care and Management in Both Clinical

ADO will conduct in wide-ranging activities such as: targeted educational campaigns; community fairs, healthy eating habits workshops; regular group exercise sessions where the Medicaid patients live, play or receive care; medication adherence incentive programs; effective care practices through innovations such as team-based care, patient-centered medical homes, and interventions to promote adherence to treatment; ensure that patient education and self-management are delivered in a culturally and linguistically

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

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Provide a brief executive summary of your emerging Performing Provider System's vision and goals and how your emerging Performing Provider System hopes to

Our vision is to have any and all current Medicaid providers participate in the PPS as they have been delivering care to the population for a long time. Our goal is to transform the participating organizations, groups, and provider practices (one member at a time) using proven methodologies, which have resulted in delivering better care at lower cost. At the

Our basic philosophy is that anytime a Medicaid recipient accesses the system through any point of entry (direct or indirect) the staff at ADO Connects ® is immediately alerted and have an opportunity to intervene and direct the care the Medicaid recipient needs so as to make sure it is provided at the level of care required; not one level above, not one level below. Hence, we will avoid unnecessary hospitalization, and get rid of all other forms of waste or abuse currently embedded in the current system.

ADO will provide access to an EHR system to all providers of the PPS who wish to use it at no charge to the participants.

The other major tenor of the ADO System is its support staff. ADO proposes to create a PPS certification program that every member must go through over the first 6 months of participating in the PPS. Once the PPS Certified status has been obtained, it must be maintained in order to continue receiving the added incentives. Every two years, the PPS

1. The acquisition of the ADO EHR or the working HL7 bridge to another system that carries PPS meaningful use data

8. Commit to work in collaboration with the ADO Connects Operations Center to reduce cost of delivering care to Medicaid recipients and reducing hospitalizations by 25% over 5

The ADO staff will train and coach providers every step of the way and make sure they become PPS certified and remain certified. Throughout the two-year certification process, PPS providers will continue to receive score cards and suggestions on steps to take to improve their scores. Hence, it will never be a surprise when a provider loses its PPS certified status as such provider would been given ample opportunities to intervene and correct any and all potentials issues preventing their recertification. This will ensure success and longevity

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

ADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants, including the

Being that we are looking into the current healthcare delivery systems for Medicaid recipients with the eyes of an outsider and we are not hospital owned or affiliated, we have absolutely no biases of any forms. Through the Stakeholders engagement exercise as well as the Community Needs Assessment, we are truly open to learning (as opposed to verifying our assumptions) the needs of both groups. Then and only then will we start to work on solutions to the identified issues as guided by the DSRIP program requirements.Furthermore, upon analyzing data for the last 5 years of the Medicaid program in NYS, we are confident that our predictive analysis tool will unveil many areas for improvement all of our participants should eagerly adopt. More importantly, these models will serve as the solid foundation for our actions in effecting practice transformation. ADO Connects® all care providers in the echo system and allows them to communicate effectively. The solution is designed to put a solid foundation for the PPS system to be built

o Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reason

o Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.With this solid foundation in place, coupled with our staff and the Operations Center, ADO is in a unique position to effect lasting change that will deliver on the promise of

Furthermore, because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year.

It is clear that our system along with the experience of all Medicaid providers will work not only in Nassau and Suffolk Counties, but anywhere a commitment is made to effect

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

Characters used: 2803

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ADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants, including the

Being that we are looking into the current healthcare delivery systems for Medicaid recipients with the eyes of an outsider and we are not hospital owned or affiliated, we have absolutely no biases of any forms. Through the Stakeholders engagement exercise as well as the Community Needs Assessment, we are truly open to learning (as opposed to verifying our assumptions) the needs of both groups. Then and only then will we start to work on solutions to the identified issues as guided by the DSRIP program requirements.Furthermore, upon analyzing data for the last 5 years of the Medicaid program in NYS, we are confident that our predictive analysis tool will unveil many areas for improvement all of our participants should eagerly adopt. More importantly, these models will serve as the solid foundation for our actions in effecting practice transformation. ADO Connects® all care providers in the echo system and allows them to communicate effectively. The solution is designed to put a solid foundation for the PPS system to be built

o Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reason

o Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.With this solid foundation in place, coupled with our staff and the Operations Center, ADO is in a unique position to effect lasting change that will deliver on the promise of

Furthermore, because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year.

It is clear that our system along with the experience of all Medicaid providers will work not only in Nassau and Suffolk Counties, but anywhere a commitment is made to effect

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

Small offices with few Medicaid providers did not adopt EHR technology; for the most part they welcomed the AIU grant of $21,250 per provider and failed to move forward with the program. To them EHR usage equates to a loss of revenue. The lack of capital to effectively make the transition as it requires not only the acquisition of the EHR software, it also requires training, support personnel and long term relationships with third party consulting companies that specialize in the transformation of practices. The consulting companies

Based on the current data set made available by NYS about the Medicaid EHR Incentives program, we notice the following:HOSPITAL PAYMENTS: a total of 304 hospital payments have been made. 162 were made in in the first year of the program (2011), 114 in the second year (2012) and 28 in 2013. One can summarize this as 53.29% of the payments in year 1, 37.50% of the payments in year 2 and 9.21% of the payments in year 3. PROVIDER PAYMENTS: A provider being a Physician, Physician Assistant, Nurse Practitioner, or Certified Nurse Midwife. A total of 10,832 have been made of which 7,829 were made in the first year of the program, 2,872 in the second year, and 131 in the third year. One can summarize this as 72.28% of the payments in year 1, 26.51% of the payments in year 2,

DENTIST PAYMENTS: A total of 1,038 have been made of which 986 were made in the first year of the program, 50 in the second year, and 2 in the third year. One can summarize

Nursing Homes NH are not interested in EHR Incentives because most of their doctors are contracted providers and want the incentives for their own officeMental Health Care Providers MH are for the most part not medical doctors, therefore do not qualify for EHR IncentivesCommunity based organizations and social services organizations, which are at the core of caring for the Medicaid recipients were not part of the EHR adoption conversation at all

1. How are we going to have any form of EFFECTIVE PPS with member organizations seamlessly sharing data and working in collaboration with each other without the basic tool

2. That is the big elephant in the room that no one is talking about while everyone is trying to take advantage of this funding opportunity to expand their influence and at the same

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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.

5.1)

Planning and Organizing

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

5.2)Characters used:

5.3)

Data Collection

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5.4)

Reporting

Needs Assessment Methodology

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

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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 current major providers of care to the Medicaid population will be invited to participate and provide input to the creation of the ADO PPS. The engagement process will take a two-prong approach: first to recognize the provider’s importance and experience in providing care to the said population and second to expose them to the ADO philosophy, technology, and care management approach to delivering quality care at the lowest possible cost. Each provider type will be engaged at different levels and challenged until consensus if not agreement is reached on philosophy, technology, and care management approach that will benefit the PPS as a whole so we can deliver on the promise of reducing hospitalization, helping the safety-net providers thrive, and deliver quality care at the lowest possible cost while keeping the doors open. The ADO PPS will strive to engage stakeholders in the following areas:

1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) – we need to show them how the PPS can help them find/increase sources of revenue in the new paradigm:a. Public Hospitalsb. Voluntary Hospitalsc. Critical Access Hospitalsd. Sole Community Providerse. Etc…

2. FQHC’s3. Article 164. Article 285. Article 316. Associations such as:a. Mental Health Association of Nassau/Sufflok/NYCb. Family and Children's Association: Home and community based servicesc. Long Island Council on Alcoholism and Drug Dependenced. Circulo de la Hispanidade. Etc…

7. Community Based Organizations8. Group Homes such as FREE9. Skilled Nursing Facilities10. Long Term Care Facilities11. Palliative Care Facilities12. Department of Social Services (Nassau and Suffolk)13. Certified Health Home Agencies such as VNS, LIJ Home Care, etc..14. Adult Daycare Program15. Private Practices (all current small and large safety net providers on the DSRIP website)16. Healthix HIE17. And others

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

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

Description

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Description

Description - Each box is restricted to 5000 characters.

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

In order to plan and organize the community needs assessment our Performing Provider System will include the following steps.

1. Find a process to improve: It is clearly understood that the current means of community needs assessment is not up to par. We would address this issue to ensure that the new and improved process is more efficient and effective in terms of continuous quality improvement in providing healthcare. An opportunity exists to improve the committee needs assessment process beginning with providers, and ending with patients. This effort should improve the effectiveness and cause the data collection to become more resourceful for the improvement in quality of care for patients. 2. Organize a Plan: First we will begin by identifying the staff integral to the process and invite them to join the team. Having the staff be present in the decision making part of the process will allow for the PPS to function at a capacity paying attention to fine details. Stakeholders will be identified as well, however they will be appointed to lead the team. Although the project will be a daunting task, a facilitator will be appointed in order to keep the project on track therefore our goals and/or deadlines will be met. The team will be assembled and comprised or team members, team leader(s), recorder(s), and a team facilitator. Ground rules will be established to ensure there is a mutual understanding amongst the team members. A grant chart will be reviewed to familiarize the team with the financial responsibility for this project. The team leader(s) will circulate agendas throughout the project and at monthly team meetings. Last but certainly not least; the recorder will document minutes at each formal proceeding.3. Clarify current knowledge: In order to tackle community needs assessment we must understand and gather information for the current process. Understanding what staff is involved, whom the current vendors are, the equipment being used, and the materials in place, will allow for our PPS to address the improvements necessary with a better understanding of what is already being done. A flow chart will be used to visually examine the relationship and sequence of the current steps and create a common understanding amongst team members of the process flow. With this method, redundancy can and will be eliminated from the process. We are sure to find unnecessary complexities and steps that are no longer efficient; once identified they will be removed. 4. Understand the source of variation: In essence our goal is to trim the “fat” off the current system being that it is unnecessary and should be removed. This allows us to more accurately compare and identify the extent to which the process differs from the norm. In turn, we will be able to identify the parts of the process that are in or out of our control. For those parts that are within our control a new and improved process will be implemented. As for the parts of the process that are out of our control, a process to positively influence the external parties of the process will also be implemented. 5. Select the improvement method: After reviewing all the possible alternative methods to remediate the current system, we will choose the best alternative for the improvement and effectiveness of the committee needs assessment process.6. Plan the improvement of the process and collect data: This part of the process will be used to determine how out PPS will implement a process to see through the improvements needed. Data will be collected in order to track our progress throughout the project in order to ensure a positive outcome, and to reach our goal/deadline. 7. Do the improvement: Our PPS will now be ready to take action in implementing the new and improved process. Here we will make the change and measure the effectiveness of said change. 8. Check the results: Monthly formal proceedings will take place in order to gather all team members and examine the collected data to determine if the improvements achieved the desired results.9. Act to improve the process: Along the way we may find that the anticipated step in the plan can be replaced by a better approach, therefore we will take the necessary steps to keep an open mind and adjust the obstacles we may face in order to hold on to the gains and progress we have made thus far.

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

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Description

1515

Description

The communities that our PPS would target are Nassau County and Suffolk County of Long Island, NY. In order to begin, we would accurately define the two target counties, in addition to defining the current health of those communities. Nassau County, for instance, is a sub urban county on Long Island, NY. The 2010 census calculates that the current number of residents was near 1.4 million people. Within Nassau County there are two cities, three towns, 64 incorporated villages, and over 100 unincorporated areas. For the purpose of this needs assessment the three towns will pose as the identified subareas of the county, which form a cluster of zip codes. We would then go into further detail and identify the demographics, size and trends, and socioeconomic indicators consistent within the county. AN identical procedure will be conducted for Suffolk County as well.The purpose of attaining the needs assessment is to determine the unmet needs of the community. Our main targets would be 1) access to essential health Care and 2) to enhance personal health behavior. The methodology involved with this project would require us to:1. Establish a community advisory.2. Obtain primary, secondary, quantitative, and qualitative data to analyze 3. Develop a report of our findings

In order to maximize the benefits of the data collection for the needs assessment we will divide the community into focus groups by; age group, location, and the number of participants. We will conduct the survey in three ways. The use of a recruitment method will encourage participants to take part in a written survey. Participants will be compensated for their travel expenses and volunteered time. Necessary language interpreters will be provided for each location. Individuals with expertise in the health and healthcare needs of the community will conduct over the phone informational interviews. Language interpreters will also be provided using this method. We will also conduct a needs assessment survey electronically. This will allow us to reach out to a larger focus group and obtain the necessary information for the needs assessment. If English is not the participant’s primary language we will provide directions for them to follow in order to complete the survey in a written format or over the phone, where interpreters will be available to assist. The collected qualitative information obtained from the focus groups and informational interviews will be analyzed by identifying and coding themes across groups and individual interviews. This data will be organized into major topic areas related to health status, access to care, special population needs, unmet needs of the community, and health care priorities. Our goal is to make the information gaps in the community as minuet as possible.

There are endless ways to interpret and utilize the data that will be collected for the community’s needs assessment. We plan to report the data in the following fashion:1. Describe the needs of the community: After the surveys are completed and the data is collected, this will give us a clear picture as to what the community actually needs.

2. Describe the differences between designated subareas: The areas of focus that we will be comparing between areas are:a. Health Status:i. Birth outcomes: birth rates, adolescent birth rates, low birth weight, and infant mortality rate.ii. Self-reported health status: fair or poor health, health conditionsiii. Communicable diseases: Hepatitis B, Lyme disease, Staphtococcal infection, chlamydia, HIV/AIDS etc.iv. Health Concerns: Here we will determine the top two main health concerns of the community.

b. Access to care: Health insurance status, emergency room utilization among the uninsured, prescription drug coverage, economic barriers, utilization of preventative services, pre-natal carec. Use of health Screenings: dental visits, recommended screenings; blood pressure, colonoscopy, pap smear test, mammogram, rectal exam for prostate cancer, etc.d. Health Behavior: nutrition, exercise, tobacco use, alcohol consumptione. Social capital and neighborhoodf. Health needs of the special populations.

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

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NYS DOH DSRIP_Project Design Grant Application Section 5 Community Needs Assessment

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?

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

1931

The current major providers of care to the Medicaid population will be invited to participate and provide input to the creation of the ADO PPS. The engagement process will take a two-prong approach: first to recognize the provider’s importance and experience in providing care to the said population and second to expose them to the ADO philosophy, technology, and care management approach to delivering quality care at the lowest possible cost. Each provider type will be engaged at different levels and challenged until consensus if not agreement is reached on philosophy, technology, and care management approach that will benefit the PPS as a whole so we can deliver on the promise of reducing hospitalization, helping the safety-net providers thrive, and deliver quality care at the lowest possible cost while keeping the doors open. The ADO PPS will strive to engage stakeholders in the following areas:

1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) – we need to show them how the PPS can help them find/increase sources of revenue in the new

d. Sole Community Providers

a. Mental Health Association of Nassau/Sufflok/NYCb. Family and Children's Association: Home and community based servicesc. Long Island Council on Alcoholism and Drug Dependence

7. Community Based Organizations8. Group Homes such as FREE

10. Long Term Care Facilities

12. Department of Social Services (Nassau and Suffolk)13. Certified Health Home Agencies such as VNS, LIJ Home Care, etc..

15. Private Practices (all current small and large safety net providers on the DSRIP website)

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NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

List of Vendors

6.1)

1 Organization Name HITS CONSULTING GROUP LLCAddress City

Organization Address 243 5TH AVENUE, SUITE 404 NEW YORKContact Person HENRY L. DENIS

Contact Phone Number (212) 979-0330Contact Email HENRY.DENIS@HITSCG.COM

3 Organization Name Pierre-Louis & Associates, LLCAddress City

Organization Address 8817 Bells Mill Road PotomacContact Person HOLDEN PIERRE-LOUIS

Contact Phone Number (301) 266-5533Contact Email HOLDEN@PIERRELOUIS-LLC.COM

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)

HITS Consulting Group LLC is a consulting firm specialized in practice transformation from paper to electronic health record. They have been in operations in NYS for the last 5 years and have helped major organization achieve success with the transition to EHR technology through their various solutions ranging from unique technology integration solutions, Cloud computing, PCMH, Meaningful Use, business consulting, ACO preparedness, and more. HITS Consulting Group LLC has worked with various Regional Extensions Centers in the area among which the NJ HITEC REC and came out as top contractor from 2010 to 2014.HITS CG is ADO’s contractor for integration of records on multiple platforms to achieve a single patient record.Their revolutionary technology will be a key component to meet our goal of having one health record per patient for the entire PPS. Hence, managing data on a system wide basis can be achieved and performance outcome attained and monitored in real time.

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

Pierre-Louis & Associates (P&L), LLC is a Business Intelligence (BI) Services & Solutions company. Since 2006, P&L has enabled 2 Federal Agencies, as well as large (Single Location…5+ providers) & multi-location healthcare providers to define, measure and monitor their KPIs (Key Performance Indicators). We’ve enabled our clients to develop (Descriptive => Diagnostic => Predictive => Prescriptive) analytics. As a result, our clients became more efficient and more effective at analyzing / visualizing their data in order to make critical strategic and operational decisions. The deliverables are usually in the form of Dashboards, Analytical (What-if), and Reporting tools.

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NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

5 Organization NameAddress City

Organization AddressContact Person

Contact Phone NumberContact Email

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 6 List of Vendors

HITS CONSULTING GROUP LLC 2 Organization Name IT ACCELState Zip Code Address

NY 10016 Organization Address 30 BROAD STREETHENRY L. DENIS Contact Person CHARLIE MILLER

Extension: Contact Phone Number (212) 564-2200HENRY.DENIS@HITSCG.COM Contact Email CHARLIE@ITACCEL.COM

Characters used: 982Pierre-Louis & Associates, LLC 4 Organization Name

State Zip Code Address

MD 20854 Organization AddressHOLDEN PIERRE-LOUIS Contact Person

Extension: Contact Phone NumberHOLDEN@PIERRELOUIS-LLC.COM Contact Email

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.**

HITS Consulting Group LLC is a consulting firm specialized in practice transformation from paper to electronic health record. They have been in operations in NYS for the last 5 years and have helped major organization achieve success with the transition to EHR technology through their various solutions ranging from unique technology integration solutions, Cloud computing, PCMH, Meaningful Use, business consulting, ACO preparedness, and more. HITS Consulting Group LLC has worked with various Regional Extensions Centers in the area among which the NJ HITEC REC and came out as top contractor from 2010 to 2014.HITS CG is ADO’s contractor for integration of records on multiple platforms to achieve a single patient record.Their revolutionary technology will be a key component to meet our goal of having one health record per patient for the entire PPS. Hence, managing data on a system wide basis can be achieved and performance outcome attained and monitored in real time.

Describe the vendor's

qualifications and how they will be

assisting the applicant in their planning efforts?

(Restricted to 1000 characters)

IT Accel is a 10 year old IT recruiting and consulting company located in the heart of the financial district of NYC with a mission to want to bring their experience and depth of knowledge to solving complex human resources issues and challenges created by an ever-changing technological and business landscape. Because they know information technology so well -- how it works, how it changes, and which employees have the best tools for the job -- they are uniquely qualified for, and focused on, handling all of your business's technological staffing needs. And because of the value they place on longstanding relationships with satisfied clients, you can rest assured that they will continue to handle those issues day after day, year after year.IT Accel has the technologist the PPS will need in order to fulfill its IT goal and integrate disparate data sets for consolidated reporting and meet our goal ONE BODY ONE HEALTH Record.

Pierre-Louis & Associates (P&L), LLC is a Business Intelligence (BI) Services & Solutions company. Since 2006, P&L has enabled 2 Federal Agencies, as well as large (Single Location…5+ providers) & multi-location healthcare providers to define, measure and monitor their KPIs (Key Performance Indicators). We’ve enabled our clients to develop (Descriptive => Diagnostic => Predictive => Prescriptive) analytics. As a result, our clients became more efficient and more effective at analyzing / visualizing their data in order to make critical strategic and operational decisions. The deliverables are usually in the form of Dashboards, Analytical (What-if), and

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 6 List of Vendors

Characters used: 6806 Organization Name

State Zip Code Address

Organization AddressContact Person

Extension: Contact Phone NumberContact Email

Characters used: 0

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 6 List of Vendors

IT ACCELAddress City State Zip Code

30 BROAD STREET NEWYORK NY 10004CHARLIE MILLER

(212) 564-2200 Extension:

CHARLIE@ITACCEL.COM

Characters used: 937

Address City State Zip Code

Extension:

IT Accel is a 10 year old IT recruiting and consulting company located in the heart of the financial district of NYC with a mission to want to bring their experience and depth of knowledge to solving complex human resources issues and challenges created by an ever-changing technological and business landscape. Because they know information technology so well -- how it works, how it changes, and which employees have the best tools for the job -- they are uniquely qualified for, and focused on, handling all of your business's technological staffing needs. And because of the value they place on longstanding relationships with satisfied clients, you can rest assured that they will continue to handle those issues day after day, year after year.IT Accel has the technologist the PPS will need in order to fulfill its IT goal and integrate disparate data sets for consolidated reporting and meet our goal ONE BODY ONE HEALTH Record.

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NYS DOH DSRIP_Project Design Grant Application Section 6 List of Vendors

Characters used: 0

Address City State Zip Code

Extension:

Characters used: 0

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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/Milestone7/7/2014 Action Identify key stakeholders in Nassau and Suffolk Counties

7/14/2014 Action Identify companies to conduct door to door survey in Nassau and Suffolk7/14/2014 Action Identify software to serve as data repository when survey results are available8/4/2014 Action Identify personnel with survey data analysis expertise

8/12/2014 Action Identify marketing and advertising partner with healthcare experience8/13/2014 Action Identify a web develoment and hosting company in healthcare space

8/1/2014 Action

8/1/2014 Action8/1/2014 Action Establish a contract with a professional printing company

7/15/2014 Action Define the requirements for EMR/EHR Softwarefor PPS providers with no HER7/15/2014 Action Define the requirement of a private cloud to gather data for PPS purposes

9/15/2014 ActionMake a list of all Interfaces to be developed to gather data for PPS operations in Nassau and Suffolk Counties

9/29/2014 Action Develop requirement for Interfaces develoment to pull data from EHR

9/30/2014 Action1/3/2015 Action Make a plan to test proprietary software to handle from 10% to 150% of targeted population

7/15/2014 Action Develop the job description for a Medical Director for the PPS project plan development7/15/2014 Action Develop the job description for a IT Director for the PPS project plan development7/15/2014 Action Develop the job description for Project Managers for the PPS project plan development7/15/2014 Action Develop the job description for Contract Negotiators for the PPS project plan development

7/15/2014 Action7/3/2014 Action Identify a predictive analysis contrator with healthcare experience

7/31/2014 Action

8/15/2014 Action

1/31/2015 Action8/22/2014 Decision Enter into contract with Community assessments vendors and contractors

8/20/2014 Decision8/15/2014 Decision Kick off the development of the EMR/EHR Software for PPS providers with no EHR8/15/2014 Decision Kick off the development of the private cloud to gather PPS data

10/15/2014 Decision Prioritize and kick off the development of Interfaces develoment to pull data from EHR

11/1/2014 Decision

1/3/2015 Decision

3/30/2015 Decision

8/16/2014 DecisionEntering into contract with a personnel recruiting agency specialized in placement of healthcare executives

8/30/2014 Decision Hiring a Medical Director to help in the developent of the PPS project paln development9/7/2014 Decision Hiring an IT Director to help in the developent of the PPS project paln development

9/14/2014 Decision Hiring two Project Manager to help in the developent of the PPS project paln development9/30/2014 Decision Hiring 6 contrat negotiators to help in the developent of the PPS project paln development9/1/2014 Decision Hiring a Legal firm to help in the developent of the PPS project paln development9/8/2014 Action Start the development of the End User License Agreement for the EMR/EHR Software 9/8/2014 Decision Start the development of the PPS Agreement for organizational providers9/8/2014 Decision Start the development of the PPS Agreement for individual providers

9/8/2014 DecisionStart the development of the PPS Agreement for non-provider participants and non safety-net providers

8/16/2014 Milestone

11/30/2014 Milestone2/1/2015 Milestone Test the interfaces to the cloud wih the top 10 to 15 EHR vendors, HIE, RHIO, etc…2/8/2015 Milestone Test data synchronization between cloud and private datacenter8/1/2014 Milestone Community assessments vendors and contractor develop the survey

8/22/2014 Milestone Community assessments vendors and contractor kick off the survey9/15/2014 Milestone Have available Marketing and Advertising collaterals, along with a performing Web site9/15/2014 Milestone Kick off the community involvements meeting across Nassau and Suffolk Counties

9/12/2014 Milestone2/28/2015 Milestone Final EULA agreement in place for EMR/EHR software2/28/2015 Milestone Final PPS Agreemetn in place for organizational providers2/28/2015 Milestone Final PPS Agreemetn in place for individual providers2/28/2015 Milestone Final PPS Agreemetn in place for non providers 3/15/2015 Milestone Final PPS Agreemetn in place for non safety-net providers3/30/2015 Milestone Integrate with chosen eDiscovery company

Description (Up to 1200 characters)

Map out small territory segments in Nassau and Suffolk and identify a local meetign place in each segment so the key stakeholders are able to easily attends meetings in their communities

Establish an account with USPS, a delvery service, and one overnight shipping company (FedEx, UPS, DHL, etc…)

Desigbn and engineer customization to be made to proprietary integration engine to normalize data to meet DSRIP requirements

Identify personnel recruting agency specialized in hiring management level personnel in Healthcare. We will not have time to be seekig such high level personnel with such a short timeframe. Therefore, we will seek the services of a reputable firm and use them in order to shorten the search, arrive at qualified candidates faster, making offers and have them start working on the PPS project plan very quickly

Identify a law firm with healthcare experience to work on various legal agreements and to provide counsel throughout the process of working on the PPS project plan

Obtain malpractice, errors and omissions insurance policies while working on the development of the PPS project plan

Identify and establish a relationship with an eDiscovery company to partner with during the PPS project plan development and beyond

Enter into contrat with Marketing and Advertising company, Web development and hosting, professional printig company,

Kick off the customization of the proprietary integration engine to normalize data to meet DSRIP requirements

Kick off the synchronization of data modules between Cloud and private datacenter where full data set is securely held and protected

Kick off the Software scaling and testing project to map out steps we will have to take as we grow from 10% to 150% of capacity

Obtain malpractice, errors and omissions insurance policies while working on the development of the PPS project plan

TEST EMR/EHR software in various settings so as to cover the full spectrum providers who will be using the software when the PPS is operational

kick off the advertising campaing to inform, educate, recruit, and galvanize support for the PPS creation in Nassau and Suffolk Counties

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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)

Billing Data for ER visits in Nassau and Suffolk Counties from 2009 to 2013

This data would greatly enhance our ability to truly understand the hidden opportunities for a PPS to intervene and manage the care of the covered lives. We will run this data through our analytics tool to determine what could have been done at the moment of seeking care in the ER and more importantly we will strive to use our predictive analysis tool to take the necessary measures to avoid having Medicaid recipients seek care at the ER when such care is available and could be delivered in a less costly manner.

Care management data from 2009 to 2013 from one or more MCO's

This data would greatly enhance our ability to truly understand the hidden opportunities for a PPS to intervene and manage the care of the covered lives. We will run this data through our analytics tool to determine what could have been done at the moment of seeking care in the ER or hospital and more importantly we will seek to determine pattern to model our case management after for better outcomes. This will continue to be a reiterative process for continuous quality improvement as more data is available to the PPS through our own care management initiative in the future.

Billing data for inpatient admissions in Nassau and Suffolk Counties from 2010 to 2013

This data would greatly enhance our ability to truly understand the hidden opportunities for a PPS to intervene and manage the care of the covered lives. We will run this data through our analytics tool to determine what could have been done at the moment of seeking care in the hospital and more importantly we will seek to determine patterns of less desirable hospitalizations as we will share our findings with hospitals in the PPS system so they help reduce non-necessary hospital admission.

Furthermore, this data will be analyzed at a macro level to determine patterns across sister hospitals within a health system so we are better prepared to work with large systems and help them avoid Medicaid patients bouncing across hospitals and avoiding being on anyone's radar

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NYS DOH DSRIP_Project Design Grant Application Section 8 Data Request

DSRIP Resources Link:See pages 87-92

EMS billing data as related to Medicaid recipients in Nassau and Suffolk Counties from 2009 to 2013

This data would greatly enhance our ability to truly understand the hidden opportunities for a PPS to intervene and manage the care of the covered lives. We will run this data through our analytics tool to determine what could have been done at the moment of picking up a Medicaid patient and more importantly this data will allow us to determine patterns that can be changes for care delivery at a lesser based on availability of electronic health record to EMS personnel and coordination with care management.

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 $ 500,000 Data Analysis $ 200,000

Other:

Total Community Needs Assessment Costs: $ 700,000

Stakeholder Engagement Costs:Advertising $ 350,000 Website Design $ 25,000 Meeting Costs $ 25,000

Other: Postage $ 10,000 Printing $ 25,000 Marketing collateral development $ 12,000 Marketing contractor $ 55,000

Total Stakeholder Engagement Costs: $ 502,000

Application Development Costs:Other: EMR/EHR Softwarefor PPS providers with no EHR $ 500,000

Setup of private cloud to gather data $ 500,000 Interfaces develoment to pull data from EHR $ 150,000

$ 750,000 $ 250,000

Software scaling and testing $ 250,000 Total Application Development Costs: $ 2,400,000

Other Category: Predictive Analytics Costs:Medical Director $ 150,000 IT Director $ 150,000 Project Management $ 150,000 Contract negotiators $ 450,000

Customizing the proprietary integration engine to normalize data to meet DSRIP requirementsdatacenter where full data set is securely held and protected

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NYS DOH DSRIP_Project Design Grant Application Section 9 Design Grant Budget

Personnl Recruitinig Firm $ 112,500 Predictive Analytics Contractor $ 400,000

Total $ 1,412,500

Other Category: Legal costs:IP Attorney $ 150,000 License agreement development $ 45,000 Malpractice Insurance $ 10,000 PPS Contract development $ 250,000 eDiscovery Preparedness $ 150,000

Total $ 605,000

Grand Total $ 5,619,500

Capital Needs

9.2) Yes

If so, how much ? (Estimate): $ 14,455,000

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

9.3)

Category Dollar Amount ($) Category Dollar Amount ($)Leasing of a new datacenter space $ 1,500,000

$ 1,000,000

Purchasing of servers $ 500,000 Purchasing of OS software $ 300,000 Vmware software $ 1,300,000 Security software $ 60,000 Storage software $ 400,000 Storage hardware $ 3,000,000 Cages $ 5,000 Racks $ 60,000 Cables $ 10,000 Fiber cables $ 40,000 Telecommunication equipment $ 600,000 Networking equipments $ 1,200,000 Security hardware equipment $ 150,000

$ 1,500,000

$ 30,000

Backup infrastructure $ 150,000

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.

Leasing of a back up datacenter space

Professional services for system setup and configuration

Fiber cable infrastructure builtoutbetween centers

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NYS DOH DSRIP_Project Design Grant Application Section 9 Design Grant Budget

Backup storage $ 150,000 Database infrastructure $ 500,000 Database software $ 2,000,000

9.4)

Characters used: 3232

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)

The capital funds will be applied to the following DSRIP projects:1. Create Integrated Delivery Systems that are focused on Evidence Based Medicine /Population Health Management2. Evidence-based strategies for disease management in high risk /affected populations (adult and children)3. Evidence based medicine guidelines for asthma management4. Strengthen Mental Health and Substance Abuse Infrastructure across systemADO proposes to set up the infrastructure for patient care, quality assurance, and provider productivity with technology that is easy to use for care participants and the hospitals. We call it ADO Connects ®.ADO Connects® all care providers in the echo system and allows them to communicate effectively: 1. Most hospitals already have EHR; they need to open up their EHR and make the data available to the consortium so the PPS may benefit as a whole2. The EHR technology for the community based providers has to bea. simple to useb. tablet readyc. cloud basedd. connected to State Medicaid and other insurance carriers

On the back end, all report generation and submission happen without the provider being involved. The back end IT team runs the reports and submit them to the State or other entities on behalf of the providers as required. Please note that the solution is designed to put a solid foundation for the PPS system to be built upon. The technology solution will be:o Limited to PPS needs. This is NOT a certified EHR platform for MU purposes.o Distributed to all PPS participants who do not have their own EHR in place or who prefer to use the new system for any reasono Connected to all Hospitals in the Systemo Offered as a standalone or integrated technology platform o Offered to all community based organization in the PPSo Offered to any and all other providers, entities, and organizations that may potentially interact with the Medicaid patients covered under the PPS contract.

This is an FULLY Integrated Delivery System. With all PPS patient’s data in one place, THE PPS WILL BE ABLE TO RUN REPORTS BASED ON COMMONLY ACCEPTED PROTOCOLS AND HAND OUT REPORT CARDS TO PROVIDERS AS OFTEN AS NEEDED IN ORDER TO CORRECT OR AT LEAST POSITIVELY INFLUENCE BEHAVIOR. Providers will always have data (evidence) to base their decision on (evidenced based medicine); with the proper incentive payment tied to the change in behavior, we will have a great chance to succeed.Finally, we will be able to access in real time the data we need to effect change management, population health management, disease management in adults and children. Specifically, with data availability in real time, we will be able to program the established behavioral health protocols into providers’ work flow and enforce, with the State’s support and backing, the proper treatment course for patients with chronic behavioral health issues. For example, a chronic alcoholic being discharged from the hospital after detoxification will have to be discharged to a rehab facility and then to their primary care provider for prescribed follow up and urine tests so as to prevent the eternal cycle of intoxication and hospitalization.The ADO Connects ® infrastructure will make all of the above possible.

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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 South Shore Rehabilitation and Nursing Center Yes 275 West Merrick Road Freeport NY 11520 Cathie Doyle (516) 623-4000 2311 cdoyless@msn.com2 Beach Terrace Care Center Yes 640 Wet Broadway Long Beach NY 11561 Martin Zwick 516-431-4400 x2033 Lynrook Restorative Therapy and Nursing No 243 Atlantic Avenue Lynbrook NY 11563 Nicolas Destinville 516-599-2744 x3117ndestinville@lynbrooktherapynursin4 Metropolitan Jewish Home Care , Inc.. (MJG Nursing Home Company LT Yes 6405 7th Ave Brooklyn NY 11220 212-356-5419 jgormley@mjhs.org5 Grandell Rehabilitation Yes 645 West Broadway Long Beach NY 11561 Bar Giberstein 516-889-1100 x214 bar@grandellrehab.com6 Oceanside Care Center Yes 2914 Lincoln Ave Oceanside NY 11572 Daniel Kret 516-536-2300 x203 dkret@oceansidecarecenter.com7 Beach Terrace Yes 640 West Broadway Long Beach NY 11561 Martin Zwick 516-431-4400 beachterrace@aol.com8 Rockville Skilled Nursing and Rehab Yes 50 Maine Ave RVC NY 11570 Susan Weige 516-536-8000 x112 sweige@rockvillerehab.com9 Menorah Home & Hospital for the Aged & Infirm d/b/a Menorah Center foYes 1516 Oriental Blvd Brooklyn NY 11235 Jay Gormley 212-356-5419 jgormley@mjhs.org

10 A. Holly Paterson Extended Care Facility Yes 875 Jerusalem Avenue Uniondale NY 11553 Robert Heatley11 South Point Plaza Nursing Rehabilitation Center Yes 1 Long Beach Island Park NY 11558 Joseph Benden 516-432-0300 jbenden@SouthPointPlazaRehab.com12 Parker Jewish Institute for Health Care & Rehabilitation Yes 271-11 76th Avenue New Hyde Park NY 11040 Lorraine Breuer 718-289-2102 research@parkerinstitute.org13 Mount Sinai Hospital(inclusive of Mount Sinai Hospital of Queens) Yes One Gustave L. Levy Place NY NY 10029 Arthur Gianelli arthur.gianelli@mountsinai.org14 Beth Israel Medical Center (Petrie Division and Brooklyn Division) Yes First Ave at 16th street NY NY 10003 Arthur Gianelli 212-523-9434 arthur.gianelli@mountsinai.org15 Dominican Sisters Family Health Services, Inc. Yes 299 North Highland Ave Ossining NY 10562-2327 Mary J. Zagajeski 914-941-1710 x1101mzagajeski@dsfhs.org16 Dominican Sister Family Health Services, Inc. Yes 299 North Highland Ave Ossining NY 10562-2327 MaryH. Zagajeski 914-941-1710 x1101mzagajeski@dsfhs.org17 the Komanoff Cener for Geriatric and Rehabilitation Medicine Yes 375 East Bay Drive Long Beach NY 11561 Dennis H. Conway 516-897-1220 dconway@lbmc.org18 NY Eye and Ear Infirmary Yes 310 East 14th Street NY NY 10003 Arthur Gianelli 212-523-9434 212-523-943419 NYU Hospital Center No 550 First Avenue NY NY 10016 Richard Donahue 212-263-5842 richard.donoghue@nyumc.org20 Queens Nassau Rehabilitation & Nursing Center Yes 520 Beach 19th St Far Rockaway NY 11631 Shie Teitelbaum 718-471-7400 mrt.queensnassaurehab21 Park Nursing Home Yes 128 Beach 115th St Far Rockaway NY 11694 Leo Friedman 347-481-2177 Leo@advancedcarestaffing.com22 The Grand Pavillion Yes 41 Maine Ave Rockville Centre NY 11570 Carol Zinno 516-536-7730 czinno@thegrandpavillion.com23 Brookhaven Memorial Hospital Medical Center - Hospital Yes 101 Hospital Rd Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org24 Brookhaven Memorial Hospital Medical Center - Hospital Renal Dialysis Yes 101 Hospital Rd Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org25 Brookhaven Memorial Hospital Medical Center - Hospice Yes 105 Main Street Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org26 Brookhaven Health Care Facility Yes 801 Gazzola Drive E. Patchogue NY 11772 Debi Gaines dgaines@mcguiregroup.com27 Brookhaven Memorial Hospital Medical Center - Psychiatric Yes 101 Hospital Rd Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org28 Brookhaven Memorial Hospital Medical Center - Renal Outpatient Yes 109 Main Street Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org29 Brookhaven Memorial Hospital Medical Center - Homecare Yes 103 Main Street Patchogue NY 11772 Brenda Farrell (631) 654-7175 bfarrell@bmhmc.org30 Bellhaven Center for Rehabilitation and Nursing Care Yes 110 Beaver Dam Rd. Brookhaven NY 11719 Bernadette Walker (631) 286-8100 702 bwalker@bellhavencenter.com

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)

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

31 Medford Multicare Center for Living Yes 3115 Horseblock Rd. Medford NY 11763 Daniel J. Monahan, (631) 730-3015 dmonahan@medfordmulticare.org32 Lenox Hill Hospital No 100 East 77th Street New York NY 11075 Jerrold E. Hirsch (516) 465-8070 jhirsch@nshs.edu33 Staten Island University Hospital Yes 475 Seaview Avenue Staten Island NY 10305 Robert Blake34 North Shore-LIJ Stern Family Center for Rehabilitation No 330 Community Drive Manhasset NY 11030 Jerrold E. Hirsch 516-465-8070 jhirsch@nshs.edu35 North Shore-LiJ Orzac Center for Rehabilitation No 900 Franklin Avenue Valley Stream NY 11580 Jerrold E. Hirsch 516-465-8070 jhirsch@nshs.edu36 Peninsula Counseling Center Yes 50 W. Hawthorne Ave. Valley Stream NY 11580 Lois Goldsmith (516) 204-1385 lgoldsmith@pccli.org37 Family Service League, Inc. Yes 790 Park Avenue Huntington NY 11743 Jeff Steigman (631) 427-3700 227 jstiegman@fsl-li.org38 Angelo Melillo Center for Mental Health, Inc. Yes 113 Glen Cove Avenue Glen Cove NY 11542 Daniel J. Vogrin (516) 676-2388 150 dvogrin@melillo.org39 Nassau University Medical Center Yes 2201 Hempstead Turnpike East Meadow NY 11554 Dr. Victor Politi (516) 572-6011 vpoliti@numc.edu40 Long Island FQHC, Inc. Yes 380 Nassau Rd Roosevelt NY 11575 David Neimroff 516-572-0086 dnemirof@numc.edu41 Long Island FQHC, Inc. - Hempstead Health Center Yes 135 Main Street Hempstead NY 11550 David Nemiroff (516) 546-4198 dnemirof@numc.edu42 Long Island FQHC, Inc. - Westbury Health Center Yes 682 Union Avenue Westbury NY 11590 David Nemiroff (516) 546-4198 dnemirof@numc.edu43 Long Island FQHC, Inc. - South Ocean Care Health Center Yes 101 South Bergen Place Freeport NY 11520 David Nemiroff (516) 546-4198 dnemirof@numc.edu44 Primary Healthcare Plus Yes 1209 Hempstead Turnpike Franklin Sq. NY 11010 Dr. Jacqueline Delmont (516) 224-7460 jdelmont@delmonthealthcare.com45 Long Island FQHC, Inc. - Elmont Health Center Yes 161 Hempstead Turnpike Elmont NY 11003 David Nemiroff (516) 546-4198 dnemirof@numc.edu46 Winthrop University Hospital No 259 First Street Mineola NY 11501 Diane Bachor (516) 663-4918 dbachor@winthrop.org47 St. John's Episcopal Hospital Yes 327 Beach 19th St. Far Rockaway NY 11691 Richard Brown (718) 869-7320 ricbrown@ehs.org48 PSCH Yes 142-02 20th Avenue Flushing NY 11351 Robert Hettenbach (718) 559-0535 robert.hettenbach@psch.org49 Pederson-Krag Center, Inc. Yes 55 Horizon Drive Huntington NY 11743 Dean Weinstock (631) 920-8009 dweinstock@pedersonkrag.org50 Hispanic Counseling Center, Inc. Yes 344 Fulton Avenue Hempstead NY 11550 Maria Munoz Kantha (516) 538-2613 227 drmck@hispaniccounseling.org51 FEGS Yes 315 Hudson Street New York NY 10013 Kristin Woodlock (212) 366-8402 kwoodlock@fegs.org52 FEGS Home Attending Services, Inc. Yes 424 East 147th Street Bronx NY 10455 Gabe Sofos (212) 491-6000 gsofos@fegshas.org53 Peninsula Counseling Center Yes 50 W. Hawthorne Ave. Valley Stream NY 11580 Lois Goldsmith (516) 204-1385 lgoldsmith@pccli.org54 Winthrop University Hospital No 259 First Street Mineola NY 11501 Diane Bachor (516) 663-4918 (516) 663-491855 Planned Parenthood of Nassau County, Inc. Yes Hempstead Far Rockaway NY 11550 Nancy O'Keefe (516) 750-2501 nancy.okeefe@ppnc.org56 Meadowbrook Care Center Yes 320 Merrick Road NY Freeport 11520 Mindy Grant (516) 371-8200 205 mcc205adm@aol.com57 Southeast Nassau Guidance Center Yes 2146 Jackson Ave. Seaford NY 11783 Brian Baldwin (516) 671-9535 bbaldwin@sngcounseling.org58 EPIC Long Island, Inc. Yes 1500 Hempstead Turnpike East Meadow NY 11554 Jennifer Colbert (516) 739-7733 400 jcolbert@epicli.org59 Townhouse Center for Rehab and Nursing Yes 755 Hempstead Turnpike Uniondale NY 11553 David Lesser (516) 565-1900 admin@townhouseecf.com60 Fulton Commons Care Center Yes 60 Merrick Avenue East Meadow NY 11554 Patrick M. Russell (516) 222-9300 prussell@bvnh.com61 Melillo Center for Mental Health Yes 113 Glen Cove Ave. Glen Cove NY 11542 Daniel Vogrin (516) 676-2388 150 dvogrin@melillo.org62 Visiting Nurse Service of New York Home Care Yes 1250 Broadway, 4th Fl. New York NY 10001 Sarah Larson (212) 609-7563 sarah.larson@vnsny.org63 Oak Hollow Nursing Center Yes 63 Oakcrest Ave. Middle Island NY 11953 Kevin Wilson (631) 924-8830 2201 kwilson@lakeviewrehab.org64 North Shore University Hospital No 300 Community Drive Manhasset NY 11030 Jerrold E. Hirsch (516) 465-8070 jhirsch@nshs.edu65 Glen Cove Hospital Plainview Hospital No 101 St. Andrews Lane Glen Cove NY 11542 Jerrold Hirsch (516) 465-8070 jhirsch@nshs.edu66 Franklin Hospital Yes 900 Franklin Avenue Valley Stream NY 11580 Jerrold Hirsch (516) 465-8070 jhirsch@nshs.edu67 LIJ Home Care No 1983 Marcus Ave, Suite E139 New Hyde Park NY 11042 Merryl Siegel (516) 876-7849 msiegel@nshs.edu68 South Nassau Communities Hospital No One Healthy Way Oceanside NY 11572 Richard Murphy (516) 632-3939 rmurphy@snch.org69 Long Island Jewish Medical Center Yes 270-05 76th Ave. New Hyde Park NY 11040 Jerrold Hirsch (516) 465-8070 jhirsch@nshs.edu70 Plainview Hospital No 888 Old Country Road Plainview NY 11803 Jerrold Hirsch (516) 465-8070 jhirsch@nshs.edu71 North Shore Home Care No 972 Brush Hollow Road, Suite 300 Westbury NY 11590 Merryl Siegel (516) 876-7849 msiegel@nshs.edu72 Cabrini of Westchester, St. Cabrini Long Term Home Health Care Progra Yes 115 Broadway Dobbs Ferry NY 10522 Patricia Krasnausky (914) 693-6800 500 pkrasnausky@cabrini-eldercare.org73 Catholic Charities Yes 333 N. Main St. Freeport NY 11520 Howard Duff (516) 634-0014 duff.howard@catholiccharities.cc74 Cabrini of Westchester, dba St. Cabrini Nursing Home Yes 115 Broadway Dobbs Ferry NY 10522 Patricia Krasnausky (914) 693-6800 500 pkrasnausky@cabrini-eldercare.org75 Cabrini of Westchester, St. Cabrini Certified Home Health Agency Yes 115 Broadway Dobbs Ferry NY 10522 Patricia Krasnausky (914) 693-6800 pkrasnausky@cabrini-eldercare.org76 The Joseph P. Addabbo Family Health Center, Inc. Yes 6200 Beach Channel Deive Averne NY 11692 Robert P. Fliegel (718) 984-7150 1777 Bezalel Rehabilitation and Nursing Center Yes 29-38 Far Rockaway Blvd. Far Rockaway NY 11692 Yossi Kraus (718) 471-260078 Visiting Nurse Associate of Long Island Inc. No 100 Garden City Plaza Garden City NY 11530 Orael M. Keenan (516) 739-1270 203 oraelk@vnali.org79 Rockaway Care Center Yes 353 Beach 48th Street Far Rockaway NY 11691 Mitchell Wechter (718) 471-5000 admin@rockawaycc.com80 Bishop Charles Waldo MacLean Episcopal Nursing Home Yes 1711 Brookhaven Avenue Far Rockaway NY 11691 Michael Biderman (718) 869-803381 Mercy Medical Center Inpatient Service Yes 1000 North village Avenue Rockville Centre NY 11570 Ron Steimel (516) 705-1100 ron.steimel@chsl.org82 Nassau Extended Care Facility Yes 1 Greenwich Street Hempstead NY 11550 Ingrid Scantlebury (516) 565-480083 The Grand Pavillion for Rehab and Nursing and RC Yes 41 Maine Ave Rockville Centre NY 11570 Richard Home 516-536-773084 Grandell Rehabilitation and Nursing Center Yes 645 West Broadway Long Beach NY 11561 Marty Dicker 516 889-1100

rfligel@addabbo.orgbeznhsnf@aol.com

mbiderman@macleancc.com

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85 Stony Brook University Hospital Yes 101 Nicolls Road Stony Brook NY 11794 Jennifer Jamilkowski (631) 444-4500 jennifer.jamilkowski@stonybrookmed86 Central Suffolk Hospital dba Peconic Bay Medical Center Yes 1300 Roanoke Ave Riverhead NY 11901 Cheryl Makoske (631) 548-6752 cmakoske@pbmchealth.org87 John T. Mather Memorial Hospital No 75 North Country Road Port Jefferson NY 11777 Christine Livreri (631) 473-1320 4285 Clivreri@matherhospital.org88 Good Samaritan Hospital Medical Center No 1000 Montauk Highway West Islip NY 11795 Nancy Simmons (631) 376-3000 nsimmons@chsli.org89 Southampton Hospital No 240 Meeting House Lane Southampton NY 11968 Robert S. Chaloner (631) 726-8300 Cschultheis@southamptonhospital.or90 Eastern Long Island Hospital Yes 201 Manor Place Greenport NY 11944 (631) 477-5100 pconnor@elih.org91 Good Samaritan Hospital Medical Center LTHHCP Yes 1000 Montauk Highway West Islip NY 11795 Terrence O'Brien Terrence O'Brien92 St. Catherine of Siena Medical Center No 50 Route 25A Smithtown NY 11787 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org93 St. Charles Hospital and Rehabilitation Center 200 Belle Terre Rd. Port Jefferson NY 11777 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org94 HRHCare Kraus Family Health Center of the Hamptons Yes 330 Meeting House Lane Southampton NY 11968 Allison McGuire (914) 734-8543 amcguire@hrhcare.org95 Elsie Owens Health Center Yes 82 Middle County Road Coram NY 11727 Allison McGuire (914) 734-8543 amcguire@hrhcare.org96 Martin Luther King, Jr. Community Health Center Yes 1556 Straight Path Wyandanch NY 11798 Dr. James Tomarken 631-854-0100 james.tomarken@suffolkcountyny.go97 Riverhead Health Center Yes County Center 300 Center Drive Riverhead NY 11901 Dr. James Tomarken (631) 854-0100 james.tomarken@suffolkcountyny.go98 Community Health Yes 327 Front Street Greenport NY 11944 Dr. Steven Zove and Carol Sloan(914) 734-8543 amcguire@hrhcare.org99 Hudson River Healthcare, Inc, dba Community Health Care Collaborative Yes 1037 Main Street Peekskill NY 10599 Allison McGuire (914) 734-8543 amcguire@hrhcare.org

100 South Brookhaven Family Health Center, West @ Patchogue Yes 365 East Main Street Patchogue NY 11772 Dr. James Tomarken 631-854-0100 james.tomarken@suffolkcountyny.go101 Suffolk County Dept Health, Bureau of Public Health Nurse Yes 100 Veterans Memorial Hwy Hauppauge NY 11788 Owen Durney 631-853-6492 owen.durney@suffolkcountyny.gov102 Brentwood Family Health Center Yes 1869 Brentwood Road Brentwood NY 11717 Dr. James Tomarken 631-854-0100 james.tomarken@suffolkcountyny.go103 Marilyn Shellabarger South Brookhaven Family Health Center East @ ShirYes 550 Montauk Highway Shirley NY 11967 james.tomarken@suffolkcountyDr. James Tomarken 631-854-0100104 Peconic Bay Skilled Nursing Facility Yes 1300 Roanoke Ave Riverhead NY 11901 Cheryl Mako (631) 548-6752 cmakoske@pbmchealth.org105 Affinity Skilled Living and Rehabilitation Yes 305 Locust Ave Oakdale NY 11769 Mayer Spilman (631) 218-5903 mspilman@affinityskilled.com106 Cardiff Bay, LLC No 5015 Beach Channel Drive Far Rockaway NY 11691 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com107 The Maxine S. Postal Tri-Community Health Center Yes 080 Sunrise Highway Amityville NY 11701 Dr. James Tomarken 631-854-0100 james.tomarken@suffolkcountyny.go108 Barnwell Nursing and Rehab Center Yes 3230 Church Street Valatie NY 12184 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com109 Daleview Care Center Yes 574 Fulton Street Farmingdale NY 11735 Mary Kochaniwsky (516) 694-9800 213 Marykochaniwsky@aol.com110 Hilaire Farm Skilled Living and Rehab Center, LLC dba Hillaire Rehab and Yes 9 Hillaire Drive Huntington NY 11743 Colleen Spitzner (631) 361-8800 203 collesp@ncnrehab.com111 Mills Pond Nursing and Rehab Center Yes 273 Moriches Rd St. James NY 11780 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com112 New Sea Crest Healthcare Center, LLC Yes 3035 West 24th Street Brooklyn NY 11224 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com113 Carillon Nursing and Rehab Center Yes 830 Park Ave Huntington NY 11747 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com114 East Neck Nursing and Rehab Cetner Yes 134 Great East Neck Rd. West Babylon NY 11704 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com115 Maria Regina Residence Yes 1725 Brentwood Rd BrentwoodNY NY 11717 Ellen Bartoldus (631) 299-3190 ebartoldus@mariareginaresidence.or116 Nesconset Acquisition, LLC dba Nesconset Center for Nursing and Rehab Yes 100 Southern Blvd Nesconset NY 11767 Colleen Spitzner (631) 361-8800 203 collesp@ncnrehab.com117 Oak Hollow Nursing Center Yes 49 Oakcrest Ave. Middle Island NY 11953 Debra Wolf (631) 924-8830 smalone@oakcares.com118 Riverhead Care Center Yes 1146 Woodcrest Ave Riverhead NY 11901 Mary Ann Mangels (631) 727-4400 116 mmangels317@aol.com119 Shore View Nursing Home Yes 2865 Brighton 3rd St Brooklyn NY 11235 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com120 St. James Rehab and Healthcare Center Yes 275 Moriches Rd St. James NY 11780 Cristen Wei (631) 862-8000 Cristenw@stjamesrehab.com121 Waters Edge at Port Jefferson for Rehab and Nursing Yes 150 dark Hollow Rd Port Jefferson NY 11777 Anthony Comerford (631) 473-5400 252 acomerford@portjeffersonrehab.com122 Woodhaven Nursing Home Yes 1360 Rte 112 Port Jefferson StatNY 11776 Kenneth E. Gaul (631) 473-7100 1167 keg5891@aol.com123 Sayville Nursing and Rehab Center No 300 Broadway Sayville NY 11788 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com124 Smithtown Center for Rehab and Nursing Care Yes 391 North Country Rd Smithtown NY 11787 Marsha Noren (631) 361-2020 mnoren@smithtowncenter.com125 Sunrise Manor for Nursing and Rehab Yes 1325 Brentwood Rd Bayshore NY 11706 Constance Fleming (631) 665-4960 19 Connie@sunrisemanorrehab.com126 Westhampton Care Center Yes 78 Old Country Rd Westhampton NY 11977 Kenneth Winston (631) 288-0101 1040 Skilled Nursing Facility127 Workman's Circle Multicare Center Yes 3155 Grace Ave. Bronx NY 10469 Michael Schrieber (917) 846-6680 mschrieber@cassenacare.com128 Bellhaven Center for Rehab and Nursing Care Yes 110 Beaver Dam Rd Brookhaven NY 11719 Bernadette Walker (631) 286-8100 bwaler@bellhavencenter.com129 Island Nursing and Rehab Center Yes 5537 Expressway Drive North Holtsville NY 11742 David Fridkin (631) 758-3336 103 dfridkin@islandnursing.org130 Nursing Sister's Home Care d/b/a Catholic Home Care No 110 Bi-County Blvd, Suite 114 Farmingdale NY 11735 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org131 Medford Multicare Center Yes 3115 Horseblock Rd. Medford NY 11763 Daniel J. Monahan (631) 730-3000 dmonahan@medfordmulticare.org132 Dominican Sisters Family Health Service, Inc. No 103-6 W. Montauk Highway Hampton Bays NY 11946-4003 Mary J. Zagajeski (914) 941-1710 x1101 mzagajeski@dsfhs.org133 Sayville Nursing and Rehab Center No 300 Broadway Avenue Sayville NY 11782 Robin DiGregorio (631) 567-9300 2505 rdgregorio@cassenacare.com134 Our Lady of Consolation Nursing and Rehabilitative Care Center LTHHCP Yes 111 Beach Drive West Islip NY 11795 Terrence O'Brien (516) 705-3712 terrence.o'brien@chsli.org135 Our Lady of Consolation Nursing and Rehabilitative Care Center Yes 111 Beach Drive West Islip NY 11795 Sr. Marilynn Breen (631) 587-1600 marilyn.breen@chsli.org136 Good Samaritan Nursing Home Yes 101 Elm Street Sayville NY 11782 Terrence O'Brien (516) 705-3712 terrence.o'brien@chsli.org137 Peconic Bay Home Health No 1300 Roanoke Ave. Riverhead NY 11901 Cheryl Makoske (631) 548-6752 cmakoske@pbmchealth.org138 St. Catherine of Siena Nursing and Rehabilitation Care Center Yes 52 Route 25A Smithtown NY 11787 Terrence O.Brien (516) 705-3712 terrence.o'brien@chsli.org

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139 Visiting Nurse Association of Long Island LTHHC Yes Garden City Garden City NY 11530 Orael Keenan (516) 739-1270 Orael.Keenan@chsli.org140 Family Service League, Inc. Yes 790 Park Ave. Huntington NY 11743 Dean Weinstock (631) 920-8009 deanweinstock@pedersonkrag.org141 Gentiva Health Services No 888 Veteran's Memorial Highway Hauppauge NY 11788 Elizabeth Anderson (631) 232-6030 225 Beth.Anderson@gentiva.com142 YMCA of Long Island, Inc. No 1150 Portion Road, Suite 6 Holtsville NY 11742 Stacey A. Spata (631) 580-7777 104 stacey.spata@ymcali.org143 Developmental Disabilities Institute Yes 99 Hollywood Drive Smithtown NY 11787 John Lessard (631) 366-2950 jlessard@ddiny.org144 Long Island State Veterans Home Yes 100 Patriots Road Stony Brook NY 11790 Fred Sganga (631) 444-8606 Fred.Sganga@lisvh.org145 YMCA of Long Island, Inc. No 324 Main Street Northport NY 11768 Stacey A. Spata (631) 580-7777 104 stacey.spata@ymcali.org146 Maryhaven Center of Hope No 51 Terryville Rd. Port Jefferson NY 11776 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org147 ProHEALTH Care Associates, LLP No 2800 Marcus Ave. Lake Success NY 11042 Carole Romano (516) 608-6849 cromano@prohealthcare.com148149 Southside Hospital Yes 301 East Main Street Bay Shore NY 11706 Jerrold E. Hirsch (516) 465-8070 jhirsch@nshs.edu150 Dolan Family Health Center Yes 284 Pulaski Road Greenlawn NY 11740 Jerrold E. Hirsch (516) 465-8070 jhirsch@nshs.edu151 Broadlawn Manor Nursing & Rehabilitation Center Yes 399 County Line Road Amityville NY 11701 Jerrold E. Hirsch (516) 465-8070 jhirsch@nshs.edu152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192

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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

Nursing Home 369086 2904300N 1811999246Nursing Home 309857 2902303N 150889025Skilled Nursing Facility 312969 2911303N 1265724298Nursing Home 353824 7001921L 1710149984Nursing Home 2902304N 1851486914Nursing Home 335158 2950314n 1275521064Nursing Home 29023003n 1505593025Skilled Nursing Facility 2909304n 1093708646Skilled Nursing Facility 708181 7001372N 1922004860Skilled Nursing Facility 378703 2950302N 1497716534Nursing Home 907020 2961302N 1952383291Nursing Home 313511 7003307N 1851467369 1932275427Voluntary Hospital (Non CAH, Non Sole Community Provider2998612 7002024H 1932103413Voluntary Hospital (Non CAH, Non Sole Community Provider243105 7002002H 1174689665Certified Home Health Agency 321971 5905601 18211848Long Term Home Health Care Provider 914-941-1710 x11015905901L 11049029Skilled Nurse Facility 313988 2902302N 1801819875Voluntary Hospital (Non CAH, Non Sole Community Provider243476 1245251222Voluntary Hospital(Non CAH,Non Sole Community Provider) 3000057 7003053H 1801992631Nursing Home 7003361n 1134231632Nursing Home 7003364N 1801887898Skilled Nursing Facility 2909305n 1912264565Hospital 245529 5123000 1053354100Hospital Renal Dialysis Unit 2999686 5123000 1235210931Hospital Based Hospice Program 1143186 5151500F 1609877364Skilled Nursing Facility/Rehabilitation 1083421 523304N 1386631547Hospital 2999700 5123000 1528133147Hospital Offsite Renal Dialysis 12999695 1487743480Hospital Based Homecare Program 2999668 5123600 1104823996Nursing Home 335755 5151321N 1528398914

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)

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Skilled Nursing Facility 2357679 5151319N 1679563464Hospital 243421 7002017H 1477616571Hospital 244202 7004003H 1407877137Skilled Nursing Facility 245510 2951305N 1437187150Skilled Nursing Facility 268328 2910000N 1396753224OMH (Article 31) Provider 244817 6797100A 1437262839OMH (Article 31) Provider 2996069 7171001 1528093242OMH & OASAS 354985 6804100APublic Hospital 1962156 2950002H 1801857172Federally Qualified Healthcare Center (FQHC) 331034 2908201R 1396059499 1962716050Federally Qualified Healthcare Center (FQHC) 331035 2908201R 1962716050Federally Qualified Healthcare Center (FQHC) 331037 2908201R 1215241302Federally Qualified Healthcare Center (FQHC) 2908201RDiagnostic & Treatment Center (Non FQHC) 2524803 2950209R 1194785824Federally Qualified Healthcare Center (FQHC) 331036 2908201RVoluntary Hospital (Non CAH, Non Sole Community Provider244211 2908000H 1114925567Voluntary Hospital (Non CAH, Non Sole Community Provider) 7001024H 1245475144OMH (Article 31) Provider 1456495 7401032A, 7401032B1932125721OMH (Article 31) Provider 2993575 6816100A 1013964170OMH (Article 31) Provider 7768100A 1023182095OMH (Article 31) Provider 257805 6287112A 1699714618 1912164120Certified Home Health Agency 922270 9659L001 9659L001 1912164120OMH (Article 31) Provider 244817 6797100A 1437262839Voluntary Hospital (Non CAH, Non Sole Community Provider244211 2908000H 1114925567Diagnostic & Treatment Center (Non FQHC) 385135 2950205R 1427090190Skilled Nursing Facility 1678000 290430N 1457358814OMH (Article 31) Provider 393339 6801100A 1083718779OMH (Article 31) Provider 355028 8046001A 1174563936Skilled Nursing Facility 2950318N 1306875141Skilled Nursing Facility 2950317N 225029234OMH (Article 31) Provider 354985 6804100ACertified Home Health Agency 2996041 7002655 1528059805Skilled Nursing Facility 335719 5151314N 1801889985Voluntary Hospital (Non CAH, Non Sole Community Provider245510 2951001H 1366459570 1295742468Voluntary Hospital (Non CAH, Non Sole Community Provider274240 2901000H 1295743060Voluntary Hospital (Non CAH, Non Sole Community Provider268328 291000H 1528075108 1962410993Certified Home Health Agency 243903 7003608 1073585691Voluntary Hospital (Non CAH, Non Sole Community Provider2999659 2950001H 1922079094Voluntary Hospital (Non CAH, Non Sole Community Provider243903 1285641514 1285641514 1982611190Voluntary Hospital (Non CAH, Non Sole Community Provider274231 2952005H 1083621130 1801804364Certified Home Health Agency 2987864 2914601 1861464471Long Term Home Health Care Provider 863850 5925901L 1003017211OMH (Article 31) Provider 403181 6814107A 1831110972Nursing Home 313671 1376523183Certified Home Health Agency pending 5925600 1003017211Federally Qualified Healthcare Center (FQHC) 990152 7003234R 1497700736Skilled Nursing Facility 7003352N 1720159379Certified Home Health Agency 2998089 1932262383Skilled Nursing Facility 309522 7003356N 1720249493 1780674192Nursing Home 337242 7003356N 1215006960Hospital 274295 2909000H 1659330173Nursing Home 2906305N 1497716534Nursing Home 2909305N 1811982705Nursing Home 2902304N 1851486914

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Public Hospital 3002260 5151001H 1972523348 1649294026Voluntary Hospital (Non CAH, Non Sole Community Provider274328 1386649804 1386649804Voluntary Hospital (Non CAH, Non Sole Community Provider3158014 5149000H 1093718728Voluntary Hospital (Non CAH, Non Sole Community Provider3000337 5154001H 1902865355Voluntary Hospital (Non CAH, Non Sole Community Provider274406 5126000H 1033224704 1558470427Voluntary Hospital (Non CAH, Non Sole Community Provider03000319, 00274337 1881690691Long Term Home Health Care Provider 3000337 1902865355Voluntary Hospital (Non CAH, Non Sole Community Provider) 5157003H 1053497248Voluntary Hospital (Non CAH, Non Sole Community Provider) 5149001H 1164481529Federally Qualified Healthcare Center (FQHC) 473038 5901200R 1619969458Federally Qualified Healthcare Center (FQHC) 473038 1619969458Diagnostic & Treatment Center (Non FQHC) 5155200RDiagnostic & Treatment Center (Non FQHC) 5155200RFederally Qualified Healthcare Center (FQHC) 473038 5901200R 1619969458Federally Qualified Healthcare Center (FQHC) 473038 1619969458Diagnostic & Treatment Center (Non FQHC) 5155200RCertified Home Health Agency 51556000 1871506055Diagnostic & Treatment Center (Non FQHC)Diagnostic & Treatment Center (Non FQHC) 5155200RSkilled Nursing Facility 1040922 5155000N 1114973856Skilled Nursing Facility 5154323N 1417903816Skilled Nursing Facility 332834 700330N 1114922689Diagnostic & Treatment Center (Non FQHC)Skilled Nursing Facility 310632 1023301N 1609863232Skilled Nursing Facility 5150302N 1457342206Skilled Nursing Facility 311073 5153310N 1316956311Skilled Nursing Facility 312029 5157316N 1780994046Skilled Nursing Facility 308865 7001390N 1154504405Skilled Nursing Facility 308383 5153306N 1265429856Skilled Nursing Facility 876444 5150303N 1235138165Skilled Nursing Facility 3026955 5154321N 1063419356Skilled Nursing Facility 2994856 5157315N 1821267519Skilled Nursing Facility 1995528 1194718262Skilled Nursing Facility 930052 930052Skilled Nursing Facility 310696 7001342N 1336134915Skilled Nursing Facility 311239 5157317N 1669739207Skilled Nursing Facility 1004640 5149303N 1396742938Nursing Home 308470 5151316N 1568459279 1568459279Skilled Nursing Facility 1374230 5154325N 1225374911Skilled Nursing Facility 1295550 5157310N 1558397323Skilled Nursing Facility 308521 5154312N 1073568671Skilled Nursing Facility 156742938 5158301N 1174509483Skilled Nursing Facility 311000 7000390N 1710328380Skilled Nursing Facility 3025216 5151321N 1528398914Nursing Home 228191 5151318N 1487669172Certified Home Health Agency 321935 2914600 1780670711Skilled Nursing Facility 2357679 5151319N 1679563464Certified Home Health Agency 00321971, 011361305905601, 5905901L 1821184839 1104902949Skilled Nursing Facility 374230 5154325N 1245324078Long Term Home Health Care Provider 5154319N 1205822400Skilled Nursing Facility 5154319NSkilled Nursing Facility 439905 5154310N 1275529612Certified Home Health Agency 274328 5155601 1821184839 1932155678Skilled Nursing Facility 2060153 5157312N 1497741763

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Certified Home Health Agency 1932262383OMH (Article 31) Provider 2993575 6816100A 1013964170Certified Home Health Agency 337232 5157600 1376575977OASIS (Article 32) Provider 161211543 1952476129Diagnostic & Treatment Center (Non FQHC) 1464520 5155202R 1144273996Certified Home Health Agency 2994521 5151310N 1184621724OASIS (Article 32) Provider 161211543 1952476129OPWDD (Article 16) provider 883298 1043354681 1568507911Certified Home Health Agency 1275596280

Hospital 268319 5154000H 1457369381 1366450298 PsychDiagnostic & Treatment Center 1743562 5153207R 1578593588Skilled Nursing Facility 314181 5120301N 1629065172

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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 RegionCare Nursing Agency N 175 Fulton Ave, Suite 200 Hempstead NY 11550 Merryl Siegel (516) 876-7849 msiegel@nshs.edu2 RegionCare Nursing Agency N 88-11 165th St, Suite 900 Jamaica NY 11432 Merryl Siegel (516) 876-7849 msiegel@nshs.edu3 RegionCare, Inc. Y 200 Community Drive Great Neck NY 11021 Merryl Siegel (516) 876-7849 msiegel@nshs.edu4 South Oaks Hospital N 400 Sunrise Highway Amityville NY 11701 Jerrold E. Hirsch 516-465-8070 jhirsch@nshs.edu5 Long Island FQHC, Inc. Y 380 Nassau Road Roosevelt NY 11575 David Nemiroff 516) 572-0086 dnemirof@numc.edu6 EAC, Inc. Y 50 Clinton Street Hempstead NY 11550 Dr. Merrill Rotter 914) 558-1691 merrill.rotter@gmail.com7 Mental Health Association of New York City Y 50 Broadway New York NY 10004 Kathryn Salisbury (212) 964-5253 ksalisbury@mhaofnyc.org8 Blythedale Children's Hospital N 95 Bradhurst Valhalla NY 12533 John E. Canning - CFO (914) 831-2412 johnc@blythedale.org9 Central Nassau Guidance Counseling Services, Inc. Y 950 S. Oyster Bay Road Hicksville NY 11801 Jeffrey Friedman, CEO (516) 822-6111 434 jfriedman@centralnassau.org

10 Concern for Independent Living, Inc N 312 Expressway Drive South Medford NY 11763 Ralph Fasano, Executive Directo(631) 758-0474 2201 rfasano@concernhousing.org11 Family Residences and Essential Enterprises, Inc. Y 191 Bethpage Sweet Hollow Road Old Bethpage NY 11804 Anu Arnold (516) 870-1623 aarnold@familyres.org12 Mental Health Association of Nassau County, Inc. N 16 Main Street Hempstead NY 11550 Michael J. Chambers, MPA (516) 489-2322 1309 mchambers@mhanc.org13 Mental Health Association of Nassau County Y 16 Main Street Hempstead NY 11550 John Javis (516) 489-2322 1101 jjavis@mhanc.org14 Nassau Medical Associates Y 101 S. Bergen Pl. Freeport NY 11520 Dr. Mark Raifman, MD (516) 779-2390 nma390@aol.com15 Jacqueline MD PC, DBA Delmont Medical Care Y 55 N. Main St. Freeport NY 11520 Dr. Jacqueline Delmont, MD PC (516) 224-7460 jdelmont@delmonthealthcare.com16 Family and Children's Association - Hicksville Chemical Dependency Trea Y 180 Broadway Hicksville NY 11801 William Stewart (516) 486-7200 2212 bstewart@fca-li.org17 Family and Children's Association - Home & Community Based Services Y 400 Oak Street Hempstead NY 11550 William Stewart (516) 486-7200 2212 bstewart@fca-li.org18 Family and Children's Association - West Nassau Community Residence Y 505 Elmont Road Elmont NY 11003 William Stewart (516) 486-7200 2212 bstewart@fca-li.org19 Family and Children's Association - Hempstead Chemical Dependency Tre Y 126 North Franklin Street Hempstead NY 11550 William Stewart (516) 486-7200 2212 bstewart@fca-li.org20 Family and Children's Association - Lakeview Community Residence Y 392 Holly Place W. Hempstead NY 11552 William Stewart (516) 486-7200 2212 bstewart@fca-li.org21 Options for Community Living, Inc. Y 202 East Main St. Smithtown NY 11787 Georgia Kuhen (631) 361-9020 120 gkuhen@optionscl.org22 54 Main Street Medical (a division of Mobile Health) Y 129 Jackson Street Hempstead NY 11550 Elizabeth Romero, LPN (516) 545-0934 eromero@mobilehealth.net23 Clubhouse of Suffolk Y 939 Johnson Ave. Ronkonkoma NY 11779 Michael Stoltz (631) 471-7242 1304 michael.stoltz@clubhouseofsuffolk.o24 Nassau County Department of Social Services N 60 Charles Lindbergh Blvd Uniondale NY 11553 John Imhof (516) 227-7403 john.imhof@hhsnassaucountyny.us25 Nassau County Office of Mental Health, Chemical Dependencies, and DevelN 60 Charles Lindbergh Blvd. Uniondale NY 11553 Dr. James Dolan (516) 227-7057 james.dolanjr@hhsnassaucountyny.u26 South Shore Association for Independent Living, Inc. Y 1976 Grand Avenue Baldwin NY 11510 Marge Vezer (516) 855-1800 1101 mvezer@sail-inc.org27 Long Island Council on Alcoholism and Drug Dependence N 114 Old Country Rd., Ste. 114 Mineola NY 11710 Steve Chassman, LCSW (516) 747-2606 schassman@licadd.org28 Health Leads N 2 Oliver Street Boston MA 2109 Vincent Brown (646) 431-7039 vbrown@healthleadsusa.org29 North Shore Child and Family Guidance Center Y 480 Old Westbury Road Roslyn NY 11577 Bruce Kaufstein (516) 626-1971 316 bkaufstein@northshorechildguidance30 Asthma Coalition of Long Island N 700 Veterans Memorial Highway Hauppauge NY 11788 Anne Little, MPH (631) 415-0940 alittle@lungne.org31 Healthix, Inc. N 50 Worth St., 5th Fl. New York NY 10013 Thomas Check (646) 432-3672 tcheck@healthix.org32 North Shore LIJ Health Home N 972 Brush Hollow Road Westbury NY 11590 Merryl Siegel (516) 876-7849 msiegel@nshs.edu33 Circulo de la Hispanidad N 26 West Park Avenue Long Beach NY 11561 Sarah Brewste (516) 431-1135 sbrewster@cdlh.org34 Cabrini of Westchester, Adult Day Health Care Program Y 115 Broadway Dobbs Ferry NY 10522 Patricia Krasnausky (914) 693-6800 500 pkrasnausky@cabrini-eldercare.org35 Cabrini of Westchester, St. Cabrini Social Day Care Program N 115 Broadway Dobbs Ferry NY 10522 Patricia Krasnausky (914) 693-6800 500 pkrasnausky@cabrini-eldercare.org36 Cabrini Care at Home N 220 East 19th Street, Lower Level New York NY 10003 Pamela Yaco (914) 693-6800 279 pdyaco@cabrini-eldercare.org37 Nassau County Office of Housing and Community Development N 40 Main Street Hempstead NY 11550 Ed Zangrillo (516) 572-1958 ezangrillo@nassaucountyny.gov38 Queens Nassau Rehab & Nursing Center Y 520 Beach 19th Street Far Rockaway NY 11691 Joshua Teitelbaum (718) 471-7400

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

SN Qualified (Y/N)

info@queensnassaurehab.com

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

39 VNSNY Hospice and Palliative Care Y 1250 Broadway, 4th New York NY 10001 212-609-7563 sarah.larson@vnsny.org40 Homefirst LHCSA, Inc. d/b/a MJHS License Home Care Services Agency Y 6323 7th Avenue Brooklyn NY 11220 Jay Gormley,VP of Planning, Res212-356-5419 jgormley@mjhs.org41 MJHS Hospice Pallative Care Y 39 Broadway, Suite 200 New York NY 10006 Jay Gormley, VP of Planning, Re 212-356-5419 jgormley@mjhs.org42 Metropolitan Jewish Home Care , Inc.. (MJG Nursing Home Company LTH Y 6405 7th Ave Brooklyn NY 11220 212-356-5419 jgormley@mjhs.org43 Metropolitan Jewish Home Care Inc. d/b/a MJHS Home Care Y 640 Wet Broadway 440 9th Avenue 1New York NY 10001 Jay Gormely, VP of Planning Res212-356-5419 jgormely@mjhs.org44 Hospice of New York, LLC Y 45-18 Court Square, Suite 500 LIC NY 11101 John Diaz-Chermack, Assistant A347-226-480445 Nassau University Medical Center Y 2201 Hempstead Tpke. East Meadow NY 11554 Dr. Victor Politi 516-572-6011 vpoliti@numc.edu46 Parker Jewish Institute for Health Care & Rehabilitation Y 271-11 76th Avenue New Hyde Park NY 11040 Lorraine Breuer 718-289-2102 research@parkerinstitute.org47 Rockaway Care Center Y 353 Beach 48th Street Far Rockaway NY 11691 Leo Friedman 347-481-2177 Leo@advancecarestaffing.com48 Peninsula Center for Extended Care & Rehabilitation Y 50-15 Beach Channel Drive Far Rockaway NY 11691 Leo Friedman 347-481-2177 Leo@advancecarestaffing.com49 Bishop Charles Waldo MacLean Episcopal Nursing Home Y 327 Beach 19th St Far Rockaway NY 11691 347-481-2177 Leo@advancedcarestaffing.com50 Brookhaven Health Care Facility Y 801 Gazzola Drive E. Patchogue NY 11772 Debi Gaines dgaines@mcguiregroup.com51 Bellhaven Center for Rehabilitation and Nursing Care Y 110 Beaver Dam Rd. Brookhaven NY 11719 Bernadette Walker (631) 286-8100 702 bwalker@bellhavencenter.com52 Federation of Organizations Y 1 Farmingdale Road W. Babylon NY 11704 Elizabeth Galati (631) 669-5355 1144 egalati@fedoforg.org53 SUNY at Stony Brook, School of Dental Medicine Y 184 Suffolk Hall (Building 310) Stony Brook NY 11794 Dr. Steven Zove and Carol Sloan(631) 632-3101 8966 steve.zove@stonybrook.edu or carol.54 Suffolk County Department of Health Services-Maternal Infant CommunityY 4 Udall Road West Islip NY 11795 Ellen Roisman 631-854-4030 ellen.roisman@suffolkcountyny.gov55 Federation of Organizations for NYS Mentally Disabled-Recovery Concept Y 456 Waverly Ave. Patchogue NY 11772 Elizabeth Galati (631) 669-5355 1144 egalati@fedoforg.org56 Riverhead Hostel Holding Corp N 51 Terryville Rd. Port Jefferson NY 11776 Lewis Grossman (631) 474-4117 Lou.Grossman@chsli.org57 Riverhead Hostel Holding Company N 51 Terryville Rd Port Jefferson NY 11776 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org58 HealthFirst PHSP, Inc. N 100 Church Street, 18th Floor New York NY Susan Beane, MD (212) 801-2437 sbeane@healthfirst.org59 Good Shepherd Hospice N 110 Bi-County Blvd., Suite 114 Farmingdale NY 11735 Terrence O'Brien (516) 705-3712 maryellen.polit@chsli.org60 Samaritan Pediatric Services, PC N 1000 Montauk Highway West Islip NY 11795 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org61 Wisdom Gardens Housing Development Fund Co, Inc. N 51 Terryville Rd. Port Jefferson NY 11776 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org62 Maryhaven School N 51 Terryville Rd. Port Jefferson NY 11776 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org63 Maryhaven Transportation Services N 51 Terryville Rd. Port Jefferson NY 11776 Terrence O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org64 Siena Village N 2000 Bishops Road Smithtown NY 11787 Terrence.O'Brien (516) 705-3712 Terrence.O'Brien@chsli.org65666768697071727374757677787980818283848586878889909192

05/09/2023 document.xlsx

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

93949596979899

100101102103104105106107108109110111112113114115116117118119120121122123124125126127128129130131132133134135136137138139140141142143144145146

05/09/2023 document.xlsx

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

147148149150151152153154155156157158159160161162163164165166167168169170171172173174175176177178179180181182183184185186187188189190191192193194195196197198199200

05/09/2023 document.xlsx

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

201202203204205206207208209210211212213214215216217218219220221222223224225226227228229230231232233234235236237238239240241242243244245246247248249250251252253254

05/09/2023 document.xlsx

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

255256257258259260261262263264265266267268269270271272273274275276277278279280281282283284285286287288289290291292293294295296297298299300301302303304305306307308

05/09/2023 document.xlsx

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

309310311312313314315316317318319320321322323324325326327328329330331332333334335336337338339340341342343344345346347348349350351352353354355356357358359360361362

05/09/2023 document.xlsx

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

363364365366367368369370371372373374375376377378379380381382383384385386387388389390391392393394395396397398399400401402403404405406407408409410411412413414415416

05/09/2023 document.xlsx

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

417418419420421422423424425426427428429430431432433434435436437438439440441442443444445446447448449450451452453454455456457458459460461462463464465466467468469470

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

471472473474475476477478479480481482483484485486487488489490491492493494495496497498499500501502503504505506507508509510511512513514515516517518519520521522523524

05/09/2023 document.xlsx

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

525526527528529530531532533534535536537538539540541542543544545546547548549550551552553554555556557558559560561562563564565566567568569570571572573574575576577578

05/09/2023 document.xlsx

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

579580581582583584585586587588589590591592593594595596597598599600601602603604605606607608609610611612613614615616617618619620621622623624625626627628629630631632

05/09/2023 document.xlsx

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

633634635636637638639640641642643644645646647648649650651652653654655656657658659660661662663664665666667668669670671672673674675676677678679680681682683684685686

05/09/2023 document.xlsx

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

687688689690691692693694695696697698699700701702703704705706707708709710711712713714715716717718719720721722723724725726727728729730731732733734735736737738739740

05/09/2023 document.xlsx

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

741742743744745746747748749750751752753754755756757758759760761762763764765766767768769770771772773774775776777778779780781782783784785786787788789790791792793794

05/09/2023 document.xlsx

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

795796797798799800801802803804805806807808809810811812813814815816817818819820821822823824825826827828829830831832833834835836837838839840841842843844845846847848

05/09/2023 document.xlsx

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

849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884885886887888889890891892893894895896897898899900901902

05/09/2023 document.xlsx

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

903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936937938939940941942943944945946947948949950951952953954955956

05/09/2023 document.xlsx

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

957958959960961962963964965966967968969970971972973974975976977978979980981982983984985986987988989990991992993994995996997998999

10001001100210031004100510061007100810091010

05/09/2023 document.xlsx

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

101110121013101410151016101710181019102010211022102310241025102610271028102910301031103210331034103510361037103810391040104110421043104410451046104710481049105010511052105310541055105610571058105910601061106210631064

05/09/2023 document.xlsx

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

106510661067106810691070107110721073107410751076107710781079108010811082108310841085108610871088108910901091109210931094109510961097109810991100110111021103110411051106110711081109111011111112111311141115111611171118

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

111911201121112211231124112511261127112811291130113111321133113411351136113711381139114011411142114311441145114611471148114911501151115211531154115511561157115811591160116111621163116411651166116711681169117011711172

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

117311741175117611771178117911801181118211831184118511861187118811891190119111921193119411951196119711981199120012011202120312041205120612071208120912101211121212131214121512161217121812191220122112221223122412251226

05/09/2023 document.xlsx

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

122712281229123012311232123312341235123612371238123912401241124212431244124512461247124812491250125112521253125412551256125712581259126012611262126312641265126612671268126912701271127212731274127512761277127812791280

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

128112821283128412851286128712881289129012911292129312941295129612971298129913001301130213031304130513061307130813091310131113121313131413151316131713181319132013211322132313241325132613271328132913301331133213331334

05/09/2023 document.xlsx

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

133513361337133813391340134113421343134413451346134713481349135013511352135313541355135613571358135913601361136213631364136513661367136813691370137113721373137413751376137713781379138013811382138313841385138613871388

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

138913901391139213931394139513961397139813991400140114021403140414051406140714081409141014111412141314141415141614171418141914201421142214231424142514261427142814291430143114321433143414351436143714381439144014411442

05/09/2023 document.xlsx

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

144314441445144614471448144914501451145214531454145514561457145814591460146114621463146414651466146714681469147014711472147314741475147614771478147914801481148214831484148514861487148814891490149114921493149414951496

05/09/2023 document.xlsx

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

149714981499150015011502150315041505150615071508150915101511151215131514151515161517151815191520152115221523152415251526152715281529153015311532153315341535153615371538153915401541154215431544154515461547154815491550

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

155115521553155415551556155715581559156015611562156315641565156615671568156915701571157215731574157515761577157815791580158115821583158415851586158715881589159015911592159315941595159615971598159916001601160216031604

05/09/2023 document.xlsx

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

160516061607160816091610161116121613161416151616161716181619162016211622162316241625162616271628162916301631163216331634163516361637163816391640164116421643164416451646164716481649165016511652165316541655165616571658

05/09/2023 document.xlsx

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

165916601661166216631664166516661667166816691670167116721673167416751676167716781679168016811682168316841685168616871688168916901691169216931694169516961697169816991700170117021703170417051706170717081709171017111712

05/09/2023 document.xlsx

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

171317141715171617171718171917201721172217231724172517261727172817291730173117321733173417351736173717381739174017411742174317441745174617471748174917501751175217531754175517561757175817591760176117621763176417651766

05/09/2023 document.xlsx

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

176717681769177017711772177317741775177617771778177917801781178217831784178517861787178817891790179117921793179417951796179717981799180018011802180318041805180618071808180918101811181218131814181518161817181818191820

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

182118221823182418251826182718281829183018311832183318341835183618371838183918401841184218431844184518461847184818491850185118521853185418551856185718581859186018611862186318641865186618671868186918701871187218731874

05/09/2023 document.xlsx

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

187518761877187818791880188118821883188418851886188718881889189018911892189318941895189618971898189919001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928

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

192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982

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

198319841985198619871988198919901991199219931994199519961997199819992000

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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

LHCSA Housing and Care Coordination 1750354619LHCSA Private Practice 2190352 1750354619LHCSA Mental and Behavioral Health 1992777510Mental Health Public Benefits 1568459204Multi Specialty Public Benefits 1396059499Other Housing and ACTOther Nonprofit 1049476 1013230374Acute Care Children's HosNonprofit 1679573083Behavioral Health Outpatient Childrens' Me1084573 1740329531 1114928462Housing Community Based Organi353824Other Health Information Exch 2407638 1497943757Other Health Home 1792052 1215268206Other Community Based Organi1962156 1215268206Other Adult Day Care Program 313511 1952541252Other Social Day Care Program 1922050749Other Licensed Home Care Service Agency 1528159217Other County Government Housing Agency 1700033149Other Rehab & Nursing Center 1083421 1568619294Other Visiting Nurse Service 335755 1558462671Other 1700033149Other 475076 1275651325 1497827182Other 1386711497Other 3007701 1578516738OtherOther 1033276662Other 1174733539Other 1243585 1689950305Other 3081918Other 1508929621OtherOtherOther 1932472107Other Dental Services -O/P and Mobile D&T COther 158232758Other PROSOther Housing provider 1053539429Other Residence OPWDD regulatedOther Health Insurer 1134231632

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

Other Hospice 1215928510MLTCP Pediatric Outpatient services 1710148549Hospice 1770669038Multi Specialty OPWDD Regulated School for Dev. Disabled 1710149984CHHA 1720019144Hospice 1013001197Multi Specialty 1306078589 1255655346Health Care and Rehabilitation 1851467369 1932275427Residential Health Care Facility 1780674192Residential Health Care Facility 1114922689Residential Health Care Facility 1215006960skilled nursing/rehabilitation 1386631547Rehabilitation and Nuring Care 1528398914Behavioral Health,Care Coordination,Residential,Outreach,Peer,Senior ServicesOther 1053482067 1144522590OtherOther 1073706032OtherOtherOtherOther 1992131635Other 1730308925OtherOther

Other

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

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

05/09/2023 document.xlsx

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

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

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

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

05/09/2023 document.xlsx

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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

1 PAYAM KASHANI DENTIST KASHANI PAYAM ARABZADEH DDS Y 1154413177 NASSAU2 MAUREEN BARBARA NURSE PRACTITIONER HUDSON RIVER HEALTHCARE INC Y 1174627384 SUFFOLK3 AHMED ELFIKY PHYSICIAN ELFIKY AHMED MD Y 1568551075 SUFFOLK4 YOLAINE ST.LOUIS PHYSICIAN YOLAINE ST LOUIS MD PC Y 1619057916 NASSAU5 MUHAMMAD KHAN PHYSICIAN HUDSON RIVER HEALTHCARE INC Y 1720044258 SUFFOLK6 PAUL KUBIAK PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1396739777 NASSAU7 NANJUNDAIAH KUMAR PHYSICIAN KUMAR NANJUNDAIAH Y 1093745556 NASSAU8 IRA WARHEIT DENTIST AMERICAN DENTAL OFFICES PLLC Y 1487891412 NASSAU9 TABINDA ANWAR DENTIST AMERICAN DENTAL OFFICES PLLC Y 1316259534 NASSAU

10 YERANEN SHABTAI DENTIST AMERICAN DENTAL OFFICES PLLC Y 1144328154 NASSAU11 AHMED NOUR-EL-DEEN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1801949078 NASSAU12 RENEE GASKA DENTIST AMERICAN DENTAL OFFICES PLLC Y 1639214083 NASSAU13 PHILIP HIRSCHHORN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1487820221 NASSAU14 CLIFFORD SAPER DENTIST AMERICAN DENTAL OFFICES PLLC Y 1548242415 NASSAU15 ANGELE DIMITREY DENTIST AMERICAN DENTAL OFFICES PLLC Y 1538378559 NASSAU16 KENNETH CHIN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1902853138 NASSAU17 ELENA HOLTZMAN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1811102239 NASSAU18 NARINDER SINGH DENTIST AMERICAN DENTAL OFFICES PLLC Y 1851513618 NASSAU19 KRISTINA SALAVERRY DENTIST AMERICAN DENTAL OFFICES PLLC Y 1376802108 NASSAU20 LEI HUANG DENTIST AMERICAN DENTAL OFFICES PLLC Y 1356601983 NASSAU21 MITCHELL BIALOR DENTIST AMERICAN DENTAL OFFICES PLLC Y 1790705614 NASSAU22 LEONARD BORETZ DENTIST BORETZ LEONARD H DDS Y 1730177072 SUFFOLK23 SIMERJIT KAUR DENTIST AMERICAN DENTAL OFFICES PLLC Y 1801023395 NASSAU24 MARIA CAMPOS DENTIST AMERICAN DENTAL OFFICES PLLC Y 1003016338 NASSAU25 JAYASHREE BHINDA DENTIST AMERICAN DENTAL OFFICES PLLC Y 1134303084 NASSAU26 THIERRY ABITBOL DENTIST AMERICAN DENTAL OFFICES PLLC Y 1407919400 NASSAU27 NEDJAT BARAVARIAN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1457552838 NASSAU28 TERRILYN REYNOLDS DENTIST AMERICAN DENTAL OFFICES PLLC Y 1093897043 NASSAU29 GOVIND BAPAT DENTIST AMERICAN DENTAL OFFICES PLLC Y 1982807244 NASSAU30 ALBERT MATUZA DENTIST AMERICAN DENTAL OFFICES PLLC Y 1619171386 NASSAU31 HOWARD KRIGSMAN DENTIST AMERICAN DENTAL OFFICES PLLC Y 1528168283 NASSAU32 RICKY MUNTER DENTIST AMERICAN DENTAL OFFICES PLLC Y 1336163997 NASSAU33 JEFFREY ROUSE DENTIST AMERICAN DENTAL OFFICES PLLC Y 1073711271 NASSAU34 RAYMOND SWAINSON DENTIST AMERICAN DENTAL OFFICES PLLC Y 1982862850 NASSAU35 SHERINE IBRAHIM DENTIST AMERICAN DENTAL OFFICES PLLC Y 1073720181 NASSAU36 LORIS ABRAHAM DENTIST AMERICAN DENTAL OFFICES PLLC Y 1972714699 NASSAU37 HOWARD BLOOM DENTIST AMERICAN DENTAL OFFICES PLLC Y 1760507024 NASSAU38 CHANDRA KAUSHIK DENTIST AMERICAN DENTAL OFFICES PLLC Y 1023160124 NASSAU39 VERONICA MARMARA DENTIST AMERICAN DENTAL OFFICES PLLC Y 1609070358 NASSAU40 SUR LEE DENTIST AMERICAN DENTAL OFFICES PLLC Y 1548463425 NASSAU41 AMIN JOSEPH DENTIST AMERICAN DENTAL OFFICES PLLC Y 1245432590 NASSAU42 MAYRA NADAL PHYSICIAN NADAL MAYRA ESTHER MD Y 1790781128 SUFFOLK43 BARRY JUPITER PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1295721405 NASSAU44 ROBERT HECHT PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1669468120 NASSAU45 MICHAEL TREPETA PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1164584553 NASSAU46 BRETT SILVERMAN PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1083620355 NASSAU47 ROBERT DRAZIC PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1578559001 NASSAU48 NABIL FARAKH PHYSICIAN ISLAND MUSCULOSKELETAL CARE MD PC Y 1699932186 NASSAU49 ROY SHANON PHYSICIAN SHANON ROY MARK Y 1285723791 SUFFOLK50 SIMMY ARORA DENTIST ARORA SIMMY DDS Y 1174659403 NASSAU51 PAVANJIT CHHABRA DENTIST CHHABRA PAVANJIT Y 1487795365 NASSAU52 JANE KUGACZEWSKI PHYSICIAN KUGACZEWSKI JANE Y 1578665543 SUFFOLK

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05/09/2023 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

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

Physicians Type: ONLY choose from the following:

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53 ELEONOR LAZO PHYSICIAN GUTIERREZ-LAZO ELEONOR PIQUER Y 1639264997 SUFFOLK54 STEVEN PERRICK PHYSICIAN PERRICK STEVEN L MD Y 1083622088 NASSAU55 ARGYRO KARIDIS PHYSICIAN KARIDIS ARGYRO Y 1922374032 NASSAU56 ELIZABETH ISSA BASCH PHYSICIAN ISSA-BASCH ELIZABETH Y 1508874553 NASSAU57 MOHAMMAD CHOHAN PHYSICIAN CHOHAN MOHAMMAD JUNAID MD Y 1154573947 SUFFOLK58 SUSAN AIKEN NURSE PRACTITIONER CATHOLIC CHARITIES ROCKVL CTR Y 1043362239 SUFFOLK59 MARIA CALMA PHYSICIAN CALMA MARIA FAUSTINA MD Y 1720107840 NASSAU60 JOEL HERSHEY PHYSICIAN AMB MEDICAL SERVICES PC Y 1760425649 SUFFOLK61 ALAAELDIN MOAWAD PHYSICIAN LONG ISLAND PEDIATRICS OF BRENTWOO Y 1396835047 SUFFOLK62 RAMON FERRAND PHYSICIAN LONG ISLAND PEDIATRICS OF BRENTWOO Y 1326141698 SUFFOLK63 CATHERINE SCRENCI PHYSICIAN SCRENCI CATHERINE R MD Y 1164505111 NASSAU64 INNIS O'ROURKE PHYSICIAN OROURKE INNIS III MD Y 1346278215 NASSAU65 JUDD LESSER DENTIST LESSER JUDD DDS Y 1619022498 NASSAU66 ROBERT BOBROW PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1548204613 SUFFOLK67 SUSAN DEBEVOISE PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1144258591 SUFFOLK68 GERALD KELLY PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1659308492 SUFFOLK69 DONNA MELTZER PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1144258500 SUFFOLK70 JEDAN PHILLIPS PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1659317956 SUFFOLK71 MANAL SOLIMAN PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1104867084 SUFFOLK72 HOWARD SUSSMAN PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1497799571 SUFFOLK73 JEFFREY TRILLING PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1396787768 SUFFOLK74 LOUIS VERARDO PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1801958459 SUFFOLK75 VIVICA VOLLMER PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1073558995 SUFFOLK76 KATHERINE WIGHTMAN PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1467489880 SUFFOLK77 JUDY FINGERGUT PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1396777199 SUFFOLK78 DAVID REAVIS PHYSICIAN REAVIS DAVID N MD Y 1104884808 SUFFOLK79 DARCY MCCONNELL PHYSICIAN STONY BROOK FAMILY MED GRP UFPC Y 1548421704 SUFFOLK80 ANDREAS NIARCHOS PHYSICIAN UCP ASSO OF NYS STATEN IS Y 1952419459 NASSAU81 RICARDO ALEXANDER DENTIST ALEXANDER RICARDO DDS Y 1902950421 SUFFOLK82 HAROLD MOSTEL DENTIST MOSTEL HAROLD DDS Y 1801999347 NASSAU83 EMAD IBRAHIM DENTIST IBRAHIM EMAD EZZAT DDS PC Y 1558403204 SUFFOLK84 SUKON KIM PHYSICIAN KIM SUKON MD Y 1528112737 SUFFOLK85 ANANT INDARAM PHYSICIAN INDARAM ANANT V MD Y 1629015037 NASSAU86 UZMA IQBAL PHYSICIAN IQBAL UZMA MD Y 1477739753 NASSAU87 ZVI YADIN NURSE PRACTITIONER STONY BROOK PSYCHIATRIC ASSOC UFP Y 1821178476 SUFFOLK88 GERALD ENTE PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1184713638 NASSAU89 MEREDITH LONG PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1720158462 NASSAU90 ROBERT VINCENT PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1356386692 SUFFOLK91 MARSHA KARANT PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1447290184 SUFFOLK92 E. VICTORIA RUNDBERG-RIVERA PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1205870037 SUFFOLK93 DONNA DONOGHUE PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1912948787 SUFFOLK94 JUDITH CROWELL PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1912947557 SUFFOLK95 EDUARDO CONSTANTINO PHYSICIAN STONY BROOK PSYCHIATRIC ASSOC UFP Y 1730122292 SUFFOLK96 RONY MASHIHI DENTIST MASHIHI RONY DDS Y 1437398104 NASSAU97 SLAVA SHAPIRO DENTIST SHAPIRO SLAVA DDS Y 1003015926 NASSAU98 KALPANA VEERABHADRAPPA PHYSICIAN VEERABHADRAPPA KALPANA MD Y 1760432439 NASSAU99 EVELYN LLANOS PHYSICIAN LLANOS EVELYN ALTAGRACIA MD Y 1760455497 SUFFOLK

100 SHITAL SHETH PHYSICIAN SHETH SHITAL MD Y 1932150877 NASSAU101 RAMA RAJU PHYSICIAN RAJU RAMA B Y 1609957000 NASSAU102 JATIN KAPADIA PHYSICIAN KAPADIA JATIN D MD PC Y 1134179831 NASSAU103 HONG LI PHYSICIAN LI HONG Y 1154514784 SUFFOLK104 SUDHARANI KOTHA PHYSICIAN SUDHARANI KOTHA S MD Y 1316028590 NASSAU

05/09/2023 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

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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)

105 KRYSTYNA CAPOCCIA NURSE PRACTITIONER OPTI-HEALTHCARE Y 1386888022 SUFFOLK106 TAMI HALL NURSE PRACTITIONER PLANNED PARENTHOOD OF NASSAU Y 1407147754 NASSAU107 SERGIO SOKOL PHYSICIAN SOKOL SERGIO MD Y 1356398713 NASSAU108 AARON WEINREB PHYSICIAN WEINREB AARON Y 1699748970 NASSAU109 SHAHIN SHAIKH PHYSICIAN SHAIKH SHAHIN FIROZ Y 1497840458 SUFFOLK110 JAY MEHLMAN PHYSICIAN MEHLMAN JAY K MD PC Y 1649251885 NASSAU111 NAHID NEMAN DENTIST NEMAN NAHID DDS Y 1750372371 NASSAU112 MICHAEL SHERMAN DENTIST SHERMAN MICHAEL L DDS Y 1245323559 SUFFOLK113 GINA CARTWRIGHT NURSE PRACTITIONER REICHMAN BROWN & KAPLAN MD PC Y 1063689859 SUFFOLK114 DEBRA HICKEY NURSE PRACTITIONER REICHMAN BROWN & KAPLAN MD PC Y 1407980097 SUFFOLK115 KAREN KESSLER NURSE PRACTITIONER REICHMAN BROWN & KAPLAN MD PC Y 1558637132 SUFFOLK116 JOYCE GUIRAND PHYSICIAN FAMILY MEDICAL CARE OF BAYSHORE PC Y 1235373978 SUFFOLK117 STUART FEINSTEIN PHYSICIAN KIDS CARE PEDIATRIC ASSOCIATES PC Y 1154366763 NASSAU118 NEIL BELLOVIN PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1194743344 SUFFOLK119 JAMES REILLY PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1558466615 SUFFOLK120 YEKATERINA RYZOVA-VAYSMAN PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1407867724 SUFFOLK121 KIMBERLY HALTIWANGER PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1336164292 SUFFOLK122 ALLEN KAPLAN PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1124056361 SUFFOLK123 NINA SIMON PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1801972013 SUFFOLK124 JASILIN MATHEW PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1891800439 SUFFOLK125 GEORGE ROGU PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1215950761 SUFFOLK126 NICHOLAS ROGU PHYSICIAN REICHMAN BROWN & KAPLAN MD PC Y 1922196948 SUFFOLK127 DARSHAN PANCHAL DENTIST PANCHAL DARSHAN JAYEBDRA DDS Y 1962412130 SUFFOLK128 PELIN SAHINLER-LYNCH DENTIST SAHINLER-LYNCH PELIN Y 1578539458 SUFFOLK129 WILLIAM BEHRBOM DENTIST TRU-DENTAL PC Y 1699912246 SUFFOLK130 EDWARDO YAMBO PHYSICIAN EDWARDO M YAMBO MD PC Y 1699711929 SUFFOLK131 SAMINA RAGHID PHYSICIAN RAGHID SAMINA DO Y 1609950450 NASSAU132 MARGARET GARLAND DENTIST FAMILY RESIDENCES & ESSTL ENT Y 1104989722 SUFFOLK133 ANDREA STENGEL NURSE PRACTITIONER FAMILY RESIDENCES & ESSTL ENT Y 1235225871 SUFFOLK134 SPIRO THEOHARAKIS PHYSICIAN FAMILY RESIDENCES & ESSTL ENT Y 1124004056 SUFFOLK135 IJAZ AHMAD PHYSICIAN AHMAD IJAZ MD Y 1902895238 NASSAU136 REGINA HENDRICKS DENTIST URBAN PEDIATRIC DENTAL PC Y 1790099075 NASSAU137 EUGENE HERMAN DENTIST MANHATTAN AVEUNE FAMILY DENTAL PL Y 1912014010 NASSAU138 FIDEL ABREU-BENITEZ DENTIST ABREU-BENITEZ FIDEL DDS Y 1396843884 NASSAU139 MARC SHERMAN PHYSICIAN AMB MEDICAL SERVICES PC Y 1528097953 SUFFOLK140 KEVIN SHEREN DENTIST SHEREN KEVIN L Y 1033133749 SUFFOLK141 DAVID PARNAGIAN DENTIST WISDOM TOOTH OF LINDENHURST Y 1003903337 SUFFOLK142 EILEEN FLYNN RICHARDS NURSE PRACTITIONER EAST END NEUROPSYCHIATRIC ASSOCIA Y 1780671446 SUFFOLK143 ALAN STEINBERG PHYSICIAN EAST END NEUROPSYCHIATRIC ASSOCIA Y 1225022072 SUFFOLK144 EVAN BARBAKOFF DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1609051606 SUFFOLK145 HOPE ARNOLDT DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1225122641 SUFFOLK146 CHANNA JAYATILAKA DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1063612810 SUFFOLK147 DAVID KIRSHENBAUM DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1013906593 SUFFOLK148 DEAN RAIO DENTIST RAIO DEAN DDS Y 1174531115 SUFFOLK149 JAMES SUNWOO DENTIST SUNWOO JAMES SR Y 1376796433 SUFFOLK150 ANTHONY DE MARCO DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1881897056 SUFFOLK151 STEVEN KAUFMAN DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1750414686 SUFFOLK152 WILLIAM PERUSO DENTIST KIRSHENBAUM PERUSO & KAUFMAN Y 1093897969 SUFFOLK153 ELIZABETH BARRY NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1043334394 SUFFOLK154 MARVIN WATSKY PHYSICIAN WATSKY MARVIN S DO Y 1457427379 SUFFOLK155 JOELLE VITAL PHYSICIAN VITAL JOELLE MD Y 1013070176 SUFFOLK156 ANA CERNA-HELFER PHYSICIAN CERNA-HELFER ANA L MD Y 1407892920 NASSAU

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DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

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Certified_Nurse_Midwife

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

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

Physicians Type: ONLY choose from the following:

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157 SAL SARMIENTO PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1104925890 SUFFOLK158 PATRICIA DELLATTO NURSE PRACTITIONER DELLATTO PATRICIA Y 1609817279 NASSAU159 EDGAR LERIAS PHYSICIAN LERIAS EDGAR F MD Y 1033284211 SUFFOLK160 SCOTT BROWN PHYSICIAN BROWN SCOTT MD Y 1801960984 NASSAU161 RESHMA PANJWANI PHYSICIAN PANJWANI RESHMA RAJU MD Y 1255329306 NASSAU162 FOROUGH MOKHTARI PHYSICIAN MOKHTARI FOROUGH B MD Y 1134138357 SUFFOLK163 SOPHIA FRANCIS STEWART PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1730324625 NASSAU164 ANTONY PERRY PHYSICIAN EAST END PEDIATRICS PC Y 1841368503 SUFFOLK165 KEITH LEVENTHAL PHYSICIAN LEVENTHAL KEITH S DO Y 1144394214 NASSAU166 ROBERT GOTTLIEB PHYSICIAN GOTTLIEB ROBERT JOSEPH MD Y 1154489847 SUFFOLK167 SHEHLA SHABNAM PHYSICIAN NOOR MEDICAL CARE PLLC Y 1730332420 SUFFOLK168 ALEXANDRA HALITSKY PHYSICIAN HALITSKY ALEXANDRA Y 1962589960 SUFFOLK169 WILLIAM PEPPIATT DENTIST A & B DENTAL PC Y 1659413987 SUFFOLK170 EDWARD FEUER DENTIST A & B DENTAL PC Y 1184766636 SUFFOLK171 THOMAS RIUTTA DENTIST A & B DENTAL PC Y 1437350691 SUFFOLK172 ALAN BERMAN DENTIST A & B DENTAL PC Y 1528185642 SUFFOLK173 ANDREW MARKOWITZ DENTIST A & B DENTAL PC Y 1013059336 SUFFOLK174 JIVTESH SINGH DENTIST A & B DENTAL PC Y 1679899348 SUFFOLK175 KENNETH HUML PHYSICIAN HUML & VANI MD'S PC Y 1861574527 SUFFOLK176 LAURA HOGAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1336308626 SUFFOLK177 SUSAN HAMILL NURSE PRACTITIONER HUDSON RIVER HEALTHCARE INC Y 1003961848 SUFFOLK178 JANET STONE NURSE PRACTITIONER HUDSON RIVER HEALTHCARE INC Y 1114904125 SUFFOLK179 SACHIN SOOD DENTIST SOOD SACHIN DDS Y 1104949007 NASSAU180 DORIS ORTIZ DENTIST ORTIZ-ABREU DORIS Y 1972578904 NASSAU181 LEWIS O'SHEA DENTIST ADVANTAGE CARE D AND T CTR Y 1275799058 NASSAU182 KASHMIRA DEMEIRELES DENTIST DEMEIRELES KASHMIRA DDS Y 1871649194 SUFFOLK183 STEVEN GRANDILLO DENTIST GRANDILLO STEVEN ANTHONY DDS Y 1023136876 SUFFOLK184 IRIS SIMON NURSE PRACTITIONER ADVANTAGE CARE D AND T CTR Y 1386869972 NASSAU185 MONA VANI PHYSICIAN HUML & VANI MD'S PC Y 1417035858 SUFFOLK186 MUHAMMAD ZAKARIA PHYSICIAN ZAKARIA MUHAMMAD R MD Y 1447269824 NASSAU187 VICTORIA CAPOBIANCO PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1912117144 NASSAU188 STEPHEN PERRET PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1699989145 NASSAU189 ANN MARIE KENNEY PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1922298447 NASSAU190 BELINDA MARQUIS PHYSICIAN MARQUIS BELINDA AGHARESE MD Y 1508827080 SUFFOLK191 ARACELI DANTES PHYSICIAN DANTES ARACELI R MD Y 1164517637 SUFFOLK192 MARK SPERBER PHYSICIAN SPERBER MARK Y 1427072677 NASSAU193 DINA PAHLAJANI PHYSICIAN PAHLAJANI DINA MD Y 1306928460 NASSAU194 PHILIPPE TASSY PHYSICIAN TASSY PHILIPPE MD Y 1205936168 NASSAU195 PAUL ROSEN DENTIST ROSEN PAUL I DMD Y 1699765651 NASSAU196 DEVENDRA BRAHMBHATT PHYSICIAN BRAHMBHATT DEVENDRA Y 1225085335 NASSAU197 MIREILLE CONSTANT PHYSICIAN CONSTANT MIREILLE M MD Y 1316032378 SUFFOLK198 JEANETTE ALVARENGA PHYSICIAN MICHAEL J EVEROSKI MD PC Y 1427072073 NASSAU199 MICHAEL EVEROSKI PHYSICIAN MICHAEL J EVEROSKI MD PC Y 1821012139 NASSAU200 YUMEI DING PHYSICIAN DING YUMEI MD Y 1821245937 NASSAU201 JEN CHIN WANG PHYSICIAN WANG JEN C MD Y 1205938115 NASSAU202 KRISHNA ANAND PHYSICIAN HUDSON RIVER HEALTHCARE INC Y 1073617288 SUFFOLK203 PORFIRIO NUNEZ DENTIST NUNEZ PORFIRIO Y 1023238326 SUFFOLK204 CAROL MARKOWITZ NURSE PRACTITIONER AMB MEDICAL SERVICES PC Y 1871674291 SUFFOLK205 JOSEPH QUINN PHYSICIAN QUINN JOSEPH B MD Y 1215095906 SUFFOLK206 BARBARA CUSUMANO PHYSICIAN CUSUMANO BARBARA JANE MD Y 1023172418 SUFFOLK207 MARGOT ROSENTHAL CERTIFIED NURSE MIDWIFE HUDSON RIVER HEALTHCARE INC Y 1114081916 SUFFOLK208 BRIAN STEIGER DENTIST THE WISDOM TOOTH OF COMMACK Y 1942230875 SUFFOLK

05/09/2023 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

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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)

209 DEBORAH HERNANDEZ NURSE PRACTITIONER HUNTINGTON HOSP DOLAN FHC Y 1619080066 SUFFOLK210 JEAN LUO PHYSICIAN RAKESH GUPTA MEDICAL Y 1679757892 NASSAU211 SAILI DESAI PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1760580088 SUFFOLK212 ROGELIO CO PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1275558157 SUFFOLK213 ROBERTO BLANDO PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1770508657 SUFFOLK214 ROXANE LACY PHYSICIAN LACY ROXANE EVONNE MD Y 1457402802 SUFFOLK215 DAVID SANCHEZ PHYSICIAN SANCHEZ DAVID EFRAIN MD Y 1528001260 SUFFOLK216 EHAB HANNA PHYSICIAN HANNA EHAB SABRY Y 1003125485 SUFFOLK217 DENISE FERRARO NURSE PRACTITIONER STONY BROOK CHILDRENS SVC UFPC Y 1518270610 SUFFOLK218 ANN COURTNEY NURSE PRACTITIONER STONY BROOK CHILDRENS SVC UFPC Y 1235128638 SUFFOLK219 JANET DIFALCO NURSE PRACTITIONER STONY BROOK CHILDRENS SVC UFPC Y 1356384168 SUFFOLK220 ALFRED SCHERZER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1699717827 SUFFOLK221 DEVINA PRAKASH PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1114935657 SUFFOLK222 SHARON NACHMAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1700828886 SUFFOLK223 JOHN POMEROY PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1659313617 SUFFOLK224 ROBERT PARKER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1902849714 SUFFOLK225 CATHY COLEMAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1962444869 SUFFOLK226 KALPANA PATEL PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1225070303 SUFFOLK227 LYCIA RYDER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1326051566 SUFFOLK228 LAURIE PANESAR PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1528216769 SUFFOLK229 ILANA PRICE PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1467612978 SUFFOLK230 JEFFREY MORGANSTERN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1306889704 SUFFOLK231 TRACI DOWNS PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1902869324 SUFFOLK232 CATHERINE KIER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1750328464 SUFFOLK233 ANNE HANSEN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1659314136 SUFFOLK234 JENNIFER OSIPOFF PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1518138395 SUFFOLK235 LESLIE QUINN' PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1578509154 SUFFOLK236 ROSA CATALDO PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1386815777 SUFFOLK237 PATRICIA GALVIN-PARTON PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1649211798 SUFFOLK238 GRACE GATHUNGU PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1639354269 SUFFOLK239 JILL CREIGHTON PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1093041451 SUFFOLK240 ROBYN LABARCA PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1710158167 SUFFOLK241 KATARINA SUPE-MARKOVINA PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1871719542 SUFFOLK242 BERRIN MONTELEONE PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1972765220 SUFFOLK243 JULIE CHERIAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1285891556 SUFFOLK244 CHRISTY BENERI PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1013178920 SUFFOLK245 SUSAN SCHUVAL PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1568517217 SUFFOLK246 JOSEPH GARTNER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1376584102 SUFFOLK247 RUPINDER GILL PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1649484791 SUFFOLK248 EDWARD CHAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1477596997 SUFFOLK249 MEGAN KASNICKI PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1396940169 SUFFOLK250 ALLISON ELISCU PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1497915862 SUFFOLK251 SUSMITA PATI PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1730102351 SUFFOLK252 ANDREW LANE PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1225070451 SUFFOLK253 PATRICIA BIGINI-QUINN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1063583052 SUFFOLK254 ANUPAMA CHAWLA PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1134162936 SUFFOLK255 ROBYN BLAIR PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1639110729 SUFFOLK256 KATHARINE KEVILL PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1700949575 SUFFOLK257 JAMES TOWNSEND PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1497973226 SUFFOLK258 THOMAS WILSON PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1063454080 SUFFOLK259 LATHA CHANDRAN PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1407894397 SUFFOLK260 SUSAN WALKER PHYSICIAN STONY BROOK CHILDRENS SVC UFPC Y 1013950955 SUFFOLK

05/09/2023 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)

261 KYLE WHITE DENTIST WHITE KYLE JEFFERSON Y 1720125537 NASSAU262 LEILANI BALAGOT CHINGCUANGCO PHYSICIAN CHINGCUANGCO LEILANI BALAGOT MD Y 1942269378 NASSAU263 THEOPHILUS OKEKE PHYSICIAN OKEKE THEOPHILUS MD Y 1083661201 NASSAU264 CLARA MAYORAL PHYSICIAN MAYORAL CLARA E MD Y 1093774432 NASSAU265 REWA THOMPSON NURSE PRACTITIONER PLANNED PARENTHOOD OF NASSAU Y 1982727574 NASSAU266 MITCHELL WEILER PHYSICIAN SOUTH ISLAND PEDIATRICS PC Y 1326046780 NASSAU267 SCOTT SHERMAN PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1215968581 NASSAU268 STEPHEN LASTIG PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1568452944 NASSAU269 LEONID REZNIK DENTIST REZNIK LEONID Y 1346447307 SUFFOLK270 RACHNA SONDHI PHYSICIAN CLUBHOUSE OF SUFFOLK INC Y 1528249950 SUFFOLK271 PAMELA KOCH CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1013055680 SUFFOLK272 JESSICA HILSENROTH CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1962410175 SUFFOLK273 GOLDIEANN MCBRIDE CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1861593501 SUFFOLK274 KRISTINE WATKINS DENTIST OPTI-HEALTHCARE Y 1043346182 SUFFOLK275 ELIZABETH CRAMER NURSE PRACTITIONER EAST END PEDIATRICS PC Y 1023003894 SUFFOLK276 PAUL OGBURN PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1992706923 SUFFOLK277 MELISSA HENRETTA PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1518175173 SUFFOLK278 ROKEYA HABIB PHYSICIAN ADVANCED REHABILITATION MED. CARE Y 1861456717 NASSAU279 DAVID LADO PHYSICIAN EAST END PEDIATRICS PC Y 1639345325 SUFFOLK280 GAIL SCHONFELD PHYSICIAN EAST END PEDIATRICS PC Y 1649264888 SUFFOLK281 ANNAMMA JOSE PHYSICIAN OPTI-HEALTHCARE Y 1942386495 SUFFOLK282 CHRISTINA KOCIS CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1437192788 SUFFOLK283 CAREEN MAURO CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1841235306 SUFFOLK284 HEATHER FINDLETAR CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1851334643 SUFFOLK285 SUSAN ALTMAN CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1063448041 SUFFOLK286 ANN VISSER CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1003859869 SUFFOLK287 AMANDA SINI CERTIFIED NURSE MIDWIFE UNIVERSITY ASSOC OB & GYN UFPC Y 1205149119 SUFFOLK288 THERESA STAVOLA NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1801045984 SUFFOLK289 JILL HINDES NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1578841466 SUFFOLK290 CHERANNE MORSE NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1861625097 SUFFOLK291 LORRAINE GIUMMULE NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1477752731 SUFFOLK292 EVA SWOBODA PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1669559043 SUFFOLK293 NANCY BUDORICK PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1275577033 SUFFOLK294 JOSEPH CHAPPELLE PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1346412855 SUFFOLK295 TODD GRIFFIN PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1013943919 SUFFOLK296 LAURI BUDNICK PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1326075367 SUFFOLK297 CHRISTINE CONWAY PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1689601445 SUFFOLK298 LISA RIMPEL PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1225130511 SUFFOLK299 RICHARD BRONSON PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1649207820 SUFFOLK300 MICHAEL DEMISHEV PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1326275256 SUFFOLK301 LEA DEFRANCISCI PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1417155243 SUFFOLK302 MICHAEL LYDIC PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1922035690 SUFFOLK303 GARY DICANIO PHYSICIAN HEALTH 1 MEDICAL PC Y 1770665721 SUFFOLK304 DAVID BAKER PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1346276276 SUFFOLK305 CECILIA AVILA PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1053353888 SUFFOLK306 ELIZABETH GARDUNO PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1306017173 SUFFOLK307 LEE WEISS PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1801936455 SUFFOLK308 MICHAEL PEARL PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1043219512 SUFFOLK309 MELISSA STRAFFORD PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1043486996 SUFFOLK310 NATALIE SEMENYUK PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1841232642 SUFFOLK311 JAMES DROESCH PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1487730149 SUFFOLK312 JAMES GERALD QUIRK PHYSICIAN UNIVERSITY ASSOC OB & GYN UFPC Y 1497756423 SUFFOLK

05/09/2023 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)

313 ALLAN ROFFE DENTIST ROFFE ALLAN DDS Y 1518009208 NASSAU314 KUSUM KATHPALIA PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1861577298 NASSAU315 NEERA AHUJA PHYSICIAN AHUJA NEERA MD PC Y 1417966185 SUFFOLK316 MARVIN WATSKY PHYSICIAN WATSKY MARVIN S DO Y 1457427379 SUFFOLK317 MARIANNE FRIERI PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1043279698 NASSAU318 JEANINE MORELLI PHYSICIAN HUDSON RIVER HEALTHCARE INC Y 1447354659 SUFFOLK319 OSKAR GAWEDA PHYSICIAN GAWEDA OSKAR ADAM Y 1174773758 NASSAU320 FARZANA AZIZ PHYSICIAN AZIZ FARZANA H MD Y 1720015506 NASSAU321 REHANA SAJJAD PHYSICIAN SAJJAD REHANA MD Y 1215946983 NASSAU322 ANU KOTHARI PHYSICIAN KOTHARI ANU MD Y 1629008180 NASSAU323 OLANREWAJU ESAN PHYSICIAN ESAN OLANREWAJU OLUSOLA Y 1861494239 NASSAU324 THULASI CHERUVANKY PHYSICIAN CHERUVANKY THULASI MD Y 1003854654 NASSAU325 SEETHA THALLUR PHYSICIAN THALLUR SEETHA MD Y 1093741761 SUFFOLK326 SUSAN TRECARTIN PHYSICIAN TRECARTIN SUSAN E MD Y 1386670826 NASSAU327 SOPHIA BICHOTTE-LIGONDE PHYSICIAN BICHOTTE LIGONDE SOPHIA MD Y 1609815612 NASSAU328 VISWANATH BALACHANDAR PHYSICIAN BALACHANDAR VISWANATHAN MD Y 1689627721 NASSAU329 SCOTT SOKOL PHYSICIAN SOKOL SCOTT K MD Y 1336181403 NASSAU330 ROY RODRIGUES PHYSICIAN RODRIGUES ROY JOHN MD Y 1710932744 NASSAU331 ELIZABETH GREENFIELD PHYSICIAN GREENFIELD ELIZABETH MD Y 1013962257 NASSAU332 MOHINDER GURAM PHYSICIAN GURAM MOHINDER K MD Y 1871546812 SUFFOLK333 IN HAN PHYSICIAN HAN IN HO MD Y 1740330356 SUFFOLK334 KENNETH HIGGINS PHYSICIAN HIGGINS KENNETH J MD Y 1780625426 NASSAU335 REGINA MCINERNEY-LOPEZ PHYSICIAN MCINERNEY-LOPEZ REGINA DO Y 1285696849 NASSAU336 THOMAS MATHEW PHYSICIAN MATHEW T POOVATHUMMOOTIL MD Y 1245282136 NASSAU337 POURUCHISHTI HIRJIBEHEDIN PHYSICIAN HIRJIBEHEDIN POURUCHISHTI MD Y 1568409308 NASSAU338 HOWARD ISENBERG PHYSICIAN ISENBERG HOWARD WARREN MD Y 1053352203 NASSAU339 SAIYEDA MADAD PHYSICIAN MADAD SAIYEDA Y 1740237866 NASSAU340 IAN WINKLER PHYSICIAN WINKLER IAN MD Y 1699703843 SUFFOLK341 ANTHONY PERROTTA DENTIST PERROTTA ANTHONY J DDS Y 1093706822 SUFFOLK342 IMRAN WAHEDNA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1073575502 NASSAU343 JAY MEHLMAN PHYSICIAN MEHLMAN JAY K MD PC Y 1649251885 NASSAU344 BLAISE NAPOLITANO PHYSICIAN HUDSON RIVER HEALTHCARE INC Y 1033318449 SUFFOLK345 QIONG WU PHYSICIAN IVY MEDICAL SERVICES PC Y 1992763916 NASSAU346 JUDITH OLSHIN DENTIST ADVANTAGE CARE D AND T CTR Y 1508932237 NASSAU347 ALISA MINKIN PHYSICIAN MINKIN ALISA NAUS Y 1063610541 NASSAU348 JANE PERR PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1730268913 NASSAU349 JULIE BATES PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1235205972 NASSAU350 BOR CHUANG PHYSICIAN FEDERATION EMPLMT/GUID SVC Y 1003997255 SUFFOLK351 CHRISTOPHER ZEOLI NURSE PRACTITIONER FEDERATION EMPLMT/GUID SVC Y 1477595114 SUFFOLK352 HARRIET HELLMAN NURSE PRACTITIONER HELLMAN HARRIET L CPNP Y 1740283613 SUFFOLK353 ELEONOR LAZO PHYSICIAN GUTIERREZ-LAZO ELEONOR PIQUER Y 1639264997 SUFFOLK354 SYEDQAMBAR NAQVI PHYSICIAN FEDERATION EMPLMT/GUID SVC Y 1700811973 SUFFOLK355 ARVENIA SWAN NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1922171222 SUFFOLK356 VALERIE SILVERMAN HARMON NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1295819530 SUFFOLK357 SEAN THOMAS NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1750635132 SUFFOLK358 NANCY FORTIN NURSE PRACTITIONER OPTI-HEALTHCARE Y 1679623896 SUFFOLK359 KAREN MALCOMSON NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1891879136 SUFFOLK360 JEANNE MORRIS-FOLEY NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1437189925 SUFFOLK361 KARINE GRIGORYANTS PHYSICIAN FEDERATION NYS MENTALLY DISAB Y 1538465299 SUFFOLK362 MICHAEL MENNELLA PHYSICIAN OPTI-HEALTHCARE Y 1366574873 SUFFOLK363 AGNIESZKA VONSTRANDTMANN PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1083740476 SUFFOLK364 DEEPIKA SOOD PHYSICIAN OPTI-HEALTHCARE Y 1518170364 NASSAU

05/09/2023 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)

365 ANAND NADKARNI PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1982779864 SUFFOLK366 MANJULA SHARMA PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1922129626 SUFFOLK367 ALEX VIDAL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1336361385 NASSAU368 SNEZHANA MULLOKANOV PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1972635753 NASSAU369 PHILIP PECORARO PHYSICIAN PEDERSON KRAG CENTER INC Y 1972618205 SUFFOLK370 JEANETTE SAMUELS NURSE PRACTITIONER WILLIAM ONYEBEKE MD PC Y 1700965787 SUFFOLK371 RENEE MCLEOD-SORDJAN NURSE PRACTITIONER WILLIAM ONYEBEKE MD PC Y 1871525535 SUFFOLK372 JUAN ZAPATA PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1255427506 SUFFOLK373 KEITH WITT PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1518065481 SUFFOLK374 NICHOLAS ROGU PHYSICIAN ROGU NICHOLAS Y 1922196948 SUFFOLK375 ANTHONY PACIA PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1235230392 SUFFOLK376 CRAIG SCANNEVIN PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1891732426 SUFFOLK377 PETER HONG PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1396707014 NASSAU378 MARIA SHEENNA SICA PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1356470785 SUFFOLK379 STEPHEN KATZ PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1295796001 NASSAU380 MONIQUE APOLLON PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1699934729 NASSAU381 JASILIN MATHEW PHYSICIAN MATHEW JASILIN D.O. Y 1891800439 SUFFOLK382 WILLIAM ONYEBEKE PHYSICIAN WILLIAM ONYEBEKE MD PC Y 1013927466 SUFFOLK383 TUSHAR VANI PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1992891287 SUFFOLK384 TABASSUM YASMIN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1255378113 NASSAU385 TERRENCE TAM PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1063592079 SUFFOLK386 WILLIAM KRUGER PHYSICIAN LONG ISLAND AMB SURG CTR LLC Y 1528169687 SUFFOLK387 FRANCISCO MEJIA DENTIST MEJIA FRANCISCO DDS Y 1225117690 SUFFOLK388 DUSTIN SOLIS DENTIST SOLIS DUSTIN R DDS Y 1730382367 NASSAU389 ERIN MCKAY NURSE PRACTITIONER GEORGE P DEMPSEY MD PC Y 1255661757 SUFFOLK390 CAROL MARKOWITZ NURSE PRACTITIONER AMB MEDICAL SERVICES PC Y 1871674291 SUFFOLK391 BEENA PATEL PHYSICIAN GEORGE P DEMPSEY MD PC Y 1407054588 SUFFOLK392 ANTHONY PELOSI PHYSICIAN CATHOLIC CHARITIES ROCKVL CTR Y 1215221858 SUFFOLK393 LILIA ZABLAN PHYSICIAN CATHOLIC CHARITIES ROCKVL CTR Y 1235222092 SUFFOLK394 YUWANNA SAVARY-LANDAU NURSE PRACTITIONER NASSAU UNIVERSITY MEDICAL CENTER Y 1447321294 NASSAU395 EILEEN INGENITO NURSE PRACTITIONER UCP ASSO OF GREATER SUFFOLK Y 1386731784 SUFFOLK396 JEANNE SPEIR NURSE PRACTITIONER HUDSON RIVER HEALTHCARE INC Y 1437101532 SUFFOLK397 VICTORIA CAPOBIANCO PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1912117144 NASSAU398 MAGGIE TETROKALASHVILI-FRIDMAN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1619944808 NASSAU399 AJENDRA SOHAL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1154399111 NASSAU400 YASMINE POMPEY PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1568531440 NASSAU401 STEVEN LEV PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1114989167 NASSAU402 EPHRAM WEINGARTEN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1619945334 NASSAU403 VLADIMIR GOTLIEB PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1073516142 NASSAU404 ELIZABETH ISSA BASCH PHYSICIAN ISSA-BASCH ELIZABETH Y 1508874553 NASSAU405 JAVED IQBAL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1841391737 NASSAU406 ROSE YOUNG PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1134147267 SUFFOLK407 NINA SIMON PHYSICIAN SIMON NINA JILL Y 1801972013 SUFFOLK408 JOEL HERSHEY PHYSICIAN AMB MEDICAL SERVICES PC Y 1760425649 SUFFOLK409 STEVEN PERRICK PHYSICIAN PERRICK STEVEN L MD Y 1083622088 NASSAU410 MARCELLE MORCOS PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1710954169 NASSAU411 ZAE KIM PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1326243031 NASSAU412 DIANE LOMBARDY PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1457313769 NASSAU413 JANICE VERLEY PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1881653707 NASSAU414 NALINI KANTH PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1790726404 NASSAU415 MAJID SAMAD PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1720040280 NASSAU416 VINETTE GREENLAND PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1164499331 NASSAU

05/09/2023 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)

417 GLENN FAUST PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1003986456 NASSAU418 DEBORAH AHERN NURSE PRACTITIONER NASSAU UNIVERSITY MEDICAL CENTER Y 1326351560 NASSAU419 PAMELA STENGEL NURSE PRACTITIONER FAMILY SVC LEAGUE SUFFOLK CTY Y 1326074329 SUFFOLK420 NANCY KEEGAN NURSE PRACTITIONER GEORGE P DEMPSEY MD PC Y 1144548942 SUFFOLK421 YUMEI DING PHYSICIAN DING YUMEI MD Y 1821245937 NASSAU422 JACOB SPERBER PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1962422535 NASSAU423 CONSTANTINE IOANNOU PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1124124003 NASSAU424 VICTOR SCARMATO PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1578613923 NASSAU425 WILBERT MANIEGO PHYSICIAN MANIEGO WILBERT BAGUYO MD Y 1356392427 NASSAU426 GEORGE DEMPSEY PHYSICIAN GEORGE P DEMPSEY MD PC Y 1407896152 SUFFOLK427 DANIEL KLAGES PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1629096672 SUFFOLK428 MANJUMMELKUDIYIL KURUVILLA PHYSICIAN FAMILY SVC LEAGUE SUFFOLK CTY Y 1790816510 SUFFOLK429 VENKATESH SASTHAKONAR ESACKIMUTHU PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1043477466 NASSAU430 KENNETH HUPART PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1356300701 NASSAU431 PRACHI ANAND PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1306805213 NASSAU432 YASMEEN NAZLI PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1952378135 NASSAU433 SHARI LOBEL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1699787481 NASSAU434 MITCHELL KARTEN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1609838655 NASSAU435 SEEMA HASHMI PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1982630430 NASSAU436 RAJENDER JINNA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1700847142 NASSAU437 KATHRYN DRAVES PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1245292275 NASSAU438 RAJVEE VORA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1831347939 NASSAU439 ADAM ISAACSON PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1871561837 NASSAU440 THOMAS POBRE PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1316915374 NASSAU441 KELLY HORN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1699730580 NASSAU442 DAVID FAGAN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1245233790 NASSAU443 LAMBROS ANGUS PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1205802493 NASSAU444 NILESH MEHTA PHYSICIAN DIGESTIVE DISEASE CARE PC Y 1649436163 NASSAU445 PAUL MUSTACCHIA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1285693820 NASSAU446 KENNETH SPITALNY PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1891878997 NASSAU447 EDWIN GONZALEZ PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1649247628 NASSAU448 DAHUA ZHOU PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1013942242 NASSAU449 ALAN MULTZ PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1558430835 NASSAU450 CHRISTINE BROWN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1992773915 NASSAU451 RICHARD BATISTA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1497722474 NASSAU452 NUBIA VARGAS-CHEN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1013081272 NASSAU453 EMILIO GARCIA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1629037072 NASSAU454 MARIE CELESTIN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1154374627 NASSAU455 SATISH KADAKIA PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1801862016 NASSAU456 JOHN KRUMENACKER PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1780661827 NASSAU457 JOEL ROSEN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1609838663 NASSAU458 ANJUM MAQBOOL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1912966946 NASSAU459 PAUL SCOTT PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1285602979 NASSAU460 LYN WEISS PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1952377988 NASSAU461 KALEEM RIZVON PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1952360968 NASSAU462 NASEEM HUSSAINI PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1306872221 NASSAU463 CHARLES FAMULARE PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1063469328 NASSAU464 AUDREY CHONG-GAYLE PHYSICIAN CHONG-GAYLE AUDREY A MD Y 1689966343 SUFFOLK465 ELIZABETH CIRINCIONE PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1134196561 NASSAU466 LENNOX BRYSON PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1235106493 NASSAU467 MARIA SAPUGAY-COZ PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1619938933 NASSAU468 LEAH BALSAM PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1184683096 NASSAU

05/09/2023 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)

469 SHADAB AHMED PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1952360935 NASSAU470 SOFIA RUBINSTEIN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1043279045 NASSAU471 ROSALIND WATMAN PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1861451775 NASSAU472 DANIEL SILBERT PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1477514172 NASSAU473 SALINI KUMAR PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1306805759 NASSAU474 CHAUR-DONG HSU PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1750325619 NASSAU475 ELSIE SANTANA-FOX PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1902874845 NASSAU476 CLARE KELLY PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1659332468 NASSAU477 OKORO UKPABI PHYSICIAN UKPABI OKORO CHIGBOH MD Y 1699873265 NASSAU478 SABIHA HAQUE PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1588623524 NASSAU479 JASON CHIANG PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1447421243 NASSAU480 NYAPATI RAO PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1801814090 NASSAU481 DAVID ROSENTHAL PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1255411708 NASSAU482 DANIEL CHIKVASHVILI PHYSICIAN NASSAU UNIVERSITY MEDICAL CENTER Y 1275592420 NASSAU483 JUDITH OLSHIN DENTIST ADVANTAGE CARE D AND T CTR Y 1508932237 NASSAU484 SANDRA WILSON NURSE PRACTITIONER ADVANTAGE CARE D AND T CTR Y 1134295876 NASSAU485 ERIC FARRON PHYSICIAN FARRON ERIC B DO Y 1295759447 NASSAU486 LILIA CHARNO NURSE PRACTITIONER MICHAEL J EVEROSKI MD PC Y 1053626226 NASSAU487 JEANETTE ALVARENGA PHYSICIAN MICHAEL J EVEROSKI MD PC Y 1427072073 NASSAU488 MICHAEL EVEROSKI PHYSICIAN MICHAEL J EVEROSKI MD PC Y 1821012139 NASSAU489 SAMINA RAGHID PHYSICIAN RAGHID SAMINA DO Y 1609950450 NASSAU490 LESLIE CESPEDES PHYSICIAN LUZ DEL CARMEN CESPEDES MD PLLC Y 1992765028 SUFFOLK491 PREETIKA GUPTA DENTIST GUPTA PREETIKA Y 1073746822 SUFFOLK492 ANDREAS NIARCHOS PHYSICIAN UCP ASSO OF NYS STATEN IS Y 1952419459 NASSAU493 LISA ROLON PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1174703193 SUFFOLK494 ALLEN KAPLAN PHYSICIAN KAPLAN ALLEN MICHAEL Y 1124056361 SUFFOLK495 VICTORIA MANNARINO NURSE PRACTITIONER PLANNED PARENTHOOD OF NASSAU Y 1063621548 NASSAU496 MARIAN COLLINS NURSE PRACTITIONER PLANNED PARENTHOOD OF NASSAU Y 1871711424 NASSAU497 JUDITH JONES NURSE PRACTITIONER PLANNED PARENTHOOD OF NASSAU Y 1689860702 NASSAU498 AARON AVNI PHYSICIAN LONG ISLAND EYE SURG CARE PC Y 1134155682 SUFFOLK499 DAVID BERGMAN PHYSICIAN PLANNED PARENTHOOD OF NASSAU Y 1427070655 NASSAU500 EDWARD RIEGEL PHYSICIAN LONG ISLAND EYE SURG CARE PC Y 1669570487 SUFFOLK501 NEIL NICHOLS PHYSICIAN LONG ISLAND EYE SURG CARE PC Y 1114140266 SUFFOLK502 JOHN PASSARELLI PHYSICIAN LONG ISLAND EYE SURG CARE PC Y 1679682702 SUFFOLK503 RAJU SARWAL PHYSICIAN LONG ISLAND EYE SURG CARE PC Y 1174627277 SUFFOLK504 ANNUPRIYA ITTEERA PHYSICIAN ITTEERA ANNUPRIYA MD Y 1518922939 NASSAU505 MEREDITH JAFFE DENTIST OPTI-HEALTHCARE Y 1619007929 SUFFOLK506 BRUCE POMERANTZ DENTIST OPTI-HEALTHCARE Y 1982730107 SUFFOLK507 LOREANE ENGELHARDT DENTIST OPTI-HEALTHCARE Y 1639297823 SUFFOLK508 BILU MATHEW DENTIST ADULTS & CHILDREN W/LDD,INC Y 1366589954 SUFFOLK509 MIRA STACO NURSE PRACTITIONER FEDERATION NYS MENTALLY DISAB Y 1235464298 NASSAU510 DEBORAH WILLOX NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1346257763 SUFFOLK511 LORRAINE RICCIARDI GOLDEN NURSE PRACTITIONER OPTI-HEALTHCARE Y 1679606784 SUFFOLK512 SUSAN MELNICK NURSE PRACTITIONER OPTI-HEALTHCARE Y 1366565202 SUFFOLK513 CHARLENE MAHER NURSE PRACTITIONER CATHOLIC CHARITIES ROCKVL CTR Y 1598898587 SUFFOLK514 JALEES AHMED PHYSICIAN FEDERATION NYS MENTALLY DISAB Y 1215945811 NASSAU515 ANTHONY ANGELO PHYSICIAN FEDERATION NYS MENTALLY DISAB Y 1932149598 SUFFOLK516 EUGENE GERARDI PHYSICIAN OPTI-HEALTHCARE Y 1245324565 SUFFOLK517 CARLA CANAVIRE WEBER PHYSICIAN FAMILY MEDICAL CARE OF BAYSHORE PC Y 1578632899 SUFFOLK518 PAUL COHEN PHYSICIAN OPTI-HEALTHCARE Y 1588751861 SUFFOLK519 MAGERY SATISH PHYSICIAN OPTI-HEALTHCARE Y 1730228800 SUFFOLK520 DEEPAK MAHAJAN PHYSICIAN DEEPAK S. MAHAJAN PHYSICIAN, P.C. Y 1295700375 NASSAU

05/09/2023 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)

521 UKUKU DIKE PHYSICIAN CENTRAL NASSAU GUIDANCE & CNS Y 1487714952 NASSAU522 RICHARD KESSLER PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1124115563 NASSAU523 NASREEN KADER PHYSICIAN KADER NASREEN MD Y 1316070030 SUFFOLK524 DULCE ALMANZAR PHYSICIAN DULCE MILAGROS ALMANZAR MD PLLC Y 1760458715 SUFFOLK525 ZEESHAN HASAN PHYSICIAN HASAN ZEESHAN SULTANA MD Y 1528005907 NASSAU526 AARON WEINREB PHYSICIAN WEINREB AARON Y 1699748970 NASSAU527 PATRICIA DELLATTO NURSE PRACTITIONER DELLATTO PATRICIA Y 1609817279 NASSAU528 DAVID ROSENBERG PHYSICIAN VI PEDIATRICS INC Y 1336134691 NASSAU529 KALPANA VEERABHADRAPPA PHYSICIAN VEERABHADRAPPA KALPANA MD Y 1760432439 NASSAU530 SHITAL SHETH PHYSICIAN SHETH SHITAL MD Y 1932150877 NASSAU531 SUDHARANI KOTHA PHYSICIAN SUDHARANI KOTHA S MD Y 1316028590 NASSAU532 STUART FEINSTEIN PHYSICIAN KIDS CARE PEDIATRIC ASSOCIATES PC Y 1154366763 NASSAU533 SHARON PERLMAN PHYSICIAN KIDS CARE PEDIATRIC ASSOCIATES PC Y 1558398305 NASSAU534 ANN MARIE KENNEY PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1922298447 NASSAU535 ELIZABETH BENJAMIN NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1629382114 SUFFOLK536 ALLAN DETWEILER PHYSICIAN DETWEILER ALLAN S MD Y 1992706402 NASSAU537 APARNA UDYAWAR PHYSICIAN PEDERSON KRAG CENTER INC Y 1912110388 SUFFOLK538 RAGHU MITRA PHYSICIAN PEDERSON KRAG CENTER INC Y 1124049226 SUFFOLK539 LUZ CESPEDES PHYSICIAN LUZ DEL CARMEN CESPEDES MD PLLC Y 1467491647 SUFFOLK540 ASHVIN DOSHI PHYSICIAN PEDERSON KRAG CENTER INC Y 1477564268 SUFFOLK541 BRENDA GEORGE PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1487826921 SUFFOLK542 BETHZAIDA PALMA-AQUINO PHYSICIAN PEDERSON KRAG CENTER INC Y 1124134234 SUFFOLK543 DEBRA EMERY PHYSICIAN PEDERSON KRAG CENTER INC Y 1164634168 SUFFOLK544 ALENA DEBROSSE NURSE PRACTITIONER CATHOLIC CHARITIES ROCKVILLE Y 1053561738 NASSAU545 VALERIE BONGIOVI NURSE PRACTITIONER CENTRAL NASSAU GUIDANCE & CNS Y 1760509863 NASSAU546 MILDRED SCHARF NURSE PRACTITIONER SCHARF MILDRED F NP Y 1891860417 SUFFOLK547 ANASTASIA BLANCHARD NURSE PRACTITIONER CATHOLIC CHARITIES ROCKVL CTR Y 1063599819 SUFFOLK548 SUK SIK KIM PHYSICIAN CATHOLIC CHARITIES ROCKVILLE Y 1770584021 NASSAU549 ESKANDAR SIMHAEE PHYSICIAN SIMHAEE ESKANDAR J MD Y 1114019155 NASSAU550 WINARDO LOMBOY DENTIST CATHOLIC CHARITIES HLTH AADC Y 1063620425 NASSAU551 FABIOLA MILORD DENTIST CATHOLIC CHARITIES HLTH AADC Y 1295728913 NASSAU552 SHAHIN SHAIKH PHYSICIAN SHAIKH SHAHIN FIROZ Y 1497840458 SUFFOLK553 YOUNGMEE LEE CERTIFIED NURSE MIDWIFE HUNTINGTON HOSP DOLAN FHC Y 1477606069 SUFFOLK554 WILLIAM GEHRHARDT PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1649297797 SUFFOLK555 RAFYA SANDHU DENTIST SANDHU RAFYA DDS Y 1326141177 NASSAU556 LEWIS O'SHEA DENTIST ADVANTAGE CARE D AND T CTR Y 1275799058 NASSAU557 SHELDON MILO DENTIST STATION ASSOCIATES INC Y 1437161965 SUFFOLK558 ROBERT WENDT DENTIST STATION ASSOCIATES INC Y 1427046606 SUFFOLK559 STELLA SLADE NURSE PRACTITIONER ADULTS & CHILDREN W/LDD,INC Y 1285779009 SUFFOLK560 CARLA CASH NURSE PRACTITIONER SUFFOLK CNTY DOH CLINIC SERV Y 1992712111 SUFFOLK561 AHMED ELKOULILY PHYSICIAN ELKOULILY AHMED MOUSTAFA MD Y 1346225927 NASSAU562 STEPHEN PERRET PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1699989145 NASSAU563 YEKATERINA RYZOVA-VAYSMAN PHYSICIAN RYZOVA-VAYSMAN YEKATERINA Y 1407867724 SUFFOLK564 ARACELI DANTES PHYSICIAN DANTES ARACELI R MD Y 1164517637 SUFFOLK565 SIRISHA DONTHIREDDY PHYSICIAN STATION ASSOCIATES INC Y 1114190303 SUFFOLK566 MAX NOEL PHYSICIAN NOEL MAX MD Y 1376513739 NASSAU567 JAMES REILLY PHYSICIAN REILLY JAMES MD Y 1558466615 SUFFOLK568 MARY PARISI PHYSICIAN PARISI MARY SIRACUSA MD Y 1023061645 NASSAU569 ROGELIO CO PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1275558157 SUFFOLK570 LESLIE RAMSAMMY PHYSICIAN LESLIE SEAN RAMSAMMY MD PC Y 1275795049 NASSAU571 NEIL BELLOVIN PHYSICIAN BELLOVIN NEIL M MD Y 1194743344 SUFFOLK572 VALERIE SCHULZ PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1184757064 NASSAU

05/09/2023 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)

573 JACK NASS PHYSICIAN ADULTS & CHILDREN W/LDD,INC Y 1467464255 SUFFOLK574 TONI ASPINALL-DALEY PHYSICIAN ASPINALL-DALEY TONI P MD Y 1720158298 NASSAU575 GEORGE ROGU PHYSICIAN ROGU GEORGE D MD Y 1215950761 SUFFOLK576 KIMBERLY HALTIWANGER PHYSICIAN HALTIWANGER KIMBERLY S MD Y 1336164292 SUFFOLK577 CATHIE GROSS PHYSICIAN GROSS CATHIE C MD Y 1710079546 NASSAU578 ANDREW AGELOFF PHYSICIAN AGELOFF ANDREW MD Y 1811085731 NASSAU579 PAULETTE GINSBURG PHYSICIAN PEDERSON KRAG CENTER INC Y 1669698494 SUFFOLK580 REHANA SAJJAD PHYSICIAN SAJJAD REHANA MD Y 1215946983 NASSAU581 ANU KOTHARI PHYSICIAN KOTHARI ANU MD Y 1629008180 NASSAU582 SUANNE KOWAL-CONNELLY PHYSICIAN KOWAL-CONNELLY SUANNE Y 1427146042 NASSAU583 ALISA MINKIN PHYSICIAN MINKIN ALISA NAUS Y 1063610541 NASSAU584 LYNDA GERBERG PHYSICIAN KINGS POINT MEDICAL PLLC Y 1740350198 NASSAU585 DANIEL BENILEVI PHYSICIAN BENILEVI DANIEL MD Y 1912941071 NASSAU586 ROBERT SOUTHARD NURSE PRACTITIONER CLUBHOUSE OF SUFFOLK INC Y 1972695377 SUFFOLK587 BERNADETTE BARRON NURSE PRACTITIONER CLUBHOUSE OF SUFFOLK INC Y 1679871032 SUFFOLK588 FRANK DOWLING PHYSICIAN CLUBHOUSE OF SUFFOLK INC Y 1255376257 SUFFOLK589 DEBORAH HERNANDEZ NURSE PRACTITIONER HUNTINGTON HOSP DOLAN FHC Y 1619080066 SUFFOLK590 JEANNINE HAND NURSE PRACTITIONER CENTRAL NASSAU GUIDANCE & CNS Y 1316130446 NASSAU591 ROBERTO BLANDO PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1770508657 SUFFOLK592 SAILI DESAI PHYSICIAN HUNTINGTON HOSP DOLAN FHC Y 1760580088 SUFFOLK593 GEORGE ISAAC PHYSICIAN CENTRAL NASSAU GUIDANCE & CNS Y 1043279342 NASSAU594 ASMA EJAZ PHYSICIAN CENTRAL NASSAU GUIDANCE & CNS Y 1841259892 NASSAU595 PAULA FABRIZIO PHYSICIAN CENTRAL NASSAU GUIDANCE & CNS Y 1457364648 NASSAU596 YUAN-FANG CHEN PHYSICIAN PEDERSON KRAG CENTER INC Y 1548336480 SUFFOLK597 CATHERINE ZILLMANN NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1326052333 SUFFOLK598 JENNIFER FERRARO NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1790983708 SUFFOLK599 MARTHA OUTCAULT NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1952488454 SUFFOLK600 CHRISTINE METZGER NURSE PRACTITIONER PEDERSON KRAG CENTER INC Y 1467419481 SUFFOLK601 HORACE HAWTHORNE PHYSICIAN SOUTH OCEAN CARE LLC Y 1750365177 NASSAU602 JAMES POWELL PHYSICIAN OPTI-HEALTHCARE Y 1467466581 SUFFOLK603 ELEONOR LAZO PHYSICIAN GUTIERREZ-LAZO ELEONOR PIQUER Y 1639264997 SUFFOLK604 SUBHASH KULKARNI PHYSICIAN PEDERSON KRAG CENTER INC Y 1861503013 SUFFOLK605 ROGER KALLHOVD PHYSICIAN PEDERSON KRAG CENTER INC Y 1134220510 SUFFOLK606 VAISHNAVI VADDIGIRI PHYSICIAN PEDERSON KRAG CENTER INC Y 1053449256 SUFFOLK607 KAMIL JAGHAB PHYSICIAN PEDERSON KRAG CENTER INC Y 1447212998 SUFFOLK608 RAYMOND PIERRE-PAUL PHYSICIAN PEDERSON KRAG CENTER INC Y 1578601399 SUFFOLK609 REDDY BEZWADA PHYSICIAN PEDERSON KRAG CENTER INC Y 1669408290 SUFFOLK610 KINGA KOREH PHYSICIAN PEDERSON KRAG CENTER INC Y 1376662957 SUFFOLK611 OANGHKARJIT BUTTAR PHYSICIAN PEDERSON KRAG CENTER INC Y 1710964051 SUFFOLK612 BETH BAILEY PHYSICIAN BAILEY BETH PLATZER MD Y 1043384613 NASSAU613 BLAISE NAPOLITANO PHYSICIAN HUDSON RIVER HEALTHCARE INC Y 1033318449 SUFFOLK614 GRETA RAINSFORD PHYSICIAN RAINSFORD GRETA M MD Y 1093891475 NASSAU615 ALAN LUBITZ PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1952348351 NASSAU616 RUSSELL GOLKOW PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1972540862 NASSAU617 STEVEN HAM PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1982646816 NASSAU618 NARAYAN PARUCHURI PHYSICIAN DOSHI DIAGNOSTIC IMAGING SRV Y 1710926134 NASSAU619 PATRICIA TAN PHYSICIAN UCP ASSO OF GREATER SUFFOLK Y 1821086737 SUFFOLK620 GAIL FRASER-FARMER PHYSICIAN UCP ASSO OF GREATER SUFFOLK Y 1841223997 SUFFOLK621 IJAZ AHMAD PHYSICIAN AHMAD IJAZ MD Y 1902895238 NASSAU622 THOMAS ZIMMERMAN PHYSICIAN SOUTH NASSAU FAMILY MED PC Y 1528057767 NASSAU623 LINDA ROETHEL PHYSICIAN SOUTH NASSAU FAMILY MED PC Y 1801881677 NASSAU624 EMAD HANNA PHYSICIAN SOUTH NASSAU FAMILY MED PC Y 1912992785 NASSAU

05/09/2023 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)

625 SAMUEL SANDOWSKI PHYSICIAN SOUTH NASSAU FAMILY MED PC Y 1952396723 NASSAU626 SCOTT IPPOLITO PHYSICIAN SOUTH NASSAU FAMILY MED PC Y 1619962586 NASSAU627 MARITZA DOMINGUEZ NURSE PRACTITIONER SOUTH OCEAN CARE LLC Y 1457339202 NASSAU628 DATA LONGJOHN PHYSICIAN SKOPE MEDICAL CARE PC Y 1215075882 SUFFOLK629 HARRIET HELLMAN NURSE PRACTITIONER HELLMAN HARRIET L CPNP Y 1740283613 SUFFOLK630 SCOTT BROWN PHYSICIAN BROWN SCOTT MD Y 1801960984 NASSAU631 JANE PERR PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1730268913 NASSAU632 OLANREWAJU ESAN PHYSICIAN ESAN OLANREWAJU OLUSOLA Y 1861494239 NASSAU633 ALLAN ROFFE DENTIST ROFFE ALLAN DDS Y 1518009208 NASSAU634 CATHERINE SCRENCI PHYSICIAN SCRENCI CATHERINE R MD Y 1164505111 NASSAU635 MITCHELL WEILER PHYSICIAN SOUTH ISLAND PEDIATRICS PC Y 1326046780 NASSAU636 KEITH LEVENTHAL PHYSICIAN LEVENTHAL KEITH S DO Y 1144394214 NASSAU637 STEVEN PERRICK PHYSICIAN PERRICK STEVEN L MD Y 1083622088 NASSAU638 ELIZABETH ISSA BASCH PHYSICIAN ISSA-BASCH ELIZABETH Y 1508874553 NASSAU639 JATIN KAPADIA PHYSICIAN KAPADIA JATIN D MD PC Y 1134179831 NASSAU640 QIONG WU PHYSICIAN IVY MEDICAL SERVICES PC Y 1992763916 NASSAU641 ELIZABETH CRAMER NURSE PRACTITIONER EAST END PEDIATRICS PC Y 1023003894 SUFFOLK642 JULIE BATES PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1235205972 NASSAU643 KUSUM KATHPALIA PHYSICIAN ADVANTAGE CARE D AND T CTR Y 1861577298 NASSAU644 NEERA AHUJA PHYSICIAN AHUJA NEERA MD PC Y 1417966185 SUFFOLK645 BELINDA MARQUIS PHYSICIAN MARQUIS BELINDA AGHARESE MD Y 1508827080 SUFFOLK646 DAVID LADO PHYSICIAN EAST END PEDIATRICS PC Y 1639345325 SUFFOLK647 GAIL SCHONFELD PHYSICIAN EAST END PEDIATRICS PC Y 1649264888 SUFFOLK648 JOEL HERSHEY PHYSICIAN AMB MEDICAL SERVICES PC 1760425649 SUFFOLK649650651652653654655656657658659660661662663664665666667668669670671672673674675676

05/09/2023 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)

677678679680681682683684685686687688689690691692693694695696697698699700701702703704705706707708709710711712713714715716717718719720721722723724725726727728

05/09/2023 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)

729730731732733734735736737738739740741742743744745746747748749750751752753754755756757758759760761762763764765766767768769770771772773774775776777778779780

05/09/2023 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)

781782783784785786787788789790791792793794795796797798799800801802803804805806807808809810811812813814815816817818819820821822823824825826827828829830831832

05/09/2023 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)

833834835836837838839840841842843844845846847848849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884

05/09/2023 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)

885886887888889890891892893894895896897898899900901902903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936

05/09/2023 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)

937938939940941942943944945946947948949950951952953954955956957958959960961962963964965966967968969970971972973974975976977978979980981982983984985986987988

05/09/2023 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)

989990991992993994995996997998999

10001001100210031004100510061007100810091010101110121013101410151016101710181019102010211022102310241025102610271028102910301031103210331034103510361037103810391040

05/09/2023 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)

1041104210431044104510461047104810491050105110521053105410551056105710581059106010611062106310641065106610671068106910701071107210731074107510761077107810791080108110821083108410851086108710881089109010911092

05/09/2023 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)

1093109410951096109710981099110011011102110311041105110611071108110911101111111211131114111511161117111811191120112111221123112411251126112711281129113011311132113311341135113611371138113911401141114211431144

05/09/2023 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)

1145114611471148114911501151115211531154115511561157115811591160116111621163116411651166116711681169117011711172117311741175117611771178117911801181118211831184118511861187118811891190119111921193119411951196

05/09/2023 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)

1197119811991200120112021203120412051206120712081209121012111212121312141215121612171218121912201221122212231224122512261227122812291230123112321233123412351236123712381239124012411242124312441245124612471248

05/09/2023 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)

1249125012511252125312541255125612571258125912601261126212631264126512661267126812691270127112721273127412751276127712781279128012811282128312841285128612871288128912901291129212931294129512961297129812991300

05/09/2023 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)

1301130213031304130513061307130813091310131113121313131413151316131713181319132013211322132313241325132613271328132913301331133213331334133513361337133813391340134113421343134413451346134713481349135013511352

05/09/2023 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)

1353135413551356135713581359136013611362136313641365136613671368136913701371137213731374137513761377137813791380138113821383138413851386138713881389139013911392139313941395139613971398139914001401140214031404

05/09/2023 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)

1405140614071408140914101411141214131414141514161417141814191420142114221423142414251426142714281429143014311432143314341435143614371438143914401441144214431444144514461447144814491450145114521453145414551456

05/09/2023 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)

1457145814591460146114621463146414651466146714681469147014711472147314741475147614771478147914801481148214831484148514861487148814891490149114921493149414951496149714981499150015011502150315041505150615071508

05/09/2023 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)

1509151015111512151315141515151615171518151915201521152215231524152515261527152815291530153115321533153415351536153715381539154015411542154315441545154615471548154915501551155215531554155515561557155815591560

05/09/2023 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)

1561156215631564156515661567156815691570157115721573157415751576157715781579158015811582158315841585158615871588158915901591159215931594159515961597159815991600160116021603160416051606160716081609161016111612

05/09/2023 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)

1613161416151616161716181619162016211622162316241625162616271628162916301631163216331634163516361637163816391640164116421643164416451646164716481649165016511652165316541655165616571658165916601661166216631664

05/09/2023 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)

1665166616671668166916701671167216731674167516761677167816791680168116821683168416851686168716881689169016911692169316941695169616971698169917001701170217031704170517061707170817091710171117121713171417151716

05/09/2023 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)

1717171817191720172117221723172417251726172717281729173017311732173317341735173617371738173917401741174217431744174517461747174817491750175117521753175417551756175717581759176017611762176317641765176617671768

05/09/2023 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)

1769177017711772177317741775177617771778177917801781178217831784178517861787178817891790179117921793179417951796179717981799180018011802180318041805180618071808180918101811181218131814181518161817181818191820

05/09/2023 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)

1821182218231824182518261827182818291830183118321833183418351836183718381839184018411842184318441845184618471848184918501851185218531854185518561857185818591860186118621863186418651866186718681869187018711872

05/09/2023 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)

1873187418751876187718781879188018811882188318841885188618871888188918901891189218931894189518961897189818991900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924

05/09/2023 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)

1925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976

05/09/2023 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)

197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

DSRIP Project Design Grant Application Section 2.3 IPA/Physician List

16

Email

05/09/2023 document.xlsx

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 Email

123456789

1011121314151617181920212223242526272829303132333435363738394041424344454647

SN Qualified (Y/N)

05/09/2023 document.xlsx

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)

4849505152535455565758596061626364656667686970717273747576777879808182838485868788899091929394

05/09/2023 document.xlsx

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)

9596979899

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

847848849850851852853854855856857858859860861862863864865866867868869870871872873874875876877878879880881882883884885886887888889890891892893

05/09/2023 document.xlsx

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)

894895896897898899900901902903904905906907908909910911912913914915916917918919920921922923924925926927928929930931932933934935936937938939940

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

988989990991992993994995996997998999

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

10821083108410851086108710881089109010911092109310941095109610971098109911001101110211031104110511061107110811091110111111121113111411151116111711181119112011211122112311241125112611271128

05/09/2023 document.xlsx

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)

11291130113111321133113411351136113711381139114011411142114311441145114611471148114911501151115211531154115511561157115811591160116111621163116411651166116711681169117011711172117311741175

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

12231224122512261227122812291230123112321233123412351236123712381239124012411242124312441245124612471248124912501251125212531254125512561257125812591260126112621263126412651266126712681269

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

13171318131913201321132213231324132513261327132813291330133113321333133413351336133713381339134013411342134313441345134613471348134913501351135213531354135513561357135813591360136113621363

05/09/2023 document.xlsx

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)

13641365136613671368136913701371137213731374137513761377137813791380138113821383138413851386138713881389139013911392139313941395139613971398139914001401140214031404140514061407140814091410

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

21162117211821192120212121222123212421252126212721282129213021312132213321342135213621372138213921402141214221432144214521462147214821492150215121522153215421552156215721582159216021612162

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

27742775277627772778277927802781278227832784278527862787278827892790279127922793279427952796279727982799280028012802280328042805280628072808280928102811281228132814281528162817281828192820

05/09/2023 document.xlsx

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)

28212822282328242825282628272828282928302831283228332834283528362837283828392840284128422843284428452846284728482849285028512852285328542855285628572858285928602861286228632864286528662867

05/09/2023 document.xlsx

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)

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05/09/2023 document.xlsx

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)

29152916291729182919292029212922292329242925292629272928292929302931293229332934293529362937293829392940294129422943294429452946294729482949295029512952295329542955295629572958295929602961

05/09/2023 document.xlsx

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)

296229632964296529662967296829692970297129722973297429752976297729782979298029812982298329842985298629872988298929902991299229932994299529962997299829993000

05/09/2023 document.xlsx

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)

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 involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be promoted through out the program. All in all the PAC is an effort to coordinate several stakeholders and eliminate the issue of department isolation.

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

The Project Advisory Committee will be involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be promoted through out the program. All in all the PAC is an effort to coordinate several stakeholders and eliminate the issue of department isolation.

05/09/2023 document.xlsx

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?

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

^ 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

Our vision is to have an all-encompassing PPS for Nassau and Suffolk Counties. Because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year. On the current application, we have included 150 General Partner Organizations. 64 Other types of organization, and over 600 MD, DO, NP, PA, CNMW, DDS, DMD. We strive to have every area of care represented on the PAC along with the non-provider participants. ADO proposes to create Like-Groups and work with each group to elect representatives on the PAC. The PAC should be limited to a workable number of representatives, no more than 20, who can work in sub-committees. Each sub-committee will have responsibilities granted to them by the Like-Groups they represent. The sub-committees will get together when needed in general assembly to vote and pass new rules and regulations governing the PPS as a whole.Each sub-committee will be empowered to make decisions up to a certain level without having to obtain the approval of the full PAC so long as the currently in-force guidelines are followed and the lines of authorities are respected. The limited autonomy of the sub-committees is paramount to the full functionality of the PPS system as it will avoid paralysis by analysis and permit for rapid intervention measures to be quickly implemented. The PAC as a group will always review sub-committees decisions and have the opportunity to question and even reverse them with a majority vote (maybe between 65% and 75%).All decisions will be guided by the general PPS philosophy, the goals of the DSRIP program as a whole, and the evidence based reports and research data available to the committee members. In order to ensure that the PAC functions effectively, all care will be given to limit authorities of all sub-committees so as to avoid having super-sub-committees and potentially powerful committee members who can halt the process with their sole vote.Through the Community Assessments Need and Stakeholder engagement we intend to seek input as to the best manner to form Like-Groups. They will need to encompass representatives from:1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) – we need to show them how the PPS can help them find/increase sources of revenue in the new paradigm:a. Public Hospitalsb. Voluntary Hospitalsc. Critical Access Hospitalsd. Sole Community Providerse. Etc…

2. FQHC’s3. Article 164. Article 285. Article 316. Associations such as:a. Mental Health Association of Nassau/Sufflok/NYCb. Family and Children's Association: Home and community based servicesc. Long Island Council on Alcoholism and Drug Dependenced. Circulo de la Hispanidad

05/09/2023 document.xlsx

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)

Name

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(1)

Name

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(1)

Name

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

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:

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

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.

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.

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 involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be promoted through out the program. All in all the PAC is an effort to coordinate several stakeholders and eliminate the issue of department isolation.

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

The Project Advisory Committee will be involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be promoted through out the program. All in all the PAC is an effort to coordinate several stakeholders and eliminate the issue of department isolation.

05/09/2023 document.xlsx

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)

Are you proposing an alternative structure for your Project Advisory Committee? Yes

Please give an explanation of how your emerging PPS will be structuring your Project Advisory Committee? (Restricted to 5000 characters)Characters used:

^ 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.

contain over 20 partnering organizations

Our vision is to have an all-encompassing PPS for Nassau and Suffolk Counties. Because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be performing at the top of their ability as they have to recertify every two year. On the current application, we have included 150 General Partner Organizations. 64 Other types of organization, and over 600 MD, DO, NP, PA, CNMW, DDS, DMD. We strive to have every area of care represented on the PAC along with the non-provider participants. ADO proposes to create Like-Groups and work with each group to elect representatives on the PAC. The PAC should be limited to a workable number of representatives, no more than 20, who can work in sub-committees. Each sub-committee will have responsibilities granted to them by the Like-Groups they represent. The sub-committees will get together when needed in general assembly to vote and pass new rules and

Each sub-committee will be empowered to make decisions up to a certain level without having to obtain the approval of the full PAC so long as the currently in-force guidelines are followed and the lines of authorities are respected. The limited autonomy of the sub-committees is paramount to the full functionality of the PPS system as it will avoid paralysis by analysis and permit for rapid intervention measures to be quickly implemented. The PAC as a group will always review sub-committees decisions and have the opportunity to question and even reverse them with a majority vote (maybe between 65% and 75%).All decisions will be guided by the general PPS philosophy, the goals of the DSRIP program as a whole, and the evidence based reports and research data available to the committee members. In order to ensure that the PAC functions effectively, all care will be given to limit authorities of all sub-committees so as to avoid having super-sub-committees and potentially powerful committee members who can halt the process with their sole vote.Through the Community Assessments Need and Stakeholder engagement we intend to seek input as to the best manner to form Like-Groups. They will need to encompass representatives from:1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) – we need to show them how the PPS can help them find/increase sources of revenue in the new paradigm:

a. Mental Health Association of Nassau/Sufflok/NYCb. Family and Children's Association: Home and community based servicesc. Long Island Council on Alcoholism and Drug Dependence

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

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.

(2) (3)

Partner Organization NameSelect 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

Partner Organization Representative/Union Representative*/Worker Representative

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(2) (3)

Partner 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 One

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(2) (3)

Partner 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 One

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

How will the Project Advisory Committee assist the emerging Performing Provider System in the development of its DSRIP Project Plan? (Restricted to 4500 characters)2421

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

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.

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

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 involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

The Project Advisory Committee will be involved through out the entire process in developing a PPS DSRIP project plan. Being that the stakeholders are investing a great deal of time and money into this project, it only makes sense to have they be considered the primary candidates to fill the positions on the PAC. A panel will be created comprised of stakeholders to stand as representatives for each participating organization. The representatives in the PAC will voice the concerns and/or opinions of the subcommittees created within each stakeholder organization. Subsequently the subcommittees will have the responsibility to report to the PAC representatives of their respective stakeholder. Meetings will be held on a monthly basis to address: issues that pose a threat to continuous quality improvement, review the progress made and milestones achieved, discuss areas that need more focus in continuous quality improvement for patient care, etc. Meeting reminders will be addressed a week prior to and one day prior to the scheduled meeting date to ensure full attendance to formal proceedings. Organizing a Project Advisory Committee will assist in emerging a PPS in development of DSRIP project plan. Having an effective PAC will require that a leader/chairperson be nominates/assigned/volunteered, whom then will assign clear responsibilities and specific function to the remaining members of the PAC. The leader/chairperson will establish and provide guidelines for ensuring committees effectiveness. Having a collaboration of providers in place for the PAC will allow for a multiplication of expertise. The Leader will set a culture within the PAC, which will encourage members to be sensitive to the group dynamic and organizational conflict considerations, counterbalance authority and facilitate communication. This will allow for an environment that promotes coordination and cooperation, which is dire throughout the process. In the event that an action needs to be postponed or even avoided, having open lines of communication within the PAC will allow for group deliberations to easily see this action into fruition. Necessary logistical support will be provided as well as periodic evaluations of the committees purposes and/or progress will be

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

3076

, qualifying PPS may propose an alternative PAC structure that will allow for a leaner committee as long as the proposed structure is still

Our vision is to have an all-encompassing PPS for Nassau and Suffolk Counties. Because we are all inclusive at the beginning, there are no providers left behind. However, every PPS provider will have to make the decision to go through the Organization/Group/Practice Transformation Process and emerge as a PPS compliant entity. It will be up to the entity to commit and remain a PPS member. Through our PPS certification program every PPS member will always be

On the current application, we have included 150 General Partner Organizations. 64 Other types of organization, and over 600 MD, DO, NP, PA, CNMW, DDS, DMD. We strive to have every area of care represented on the PAC along with the non-provider participants. ADO proposes to create Like-Groups and work with each group to elect representatives on the PAC. The PAC should be limited to a workable number of representatives, no more than 20, who can work in sub-committees. Each sub-committee will have responsibilities granted to them by the Like-Groups they represent. The sub-committees will get together when needed in general assembly to vote and pass new rules and

Each sub-committee will be empowered to make decisions up to a certain level without having to obtain the approval of the full PAC so long as the currently in-force guidelines are followed and the lines of authorities are respected. The limited autonomy of the sub-committees is paramount to the full functionality of the PPS system as it will avoid paralysis by analysis and permit for rapid intervention measures to be quickly implemented. The PAC as a group will

All decisions will be guided by the general PPS philosophy, the goals of the DSRIP program as a whole, and the evidence based reports and research data available to the committee members. In order to ensure that the PAC functions effectively, all care will be given to limit authorities of all sub-committees so as to avoid having super-sub-committees and potentially powerful committee members who can halt the process with their sole vote.Through the Community Assessments Need and Stakeholder engagement we intend to seek input as to the best manner to form Like-Groups. They will need to encompass representatives from:1. Hospitals: on the surface, they seems to have the most to lose (25% of admissions) – we need to show them how the PPS can help them find/increase sources of revenue in the new paradigm:

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

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.

(4)

*Union Organization Name

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(4)

*Union Organization Name

05/09/2023 document.xlsx

NYS DOH DSRIP_Project Design Grant Application Section 10 Section 10 - Project Advisory Committee (PAC)

(4)

*Union Organization Name

Domain 2

2A.2B.2C.

Select One2.A.I

2.A.II2.A.III2.A.IV2.A.V

Select One2.B.I

2.B.II2.B.III2.B.IV2.B.V

2.B.VI2.B.VII

2.B.VIII2.B.IX

2.C.I2.C.II

Select One2.A.I

2.A.II2.A.III2.A.IV2.A.V2.B.I

2.B.II2.B.III2.B.IV2.B.V

2.B.VI2.B.VII

2.B.VIII2.B.IX

2.C.I2.C.II

Domain 33A.3B.3C.3D.3E.3F.3G.3H.

Select One3.A.I

3.A.II3.A.III3.A.IV3.A.V3.B.I

3.B.II3.C.I

3.C.II3.D.I

3.D.II3.D.III

3.E.I3.F.I3.G.I

3.G.II3.G.III

3.H.I

Domain 44A.4B.4C.4D.

Select One4.A.I

4.A.II4.A.III

4.B.I4.B.II4.C.I

4.C.II4.C.III4.C.IV

4.D.I

System Transformation Projects

Create Integrated Delivery Systems (required)Implementation of care coordination and transitional care programsConnecting system

Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 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))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. Create a medical village using existing hospital infrastructure Create a medical village/ alternative housing using existing nursing home

Ambulatory ICUsDevelopment of co-located primary care services in the emergency department (ED) ED care triage for at-risk populationsCare transitions intervention model to reduce 30 day readmissions for chronic health conditionsCare transitions intervention for skilled nursing facility residentsTransitional supportive housing servicesImplementing the INTERACT project (inpatient transfer avoidance program for SNF)Hospital-Home Care Collaboration SolutionsImplementation of observational programs in hospitals Development of community-based health navigation services Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services

Create Integrated Delivery Systems that are focused on Evidence Based Medicine / Population Health Management 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))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. Create a medical village using existing hospital infrastructure Create a medical village/ alternative housing using existing nursing homeAmbulatory ICUsDevelopment of co-located primary care services in the emergency department (ED) ED care triage for at-risk populationsCare transitions intervention model to reduce 30 day readmissions for chronic health conditionsCare transitions intervention for skilled nursing facility residentsTransitional supportive housing servicesImplementing the INTERACT project (inpatient transfer avoidance program for SNF)Hospital-Home Care Collaboration SolutionsImplementation of observational programs in hospitals Development of community-based health navigation services Expand usage of telemedicine in underserved areas to provide access to otherwise scarce services

Clinical Improvement ProjectsBehavioral Health (Required)Cardiovascular HealthDiabetes CareAsthmaHIVPerinatalPalliative CareRenal Care

Integration of primary care services and behavioral health Behavioral health community crisis stabilization services Implementation of evidence based medication adherence program (MAP) in community based sites for behavioral health medication complianceDevelopment of withdrawal management (ambulatory detoxification) capabilities within communitiesBehavioral Interventions Paradigm in Nursing Homes (BIPNH) Evidence based strategies for disease management in high risk/affected populations (adult only)Implementation of evidence-based strategies in the community to address chronic disease -- primary and secondary prevention projects (adult only)Evidence-based strategies for disease management in high risk/affected populations (adults only)Implementation of evidence-based strategies in the community to address chronic disease – primary and secondary prevention projects (adults only)

Development of evidence-based medication adherence programs (MAP) in community settings –asthma medicationExpansion of asthma home-based self-management programEvidence based medicine guidelines for asthma management Comprehensive Strategy to decrease HIV/AIDS transmission to reduce avoidable hospitalizations – development of a Center of Excellence for management of HIV/AIDS Increase support programs for maternal & child health (including high risk pregnancies) (Example: Nurse-Family Partnership)

IHI “Conversation Ready” modelIntegration of palliative care into medical homesIntegration of palliative care into nursing homesSpecialized Medical Home from Chronic Renal Failure

Population-Wide ProjectsPromote Mental Health and Prevent Substance Abuse (MHSA)Prevent Chronic DiseasesPrevent HIV and STD'sPromote Healthy Women, Infants and Children

Promote mental, emotional and behavioral (MEB) well-being in communitiesPrevent Substance Abuse and other Mental Emotional Behavioral DisordersStrengthen Mental Health and Substance Abuse Infrastructure across SystemsPromote tobacco use cessation, especially among low SES populations and those with poor mental healthIncrease 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)

Decrease HIV morbidity Increase early access to, and retention in, HIV careDecrease STD morbidityDecrease HIV and STD disparitiesReduce premature births

INDEX SCORE

5637465442

3640434341474145363731

56374654423640434341474145363731

393729364030263026283131282929222529

23202023171919151824