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State of Wisconsin Provider Directory 2020 W9

2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

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Page 1: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

State of WisconsinProvider Directory2020 W9

Live well.We’ll insure you do.

Live well.We’ll insure you do.

Page 2: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth
Page 3: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare ID Card

MercyCare ID cards include:

INSURED NUMBER: Identification number

GROUP NUMBER: How MercyCare identifies your benefit package

MEMBER NUMBER: Personal identification number

PCP NAME: Your primary care physician (family medicine, internal medicine, pediatrician)

PLAN ID: Designates your plan

NAME OF PLAN: Type of plan you have

Customer service department: (800) 895-2421

Important information to know:

This provider list is the only paper version you will receive, unless you call our customer service department at (800) 895-2421 for additional copies.

MercyCare encourages you to visit our website or contact customer service for the most current information regarding your provider network. To ensure accurate provider network listings, the on-line provider directory is continuously updated while the requestable paper directory is updated semi-annually only. Please visit www.mercycarehealthplans.com to see which providers participate in your plan.

Above is an illustration of a MercyCare HMO membership card. To determine which plan you are in, please refer to your ID card.

The card(s) you receive states the plan name, as well as the plan ID. Should you have any questions, or if you are unable to determine your specific plan name and/or plan ID, please call our customer service department at (800) 895-2421.

MercyCare Senior

Insured Number Effective Date Group Numberxxx-xx-xxxx xxxxxx

Member Number Last Name PCP Namexxx-xx-xxxx John Doe Dr. Smith

XX5

1

6

2

3 4

1

5

6

2

3

4

Page 4: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

Hospitals

Javon Bea Hospital–Riverside 8201 East Riverside Blvd. Rockford, IL(815) 971-7000

Javon Bea Hospital–Rockton 2400 N. Rockton Ave. Rockford, IL (815) 971-5000

Mercyhealth Hospital and Medical Center–Harvard 901 Grant St. Harvard, IL (815) 943-5431

Mercyhealth Hospital and Medical Center–Walworth N2950 State Rd. 67 Lake Geneva, WI (262) 245-2230

Mercyhealth Hospital and Trauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000

Fort Memorial Hospital 611 Sherman Ave. East Fort Atkinson, WI (920) 568-5000

Watertown Memorial Hospital 125 Hospital Dr. Watertown, WI (920) 261-4210

Emergency Care

Javon Bea Hospital–Riverside 8201 East Riverside Blvd. Rockford, IL(815) 971-7000

Javon Bea Hospital–Rockton 2400 N. Rockton Ave. Rockford, IL (815) 971-5000

Mercyhealth Hospital and Medical Center–Harvard 901 Grant St. Harvard, IL (815) 943-5431

Mercyhealth Hospital and Trauma Center Emergency North 3400 Deerfield Dr. Janesville, WI (608) 314-3605

Mercyhealth Hospital and Trauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000

Mercyhealth Hospital and Medical Center–Walworth N2950 State Rd. 67 Lake Geneva, WI (262) 245-2230

Fort Memorial Hospital 611 Sherman Ave. East Fort Atkinson, WI (920) 568-5000

Watertown Memorial Hospital 125 Hospital Dr. Watertown, WI (920) 261-4210

Urgent Care Clinics

Mercyhealth Beloit 2825 Prairie Ave. Beloit, WI (608) 363-5500

Mercyhealth Belvidere 1747 Henry Luckow Ln. Belvidere, IL (815) 971-3055

Mercyhealth Byron 130 Kysor Dr. Byron, IL (815) 971-3099

Mercyhealth East 3524 E. Milwaukee St. Janesville, WI (608) 756-8484

Mercyhealth Mall 1010 N. Washington St. Janesville, WI (608) 741-3800

Mercyhealth McHenry 3922 Mercy Dr. McHenry, IL (815) 578-2020

Mercyhealth North 3400 Deerfield Dr. Janesville, WI (608) 314-3605

Mercyhealth Perryville 3401 N. Perryville Rd. Rockford, IL (815) 971-8000

Mercyhealth Rockton Avenue 2300 N. Rockton Ave., Bldg. 1 Rockford, IL (815) 971-2572

Mercyhealth Roscoe 5000 Prairie Rose Dr. Roscoe, IL (815) 971-3450

Mercyhealth South 849 Kellogg Ave. Janesville, WI (608) 755-7960

Mercyhealth Hopsital and Medical Center–Walworth N2950 State Rd. 67 Lake Geneva, WI (262) 245-2230

Mercyhealth Whitewater 507 W. Main St. Whitewater, WI (262) 473-0401

Mercyhealth Winnebago 102 Landmark Dr. Winnebago, IL (815) 971-3250

Mercyhealth Woodstock 2000 Lake Ave. Woodstock, IL (815) 337-1544

Fort HealthCare Lake Mills 200 E. Tyranena Park Rd. Lake Mills, WI (920) 648-3113

Fort Memorial Hospital 611 Sherman Ave. East Fort Atkinson, WI (920) 568-5000

Watertown Memorial Hospital 125 Hospital Dr. Watertown, WI (920) 261-4210 Skip the waiting room!

Visit MercyInQuicker.org to reserve your spot at a participating facility.

Hospitals, Emergency and Urgent Care

Page 5: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

Algonquin, IL ................... 37

Barrington, IL .................. 37

Beloit, WI ........................... 1

Belvidere, IL ................ 37-38

Brodhead, WI .................. 1-2

Brown Deer, WI ................. 2

Byron, IL .......................... 39

Cambridge, WI .................. 2

Cherry Valley, IL ............... 39

Clinton, WI ......................... 2

Crystal Lake, IL ........... 39-40

Delavan, WI ...................... 2

Edgerton, WI ................... 2-3

Elkhorn, WI ....................... 3

Evansville, WI ................ 3-4

Fort Atkinson, WI ............ 4-6

Harvard, IL ................. 40-41

Ixonia, WI ........................... 7

Janesville, WI ............... 7-21

Jefferson, WI ............. 21-22

Johnson Creek, WI ..... 22-23

Juneau, WI ....................... 23

Kenosha, WI ..................... 23

Lake Geneva, WI ....... 23-27

Lake Mills, WI ............ 26-27

Loves Park, IL ............. 41-42

Madison, WI ............... 27-28

Machesney Park, IL ......... 43

McHenry, IL ................ 43-44

Milton, WI ........................ 28

Milwaukee, WI ................. 28

Monona, WI ..................... 28

Monroe, WI ................. 28-29

Northbrook, IL ................. 44

Oconomowoc, WI............ 29

Racine, WI ........................ 29

Richmond, IL ................... 44

Rockford, IL ................ 44-63

Roscoe, IL ................... 63-64

Schaumburg, IL ............... 64

Waterloo, WI ............... 29-30

Watertown, WI ............ 30-35

Waukesha, WI .................. 35

West Allis, WI ................... 35

West Milwaukee, WI........ 35

Whitewater, WI ........... 35-36

Williams Bay, WI ........ 36-37

Winnebago, IL ................. 64

Woodstock, IL .................. 65

Index by City

Page 6: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Beloit, WI

Beloit Comprehensive Treatment Center

2240 Prairie Ave

(608) 361-7200

Beloit, WI 53511

Methadone Clinic Practice Status:

Beloit Comprehensive Treatment Center, , Open

Board Certified: Council on Accreditation

,

,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Beloit

2825 Prairie Ave

(608) 756-5555

Beloit, WI 53511

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Beloit, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

DeGarmo-Haakenson, Karla, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Mattison, Faith, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Mercyhealth Beloit

2825 Prairie Ave

(608) 363-5500

Beloit, WI 53511

Advanced Practice Nurse Prescriber Practice Status:

Huenerberg, Carmen, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Parker, Natalie, APRN Open

Board Certified: National Certification Corporation (Women's Health Care Nurse Practitioner)Univ of Cincinnati, Cincinnati, OH

,

Medical School:

Residency:

Family Medicine Practice Status:

Flood, James, MD Open

Board Certified: American Board of Family Medicine

University of Michigan Medical School, AnnArbor, MI

Loma Linda University Family Practice Residency Program, Loma Linda, CA

Medical School:

Residency:

So, Jason, DO Open

Board Certified: American Board of Family Medicine

Des Moines Univ, Des Moines, IA

Univ of Illinois College of Medicine at Peoria, Peoria, IL

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Kaldor, Katheryn, DO Open

Board Certified: American Osteopathic Board of Obstetrics and Gynecology

Kansas City Univ of Medicine, Kansas City, MO

Philadelphia College of Osteopathic Medicine, Philadelphia, PA

Medical School:

Residency:

Wistrom, Elana, DO Open

Board Certified: American Osteopathic Board of Obstetrics and Gynecology

A.T. Still Univ, Kirksvill, MO

Henry Ford Macomb Hospital, Clinton Twp, MI

Medical School:

Residency:

Pediatrics Practice Status:

Peete, Emarcia, MD Open

Board Certified: Not Board Certified

Medical College of Wisconsin, Milwaukee, WI

Morehouse School of Medicine, Atlanta, GA

Medical School:

Residency:

Podiatry Practice Status:

Feuerstein, Catherine, DPM Open

Board Certified: American Board of Foot and Ankle Surgery

Scholl College of Podiatric Medicine, North Chicago, IL

North Port VA Residency, North Port, NY

Medical School:

Residency:

Swanson, Brock, DPM Open

Board Certified:

Temple University School of Podiatric Medicine, Philadelphia, PA

Main Line Health, Bryn Mawr Hospital, Bryn Mawr, PA

Medical School:

Residency:

Mercyhealth Beloit Urgent Care

2825 Prairie Ave

(608) 363-5500

Beloit, WI 53511

Urgent Care Center Practice Status:

Mercyhealth Beloit UC, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

The Green Knolls at Beloit Operations LLC

1905 West Hart Rd

(608) 365-2554

Beloit, WI 53115

Skilled Nursing Facility Practice Status:

The Green Knolls at Beloit Operations LLC, , Open

Board Certified:

,

,

Medical School:

Residency:

Brodhead, WI

Mercyhealth Brodhead

2310 First Center Ave

(608) 897-8664

Brodhead, WI 53520

Advanced Practice Nurse Prescriber Practice Status:

Huenerberg, Carmen, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Family Medicine Practice Status:

Bluemel, Kevin, MD Closed

Board Certified: American Board of Family Medicine

Indiana University School of Medicine, Indianapolis, IN

Mercy Health System Family Practice Residency Program, Janesville, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 1 of 65W9

Page 7: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Wilke Chiropractic Office, SC

E101 4th Street

(608) 897-3010

Brodhead, WI 53520

Chiropractic Practice Status:

Malott, Travis, DC Open

Board Certified: National Board Chiropractic Examiners

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Brown Deer, WI

Rogers Memorial Hospital - Brown Deer

4600 Schroeder Dr

(800) 767-4411

Brown Deer, WI 53223

Child & Adolescent Mental Health

ProgramPractice Status:

Rogers Memorial Hospital - Brown Deer, Open

Board Certified: The Joint Commission

Not Applicable

Not Applicable

Medical School:

Residency:

Cambridge, WI

Fort HealthCare Cambridge Clinic

704 Katie Ct

(608) 423-1100

Cambridge, WI 53523

Family Medicine Practice Status:

Nottestad, Stephanie, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin School of Medicine, Madison, WI

University of Wisconsin-Madison Family Medicine Residency Program,

Madison, WI

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Lee, Joshua, LPC Open

Board Certified:

Univ of Wi Whitewater, Whitewater, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Sund, Joni, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Nebraska, Lincoln, NE

Medical School:

Residency:

Clinton, WI

Alden Meadow Park Health Care Center, Inc.

709 Meadow Park Dr

(608) 676-2202

Clinton, WI 53525

Skilled Nursing Facility Practice Status:

Alden Meadow Park Health Care Center, Inc., Open

Board Certified: Not Accredited

Medical School:

Residency:

Delavan, WI

Mercyhealth Delavan

1038 E Geneva St

(262) 728-4301

Delavan, WI 53115

Advanced Practice Nurse Prescriber Practice Status:

Wang, Lisa, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Univ of Massachusetts, Boston, MA

,

Medical School:

Residency:

Family Medicine Practice Status:

Gronau, Rachel, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin, Milwaukee, WI

St. Luke's Family Medicine Residency, Milwaukee, WI

Medical School:

Residency:

Terry, Richard, DO Open

Board Certified: American Osteopathic Board of Family Physicians

Michigan State Univ College of Osteopathic Medicine, East Lansing, MI

St. Joseph Family Medicine Residency Program, Milwaukee, WI

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Villegas Van der Linde, Silvia, MD Open

Board Certified: American Board of Obstetrics and Gynecology

UNIBE - Universidad Iberoamericana, Santo Domingo, Dominican

RepublicMount Sinai Hospital, Chicago, IL

Medical School:

Residency:

Walworth County Chiropractic

1221 E Phoenix St

(262) 728-8208

Delavan, WI 53115

Chiropractic Practice Status:

Heller, Clark, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Medical School:

Residency:

Willowfield Nsg & Rehab Center

905 E Geneva St

(262) 728-6319

Delavan, WI 53115

Skilled Nursing Facility Practice Status:

Willowfield NH & Rehab, Open

Board Certified: Not Accredited

Not Applicable

Not Applicable

Medical School:

Residency:

Edgerton, WI

Edgerton Care Center

313 Stoughton Rd

(608) 884-1330

Edgerton, WI 53534

Skilled Nursing Facility Practice Status:

Edgerton Care Center Open

Board Certified: Not Accredited

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 2 of 65W9

Page 8: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Edgerton

217 N Main St

(608) 884-9431

Edgerton, WI 53534

Family Medicine Practice Status:

Frey, Justin, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin School of Medicine & Public Health, Madison, WI

Mercy Health System, Janesville, WI

Medical School:

Residency:

Rejon, Veronica, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin School of Medicine & Public Health, Madison, WI

Mercy Health System, Janesville, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Akbar, Muhammad, MD Open

Board Certified: American Board of Internal Medicine

Univ of the Punjab - Allama Iqbal Medical College, Lahore, Pakistan

Monmouth Medical Center, Long Branch, NJ

Medical School:

Residency:

Petry Chiropractic & Wellness, LLC

75 West Fulton St

(608) 884-3100

Edgerton, WI 53534

Chiropractic Practice Status:

Eliszewski, Andrew, DC Open

Board Certified: Not Applicable

Bannockburn Chiropractice, Bannockburn, IL

Not Applicable

Medical School:

Residency:

Houfe, Matthew, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Medical School:

Residency:

Petry, John, DC Open

Board Certified: National Board of Chiropractic Examiners

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

Elkhorn, WI

Holton Manor

645 N Church St

(262) 723-4963

Elkhorn, WI 53121

Skilled Nursing Facility Practice Status:

Holton Manor Open

Board Certified: Not Accredited

Medical School:

Residency:

Mercyhealth Elkhorn

839 N Wisconsin St

(262) 741-1400

Elkhorn, WI 53121

Family Medicine Practice Status:

Kowalski, Jeffrey, MD Open

Board Certified: American Board of Family Medicine

Ross Univ School of Medicine, North Brunswick, NJ

Medical College of Wisconsin, St. Joseph's, Milwaukee, WI

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Knavel, James, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Iowa College of Medicine, Iowa City, IA

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Evansville, WI

Evansville Manor

470 Garfield Ave

(608) 882-5700

Evansville, WI 53536

Skilled Nursing Facility Practice Status:

Evansville Manor Open

Board Certified: Not Accredited

Not Applicable

Not Applicable

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Evansville

300 Union St

(608) 756-5555

Evansville, WI 53536

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Evansville Open

Board Certified: Not Applicable

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Otto, Kimberlyn, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

Not Applicable,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Quick, Cassandra, LPC Open

Board Certified: Not Applicable

Marquette Univ, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Evansville

300 Union St

(608) 882-5613

Evansville, WI 53536

Advanced Practice Nurse Prescriber Practice Status:

Huenerberg, Carmen, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

Medical School:

Residency:

Family Medicine Practice Status:

White, Samuel, MD Open

Board Certified:

Medical Univ of South Carolina, Charleston, SC

Spartanburg Regional Family Medicine Residency Program, Spartanburg,

SC

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 3 of 65W9

Page 9: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Wilke Chiropractic Office, SC

503 E Main St

(608) 882-4146

Evansville, WI 53536

Chiropractic Practice Status:

Scheurell, Megan, DC Open

Board Certified: American Board of Chiropractic

Palmer College of Chiro, Davenport,IA

Medical School:

Residency:

Wilke, Peter, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

Fort Atkinson, WI

Fort Atkinson Hospital Outpatient Clinic

611 Sherman Ave East

(920) 568-5334

Fort Atkinson, WI 53538

Family Medicine Practice Status:

Rutledge, David, MD Open

Board Certified: American Board of Family Medicine

Northwestern Univ Medical School, Chicago, IL

Rockford Med Edu, Rockford, IL

Medical School:

Residency:

Physician Assistant Practice Status:

Collins, Clark, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

University of Nebraska Medical, Omaha, NE

,

Medical School:

Residency:

Fort HealthCare Behavioral Health - Fort

Atkinson

500 McMillen St

(920) 563-9542

Fort Atkinson, WI 53538

Behavioral Health Clinic Practice Status:

Fort HealthCare Behavioral Health Open

Board Certified: Not Applicable

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Quast, Courtney, LPC Open

Board Certified:

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Shea, Nancy, LCSW Open

Board Certified:

University of Wisconsin, Oshkosh, Wi

Medical School:

Residency:

Psychiatry Practice Status:

Bleak, Jennifer, MD Closed

Board Certified: American Board of Psychiatry and Neurology

Univ of Illinois College of Medicine, Chicago, IL

Univ of Chicago, The Pritzker School of Medicine, Chicago, IL

Medical School:

Residency:

Psychiatry Practice Status:

Fudala, Stanley, MD Open

Board Certified: American Board of Psychiatry and Neurology

Medical Academy of Lubin, Poland

University of Cincinnati, Cincinnati, OH

Medical School:

Residency:

Fort HealthCare Behavioral Health - Fort

Atkinson (Madison Ave)

1520 Madison Ave

(920) 563-4028

Fort Atkinson, WI 53538

Behavioral Health Clinic Practice Status:

Fort HealthCare Behavioral Health Open

Board Certified: Not Applicable

Medical School:

Residency:

Fort HealthCare Center for Dermatology

611 Sherman Ave East, 3rd Floor

(920) 568-1000

Fort Atkinson, WI 53538

Dermatology Practice Status:

Glinert, Robert, MD Open

Board Certified: American Board of Dermatology AND American Board of Internal

Medicine AND American Board of Allergy & ImmunologyRush Medical College, Chicago, IL

Univ of Rochester Associated Hospitals, Rochester, NY

Medical School:

Residency:

Fort HealthCare Center for Womens Health

650 McMillen St

(920) 563-8900

Fort Atkinson, WI 53538

Advanced Practice Nurse Prescriber Practice Status:

Bingham, Fawn, FNP Open

Board Certified: American Nurses Credentialing Center

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Dedrick, Joyce, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Univ of Wisconsin, Madison, WI

Not Applicable,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Chuppa, Christine, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of WI Medical School, Madison, WI

Univ of MO, Kansas City, MO

Medical School:

Residency:

Lynk, Elizabeth, MD Open

Board Certified: Not Board Certified

Northwestern Univ Feinberg School of Medicine, Chicago, IL

St Joseph Hospital, Denver, CO

Medical School:

Residency:

Mokhtar, Julie, DO Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Osteopathic Medicine & Health Sciences, Des Moines, IA

Brooklyn Hospital Center, New York

Medical School:

Residency:

Physician Assistant Practice Status:

Sund, Joni, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Nebraska, Lincoln, NE

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 4 of 65W9

Page 10: 2020 W9 - MercyCare...3400 Deerfield Dr. Janesville, WI (608) 314-3605 Mercyhealth Hospital and T rauma Center–Janesville 1000 Mineral Point Ave. Janesville, WI (608) 756-6000 Mercyhealth

MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Fort HealthCare Ear, Nose and Throat

Specialists

512 Wilcox St

(920) 563-6667

Fort Atkinson, WI 53538

Otolaryngology Practice Status:

Anderson, Michael, MD Open

Board Certified: American Board of Otolaryngology

Univ of Wisconsin, Madison, WI

Indiana University, Indianapolis, IN

Medical School:

Residency:

Hofmann, William, MD Open

Board Certified: American Board of Otolaryngology

Univ of Cincinnati College of Medicine, Cincinnati, OH

Indiana Univ Medical Center, Indianapolis, IN

Medical School:

Residency:

Fort HealthCare Fort Memorial Hospital

611 Sherman Ave East

(920) 568-5000

Fort Atkinson, WI 53538

Hospital Practice Status:

Fort HealthCare Fort Memorial Hosp Open

Board Certified: The Joint Commission

Not Applicable

Not Applicable

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Gupta, Vivek, MD Open

Board Certified:

St Georges University School, West Indies Grenada

NYU Hospitals Center, NY, NY

Medical School:

Residency:

Koike, Jun, MD Open

Board Certified: American Boiard of Obstetrics & Gynecology

Ross University, School of Medicine, Dominica

Charleston Area Medical Center, West Virginia

Medical School:

Residency:

Urgent Care Center Practice Status:

Fort HealthCare Fort Memorial-UC Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Fort HealthCare Integrated Family Care Clinic

1520 Madison Ave

(920) 563-5500

Fort Atkinson, WI 53538

Advanced Practice Nurse Prescriber Practice Status:

Beck Metzger, Mary, NP Open

Board Certified: ANCC

Univ of WI Oshkosh, Oshkosh, WI

Medical School:

Residency:

Ipsen, Susan, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Graceland College, Lamour, IA

Medical School:

Residency:

Family Medicine Practice Status:

Beck, Aaron, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin, Milwaukee, WI

Univ of North Carolina at Chapel Hill School of Medicine, Hendersonville, NC

Medical School:

Residency:

Internal Medicine Practice Status:

Winter, Jennifer, MD Open

Board Certified: American Board of Internal Medicine AND American Board of Pediatrics

Medical College of Wisconsin, Milwaukee, WI

Univ of Illinois College of Medicine, Peoria, IL

Medical School:

Residency:

Psychology Practice Status:

Roets, Cheryl, PhD Open

Board Certified: Not Applicable

Marquette Univ, Milwaukee, WI

Psychology,

Medical School:

Residency:

Fort HealthCare Internal Medicine & Pediatrics

500 McMillen St

(920) 563-5571

Fort Atkinson, WI 53538

Advanced Practice Nurse Prescriber Practice Status:

Bingham, Fawn, FNP Open

Board Certified: American Nurses Credentialing Center

Alverno College, Milwaukee, WI

Medical School:

Residency:

Jennrich, Heidi, APNP Open

Board Certified: Not Board Certified

Univ of Virginia School of Nursing,

Medical School:

Residency:

Mayer, Lauren, APNP Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse Practitioner - Primary Care)Marquette Univ, Milwaukee, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Cannon, William, MD Open

Board Certified: Not Board Certified

Loyola Univ Chicago Stritch School of Medicine, Maywood, IL

Loyola Univ Medical Center, Maywood, IL

Medical School:

Residency:

Tackman, Thomas, MD Open

Board Certified: American Board of Internal Medicine

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin Affiliated Hospitals,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Atkinson, Tracey, LCP Open

Board Certified:

Univ of WI Platteville, Platteville, Wi

Medical School:

Residency:

Pediatrics Practice Status:

Dewey, Julia, MD Open

Board Certified: American Board of Pediatrics

Pennsylvania State University College of Medicine, Hershey, PA

University of Wisconsin Medical School, Madison, WI

Medical School:

Residency:

Musete, Monica, MD Open

Board Certified: American Board of Pediatrics

Univ of Medicine & Pharmacy, Bucjarest, Romania

Brooklyn Hospital Center, Brooklyn, NY

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 5 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Pediatrics Practice Status:

Sweeney, Catherine, MD Open

Board Certified: American Board of Pediatrics

Chicago Medical School at Rosalind Franklin, North Chicago, IL

UT Health San Antonio, San Antonio, Texas

Medical School:

Residency:

Williams, Donald, MD Open

Board Certified: American Board of Pediatrics AND American Board of Internal Medicine

Univ of Illinois, Peoria, IL

Akron Children's Hospital, Akron, OH

Medical School:

Residency:

Fort HealthCare Orthopaedic Associates

1504 Madison Ave

(920) 563-7888

Fort Atkinson, WI 53538

Orthopedic Surgery Practice Status:

Schuppner, Paul, DO Open

Board Certified: Not Board Certified

Midwestern Univ Chicago College of Osteopathic Medicine, Downers

Grove, ILMichigan State Univ College of Osteopathic Medicine, Lansing, MI

Medical School:

Residency:

Zambrano, Isidoro, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

State Univ of New York College of Medicine Stony Brook Univ Hospital,

Medical School:

Residency:

Physician Assistant Practice Status:

Degnan, Deborah, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

Medical School:

Residency:

Fort HealthCare Surgical Associates

212 Milwaukee Ave West

(920) 563-7900

Fort Atkinson, WI 53538

Surgery Practice Status:

Erickson, Marc, MD Open

Board Certified: American Board of Surgery

Medical College of Wisconsin, Milwaukee, WI

Michigan State Univ, Butterworth Hosp,

Medical School:

Residency:

Kontny, Billie Gerard, MD Open

Board Certified: American Board of Surgery

Medical College of Wisconsin, Milwaukee, WI

Loyola Medical Center,, Maywood, IL

Medical School:

Residency:

McLaughlin, Jonathan, MD Open

Board Certified: American Board of Surgery

Univ of Minnesota, Minneapolis, MN

Butterworth Hospital Michigan State Univ, Grand Rapids, MI

Medical School:

Residency:

Luedtke-Storm-Mackey Chiropractic Clinic

825 Lexington Blvd, Ste 4

(920) 563-4970

Fort Atkinson, WI 53538

Chiropractic Practice Status:

Smith, Luke, DC Closed

Board Certified: Not Applicable

National Univ of Health Science, Lombard, IL

Medical School:

Residency:

Tesch, Todd, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

Chiropractic Practice Status:

Weyenberg, Ryan, DC Open

Board Certified: Not Applicable

Northwestern College of Chiropractic, Minneapolis, MN

Medical School:

Residency:

PMRis, SC - Fort Atkinson

611 Sherman Ave East

(877) 337-6747

Fort Atkinson, WI 53538

Physical Medicine & Rehabilitation Practice Status:

Fowler, William, MD Open

Board Certified: American Board of Physicial Medicine and Rehabilitation

Univ of North Dakota School of Medicine, Grand Forks, ND

Univ of Minnesota Hospital & Clinics, Minneapolis, MN

Medical School:

Residency:

Shopko Optical #4051

1425 Janesville Ave

(920) 563-2171

Fort Atkinson, WI 53538

Optometry Practice Status:

Cheek, Amanda, OD Open

Board Certified: Not Applicable

Indiana College of Optometry, Bloomington, IN

Medical School:

Residency:

UW Health Ft Atkinson

1620 Mehta Lane

(920) 563-5544

Fort Atkinson, WI 53538

Family Medicine Practice Status:

Brantmeier, Scott, DO Closed

Board Certified: American Board of Family Medicine

Chicago College of Osteopathic Medicine, Downers Grove, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

McGuire, Jeffrey, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Univ of Wisconsin, Appleton-Fox Valley Family Practice Residency, Appleton, WI

Medical School:

Residency:

Quinn, Rachel, MD Closed

Board Certified: American Board of Family Medicine

Univ of Wisconsin, Madison, WI

UW Family Medicine Residency Program, Madison, WI

Medical School:

Residency:

Family Medicine including Obstetrics Practice Status:

Meyer, Shauna, MD Closed

Board Certified: American Board of Family Medicine

Univ of South Dakota School of Medicine, Sioux Falls, SD

UW Family Medicine Residency, St. Mary's Hospital, Madison, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Stelse, Megan, PA-C Open

Board Certified: NCCPA 1144361

Marquette University, Milwaukee, WI

Medical School:

Residency:

Urology Practice Status:

Kozler, Craig, MD Open

Board Certified: American Board of Urology

Michigan State University, East Lansing, MI

University of Michigan, Ann Arbor, MI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 6 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Ixonia, WI

WRMC Ixonia

W1046 Marietta Ave, Ste 230

(920) 206-6310

Ixonia, WI 53036

Advanced Practice Nurse Prescriber Practice Status:

Stinnett, Dana, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

Medical School:

Residency:

Family Medicine Practice Status:

Box, Helen, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Gunderson Lutheran, LaCrosse, WI

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

DeJong, Julie, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Wisconsin, Madison, WI

Univ of Iowa Hospital and Clinics, Iowa City, IA

Medical School:

Residency:

Janesville, WI

Cedar Crest Health Center

1702 S River Rd

(608) 756-0344

Janesville, WI 53546

Skilled Nursing Facility Practice Status:

Cedar Crest Health Center Open

Board Certified: Not Accredited

Medical School:

Residency:

Damrow Chiropractic Office

3628 Ridge Dr

(608) 754-3696

Janesville, WI 53548

Chiropractic Practice Status:

Byrnes-Pierce, Tina, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Medical School:

Residency:

Damrow, James, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

Keehn Chiropractic Office

2707 Kennedy Rd, Ste 202

(608) 755-1035

Janesville, WI 53545

Chiropractic Practice Status:

Hanewold, Lori, DC Open

Board Certified: National Board of Chiropractic Examiners

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

West, Betsy, DC Open

Board Certified: National Board of Chiropractic Examiners

Palmer College of Chiropractic, Davenport, IA

Not Applicable

Medical School:

Residency:

Mercy Assisted Care, Inc. Home Health

Care

901 Mineral Point Ave

(800) 369-2201

Janesville, WI 53548

Home Health Provider Practice Status:

Mercy Assisted Care HHC Open

Board Certified: Not Accredited

Not Applicable

Not Applicable

Medical School:

Residency:

Mercy Assisted Care, Inc. Hospice Care

901 Mineral Point Ave

(800) 369-2201

Janesville, WI 53548

Hospice Care Practice Status:

Mercy Assisted Care Hospice Care Open

Board Certified: Not Applicable

Not Applicable

Not Applicable

Medical School:

Residency:

Mercyhealth Addiction Day Treatment Program

2600 Humes Rd, Ste 100

(608) 741-2117

Janesville, WI 53545

Advanced Practice Nurse Prescriber Practice Status:

Bunnell, Ann, APNP Open

Board Certified: American Nurses Credentialing Center (Child and Adolescent Mental Health)

Medical School:

Residency:

Child & Adolescent Addictions Program Practice Status:

Mercyhealth Child & Adol TX Open

Board Certified: The Joint Commission

Not Applicable

Not Applicable

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Schlegel, Courtney, LCSW Open

Board Certified: Not Applicable

UW-Madison School of Social Work, Madison, WI

Medical School:

Residency:

Mercyhealth at Home - Medical Equipment - Janesville

1010 N Washington St

(608) 755-7989

Janesville, WI 53548

Durable Medical Equipment Supplier Practice Status:

Mercyhealth at Home - DME JVL Open

Board Certified: Not Applicable

Not Applicable

Not Applicable

Medical School:

Residency:

Mercyhealth Autism Program

580 N Washington St

(608) 756-5555

Janesville, WI 53548

Autism Treatment Practice Status:

Mercyhealth Autism Program Open

Board Certified: Not Applicable

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 7 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Licensed Clinical Social Worker Practice Status:

Schlegel, Courtney, LCSW Open

Board Certified: Not Applicable

UW-Madison School of Social Work, Madison, WI

Medical School:

Residency:

Psychology Practice Status:

Keller, Kathryn, PhD Open

Board Certified: Not Applicable

Medical School:

Residency:

Speech-Language Pathology Practice Status:

Haning, Maria, SLP Open

Board Certified:

Univ of WI Whitewater, Whitewater, WI

Medical School:

Residency:

Mercyhealth Behavioral Health - Inpatient

1000 Mineral Point Ave

(608) 756-6508

Janesville, WI 53548

Psychologist Practice Status:

Sosa, Amy, PsyD Open

Board Certified:

Il School of Prof Psych, Chgo, IL

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - East

3524 E Milwaukee St

(608) 756-5555

Janesville, WI 53546

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - East Open

Board Certified: Not Applicable

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Kropf, Anita, LCSW Open

Board Certified: Not Applicable

George Williams College,

Not Applicable,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Janesville

903 Mineral Point Ave

(608) 756-6530

Janesville, WI 53548

Licensed Clinical Social Worker Practice Status:

Eastman, Laurie, LCSW Open

Board Certified:

Loyola Univ Chgo, Chicago, IL

Medical School:

Residency:

Thompson, Lorrie, LCSW Open

Board Certified:

Univ of Milwaukee, Milwaukee, WI

Medical School:

Residency:

Social Worker Practice Status:

Ebben, Danielle, MSW Open

Board Certified:

Aurora Univ, Aurora, IL

Medical School:

Residency:

Substance Abuse Counselor Practice Status:

Grob, Ann, SAC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Janesville (Henry Palmer Building)

903 Mineral Point Ave

(608) 756-5555

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Bonaccorsi, Mary, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Rush Univ, Chicago, IL

Medical School:

Residency:

Bunnell, Ann, APNP Open

Board Certified: American Nurses Credentialing Center (Child and Adolescent Mental

Health)

Medical School:

Residency:

Westmoreland, Danielle, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Psychiatric & Mental Health Nurse Practitioner)Univ of Wisconsin, Madison, WI

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Janesville Open

Board Certified: Not Applicable

Medical School:

Residency:

Clinical Psychologist Practice Status:

Crull, Ashley, PsyD Open

Board Certified:

Midwestern University, Downers Grove, IL

Medical School:

Residency:

Clinical Substance Abuse Counselor Practice Status:

Hebert, Jaclyn, CSAC; LPC Open

Board Certified: Not Applicable

Medical School:

Residency:

Johnson, Sally, CSAC, LPC Open

Board Certified: Not Applicable

Medical School:

Residency:

Wilson, Beverly, CSAC; LPC Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 8 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Clinical Substance Abuse Counselor Practice Status:

Winiecki, Adrienne, CSAC Open

Board Certified: Not Applicable

Indiana Univ Northwest, Gary, IN

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Legler, Jackie, LCPC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

VandenAkker, Tricia, LCSW Open

Board Certified:

University of Wisconsin, Madison, WI

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Barger, Sharon, LCSW Open

Board Certified:

University of Wisconsin Madison, Madison, WI

,

Medical School:

Residency:

Baumel, Victoria, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin - Milwaukee, Milwuakee, WI

,

Medical School:

Residency:

Benash, Jessica, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Kollmansberger, Benno, LPC, LCSW Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Kropf, Anita, LCSW Open

Board Certified: Not Applicable

George Williams College,

Not Applicable,

Medical School:

Residency:

Mattison, Faith, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Otto, Kimberlyn, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

Not Applicable,

Medical School:

Residency:

Pedretti, Christine, LCSW Open

Board Certified: Not Applicable

UW-Milwaukee, Milwaukee WI

,

Medical School:

Residency:

Splinter, Sarah, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Milwaukee, WI

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Stried, Chantel, LCSW Open

Board Certified: Not Applicable

George Williams College of Aurora Univ, Aurora, IL

Not Applicable,

Medical School:

Residency:

Licensed Marriage & Family Therapist Practice Status:

Janes, Kelly, LMFT Open

Board Certified:

Arg University, Chicago, IL

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Chellevold, Jennifer, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater

,

Medical School:

Residency:

Cisneros, Kamela, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

DeSloover, Dan, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater

,

Medical School:

Residency:

Hebert, Jaclyn, LPC; CSAC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Johnson, Sally, LPC; CSAC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Laehn, Larry, LPC, SAC Open

Board Certified: Not Applicable

Univ of Wisconsin, Oshkosh, WI

,

Medical School:

Residency:

Littig, Karen, LPC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Loescher, Bret, LPC, SAC Open

Board Certified: Not Applicable

WI School of Professional Psychology, Milwaukee, WI

,

Medical School:

Residency:

Mendenhall, Jeanine, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Oczus, Alicia, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Quick, Cassandra, LPC Open

Board Certified: Not Applicable

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 9 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Licensed Professional Counselor Practice Status:

Wilson, Beverly, CSAC; LPC Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Zamborsky, Melanie, LPC Open

Board Certified: Not Applicable

Seton Hill Univ, Greensburg, PA

,

Medical School:

Residency:

Psychiatry Practice Status:

Callison, (Sue) Ann, MD Open

Board Certified: American Board of Psychiatry and Neurology (Child & Adolescent Psychiatry)University of Arizona, Tucson, AZ

Univ. of Arizona, Tucson, AZ

Medical School:

Residency:

Kirmani-Moe, Sobia, MD Open

Board Certified: American Board of Psychiatry & Neurology

The Texas A & M Health & Science Center, Byron, TX

Hennepin County Medical Center, Minneapolis, MN

Medical School:

Residency:

Kosnar, Tina, MD Open

Board Certified: American Board of Psychiatry and Neurology (Child & Adolescent

Psychiatry)Creighton Univ School of Medicine, Omaha, NE

Creighton-Nebraska Combined, Omaha, NE

Medical School:

Residency:

Rahemtulla, Mohammed, DO Open

Board Certified: American Board of Psychiatry and Neurology

Des Moines Univ, Des Moines, IA

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Wagner, Richard, MD Open

Board Certified: American Board of Psychiatry and Neurology

St. George Univ School of Medicine,

Texas Tech Univ Health Sciences Center, El Paso, TX

Medical School:

Residency:

Psychology Practice Status:

Hanson, Christine, PhD Open

Board Certified: Not Applicable

Ohio State Univ, Columbus, OH

,

Medical School:

Residency:

Rose-Barajas, Michelle, PsyD Open

Board Certified: Not Applicable

Illinois School of Professional Psychology, Chicago, IL

,

Medical School:

Residency:

Substance Abuse Counselor Practice Status:

Laehn, Larry, SAC, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Oshkosh, WI

,

Medical School:

Residency:

Mallon, Jocelyn, SAC, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin-Whitewater, Whitewater, WI

Medical School:

Residency:

Maly, Sara, SAC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Mall

1010 N Washington St

(608) 756-5555

Janesville, WI 53548

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Mercy Mall, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - MercyCare Building

580 N Washington St

(608) 756-5555

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Bunnell, Ann, APNP Open

Board Certified: American Nurses Credentialing Center (Child and Adolescent Mental

Health),

,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - North

3400 Deerfield Dr

(608) 756-5555

Janesville, WI 53546

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - North, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Kropf, Anita, LCSW Open

Board Certified: Not Applicable

George Williams College,

Not Applicable,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic -

West

1000 Mineral Point Ave

(608) 756-5555

Janesville, WI 53548

Licensed Clinical Social Worker Practice Status:

Otto, Kimberlyn, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

Not Applicable,

Medical School:

Residency:

Psychiatry Practice Status:

Curtis, Erin, MD Open

Board Certified: American Board of Psychiatry & Neurology

Univ of Pittsburgh, Pittsburgh, PA

Univ of WI, Madison, WI

Medical School:

Residency:

Wagner, Richard, MD Open

Board Certified: American Board of Psychiatry and Neurology

St. George Univ School of Medicine,

Texas Tech Univ Health Sciences Center, El Paso, TX

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 10 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Cancer Ctr - Hem/Med

Oncology

1000 Mineral Point Ave

(608) 756-6871

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Disch, Nicole, APRN Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse)Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Medical Oncology Practice Status:

Robinson, Emily, MD Open

Board Certified: American Board of Internal Medicine (Medical Oncology)

Univ of Wisconsin Medical School, Madison, WI

North Carolina Baptist Hospital, Winston-Salem, NC

Medical School:

Residency:

Shekhani, Shahid, MD Open

Board Certified: American Board of Internal Medicine (Medical Oncology)(Hospice &

Palliative Care)Sind Medical College, Karachi, Pakistan

Prince Georges Hospital Center, Cheverly, MD

Medical School:

Residency:

Mercyhealth Cancer Ctr - Radiation

Oncology

1000 Mineral Point Ave

(608) 756-6500

Janesville, WI 53548

Physician Assistant Practice Status:

Johnson, Amanda, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Western Michigan Univ, Kalamazoo, MI

None,

Medical School:

Residency:

Radiation Oncology Practice Status:

Kozak, Kevin, MD Open

Board Certified: American Board of Radiology-Radiation Oncology

Vanderbilt Univ School of Medicine, Nashville, TN

Harvard Radiation Oncology Program, Boston, MA

Medical School:

Residency:

Mercyhealth Cardiac Rehab Center -

Janesville

1000 Mineral Point Ave

(608) 756-6868

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Martin, Jennifer, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

,

,

Medical School:

Residency:

Rye, Heidi, APNP Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Acute Care

Nurse Practitioner)Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Cardiology Practice Status:

Ahmed, Imdad, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular

Disease)(Electrophysiology)Gauhati Medical College, Guwahati Assam, India

Bronx Lebanon Hospital Center, Bronx, NY

Medical School:

Residency:

Cardiology Practice Status:

Gulliver, Eugene, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular

Disease)(Interventional Cardiology)Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Volkert, Paul, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular

Disease)(Interventional Cardiology)Medical College of Wisconsin, Wauwatosa, WI

Medical College of WI Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

Cardio-Thoracic Surgery Practice Status:

Goldstein, A. Sandor, MD Open

Board Certified:

McGill University, Canada

University of Toronto, Tononto, Ontario, Canada

Medical School:

Residency:

Wolnak, Kenneth, DO Open

Board Certified: American Osteopathic Board of Thoracic Cardiovascular Surgery

Chicago College of Osteopathic Medicine, Downers Grove, IL

Chicago College of Osteopathic Medicine,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Chilukuri, Karuna, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Jawaharlal Institute of Post Graduate Medical Education and Research,

Pondicherry, IndiaSt. John Hospital and Medical Center, Detroit, MI

Medical School:

Residency:

Stoiber, Thomas, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Univ of Wisconsin Medical School, Madison, WI

Medical College of Wisconsin, Madison, WI

Medical School:

Residency:

Clinical Cardiac Electrophysiology Practice Status:

Narra, Leela, MD Open

Board Certified: American Board of Internal Medicine (Clinical Cardiac Elecrtophysiology)(Cardiovascular Disease)Guntur Medical College, Andhra Pradesh India

Cook County Hospital, Chicago, IL

Medical School:

Residency:

Clinical Cardiac-Electrophysiology Practice Status:

Smith, Jeffrey, MD Open

Board Certified: American Board of Internal Medicine (Clinical Cardiac Electrophysiology)(Cardiovascular Disease)Univ of Illinois College of Medicine, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Medical School:

Residency:

Interventional Cardiology Practice Status:

Gulliver, Eugene, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular

Disease)(Interventional Cardiology)Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Volkert, Paul, MD Open

Board Certified: American Board of Internal Medicine (Interventional Cardiology)

(Cardiovascular Disease )Medical College of Wisconsin, Wauwatosa, WI

Medical College of WI Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 11 of 65W9

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State of Wisconsin - 2020Pediatric Cardiology Practice Status:

Kazmouz, Suhaib, MD Open

Board Certified: American Board of Pediatrics (Pediatric Cardiology)

Aleppo Univ, Aleppo, Syria

Crozer Chester Medical Center, Chester, PA

Medical School:

Residency:

Masood, Syed, MD Open

Board Certified: American Board of Pediatrics

Dow Medical Univ - Pakistan, Karachi Sindh Pakistan

Louisiana State Univ Health Science Center, Shreveport, LA

Medical School:

Residency:

Physician Assistant Practice Status:

Dorshorst, Robert, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin - Madison, Madison, WI

,

Medical School:

Residency:

Streff, Scott, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Thoracic and Cardiac Surgery Practice Status:

Snider, John, MD Open

Board Certified: American Board of Thoracic Surgery (Thoracic and Cardiac Surgery)

,

,

Medical School:

Residency:

Mercyhealth Child & Adolescent MH Program

903 Mineral Point Avenue

(608) 756-5555

Janesville, WI 53548

Child & Adolescent Mental Health

ProgramPractice Status:

Mercyhealth Child & Adol MHealth Pgm, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Mercyhealth Complementary Medicine

1010 N Washington St

(608) 741-6799

Janesville, WI 53548

Acupuncture Practice Status:

Warnke, Matthew, Lac Open

Board Certified: Not Applicable

Southwest Acupuncture College, Santa Fe, New Mexico

,

Medical School:

Residency:

Chiropractic Practice Status:

Bridge, Karen, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable,

Medical School:

Residency:

Priske, Scott, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable,

Medical School:

Residency:

Mercyhealth Comprehensive Inpatient

Rehab Ctr

1000 Mineral Point Ave

(608) 756-6822

Janesville, WI 53548

Physical Medicine & Rehabilitation Practice Status:

Garcia, Ronald Allan M, MD Open

Board Certified: American Board of Physical Medicine and Rehabilitation

Univ of the East-Ramon Magsaysay Memorial Med Cntr, Philippines

Rehabilitation Insititue of Chicago, Northwestern University Medical

School, Chicago, IL

Medical School:

Residency:

Mercyhealth Diabetes Center

1010 N Washington St

(608) 741-2459

Janesville, WI 53548

Family Medicine Practice Status:

Reid, Timothy, MD Open

Board Certified: American Board of Family Medicine

Medical College of Ohio, Toledo, OH

St. Elizabeth Med Cntr-South, Edgewood, KY

Medical School:

Residency:

Mercyhealth Dialysis Center

903 Mineral Point Ave

(608) 741-3814

Janesville, WI 53548

Nephrology Practice Status:

Anjum, Ehteshamul, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Patna Medical College, Patna Bihar, India

Metropolitan Hospital Center, New York, NY

Medical School:

Residency:

Mercyhealth East

3524 E Milwaukee St

(608) 756-7100

Janesville, WI 53546

Advanced Practice Nurse Prescriber Practice Status:

Baird, Susan, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Carlow Univ, Pittsburgh, PA

,

Medical School:

Residency:

Allergy & Immunology Practice Status:

Ragotzy, Ronald, MD Open

Board Certified: American Board of Allergy and Immunology

Wayne State Univ School of Medicine, Detroit, MI

Southwest MI Area Health Education Center, Kalamazoo, MI

Medical School:

Residency:

Dermatology Practice Status:

Nelsen, David, MD Open

Board Certified: American Board of Dermatology

Univ of Minnesota, Minneapolis, MN

Marshfield Clinic, Marshfield, WI

Medical School:

Residency:

Endocrinology Practice Status:

Litonjua, Patrick Paul, MD Open

Board Certified:

Univ of the Philippines College of Medicine, Manila, Philippines

Univ of the Philippines-Philippine General Hospital, Ermita Manila

Philippines

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 12 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Family Medicine Practice Status:

Altbuch, Arthur, MD Open

Board Certified: American Board of Family Medicine (Geriatric Medicine) (Sports Medicine)

Albany Medical College, Albany, NY

Bayfront Medical Center, St. Petersburg, FL

Medical School:

Residency:

Bean, Ryne, MD Open

Board Certified: American Board of Family Medicine

Windsor Univ School of Medicine, Canyon, St Kitts and Nevis

Mercyhealth Family Medicine Residency Program, Janesville, WI

Medical School:

Residency:

Ewing, Debra, DO Open

Board Certified: American Osteopathic Association

Oklahoma State Univ, Tulsa, OK

Via Christi Riverside Medical Center, Wichita, KS

Medical School:

Residency:

Hahn, Leanne, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin, Milwaukee, WI

Mercy Health System Family Practice Residency Program, Janesville, WI

Medical School:

Residency:

Hussli, Jennifer, MD Open

Board Certified: American Board of Family Medicine

Univ of Sint Eustatius School of Medicine, Goldenrock, Sint Eustatius, Netherlands, Dutch CaribbeanMercy Health System, Janesville, WI

Medical School:

Residency:

Maldonado, Dennys, MD Open

Board Certified: American Board of Family Medicine

Ross University, North Brunswick, NJ

Mercy Health System, Janesville, WI

Medical School:

Residency:

Poste, Alethea, MD Open

Board Certified: American Board of Family Medicine

Univ Autonoma de Guadalajara, Guadalajar, Mexico

Mercy Health System, Janesville, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Bautista, Ryndon, MD Open

Board Certified: American Board of Internal Medicine

Univ of Philippines College of medicine, Manila, Philippines

Univ of Illinois at Chicago - Advocate Christ Medical Center, Oak Lawn, IL

Medical School:

Residency:

Goelzer, Kristen, MD Closed

Board Certified: American Board of Internal Medicine AND American Board of Pediatrics

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Honarkhah, Nader, MD Open

Board Certified:

Medical College of Ohio, Toledo, OH

Oakwood Hospital & Medical Center, Dearborn, MI

Medical School:

Residency:

Khan, Kauseruzzaman, MD Open

Board Certified: American Board of Internal Medicine

Dhaka Medical College, Dhaka, Bangladesh

Mercy Catholic Medical Center, Darby, PA

Medical School:

Residency:

Ophthalmology Practice Status:

Altaweel, Michael, MD Open

Board Certified: American Board of Ophthalmology

Dalhousie Univ Medical School, Halifax, NS, Canada

Dalhousie Univ, Halifax, NS, Canada

Medical School:

Residency:

Ophthalmology Practice Status:

Lovelace, Kimberley, MD Open

Board Certified: American Board of Ophthalmology

Univ of Arkansas for Medical Sciences, Little Rock, AR

Univ of Tennessee Medical, Memphis, TN

Medical School:

Residency:

Optometry Practice Status:

Rockwell, John, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Angeline, Michael, MD Open

Board Certified: American Board of Orthopaedic Surgery (Orthopaedic Sports Medicine)

Georgetown Univ School of Medicine, Washington, DC

Univ of Chicago Medical Center, Chicago, IL

Medical School:

Residency:

Palmer, Douglas, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Schulman, Sidney, MD Open

Board Certified: American Board of Orthopaedic Surgery

University of Toronto Faculty of Medicine, Toronto, ON

University of Ottawa, Faculty of Medicine, Ottawa, ON

Medical School:

Residency:

Otolaryngology Practice Status:

Riggs, Landon, MD Open

Board Certified: American Board of Otolaryngology

Loyola Univ of Chicago Stritch School of Medicine, Maywood, IL

Loyola Univ of Chicago, Maywood, IL

Medical School:

Residency:

Yang, Eric, MD Open

Board Certified: American Board of Otolaryngology

Univ of Southern California, Keck School of Medicine, Los Angeles, CA

Univ of Utah, Salt Lake City, UT

Medical School:

Residency:

Pediatric Gastroenterology Practice Status:

Deutsch, David, MD Open

Board Certified: American Board of Pediatrics (Pediatric Gastroenterology)

Univ of Illinois College of Medicine - Rockford, Rockford, IL

Columbus Children's Hospital/The Ohio State Univ, Columbus, OH

Medical School:

Residency:

Nguyen, Kim-Doan, MD Open

Board Certified: American Board of Internal Medicine AND American Board of Pediatrics

(Pediatric Gastroenterology)American Univ of the Caribbean School of Medicine, Coral Gables, FL

Univ of Missouri-Columbia, Columbia, MO

Medical School:

Residency:

Vortia, Eugene, MD Open

Board Certified: American Board of Pediatrics (Pediatric Gastroenterology) and American Board of Internal MedicineUniv of Ghana Medical School, Korle Bu, ACCRA Ghanna

MI State Univ - Kalamazoo Ctr for Medical Studies, Kalamazoo, MI

Medical School:

Residency:

Pediatrics Practice Status:

Goelzer, Mark, MD Open

Board Certified: American Board of Pediatrics

Univ of Wisconsin Medical School, Madison, WI

University of MI Medical Center, Ann Arbor, MI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 13 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Pediatrics Practice Status:

Goelzer, Kristen, MD Closed

Board Certified: American Board of Pediatrics AND American Board of Internal Medicine

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Gordon, Christal, MD Open

Board Certified: American Board of Pediatrics

Creighton Univ School of Medicine, Omaha, NE

Univ of Michigan Hospitals, Ann Arbor, MI

Medical School:

Residency:

Loconto, Elizabeth, DO Open

Board Certified: American Board of Pediatrics

A.T. Still Univ, Kirksville College of Osteopathic Medicine, Kirksville, MO

Children's Hospital of Wisconsin/Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Nowak, Blaine, MD Open

Board Certified: American Board of Pediatrics

Medical College of Wisconsin, Milwaukee, WI

Milwaukee Childrens Hospital, Milwaukee, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Murphy, Cristina, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Midwestern Universit, Downers Grove, IL

,

Medical School:

Residency:

Pechacek, Jaime, PA-c Open

Board Certified: NCCPA

Marquette University, Milwaukee, WI

,

Medical School:

Residency:

Schnell, Tina, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Colorado Health Science Center, Denver, CO

Not Applicable,

Medical School:

Residency:

Schulz, Eric, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Rosalind Franklin Univ of Medicine and Science, North Chicago, IL

,

Medical School:

Residency:

Podiatry Practice Status:

Feuerstein, Catherine, DPM Open

Board Certified: American Board of Foot and Ankle Surgery

Scholl College of Podiatric Medicine, North Chicago, IL

North Port VA Residency, North Port, NY

Medical School:

Residency:

Reinicke, Alan, DPM Open

Board Certified: American Board of Foot and Ankle Surgery

Scholl College of Podiatric Medicine, Chicago, IL

Not Applicable,

Medical School:

Residency:

Rheumatology Practice Status:

Bolek Berquist, Jilaine, MD Open

Board Certified: American Board of Internal Medicine (Rheumatology)

Univ of Illinois Collegeof Medicine, Rockford, IL

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Mercyhealth East Urgent Care

3524 E Milwaukee St

(608) 756-8484

Janesville, WI 53546

Urgent Care Center Practice Status:

Mercyhealth East Urgent Care, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Mercyhealth Eye Center - Health Mall

1010 N Washington St

(608) 741-6794

Janesville, WI 53548

Optometry Practice Status:

Dunphy, Erin, OD Open

Board Certified: Not Applicable

Southern College of Optometry, Memphis, TN

Not Applicable,

Medical School:

Residency:

McLaughlin, Michelle, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Rockwell, John, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Mercyhealth Eye Center - Janesville

3524 E Milwaukee St

(608) 756-7110

Janesville, WI 53548

Ophthalmology Practice Status:

Bussa, John, MD Open

Board Certified: American Board of Ophthalmology

University of Texas Health Science Center, San Antonio, TX

Walter Reed Army Medical Center, Washington, DC

Medical School:

Residency:

Luellwitz, David, DO Open

Board Certified: American Osteopathic Board of Ophthalmology

Western Univ of Health Sciences, Pomona, CA

Midwestern University, Olympia Fields, IL

Medical School:

Residency:

Thomassen, Thom, MD Open

Board Certified: American Board of Ophthalmology

Duke University, Durham, NC

Walter Reed Army Medical Center, Washington, DC

Medical School:

Residency:

Whitehead, A. Jeffrey, MD Open

Board Certified:

Univ of Wisconsin, Madison, WI

Washington Univ in St. Louis, St. Louis, MO

Medical School:

Residency:

Optometry Practice Status:

Dunphy, Erin, OD Open

Board Certified: Not Applicable

Southern College of Optometry, Memphis, TN

Not Applicable,

Medical School:

Residency:

McLaughlin, Michelle, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 14 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Hand Center

557 N Washington St

(608) 741-3812

Janesville, WI 53548

Orthopedic Surgery Practice Status:

Palmer, Douglas, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Pittenger, David, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

Blodgett Memorial Medical Center, Grand Rapids MI

Medical School:

Residency:

Mercyhealth Hospital & Trauma Center -

Janesville

1000 Mineral Point Ave

(608) 756-6000

Janesville, WI 53548

Adult Addictions Program Practice Status:

Mercyhealth Addiction Day Treatment Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Adult Mental Health Program Practice Status:

Mercyhealth WINGS Program Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Advanced Practice Nurse Practice Status:

Conway, Diane, NP Open

Board Certified: ANCC

Univ of Alabama, Huntsville, AL

,

Medical School:

Residency:

Dodson, Dayna, NP Open

Board Certified: ANCC

Concordia University, Mequon, WI

,

Medical School:

Residency:

Lee, Sandra, RN Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse Practitioner)Univ of Cincinnati, Cincinnati, OH

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Chady, Heather, ACNP Open

Board Certified: ANCC

Marquette University, Milwaukee, WI

,

Medical School:

Residency:

Jensen, Nichelle, APNP Open

Board Certified: American Nurses Credentialing Center

,

,

Medical School:

Residency:

Wallace, Jessica, NP Open

Board Certified: ANCC

Walden University, Minneapolis, MN

,

Medical School:

Residency:

Family Medicine Practice Status:

Aziz, Imad, DO Open

Board Certified: American Board of Family Medicine

Chgo College of Osteopathic Med, Downers Grove, IL

Medical College of WI, Milwaukee, WI

Medical School:

Residency:

Kaur, Amandeep, MD Open

Board Certified:

Ross University, Roseau

Mercy Janesville, Janesville, WI

Medical School:

Residency:

Hospital Practice Status:

Mercyhealth Hospital & Trauma Center - Jvl, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Infectious Disease Practice Status:

Baig, Mirza, MD Open

Board Certified: American Board of Int Med/Inf Dis

Dow Medical College, Karachi

Rosaling Franklin Univ, N Chgo, IL

Medical School:

Residency:

Medical Oncology Practice Status:

Pauff, James, MD Open

Board Certified: American Board of Internal medicine

Ohio State Univ, Columbus, OH

Vanderbilt Univ Sch of Med, Nashville, TN

Medical School:

Residency:

Neurology Practice Status:

Levine, Ross, MD Open

Board Certified: American Board of Psychiatry and Neurology

UW Medical School, Madison, WI

UW Health, Madison, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Dombeck, Nathan, PA Open

Board Certified: NCCPA

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Rasmussen, Alyssa, Pa-C Open

Board Certified: NCCPA

UW Lacrosse, LaCrose, WI

,

Medical School:

Residency:

Winkels, Joyce, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

University of Wisconsin at Madison, Madison, WI

,

Medical School:

Residency:

Psychiatry Practice Status:

Khan, Ahadullah, DO Open

Board Certified: Americna Board of Psychiatry & Neurology

Michigan State Univ, East Lansing, MI

Ozark center, Joplin MO

Medical School:

Residency:

Rupert, Loucresie, DO Open

Board Certified: American Board of Psychiatry & Neurology

Univ of South Alabama College of Medicine, Mobile, AL

Univ of S Alabama, Mobile, Al

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 15 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Pulmonary Disease Practice Status:

Habel, Alfred, MD Open

Board Certified: American Board of Int Med

Medical College of WI, Milwaukee, WI

Hennepin County Med Ctr, Minneapolis, MN

Medical School:

Residency:

Lababidy, Muhammad, MD Open

Board Certified: American Board of Internal Medicine

Damascus Univ, Damascus

Univ of IL, Chgo, IL

Medical School:

Residency:

Radiation Oncology Practice Status:

Burr, Adam, MD, PhD Open

Board Certified:

Univ of Cincinnatti, Cincinnatto, OH

Univ of Wisconsin, Madison, WI

Medical School:

Residency:

Surgery Practice Status:

Sauter, Douglas, MD Open

Board Certified: American Board of Surgery

University of Illinois, Rockford, IL

VA Des Moines Med Ctr, Des Moines, IA

Medical School:

Residency:

Mercyhealth Hospital Emergency

Department -Janesville

1000 Mineral Point Ave

(608) 756-6611

Janesville, WI 53548

Emergency Department Practice Status:

Mercyhealth Hospital & Trauma Center - Jvl, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Mercyhealth HPB Outpatient Palliative Care Clinic

903 Mineral Point Ave

(608) 563-7720

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

van Veldhuisen, Kathleen, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Medical Oncology Practice Status:

Green, Dena, MD Open

Board Certified: American Board of Internal Medicine (Hospice & Palliative Medicine; and

Medical Oncology)Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Lung Center

903 Mineral Point Ave

(608) 752-6255

Janesville, WI 53548

Pulmonary Disease Practice Status:

Tuck, Hazen, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

MedicineThe Chicago Medical School (Rosalind Franklin Univ), North Chicago, IL

Univ of Illinois, Peoria, IL

Medical School:

Residency:

Pulmonary Disease (Critical Care

Medicine)Practice Status:

Cook, Robert, MD Open

Board Certified: American Board of Internal Medicine (Sleep Medicine)

OH State University College of Medicine, Columbus, OH

Barnes Hosp, Washington U, St. Louis, MO

Medical School:

Residency:

Mercyhealth Mall

1010 N Washington St

(608) 741-2430

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Cleveland, Michelle, NP Open

Board Certified: AANP

Marian Univ, Fond du lac, WI

,

Medical School:

Residency:

McCarthy, Leaellyn, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Samford University, Birmingham, AL

,

Medical School:

Residency:

Family Medicine Practice Status:

Perez, Enrique, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin/St. Luke's Hospital, Racine, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Pogorelova, Mariya, MD Open

Board Certified: American Board of Internal Medicine

Karaganda State Medical Institute, Varagana, Vazakhstan

St. Joseph Hospital, Joel, MD

Medical School:

Residency:

Optometry Practice Status:

Moseman, Kristin, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Podiatry Practice Status:

Zainer, Gregory, DPM Open

Board Certified: American Board of Podiatric Medicine

Ohio College of Podiatric Medicine, Cleveland, OH

Not Applicable,

Medical School:

Residency:

Mercyhealth Michael Berry Building

1000 Mineral Point Ave

(608) 756-6588

Janesville, WI 53548

Advanced Practice Nurse Practice Status:

Salter Braun, Nicole, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Univ of Wsconsin - Milwaukee, Milwaukee, WI

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Nehls, Teresa, APNP Open

Board Certified: ANCC

Marian College of Fond du Lac, Fond Du Lac, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 16 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Advanced Practice Nurse Prescriber Practice Status:

Schlueter, Stephanie, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Gastroenterology Practice Status:

Castillo, Rodrigo, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

P. Universidad Javeriana, Bogota, Columbia

Hahnemann Univ Hospital, Philadelphia, PA

Medical School:

Residency:

Khoury, Ramez, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Damascus Univ, Damascus, Syria

The Graduate Hospital, Philadelphia, PA

Medical School:

Residency:

Hematology and/or Medical Oncology Practice Status:

Bamrolia, Anshul, MD Open

Board Certified: American Board of Internal Medicine

,

,

Medical School:

Residency:

Physician Assistant Practice Status:

Hughes, Angela, PA-C Closed

Board Certified: National Commission on Certification of Physician Assistants

Univ of Texas Medical Branch, Galveston, TX

,

Medical School:

Residency:

Mcbride, Karleen, PA Open

Board Certified: NCCPA

Marquette University, Milwaukee, Wi

,

Medical School:

Residency:

Mercyhealth Neurosurgery Center

1000 Mineral Point Ave

(608) 756-6826

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Bestland, Jennifer, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Marquette Univ College of Nursing, Milwaukee, WI

Not Applicable,

Medical School:

Residency:

Castelein, Courtney, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Chamerlain College, Downers Grove, IL

,

Medical School:

Residency:

Hanson, Cynthia, NP Open

Board Certified: ANCC

St Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Neurological Surgery Practice Status:

Rust, Merle, MD Open

Board Certified: American Board of Neurological Surgery

Univ of Illinois College of Medicine, Peoria, IL

Univ of Illinois College of Medicine, Peoria, IL

Medical School:

Residency:

Sturm, Christopher, MD Open

Board Certified: American Board of Neurological Surgery

St. Louis Univ School of Medicine, St. Louis, MO

St. Louis Univ School of Medicine, St. Louis, MO

Medical School:

Residency:

Neurology Practice Status:

Holla, Smitha, MD Open

Board Certified: American Board of Psychiatry and Neurology

Bangalore Medical College and Research Institute, Bengaluru, Karnataka, IndiaUniv of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Wallery, Shawn, MD Open

Board Certified: American Board of Psychiatry and Neurology (Neruomuscular Medicine)

Ross Univ School of Medicine, Ediston, NJ

Loyola Medical Center, Maywood, IL

Medical School:

Residency:

Mercyhealth North

3400 Deerfield Dr

(608) 314-3600

Janesville, WI 53546

Family Medicine Practice Status:

Dabson, Janet, MD Open

Board Certified: American Board of Family Medicine

St. George's Univ, Grenada, West Indies

Mercy Health System Family Practice Residency Program, Janesville, WI

Medical School:

Residency:

Kramer, Tamara, MD Open

Board Certified: American Board of Family Medicine

University of WI- Madison, Madison, WI

Mercy Family Medicine Residency Program, Janesville, WI

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Miller, Kristin, DO Open

Board Certified: American Board of Obstetrics and Gynecology

Des Moines Univ College of Osteopathic Medicine, Des Moines, IA

Tripler Army Medical Center, Honolulu, HI

Medical School:

Residency:

Pediatrics Practice Status:

Roe, Jonathan, MD Open

Board Certified: American Board of Pediatrics

Medical College of Milwaukee, Milwaukee, WI

Univ of Massachusetts Medical Center, Worchester, MA

Medical School:

Residency:

Mercyhealth North Emergency

3400 Deerfield Dr

(608) 314-3605

Janesville, WI 53546

Emergency Department Practice Status:

Mercyhealth Hospital & Trauma Center - North, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Mercyhealth North Urgent Care

3400 Deerfield Dr

(608) 314-3605

Janesville, WI 53546

Urgent Care Center Practice Status:

Mercyhealth North Urgent Care, , Open

Board Certified:

,

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 17 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Options Child & Adolescent

Day TX

2600 Humes Road, Ste 100

(608) 741-2117

Janesville, WI 53545

Licensed Clinical Social Worker Practice Status:

Condon, Stacy, LCSW Open

Board Certified:

George Williams College of Aurora Univ, Williams Bay, WI

,

Medical School:

Residency:

Professional Counselor Substance

AbusePractice Status:

Dubanowich, Deborah, SAC Open

Board Certified:

Lakeland Univ, Madison, WI

,

Medical School:

Residency:

Substance Abuse Counselor Practice Status:

Sanderson, Rachel, SAC Open

Board Certified:

,

,

Medical School:

Residency:

Mercyhealth Pain Center - Janesville

1000 Mineral Point Ave

(608) 756-6049

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Junghen, Jennifer, APNP Open

Board Certified: American Academy of Nurse Practitioners (Adult Nurse Practitioner)

Univ of Wisconsin-Milwaukee, Milwaukee

,

Medical School:

Residency:

Pain Management Practice Status:

Shah, Jaymin, DO Open

Board Certified: American Board of Anesthesiology (Pain Medicine)

Chicago College of Osteopathic Medicine, Downers Grove, IL

Medical College of WI, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Plastic Surgery, Skin & Laser

Center

1000 Mineral Point Ave

(608) 756-6300

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Ratzlaff, Karri, APNP Open

Board Certified: American Nurses Credentialing Center (Acute Care Nurse Practitioner)

Univ of Wisconsin School of Nursing, Madison, WI

,

Medical School:

Residency:

Physician Assistant Practice Status:

De Vos, Alissa, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Plastic Surgery Practice Status:

Paulius Quinn, Karina, MD Open

Board Certified: American Board of Surgery

Univ of Illinois at Chicago, Chicago, IL

Univ of IL - Mt. Sinai Hospital Program, Chicago, IL

Medical School:

Residency:

Mercyhealth Sleep Center - Janesville

903 Mineral Point Ave

(608) 758-5765

Janesville, WI 53548

Pulmonary Disease (Critical Care

Medicine)Practice Status:

Cook, Robert, MD Open

Board Certified: American Board of Internal Medicine (Sleep Medicine)

OH State University College of Medicine, Columbus, OH

Barnes Hosp, Washington U, St. Louis, MO

Medical School:

Residency:

Mercyhealth South

849 Kellogg Ave

(608) 755-7960

Janesville, WI 53546

Family Medicine Practice Status:

Altbuch, Arthur, MD Open

Board Certified: American Board of Family Medicine (Geriatric Medicine) (Sports Medicine)

Albany Medical College, Albany, NY

Bayfront Medical Center, St. Petersburg, FL

Medical School:

Residency:

Anderson, Jane, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin, Madison, WI

Mercy Health System, Janesville, WI

Medical School:

Residency:

Barkhou, Janet, MD Open

Board Certified:

Ross Univ School of Med, Roseau, Dominica

Mercy Health Sys, Janesville, WI

Medical School:

Residency:

Bello, Shakirat, MD Open

Board Certified: American Board of Family Medicne

Ross University, Roseau

Mercy health, Janesville, WI

Medical School:

Residency:

Cooper, Keith, DO Open

Board Certified: American Osteopathic Association

Chicago College of Osteopathic Medicine, Downers Grove, IL

Medical College of Ohio, Toledo, OH

Medical School:

Residency:

Shaikh, Suhail, MD Open

Board Certified: American Board of Family Medicine

Sindh Medical College Univ or Karachi, Karachi, Pakistan

Univ of Texas Medical School at San Antonio, San Antonio, TX

Medical School:

Residency:

Stahlecker, Jared, MD Open

Board Certified: American Board of Family Medicine

Ross Univ School of Medicine, Roseau, Dominica

Mercyhealth, Janesville, WI

Medical School:

Residency:

Mercyhealth South Urgent Care

849 Kellogg Ave

(608) 755-7960

Janesville, WI 53546

Urgent Care Center Practice Status:

Mercyhealth South Urgent Care, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 18 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Sports Medicine & Rehab Ctr -

Janesville

557 N Washington St

(608) 754-6000

Janesville, WI 53548

Orthopaedic Surgery Practice Status:

Lee, Thomas, MD Open

Board Certified:

Univ of Cincinnatti, Cincinnatti, OH

UPMC Hamot, Erie, PA

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Klean, Kevin, DO Open

Board Certified: American Osteopathic Board of Orthopedic Surgery

Des Moines Univ-College of Osteopathic Medicine, Des Moines, IA

Midwestern Univ-Franciscan St. James Health, Olympia Fields, IL

Medical School:

Residency:

Pittenger, David, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

Blodgett Memorial Medical Center, Grand Rapids MI

Medical School:

Residency:

Physical Medicine & Rehabilitation Practice Status:

Garcia, Ronald Allan M, MD Open

Board Certified: American Board of Physical Medicine and Rehabilitation

Univ of the East-Ramon Magsaysay Memorial Med Cntr, Philippines

Rehabilitation Insititue of Chicago, Northwestern University Medical

School, Chicago, IL

Medical School:

Residency:

Physician Assistant Practice Status:

Curtis, Stephanie, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Midwestern Univ, Downers Grove, IL

,

Medical School:

Residency:

Psychology Practice Status:

Gartland, Howard, PhD Open

Board Certified: Not Applicable

Texas Woman's University, Denton, TX

Not Applicable,

Medical School:

Residency:

Sports Medicine Practice Status:

Rutherford, Darin, MD Open

Board Certified: American Board of Family Medicine (Sports Medicine)

Univ of Iowa College of Medicine, Iowa City,IA

St. Mary's Hospital, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Terrace - Nephrology

510 North Terrace St

(608) 756-6007

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Berner, Julie, APRN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Mercyhealth Terrace - Surgery

510 North Terrace St

(608) 756-6869

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Kostantacos, Maria, NP Open

Board Certified: ANCC

St Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Surgery Practice Status:

Garner, Patricia, MD Open

Board Certified: American Board of Surgery

Univ of Arkansas for Medical Sciences, Little Rock, AR

Naval Medical Center, San Diego, cA

Medical School:

Residency:

Lynn, David, MD Open

Board Certified: American Board of Surgery

Univ of Illinois College of Medicine, Rockford, IL

Baystate Medical Center, Springfield, MA

Medical School:

Residency:

McGauley, Michael, DO Open

Board Certified: American Osteopathic Board of Surgery - General

Kansas City Univ of Medicine and Biosciences, Kansas City, MO

Garden City Osteopathic Hosp-MI State Univ, Garden City, MI

Medical School:

Residency:

Squires, William, MD Open

Board Certified:

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WWI

Medical School:

Residency:

Trauma Surgery Practice Status:

Nelson, Lawrence, MD Open

Board Certified: American Board of Surgery

Chicago College of Osteopathic Medicine, Downers Grove, IL

Metropolitan Hospital, Grand Rapids, MI

Medical School:

Residency:

Mercyhealth Transitional Care Center

1000 Mineral Point Ave

(608) 756-6050

Janesville, WI 53548

Skilled Nursing Facility Practice Status:

Mercy Manor Transition Center SNF, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Mercyhealth Urology Center

1000 Mineral Point Ave

(608) 741-6990

Janesville, WI 53548

Urology Practice Status:

Gianitsos, A. Nicholas, MD Open

Board Certified: American Board of Urology

Boston Univ School of Medicine, Boston, MA

Univ of Wisconsin Hospitals & Clinics, Madison, WI

Medical School:

Residency:

Kaveggia, Francis, MD Open

Board Certified: American Board of Urology

Univ of Wisconsin Medical School, Madison, WI

Univ of Nebraska Medical Center, Omaha, NE

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 19 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth West

1000 Mineral Point Ave

(608) 756-6800

Janesville, WI 53548

Advanced Practice Nurse Practitioner Practice Status:

Atkins, Rebecca, APNP Open

Board Certified: ANCC

Univ of Wi Madison, Madison, WI

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Wimmer, Jennifer, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Internal Medicine Practice Status:

Shaikh, Sumaira, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Aga Khem Univ, Karachi Pakistan

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Corbit, Justin, Pa-C Open

Board Certified: NCCPA

Univ of WI School of Medicine, Madison, WI

,

Medical School:

Residency:

Mercyhealth WINGS Program

903 Mineral Point Ave

(608) 756-6530

Janesville, WI 53548

Licensed Professional Counselor Practice Status:

Davis, Rebecca, LPC, SAC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, Whitewater, WI

,

Medical School:

Residency:

Substance Abuse Counselor Practice Status:

Davis, Rebecca, CSAC, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, Whitewater, WI

,

Medical School:

Residency:

Mercyhealth Women's Center - Janesville

1000 Mineral Point Ave

(608) 756-6890

Janesville, WI 53548

Advanced Practice Nurse Prescriber Practice Status:

Harris, Margot, APNP Open

Board Certified: National Certification Corporation (Women's Health Care Nurse

PractitionerVanderbilt Univ School of Nursing, Nashville, TN

Not Applicable,

Medical School:

Residency:

Gynecology Practice Status:

Neuman, Carol, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Emory Univ School of Medicine, Atlanta, GA

Emory Univ School of Medicine, Atlanta, GA

Medical School:

Residency:

Maternal-Fetal Medicine Practice Status:

Rogers, Dennie, MD Open

Board Certified: American Board of Obstetrics and Gynecology (Maternal-Fetal Medicine)

Univ of Illinois, Chicago, IL

Univ of Illinois @ Chicago, Chicago, IL

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Kaldor, Katheryn, DO Open

Board Certified: American Osteopathic Board of Obstetrics and Gynecology

Kansas City Univ of Medicine, Kansas City, MO

Philadelphia College of Osteopathic Medicine, Philadelphia, PA

Medical School:

Residency:

Munns, Meridyth, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Health Sciences, North Chicago, IL

Univ of WI Hospitals and Clinics, Madison, WI

Medical School:

Residency:

Nahn, Patricia, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Wisconsin Medical School, Madison, WI

Univ of Texas, Houston, TX

Medical School:

Residency:

Newmark, Dorothy, MD Open

Board Certified: American Board of Obstetrics and Gynecology

State Univ of New York, Syracuse, NY

Univ of WI Hospital & Clinics, Madison, WI

Medical School:

Residency:

Okocha, Chukwunonyeluanyi, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Minnesota-Twin Cities, Minneapolis, MN

Univ of Texas Medical Branch, Galveston, TX

Medical School:

Residency:

Wistrom, Elana, DO Open

Board Certified: American Osteopathic Board of Obstetrics and Gynecology

A.T. Still Univ, Kirksvill, MO

Henry Ford Macomb Hospital, Clinton Twp, MI

Medical School:

Residency:

Premier Oral & Maxillofacial Surgery

1602 N Randall Ave

(608) 756-8744

Janesville, WI 53545

Oral & Maxillofacial Surgery Practice Status:

Gams, Kevin, DDS Open

Board Certified:

Univ of iowa College of Dentistry, Iowa City, IA

Summa Health System, Akron, OH

Medical School:

Residency:

Khader, Ruba, BDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Jordan Un iv of Science and Technology, Irbid, Jordan

Tufts University, Boston, MA

Medical School:

Residency:

Meister, Richard, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Marquette Univ School of Dentistry, Milwaukee, WI

Hosp of St Raphael, New Haven, CT

Medical School:

Residency:

Swantek, Jason, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

UIC College of Dentistry, Chicago, IL

Woodhull Medical Center, Brooklyn, NY

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 20 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Rock Haven

3400 N County HWY F

(608) 757-5000

Janesville, WI 53547

Skilled Nursing Facility Practice Status:

Rock Haven, , Open

Board Certified: Not Accredited

,

,

Medical School:

Residency:

St. Elizabeth Nursing Home

109 S. Altwood Ave

(608) 752-6709

Janesville, WI 53455

Skilled Nursing Facility Practice Status:

St Elizabeth Nursing Home, , Open

Board Certified: Not Accredited

,

,

Medical School:

Residency:

Jefferson, WI

Central Jefferson Chiropractic

202 N Main St

(920) 674-5025

Jefferson, WI 53549

Chiropractic Practice Status:

Lewis, Alan, DC Open

Board Certified: Not Applicable

National College of Chiropractic, Lombard, IL

Not Applicable,

Medical School:

Residency:

Fort HealthCare Jefferson

840 W Racine St

(920) 674-6000

Jefferson, WI 53549

Licensed Professional Counselor Practice Status:

Lee, Joshua, LPC Open

Board Certified:

Univ of Wi Whitewater, Whitewater, WI

,

Medical School:

Residency:

Physician Assistant Practice Status:

Dethier, Miranda, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Sund, Joni, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Nebraska, Lincoln, NE

,

Medical School:

Residency:

Fort HealthCare Orthopaedic Associates

840 W Racine St

(920) 563-7888

Jefferson, WI 53549

Orthopedic Surgery Practice Status:

Bliss, Matthew, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of New Mexico School of Medicine, Albuquerque, NM

Wake Forest Univ Baptist Medical Center,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Schuppner, Paul, DO Open

Board Certified: Not Board Certified

Midwestern Univ Chicago College of Osteopathic Medicine, Downers Grove, ILMichigan State Univ College of Osteopathic Medicine, Lansing, MI

Medical School:

Residency:

Jefferson County Human Services

1541 Annex Rd

(920) 674-3105

Jefferson, WI 53549

Addiction Counselor Practice Status:

Krueger, Cory, LPC Open

Board Certified:

University of Wisconsin Whitewater, Whitewater, WI

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Bykowski, Brandon, LCSW Open

Board Certified: Not Applicable

Univ of WI - Madison, Madison, WI

,

Medical School:

Residency:

Dunham, Lisa, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Milwaukeem WI

,

Medical School:

Residency:

Fischer, David, LCSW Open

Board Certified: Not Applicable

Aurora Univ at George Williams College, Aurora, IL

,

Medical School:

Residency:

North, Kelly, LCSW Open

Board Certified:

Univ odf WI Milwaukee, Milwaukee, WI

,

Medical School:

Residency:

Turner, Elizabeth, MSW Open

Board Certified:

UW Madison, Madison, WI

,

Medical School:

Residency:

Licensed Marriage & Family Therapist Practice Status:

Melvin, Katherin, LMFT Open

Board Certified: Not Applicable

Edgewood College, Madison, WI

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Bellford, Heather, LPC Open

Board Certified: National Board of Certified Counselors

,

,

Medical School:

Residency:

Doerr, Krista, LPC Open

Board Certified: Not Applicable

Univ of Wiscons - Whitewater, Whitewater, WI

,

Medical School:

Residency:

Lightner, Amanda, LPC Open

Board Certified: Not Applicable

Multmomah Dept of Juvinielle Justice, Portland, OR

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 21 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Licensed Professional Counselor Practice Status:

Porter, Amy, LPC Open

Board Certified:

University of Wisconsin Whitewater, Whitewater, WI

,

Medical School:

Residency:

Wendt, Jennifer, LPC Open

Board Certified: Not Applicable

Chicago School of Professional Psychology, Chicago, IL

,

Medical School:

Residency:

Johnson Creek, WI

Fort HealthCare Center for Womens Health

400 Doctors Ct

(920) 699-3600

Johnson Creek, WI 53038

Obstetrics and Gynecology Practice Status:

Chuppa, Christine, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of WI Medical School, Madison, WI

Univ of MO, Kansas City, MO

Medical School:

Residency:

Fort HealthCare Johnson Creek

400 Doctors Ct

(920) 699-4000

Johnson Creek, WI 53038

Family Medicine Practice Status:

Misorski, David, MD Open

Board Certified: American Board of Family Medicine

Medical College of WI-Milwaukee, Milwaukee, WI

Medical College of WI-Milwaukee, Milwaukee, WI

Medical School:

Residency:

Misorski, David, MD Open

Board Certified: American Board of Family Medicine

Medical College of WI-Milwaukee, Milwaukee, WI

Medical College of WI-Milwaukee, Milwaukee, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Dethier, Miranda, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Sund, Joni, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Nebraska, Lincoln, NE

,

Medical School:

Residency:

Fort HealthCare Wound & Edema Center

400 Doctors Ct

(920) 699-4245

Johnson Creek, WI 53038

Physical Medicine & Rehabilitation Practice Status:

Goldman, Robert, MD Open

Board Certified: American Board of Physicial Medicine and Rehabilitation AND American Board of Preventive Medicine (Undersea & Hyperbaric Medicine)Univ of Texas Medical Branch at Galveston, Galveston, TX

MCP Hahnemann Univ School of Medicine, Philadephia, PA

Medical School:

Residency:

Surgery Practice Status:

McLaughlin, Jonathan, MD Open

Board Certified: American Board of Surgery

Univ of Minnesota, Minneapolis, MN

Butterworth Hospital Michigan State Univ, Grand Rapids, MI

Medical School:

Residency:

Three Oaks Health, SC

480 Village Walk Ln, Ste F

(920) 542-3010

Johnson Creek, WI 53038

Family Medicine Practice Status:

Milford, James, MD Open

Board Certified: American Board of Family Medicine

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

St. Michael's, Milwaukee, WI

Medical School:

Residency:

UWHP Center for Eye Care - Johnson

540 Village Walk Ln, Ste G

(920) 699-4388

Johnson Creek, WI 53038

Ophthalmology Practice Status:

Van Hecke, Holly, MD Open

Board Certified: American Board of Ophthalmology

Univ of Illinois College of Medicine, Chicago, IL

Univ of Illinois Eye & Ear Infirmary, Chicago, IL

Medical School:

Residency:

Optometry Practice Status:

Anslinger, John, OD Open

Board Certified: Not Applicable

Indiana Univ, Indiana

Not Applicable,

Medical School:

Residency:

WRMC Center for Eye Care - Johnson Creek

540G Village Walk Ln

(920) 699-4388

Johnson Creek, WI 53038

Ophthalmology Practice Status:

Boush, George, MD Open

Board Certified: American Board of Ophthalmology

Univ of Wisconsin, Madison, WI

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Sullivan, Sheila, DO Open

Board Certified: Not Board Certified

DesMoines Univ, College of Osteopathic Medicine, Des Moines, IA

Philadeplphia College of Osteopathic Medicine, Philadelphia, PA

Medical School:

Residency:

Optometry Practice Status:

Roberson, Daniel, OD Open

Board Certified: Not Applicable

New England College of Optometry, Boston, MA

Captain James A. Lovell Federal Health Care Center, N. Chicago, IL

Medical School:

Residency:

WRMC Johnson Creek Clinic

540 Village Walk Ln, Ste J

(920) 699-6200

Johnson Creek, WI 53038

Advanced Practice Nurse Prescriber Practice Status:

Davey, Melissa, NP Open

Board Certified: AANP

Maryville Univ, St Louis, MO

,

Medical School:

Residency:

Lambrecht, Shauna, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 22 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Advanced Practice Nurse Prescriber Practice Status:

Price, Teresa, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Raatz, Heather, APNP Open

Board Certified: Not Board Certified

Univ of Cincinnati, Cincinnatio, OH

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Cullinane, David, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

UW Medical School, Madison, WI

Medical College of Wisconsin Hospital & Clinics, Milwaukee, WI

Medical School:

Residency:

Iqbal, Fahad, MD Open

Board Certified: American Board of Internal Medicine

Ross University,

University of IL St. Joseph's,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Roman, Terry, DO Open

Board Certified: American Osteopathic Orthopedic Surgery

A.T. Still University, Kirksville, MO

Michigan State University, Grand Blanc, MI

Medical School:

Residency:

Physician Assistant Practice Status:

Hunter, Cathy, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Kolkovich, Cheryl, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Finch Univ of Health Sciences, The Chicago Medical School, North Chicago, ILNot Applicable,

Medical School:

Residency:

Juneau, WI

WRMC Juneau Clinic

334 South Western Avenue

(920) 386-0290

Juneau, WI 53039

Advanced Practice Nurse Prescriber Practice Status:

Davey, Melissa, NP Open

Board Certified: AANP

Maryville Univ, St Louis, MO

,

Medical School:

Residency:

Lambrecht, Shauna, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Price, Teresa, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Raatz, Heather, APNP Open

Board Certified: Not Board Certified

Univ of Cincinnati, Cincinnatio, OH

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Cullinane, David, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

UW Medical School, Madison, WI

Medical College of Wisconsin Hospital & Clinics, Milwaukee, WI

Medical School:

Residency:

Iqbal, Fahad, MD Open

Board Certified: American Board of Internal Medicine

Ross University,

University of IL St. Joseph's,

Medical School:

Residency:

Family Medicine Practice Status:

Box, Helen, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Gunderson Lutheran, LaCrosse, WI

Medical School:

Residency:

Orthopedic Surgery Practice Status:

O'Halloran, Kevin, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Illinois College of Medicine, Chicago, IL

Rush-Presbyterian-St. Lukes,, Chicago, Il

Medical School:

Residency:

Roman, Terry, DO Open

Board Certified: American Osteopathic Orthopedic Surgery

A.T. Still University, Kirksville, MO

Michigan State University, Grand Blanc, MI

Medical School:

Residency:

Physician Assistant Practice Status:

Lentscher, Luke, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Midwestern Univ, Downers Grove, IL

,

Medical School:

Residency:

Kenosha, WI

Rogers Memorial Hospital - Kenosha

9916 - 75th St

(800) 767-4411

Kenosha, WI 53140

Child & Adolescent Mental Health

ProgramPractice Status:

Rogers Memorial Hospital - Kenosha, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Lake Geneva, WI

Geneva Lakes Manor

211 S Curtis St

(262) 248-3145

Lake Geneva, WI 53147

Skilled Nursing Facility Practice Status:

Geneva Lakes Manor, , Open

Board Certified: Not Accredited

,

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 23 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Hospital & Medical Center -

Walworth

N2950 State Road 67

(877) 893-5503

Lake Geneva, WI 53147

Advanced Practice Nurse Prescriber Practice Status:

Disch, Nicole, APRN Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse)Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Farrell, Amanda, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

UW- Milwaukee, Milwaukee, WI

,

Medical School:

Residency:

Junghen, Jennifer, APNP Open

Board Certified: American Academy of Nurse Practitioners (Adult Nurse Practitioner)

Univ of Wisconsin-Milwaukee, Milwaukee

,

Medical School:

Residency:

Martin, Jennifer, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

,

,

Medical School:

Residency:

Young, Deborah, APNP Open

Board Certified: American Academy of Nurse Practitioners - Family Nurse Practitioner

Walden Univ, Minnapolis, MN

,

Medical School:

Residency:

Cardiology Practice Status:

Bortin, Kenneth, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Hahnemann Univ, Philadelphia, PA

Medical College of Pennsylvania, Philadelphia, PA

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Khemani, Anil, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Patna Med College, Patna, India

All India Inst of Med Sciences, New Delhi, India

Medical School:

Residency:

Dermatology Practice Status:

Compton, Marguerite, MD Open

Board Certified: American Board of Dermatology

Medical College of Wisconsin, Milwaukee, WI

Medical College of WI Clinics at Froedtert Hospital, Milwaukee, WI

Medical School:

Residency:

Gharia, Manish, MD Open

Board Certified: American Board of Dermatology

Medical College of Wisconsin, Milwaukee, WI

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Emergency Department Practice Status:

Mercyhealth Walworth Hospital ED, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Family Medicine Practice Status:

Draper, Dominic, MD Open

Board Certified: American Board of Family Medicine

American Univ of Antigua, New York, NY

Medical College of Wisconsin St. Joseph's/All Saints, Milwaukee, WI

Medical School:

Residency:

McCoy, James, MD Open

Board Certified: American Board of Family Medicine (Geriatric Medicine)

Loyola Univ , Stritch School of Medicine, Maywood, IL

MacNeal Memorial Hospital, Berwyn, IL

Medical School:

Residency:

Gastroenterology Practice Status:

Khoury, Ramez, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Damascus Univ, Damascus, Syria

The Graduate Hospital, Philadelphia, PA

Medical School:

Residency:

Qazi, Baseer, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Declan College of Medical Sciences, Hyderabad, India

Advocate Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Hospital Practice Status:

Mercyhealth Walworth Hospital & Med CTR, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Internal Medicine Practice Status:

Shaikh, Sumaira, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Aga Khem Univ, Karachi Pakistan

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Medical Oncology Practice Status:

Shekhani, Shahid, MD Open

Board Certified: American Board of Internal Medicine (Medical Oncology)(Hospice & Palliative Care)Sind Medical College, Karachi, Pakistan

Prince Georges Hospital Center, Cheverly, MD

Medical School:

Residency:

Neurological Surgery Practice Status:

Rust, Merle, MD Open

Board Certified: American Board of Neurological Surgery

Univ of Illinois College of Medicine, Peoria, IL

Univ of Illinois College of Medicine, Peoria, IL

Medical School:

Residency:

Neurology Practice Status:

Gorelik, Maxim, MD Open

Board Certified: American Board of Psychiatry and Neurology (Pain Medicine)

Rush Medical College of Rush Univ, Chicago, IL

Univ of California, Davis Medical Center, Sacramento, CA

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Osipova, Anastasia, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Russian State Medical Univ, Moscow, Russia

Russian State Medical Academy of Postgraduate Education, Moscow,

Russia

Medical School:

Residency:

Schwartz, Amanda, MD Open

Board Certified:

University of Vermont College of Medicine, Burlington, VA

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 24 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Obstetrics and Gynecology Practice Status:

Villegas Van der Linde, Silvia, MD Open

Board Certified: American Board of Obstetrics and Gynecology

UNIBE - Universidad Iberoamericana, Santo Domingo, Dominican RepublicMount Sinai Hospital, Chicago, IL

Medical School:

Residency:

Ophthalmology Practice Status:

Luellwitz, David, DO Open

Board Certified: American Osteopathic Board of Ophthalmology

Western Univ of Health Sciences, Pomona, CA

Midwestern University, Olympia Fields, IL

Medical School:

Residency:

Whitehead, A. Jeffrey, MD Open

Board Certified:

Univ of Wisconsin, Madison, WI

Washington Univ in St. Louis, St. Louis, MO

Medical School:

Residency:

Optometry Practice Status:

Rockwell, John, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Fideler, Bradley, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Iowa College of Medicine, Iowa City, IA

Univ of Southern California, Los Angeles, CA

Medical School:

Residency:

Lyon, Craig, MD Open

Board Certified: American Board of Orthopaedic Surgery

Rush Medical College, Chicago, Il

Univ of Iowa Hospitals & Clinics, Iowa City, IA

Medical School:

Residency:

Otolaryngology Practice Status:

Riggs, Landon, MD Open

Board Certified: American Board of Otolaryngology

Loyola Univ of Chicago Stritch School of Medicine, Maywood, IL

Loyola Univ of Chicago, Maywood, IL

Medical School:

Residency:

Yang, Eric, MD Open

Board Certified: American Board of Otolaryngology

Univ of Southern California, Keck School of Medicine, Los Angeles, CA

Univ of Utah, Salt Lake City, UT

Medical School:

Residency:

Pediatrics Practice Status:

Klawitter, Joseph, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

Potsch, Shirley, MD Open

Board Certified: American Board of Pediatrics

Southern Illinois Univ School of Medicine, Springfield, IL

Univ of Nebraska Medical Center, Omaha, NE

Medical School:

Residency:

Physical Medicine & Rehabilitation Practice Status:

Garcia, Ronald Allan M, MD Open

Board Certified: American Board of Physical Medicine and Rehabilitation

Univ of the East-Ramon Magsaysay Memorial Med Cntr, Philippines

Rehabilitation Insititue of Chicago, Northwestern University Medical School, Chicago, IL

Medical School:

Residency:

Physician Assistant Practice Status:

Burnett, Melinee, Pa-C Open

Board Certified: NCCPA

Medical College of Georgia, Augusta, GA

,

Medical School:

Residency:

Burns, Kevin, PA-C Open

Board Certified: The National Commission on Certification of Physician Assistants

Rosalind Franklin Univ of Medicine and Health Sciences, North Chicago,

IL,

Medical School:

Residency:

Gladchenko, Nicole, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Alderson Broaddus, Phillippi, WV

,

Medical School:

Residency:

Houtakker, Jeremy, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

,

,

Medical School:

Residency:

Palecek, Erin, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Toledo, Toledo, OH

,

Medical School:

Residency:

Schnell, Tina, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Colorado Health Science Center, Denver, CO

Not Applicable,

Medical School:

Residency:

Plastic Surgery Practice Status:

Paulius Quinn, Karina, MD Open

Board Certified: American Board of Surgery

Univ of Illinois at Chicago, Chicago, IL

Univ of IL - Mt. Sinai Hospital Program, Chicago, IL

Medical School:

Residency:

Podiatry Practice Status:

Loch, Archibald, DPM Open

Board Certified: American Board of Foot and Ankle Surgery

Rosalind Franklin Univ, North Chicago, IL

Massachusetts General Hospital, Boston, MA

Medical School:

Residency:

Psychology Practice Status:

Catuara, Katherine, PsyD Open

Board Certified: Not Applicable

Roosevelt Univ, Chicago, IL

,

Medical School:

Residency:

Gartland, Howard, PhD Open

Board Certified: Not Applicable

Texas Woman's University, Denton, TX

Not Applicable,

Medical School:

Residency:

Hanson, Christine, PhD Open

Board Certified: Not Applicable

Ohio State Univ, Columbus, OH

,

Medical School:

Residency:

Pulmonary Disease Practice Status:

Balagani, Rajesh, DO Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease)(Critical Care Medicine)Chicago College of Osteopathic Medicine, Midwestern Univ, Downers Grove, IL

Evanston Northwestern Hospital, Evanston, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 25 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

Greenberg, James, MD Open

Board Certified: American Board of Surgery

Univ of Missouri, Kansas City, MO

Loyola Univ Medical Center, Maywood, IL

Medical School:

Residency:

Wilczak, Emily, MD Open

Board Certified: American Board of Surgery

,

,

Medical School:

Residency:

Urology Practice Status:

Gianitsos, A. Nicholas, MD Open

Board Certified: American Board of Urology

Boston Univ School of Medicine, Boston, MA

Univ of Wisconsin Hospitals & Clinics, Madison, WI

Medical School:

Residency:

Kaveggia, Francis, MD Open

Board Certified: American Board of Urology

Univ of Wisconsin Medical School, Madison, WI

Univ of Nebraska Medical Center, Omaha, NE

Medical School:

Residency:

Vascular Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

Mercyhealth Lake Geneva

350 Peller Rd

(262) 249-0221

Lake Geneva, WI 53147

Family Medicine Practice Status:

Myron, Gary, MD Open

Board Certified: American Board of Family Medicine

Ross Univ School of Medicine, Edison, NJ

Oklahoma University, Oklahoma City,OK

Medical School:

Residency:

Mercyhealth Lakeside Orthopaedics

352 Peller Rd

(262) 248-4467

Lake Geneva, WI 53147

Orthopedic Surgery Practice Status:

Knavel, James, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Iowa College of Medicine, Iowa City, IA

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Sports Medicine & Rehab Ctr - Walworth

N2950 State Road 67

(877) 893-5503

Lake Geneva, WI 53147

Physical Medicine & Rehabilitation Practice Status:

Garcia, Ronald Allan M, MD Open

Board Certified: American Board of Physical Medicine and Rehabilitation

Univ of the East-Ramon Magsaysay Memorial Med Cntr, Philippines

Rehabilitation Insititue of Chicago, Northwestern University Medical School, Chicago, IL

Medical School:

Residency:

Mercyhealth Walworth Urgent Care

N2950 State Road 67

(262) 245-2230

Lake Geneva, WI 53147

Urgent Care Center Practice Status:

Mercyhealth Urgent Care - Walworth, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Lake Mills, WI

Fort HealthCare Lake Mills Clinic

200 E Tyranena Park Rd

(920) 648-8393

Lake Mills, WI 53551

Advanced Practice Nurse Prescriber Practice Status:

Runte, Laurel, APNP Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse

Practitioner)Not Applicable,

Not Applicable,

Medical School:

Residency:

Schultz, Kristin, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Family Medicine Practice Status:

Philbin, Jennifer, MD Open

Board Certified: American Board of Family Medicine

Univ of Illinois College of Medicine, Chicago, IL

Univ of Illinois College of Medicine, Chicago, IL

Medical School:

Residency:

Internal Medicine Practice Status:

Wishau, James, MD Open

Board Certified: American Board of Internal Medicine

Univ of Wisconsin Medical School, Madison, WI

Kettering Med Cntr, Wright ST Univ., Dayton, OH

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Lee, Joshua, LPC Open

Board Certified:

Univ of Wi Whitewater, Whitewater, WI

,

Medical School:

Residency:

Fort HealthCare Lake Mills Urgent Care

200 E Tyranena Park Rd

(920) 648-3113

Lake Mills, WI 53551

Urgent Care Center Practice Status:

Fort HealthCare Lake Mills UC, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Fort HealthCare Orthopaedic Associates

200 E Tyranena Park Rd

(920) 563-7888

Lake Mills, WI 53551

Orthopedic Surgery Practice Status:

Zambrano, Isidoro, MD Open

Board Certified: American Board of Orthopaedic Surgery

Medical College of Wisconsin, Milwaukee, WI

State Univ of New York College of Medicine Stony Brook Univ Hospital,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 26 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020WRMC Lake Mills Clinic

1025 Mulberry St

(920) 478-3776

Lake Mills, WI 53551

Advanced Practice Nurse Prescriber Practice Status:

Davey, Melissa, NP Open

Board Certified: AANP

Maryville Univ, St Louis, MO

,

Medical School:

Residency:

Howard, Karen, APNP Open

Board Certified: National Certification Corporation (Women's Health Care Nurse

Practitioner)Mt. Senario Collge, Ladysmith, WI

,

Medical School:

Residency:

Family Medicine Practice Status:

Box, Helen, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Gunderson Lutheran, LaCrosse, WI

Medical School:

Residency:

Van Reesen, Whitney, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin, Milwaukee, WI

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Peters, Christopher, LCSW Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

DeJong, Julie, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Wisconsin, Madison, WI

Univ of Iowa Hospital and Clinics, Iowa City, IA

Medical School:

Residency:

Nguyen, VanLy, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Arkansas for Medical Sciences, Little Rock, AR

Cooper Univ Hospital UMDNJ, Camden, NJ

Medical School:

Residency:

Siddiqui, Danish, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Aga Khan Medical College, Karachi, Pakistan

Bridgeport Hospital, Bridgeport, CT

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Rhodes, Steven, MD Open

Board Certified: American Board of Orthopaedic Surgery

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Hunter, Cathy, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Kolkovich, Cheryl, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Finch Univ of Health Sciences, The Chicago Medical School, North Chicago, ILNot Applicable,

Medical School:

Residency:

Madison, WI

AIDS Resource Center

600 Williamson Stt, Ste H

(800) 486-6276

Madison, WI 53703

Patient Centered Medical Home Practice Status:

AIDS Resource Center, , Open

Board Certified: NCQA - Patient Centered Medical Home

,

,

Medical School:

Residency:

Madison East Comprehensive Treatment Center

5109 World Dairy Expo Dr

(608) 242-0220

Madison, WI 53718

Methadone Clinic Practice Status:

Madison East Comprehensive Treatment Center, , Open

Board Certified: CARF Accredited

,

,

Medical School:

Residency:

Madison West Comprehensive Treatment

Center

151 E Badger Rd, Ste A

(608) 250-2512

Madison, WI 53713

Methadone Clinic Practice Status:

Madison West Comprehensive Treatment Center, , Open

Board Certified: Council on Accreditation

,

,

Medical School:

Residency:

Meriter Hospital

202 South Park St

(608) 267-6000

Madison, WI 53715

Child & Adolescent Addictions Program Practice Status:

Meriter Hospital Inc, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Meriter Hospital Inc, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

MW Counseling, LLC

429 Gammon Place, Ste 200

(608) 843-7055

Madison, WI 53719

Licensed Professional Counselor Practice Status:

Walden, Melissa, LPC Open

Board Certified: Not Applicable

Nova Univ, Fort Lauderdale, FL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 27 of 65W9

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State of Wisconsin - 2020Psychological Addiction Services

3113 E Washington Avenue

(608) 416-5777

Madison, WI 53704

Licensed Clinical Professional

CounselorPractice Status:

Brown, Amy, PC Open

Board Certified: National Certified Counselor

Univ of Wisconsin, Oshkosh, WI

,

Medical School:

Residency:

DeGroot, Katelin, LPC Open

Board Certified:

,

,

Medical School:

Residency:

Substance Abuse Counselor Practice Status:

Dabetic, Bojan, CSAC Open

Board Certified:

,

,

Medical School:

Residency:

Milton, WI

Hammer Chiropractic, LLC

840 Arthur Dr

(608) 868-4343

Milton, WI 53563

Chiropractic Practice Status:

Hammer, Christopher, DC Open

Board Certified: Not Applicable

Northwestern College of Chiropractic, Bloomington, MN

Reeve Chiro Clinic, Austin, MN

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic - Milton

725 S Janesville St

(608) 756-5555

Milton, WI 53563

Licensed Clinical Social Worker Practice Status:

Benash, Jessica, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Mercyhealth Milton

725 South Janesville St

(608) 868-5800

Milton, WI 53563

Advanced Practice Nurse Prescriber Practice Status:

Wixom, Shannon, NP Open

Board Certified: AANP

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Family Medicine Practice Status:

Kulas, Daniel, MD Open

Board Certified: American Board of Family Medicine

Medical College of Wisconsin,

Mercy Health System Family Medicine Residency Program, Janesville, WI

Medical School:

Residency:

Van Beek, Rodney, MD Open

Board Certified: American Board of Family Medicine

Univ of Oklahoma College of Medicine, Oklahoma City, OK

Mercy Health System Family Practice Residency Program, Janesville, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Shaikh, Sumaira, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Aga Khem Univ, Karachi Pakistan

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Wistrom, Elana, DO Open

Board Certified: American Osteopathic Board of Obstetrics and Gynecology

A.T. Still Univ, Kirksvill, MO

Henry Ford Macomb Hospital, Clinton Twp, MI

Medical School:

Residency:

Physician Assistant Practice Status:

Dahl, Carrie, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Milwaukee, WI

10th Street Comprehensive Treatment Center

4800 S 10th St, Unit 1

(414) 744-5370

Milwaukee, WI 53221

Methadone Clinic Practice Status:

10th Street Comprehensive Treatment Center, , Open

Board Certified: CARF Accredited

,

,

Medical School:

Residency:

River's Shore Comprehensive TX

3707 N Richards St

(414) 967-7012

Milwaukee, WI 53212

Methadone Clinic Practice Status:

River's Shore Comprehensive TX CTR, , Open

Board Certified: CARF Accredited

,

,

Medical School:

Residency:

Monona, WI

Tellurian Outpatient Clinic

5900 Monona Dr, Ste 300

(608) 442-4333

Monona, WI 53716

Adult Addictions Program Practice Status:

Tellurian Outpatient Clinic, , Open

Board Certified:

,

,

Medical School:

Residency:

Monroe, WI

Monroe Manor

516 26th Ave

(608) 325-9141

Monroe, WI 53566

Skilled Nursing Facility Practice Status:

Monroe Health Services, , Open

Board Certified: Not Accredited

Not Applicable,

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 28 of 65W9

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State of Wisconsin - 2020Premier Oral & Maxillofacial Surgery

1005 16th Ave

(608) 325-7177

Monroe, WI 53566

Oral & Maxillofacial Surgery Practice Status:

Meister, Richard, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Marquette Univ School of Dentistry, Milwaukee, WI

Hosp of St Raphael, New Haven, CT

Medical School:

Residency:

Swantek, Jason, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

UIC College of Dentistry, Chicago, IL

Woodhull Medical Center, Brooklyn, NY

Medical School:

Residency:

Oconomowoc, WI

Rogers Memorial Hospital - Oconomowoc

34700 Valley Rd

(800) 767-4411

Oconomowoc, WI 53066

Adult Addictions Program Practice Status:

Rogers Memorial Hospital - Oconomowoc, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rogers Memorial Hospital - Oconomowoc, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Watertown General & Vascular Surgeons, SC

888 Thackeray Trail, Ste 103

(920) 567-1499

Oconomowoc, WI 53066

Surgery Practice Status:

Stoddard, Emily, MD Open

Board Certified: American Board of Surgery

Univ of Wisconsin Medical School, Madison, WI

Univ of Wisconsin Hospital and Clinics, Madison, WI

Medical School:

Residency:

Racine, WI

Racine Comprehensive Treatment Center

5735 Durand Ave, Ste A

(262) 598-1392

Racine, WI 53406

Methadone Clinic Practice Status:

Racine Comprehensive TX Center, , Open

Board Certified: Council on Accreditation

,

,

Medical School:

Residency:

Waterford, WI

Lakeview Neurorehab Center Midwest dba Lakeview Specialty Hosp & Rehab Ctr

1701 Sharp Rd Waterford, WI 53185

Long Term Hospital Practice Status:

Lakeview Neurorehab Center Midwest dba Lakeview

Specialty Hosp & Rehab Ctr, ,

Open

Board Certified:

,

,

Medical School:

Residency:

Waterloo, WI

WRMC Waterloo Clinic

111 Anna St

(920) 478-3776

Waterloo, WI 53594

Advanced Practice Nurse Prescriber Practice Status:

Howard, Karen, APNP Open

Board Certified: National Certification Corporation (Women's Health Care Nurse Practitioner)Mt. Senario Collge, Ladysmith, WI

,

Medical School:

Residency:

Lambrecht, Shauna, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Price, Teresa, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Raatz, Heather, APNP Open

Board Certified: Not Board Certified

Univ of Cincinnati, Cincinnatio, OH

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Cullinane, David, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

UW Medical School, Madison, WI

Medical College of Wisconsin Hospital & Clinics, Milwaukee, WI

Medical School:

Residency:

Iqbal, Fahad, MD Open

Board Certified: American Board of Internal Medicine

Ross University,

University of IL St. Joseph's,

Medical School:

Residency:

Family Medicine Practice Status:

Box, Helen, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Gunderson Lutheran, LaCrosse, WI

Medical School:

Residency:

Siragusa, Jenifer, DO Open

Board Certified: American Board of Family Medicine

Arizona College of Osteopathic Medicine - Midwestern Univ, Glendale, AZ

St. Luke's Family Practice, Milwaukee, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 29 of 65W9

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State of Wisconsin - 2020Obstetrics and Gynecology Practice Status:

Nguyen, VanLy, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Arkansas for Medical Sciences, Little Rock, AR

Cooper Univ Hospital UMDNJ, Camden, NJ

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Rhodes, Steven, MD Open

Board Certified: American Board of Orthopaedic Surgery

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Roman, Terry, DO Open

Board Certified: American Osteopathic Orthopedic Surgery

A.T. Still University, Kirksville, MO

Michigan State University, Grand Blanc, MI

Medical School:

Residency:

Physician Assistant Practice Status:

Marsden, (Gordon) Roy, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin, Madison, WI

,

Medical School:

Residency:

Watertown, WI

Central Otologic, LTD

123 Hospital Dr, Ste 106A

(920) 261-0226

Watertown, WI 53098

Otolaryngology Practice Status:

Janowak, Michael, MD Open

Board Certified: American Board of Otolaryngology

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

Med College of Wisconsin, Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

Martinelli, Dean, MD Open

Board Certified: American Board of Otolaryngology

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

Milwaukee County General Hosp,

Medical School:

Residency:

Directions Counseling Center

129 Hospital Dr

(920) 262-4800

Watertown, WI 53098

Behavioral Health Clinic Practice Status:

Directions Counseling Center, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Loescher, Janell, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin Milwaukee, Milwaukee, WI

,

Medical School:

Residency:

O'Neill, Kathleen, LCSW Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Peters, Christopher, LCSW Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Psychology Practice Status:

Beaver, Erik, PhD Open

Board Certified: Not Applicable

Northern IL Univ, Dekalb, IL

Not Applicable,

Medical School:

Residency:

Face and Skin, LLC

123 Hospital D, Ste 212

(920) 262-4843

Watertown, WI 53098

Otolaryngology Practice Status:

Yaish, Ayman, DO Open

Board Certified: Not Board Certified

Michigan State Univ College of Osteopathic Medicine, East Lansing, MI

Genesys Regional Medical Center, Grand Blanc, MI

Medical School:

Residency:

Yaish, Ayman, DO Open

Board Certified: Not Board Certified

,

,

Medical School:

Residency:

Fort HealthCare Ear, Nose and Throat Specialists

123 Hospital Dr, Ste 106a

(920) 261-8196

Watertown, WI 53098

Otolaryngology Practice Status:

Anderson, Michael, MD Open

Board Certified: American Board of Otolaryngology

Univ of Wisconsin, Madison, WI

Indiana University, Indianapolis, IN

Medical School:

Residency:

Hofmann, William, MD Open

Board Certified: American Board of Otolaryngology

Univ of Cincinnati College of Medicine, Cincinnati, OH

Indiana Univ Medical Center, Indianapolis, IN

Medical School:

Residency:

Luedtke-Storm-Mackey Chiropractic Clinic

808 E Main St

(920) 206-7959

Watertown, WI 53094

Chiropractic Practice Status:

Tesch, Todd, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable,

Medical School:

Residency:

Weyenberg, Ryan, DC Open

Board Certified: Not Applicable

Northwestern College of Chiropractic, Minneapolis, MN

,

Medical School:

Residency:

Meade Medical Clinic

134 Hospital Dr

(920) 261-6500

Watertown, WI 53098

Advanced Practice Nurse Prescriber Practice Status:

Beyer, Jan, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Univ of Wisconsin Oshkosh, Oshkosh, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 30 of 65W9

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State of Wisconsin - 2020Family Medicine Practice Status:

Meade, James, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Harrisburg Hospital, Harrisburg, PA

Medical School:

Residency:

Pediatrics Practice Status:

Hayes, Kevin, DO Open

Board Certified: American Board of Pediatrics

Des Moines Univ, Des Moines, IA

Univ of Wisconsin, Madison, WI

Medical School:

Residency:

Martin, Scott, MD Open

Board Certified: American Board of Pediatrics

Univ of Wisconsin School of Medicine, Madison, WI

Marshfield Clinic/St. Joseph's Hospital, Marshfield, WI

Medical School:

Residency:

Meade, Jeffrey, MD Open

Board Certified: American Board of Pediatrics

Univ of Wisconsin Medical School, Madison, WI

Mercy Hospital of Pittsburgh, Pittsburgh, PA

Medical School:

Residency:

Physician Assistant Practice Status:

Fields, Dana, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette University, Milwaukee, WI

,

Medical School:

Residency:

Philip M. Marden, MD, SC

123 Hospital Dr, Ste 212-East

(920) 261-3898

Watertown, WI 53098

Pediatrics Practice Status:

Marden, Philip, MD Open

Board Certified: American Board of Pediatrics

Univ of Wisconsin, Madison, WI

University of Minnesota, Minneapolis, MN

Medical School:

Residency:

PMRis, SC - Watertown

123 Hospital Dr, Ste 2004

(877) 337-6747

Watertown, WI 53098

Physical Medicine & Rehabilitation Practice Status:

Fowler, William, MD Open

Board Certified: American Board of Physicial Medicine and Rehabilitation

Univ of North Dakota School of Medicine, Grand Forks, ND

Univ of Minnesota Hospital & Clinics, Minneapolis, MN

Medical School:

Residency:

Regional Gen & Vascular Surgeons

123 Hospital Dr

(920) 261-5101

Watertown, WI 53098

General Surgery Practice Status:

Schmidt, Travis, MD Open

Board Certified:

University of Wisconsin, Madison WI

St Joseph Mercy Oakland, Pontiac, MI

Medical School:

Residency:

Surgery Practice Status:

Markus, Stanley, MD Open

Board Certified: American Board of Surgery

Wright State Univ, Dayton, OH

Mt. Carmel Hospital,

Medical School:

Residency:

Richard Neils, MD Office

123 Hospital Dr, Ste 106

(920) 261-4143

Watertown, WI 53098

Dermatology Practice Status:

Neils, Richard, MD Open

Board Certified: American Board of Dermatology AND American Board of Internal Medicine

Univ of Minnesota, Minneapolis, MN

Roger Williams General Hosp, Providence, RI

Medical School:

Residency:

Watertown Family Practice Asso, SC

127 Hospital Dr

(920) 261-8500

Watertown, WI 53098

Advanced Practice Nurse Prescriber Practice Status:

Angove, Jessica, APNP Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse Practitioner)Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Cantwell-Durand, Andrea, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Univ of Wisconsin College of Nursing, Milwaukee, WI

,

Medical School:

Residency:

DeFouw, Melodie, NP Open

Board Certified: AANP

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Family Medicine Practice Status:

Basarich, John, MD Open

Board Certified: American Board of Family Medicine (Hospice & Palliative Medicine)

Medical College of Wisconsin, Milwaukee, WI

Univ of Wisconsin Dept of Family Medicine, Madison, WI

Medical School:

Residency:

Cochrane, Bruce, MD Open

Board Certified: American Board of Family Medicine

Chicago Medical School, Chicago, IL

Southern Illiniois Univ School of Medicine, Springfield, IL

Medical School:

Residency:

LeGrow, Robert, MD Open

Board Certified: American Board of Family Medicine

Univ of Texas Medical School, Houston, TX

Memorial Family Medicine Residency Program, South Bend, IN

Medical School:

Residency:

Sullivan, Michael, MD Open

Board Certified: American Board of Family Medicine

Univ of Illinois College of Medicine at Rockford,

Memorial Family Practice Residency, South Bend, IN

Medical School:

Residency:

Tonelli, Danielle, DO Open

Board Certified: American Board of Family Medicine

Chicago College of Osteopathic Medicine, Chicago, IL

Aurora St. Luke's Family Practice Residency, Milwaukee, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Busalacchi, Rachel, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Ventura, Margaret, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 31 of 65W9

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State of Wisconsin - 2020Watertown Medical Clinic

132 Hospital Dr

(920) 261-2020

Watertown, WI 53098

Family Medicine Practice Status:

Turke, Terry, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Univ of Wisconsin Affiliated Hospitals, Madison, Wi

Medical School:

Residency:

Physician Assistant Practice Status:

Hanington Erickson, Kristin, Pa-C Open

Board Certified: NCCPA

Univ of St Francis, Fort Watne, IN

,

Medical School:

Residency:

Watertown Orthopedics, LTD

123 Hospital Dr, Ste 1008

(920) 261-3532

Watertown, WI 53098

Orthopedic Surgery Practice Status:

Habeck, Jason, MD Open

Board Certified:

Univ of WI Med School, Madison, WI

Western Michigan Univ, Kalamazoo, MO

Medical School:

Residency:

Physician Assistant Practice Status:

Hennes, Morgan, Pa-C Open

Board Certified: NCCPA

Univ of WI, LaCrosse, WI

,

Medical School:

Residency:

Watertown Regional Med CTR, LLC

125 Hospital Dr

(920) 261-4210

Watertown, WI 53098

Addiction Counselor Practice Status:

Howard, Patricia, AODA Open

Board Certified:

Alverno College, Milwaukee, Wi

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Finlayson, Sharon, NP Open

Board Certified: ANCC

Univ of WI Oshkosh, Oshkosh, WI

,

Medical School:

Residency:

Hospital Practice Status:

Watertown Regional Medical Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Physician Assistant Practice Status:

Yohann, Aaron, PA Open

Board Certified: NCCPA

Midwestern Univ, Downers Grove, IL

,

Medical School:

Residency:

Womens Health nurse Practitioner Practice Status:

Walter, Mandy Jo, NP Open

Board Certified: Nurses Credentialing Center

Georgetown University, Wash DC

,

Medical School:

Residency:

Watertown Specialty Clinic

123 Hospital Drive, Ste 2009

(920) 262-4560

Watertown, WI 53098

Gastroenterology Practice Status:

Sud, Anchal, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Univ of Michigan Medical School, Ann Arbor, MI

Univ of Michigan Dpt of Anesthesiology, Ann Arbor, MI

Medical School:

Residency:

Sud, Anchal, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Univ of Michigan Medical School, Ann Arbor, MI

Univ of Michigan Dpt of Anesthesiology, Ann Arbor, MI

Medical School:

Residency:

Neurology Practice Status:

Nasir, Sajjad, MD Open

Board Certified: American Board of Psychiatry and Neurology

American University of Integrative Sciences, Tucker, GA

University of Mississippi Medical Center, Jackson, MS

Medical School:

Residency:

Pulmonary Disease Practice Status:

Eyzaguirre, Arturo, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care Medicine)Alberto Hurtado Medical School, Lima, Peru

Henry Ford Hospital, Detroit, MI

Medical School:

Residency:

Lisi, Paul, DO Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine)Des Moines Univ - College of Osteopathic Medicine, Des Moines, IA

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Mathai, Mathew, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine)American Univ of the Caribbean, Plymouth Montserrat British West Indies

,

Medical School:

Residency:

Stuleanu, Florin, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Sleep Medicine)(Critical Care Medicine)Carol Davile Univ of Medicine & Pharmacy, Bucharest, Romania

The New York Flushing Hospital Medical Center/Cornell Univ, Flushing,

NY

Medical School:

Residency:

Weber, Joseph, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine)The Ohio State Univ College of Medicine & Public Health, Columbus, OH

McGaw Medical Center of Northwestern Univ, Chicago, Il

Medical School:

Residency:

Surgery Practice Status:

Cronin, David, MD Open

Board Certified: American Board of Surgery

Univ of Chgo, Chgo, IL

Univ of Chgo Med Ctr, Chgo, Il

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 32 of 65W9

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State of Wisconsin - 2020Surgery Practice Status:

Dachman, Adam, DO Open

Board Certified: American osteo Board of surgery

Des Moines Univ College of Osteo Med, Des Moines, IA

,

Medical School:

Residency:

WRMC Center for Eye Care

123 Hospital Dr, Ste 1002

(920) 261-8225

Watertown, WI 53098

Ophthalmology Practice Status:

Boush, George, MD Open

Board Certified: American Board of Ophthalmology

Univ of Wisconsin, Madison, WI

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Drake, Susie, MD Open

Board Certified:

University of Wisconsin medical School, Madison WI

,

Medical School:

Residency:

Met, Jay, MD Open

Board Certified: American Board of ophthalmology

Albert Einstein College of Medicine, Bronx, NY

New York Eye & Ear Infirmary, New York, NY

Medical School:

Residency:

Sullivan, Sheila, DO Open

Board Certified: Not Board Certified

DesMoines Univ, College of Osteopathic Medicine, Des Moines, IA

Philadeplphia College of Osteopathic Medicine, Philadelphia, PA

Medical School:

Residency:

Van Hecke, Holly, MD Open

Board Certified: American Board of Ophthalmology

Univ of Illinois College of Medicine, Chicago, IL

Univ of Illinois Eye & Ear Infirmary, Chicago, IL

Medical School:

Residency:

Optometry Practice Status:

Anslinger, John, OD Open

Board Certified: Not Applicable

Indiana Univ, Indiana

Not Applicable,

Medical School:

Residency:

Roberson, Daniel, OD Open

Board Certified: Not Applicable

New England College of Optometry, Boston, MA

Captain James A. Lovell Federal Health Care Center, N. Chicago, IL

Medical School:

Residency:

WRMC Center for Women's Health

128 Hospital Dr

(920) 262-4825

Watertown, WI 53098

Advanced Practice Nurse Prescriber Practice Status:

Howard, Karen, APNP Open

Board Certified: National Certification Corporation (Women's Health Care Nurse

Practitioner)Mt. Senario Collge, Ladysmith, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Anderson, Mary, MD Open

Board Certified: American Board of Obstetrics & Gynecology

Medical College of Wisconsin, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

DeJong, Julie, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Wisconsin, Madison, WI

Univ of Iowa Hospital and Clinics, Iowa City, IA

Medical School:

Residency:

Nguyen, VanLy, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Arkansas for Medical Sciences, Little Rock, AR

Cooper Univ Hospital UMDNJ, Camden, NJ

Medical School:

Residency:

Siddiqui, Danish, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Aga Khan Medical College, Karachi, Pakistan

Bridgeport Hospital, Bridgeport, CT

Medical School:

Residency:

Van Fossen, Katharine, MD Open

Board Certified: American Board of OB/Gyne

Univ of WI Medical School, Madison< WI

Univ of Cin Col of Med, Cinn, OH

Medical School:

Residency:

Urology Practice Status:

Sokovich, Ronald, MD Open

Board Certified: American Board of Urology

Southern Illinois Univ School of Medicine, Springfield, IL

URO Rush Medical Center, Chicago, IL

Medical School:

Residency:

WRMC Directions Counseling Center

123 Hospital Dr, Ste 110

(920) 262-4800

Watertown, WI 53098

Advanced Practice Nurse Practitioner Practice Status:

Unger, Lori, NP Open

Board Certified: American Nurses Credentialing Center

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Psychiatry Practice Status:

Mostaghimi Tehrani, Ladan, MD Open

Board Certified: American Board of Psychiatry & Neurology

Univ of Tehran, Tehran, Iran

Charleston Area Med Ctr, Charleston, WV

Medical School:

Residency:

Psychiatry & Neurology Practice Status:

Kohlenberg, Cary, MD Open

Board Certified: American Board of Psychiatry & Neurology

University of Wisconsin Medical School, Madison, WI

,

Medical School:

Residency:

Moore, Sarah, MD Open

Board Certified: American Board of Psychiatry & Neurology

Univ of WI Med Sch, Madison, WI

Univ of WI Hosp, Madison, WI

Medical School:

Residency:

Vidic, Nino, MD Open

Board Certified:

American University of the Caribbean, Netherland Antilles

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 33 of 65W9

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State of Wisconsin - 2020WRMC Doctors Court Clinic

1507 Doctors Ct

(920) 261-4111

Watertown, WI 53094

Advanced Practice Nurse Prescriber Practice Status:

Davey, Melissa, NP Open

Board Certified: AANP

Maryville Univ, St Louis, MO

,

Medical School:

Residency:

Family Medicine including Obstetrics Practice Status:

Grajewski, Michael, MD Open

Board Certified: American Board of Family Medicine

Univ of Wisconsin Medical School, Madison, WI

Univ of Missouri, Kansas City, MO

Medical School:

Residency:

Internal Medicine Practice Status:

Samdani, Moazam Jah, MD Open

Board Certified: American Board of Internal Medicine

Liaquat Medical College, Pakistan,

Louis A. Weiss Mem Hosp,, Chicago, IL

Medical School:

Residency:

Physician Assistant Practice Status:

Barnett, Sarah, PA-C Open

Board Certified: National Commission on Certification of Physican Assistants

Marquette University, Milwaukee, WI

Not Applicable,

Medical School:

Residency:

Kolkovich, Cheryl, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Finch Univ of Health Sciences, The Chicago Medical School, North

Chicago, ILNot Applicable,

Medical School:

Residency:

Suwanabol, Promporn (June), PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Univ of Wisconsin-Madison Physician Assistant Program, Madison, WI

,

Medical School:

Residency:

WRMC Heart & Vascular Center

125 Hospital Dr

(920) 262-4434

Watertown, WI 53098

Advanced Practice Nurse Prescriber Practice Status:

Lambrecht, Shauna, APNP Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Concordia Univ, Mequon, WI

,

Medical School:

Residency:

Price, Teresa, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Alverno College, Milwaukee, WI

,

Medical School:

Residency:

Raatz, Heather, APNP Open

Board Certified: Not Board Certified

Univ of Cincinnati, Cincinnatio, OH

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Cullinane, David, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

UW Medical School, Madison, WI

Medical College of Wisconsin Hospital & Clinics, Milwaukee, WI

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Iqbal, Fahad, MD Open

Board Certified: American Board of Internal Medicine

Ross University,

University of IL St. Joseph's,

Medical School:

Residency:

Physician Assistant Practice Status:

Wheeler, Molly, Pa-C Open

Board Certified: NCCPA

Grand Valley State Univ, Grand Rapids MI

,

Medical School:

Residency:

WRMC Hospital Drive Clinic

123 Hospital Dr, Ste 2009

(920) 262-9833

Watertown, WI 53098

Physician Assistant Practice Status:

Coffey, Sarah, Pa-C Open

Board Certified: NCCPA

Bethel University, Arden Hills, MN

,

Medical School:

Residency:

WRMC Neurology Center

123 Hospital Dr, Ste 2002

(920) 262-4829

Watertown, WI 53098

Psychiatry Practice Status:

Herald, Matthew, MD Open

Board Certified: American Board of Psychiatry & Neurology

University of Texas Medical School at San Antonio, San Antonio, TX

,

Medical School:

Residency:

WRMC Orthopedics and Sports Medicine

123 Hospital Dr, Ste 1008

(920) 206-6500

Watertown, WI 53098

Advanced Practice Nurse Practice Status:

Hostetler, Nicole, NP Open

Board Certified: AANP

Chamberlain College of Nursing, Downers Grove, IL

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Damon, Rachel, APNP Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Univ of Wiscons - Oshkosh, Oshkosh, WI

,

Medical School:

Residency:

Muras (Weiss), Emily, APNP Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Acute Care

Nurse Practitioner)Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

O'Halloran, Kevin, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Illinois College of Medicine, Chicago, IL

Rush-Presbyterian-St. Lukes,, Chicago, Il

Medical School:

Residency:

Rhodes, Steven, MD Open

Board Certified: American Board of Orthopaedic Surgery

Loyola Univ of Chicago Stritch School of Medicine, Chicago, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 34 of 65W9

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State of Wisconsin - 2020Orthopedic Surgery Practice Status:

Roman, Terry, DO Open

Board Certified: American Osteopathic Orthopedic Surgery

A.T. Still University, Kirksville, MO

Michigan State University, Grand Blanc, MI

Medical School:

Residency:

Physician Assistant Practice Status:

Lentscher, Luke, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Midwestern Univ, Downers Grove, IL

,

Medical School:

Residency:

WRMC Pulmonology Center

123 Hospital Dr, Ste 2009

(920) 262-4560

Watertown, WI 53098

Pulmonary Disease Practice Status:

Bawaadam, Hasnain, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine)Grant Medical College, Bombay, India

West Suburban Medical Center, Oak Park, IL

Medical School:

Residency:

WRMC Urgent Care

125 Hospital De

(920) 262-4210

Watertown, WI 53098

Urgent Care Center Practice Status:

Watertown Regional Medical Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

WRMC Urology Clinic

123 Hospital Dr, Ste 2006

(920) 261-1334

Watertown, WI 53098

Urology Practice Status:

Sokovich, Ronald, MD Open

Board Certified: American Board of Urology

Southern Illinois Univ School of Medicine, Springfield, IL

URO Rush Medical Center, Chicago, IL

Medical School:

Residency:

Waukesha, WI

Waukesha Comp TX Center

2422 N Grandview Blvd

(262) 549-6600

Waukesha, WI 53188

Methadone Clinic Practice Status:

Waukesha Comprehensive TX CTR, , Open

Board Certified: Council on Accreditation

,

,

Medical School:

Residency:

West Allis, WI

Rogers Memorial Hospital - West Allis

11101 West Lincoln Ave

(800) 767-4411

West Allis, WI 53227

Child & Adolescent Mental Health

ProgramPractice Status:

Rogers Memorial Hospital - West Allis, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Rogers Memorial Hospital - West Allis, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

West Milwaukee, WI

West Milwaukee Comp TX Center

1610 Miller Pkwy

(414) 672-3801

West Milwaukee, WI 53214

Methadone Clinic Practice Status:

West Milwaukee Comprehensive TX CTR, , Open

Board Certified: Council on Accreditation

,

,

Medical School:

Residency:

Whitewater, WI

Fort HealthCare Center for Womens Health

1461 W Main St

(262) 473-8920

Whitewater, WI 53190

Advanced Practice Nurse Prescriber Practice Status:

Dedrick, Joyce, APNP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Univ of Wisconsin, Madison, WI

Not Applicable,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Mokhtar, Julie, DO Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Osteopathic Medicine & Health Sciences, Des Moines, IA

Brooklyn Hospital Center, New York

Medical School:

Residency:

Fort HealthCare Ear, Nose and Throat

Specialists

1461 West Main St

(262) 473-4081

Whitewater, WI 53190

Otolaryngology Practice Status:

Hofmann, William, MD Open

Board Certified: American Board of Otolaryngology

Univ of Cincinnati College of Medicine, Cincinnati, OH

Indiana Univ Medical Center, Indianapolis, IN

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 35 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Fort HealthCare Internal Medicine &

Pediatrics

1461 West Main St, Ste A

(262) 473-5888

Whitewater, WI 53190

Internal Medicine Practice Status:

Koenig, Laura, MD Open

Board Certified: American Board of Internal Medicine

Univ of Wisconsin, Madison, WI

Univ of Wisconsin Hospital & Clinics, Madison, WI

Medical School:

Residency:

Fort HealthCare Urology Associates

1461 West Main St

(262) 473-7774

Whitewater, WI 53190

Urology Practice Status:

Kozler, Craig, MD Open

Board Certified: American Board of Urology

Michigan State University, East Lansing, MI

University of Michigan, Ann Arbor, MI

Medical School:

Residency:

Luedtke-Storm-Mackey Chiropractic Clinic

1139 W Main St

(262) 753-0017

Whitewater, WI 53190

Chiropractic Practice Status:

Tesch, Todd, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

Not Applicable,

Medical School:

Residency:

Mercyhealth Behavioral Health Clinic -

Whitewater

507 W Main St

(608) 756-5555

Whitewater, WI 53190

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Whitewater, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Clinical Substance Abuse Counselor Practice Status:

Winiecki, Adrienne, CSAC Open

Board Certified: Not Applicable

Indiana Univ Northwest, Gary, IN

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Kollmansberger, Benno, LPC, LCSW Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Oczus, Alicia, LPC Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Mercyhealth Whitewater

507 W Main St

(262) 473-0400

Whitewater, WI 53190

Family Medicine Practice Status:

Harris, Nancy, MD Open

Board Certified: American Board of Family Medicine

Univ of Texas Southwestern Medical Center, Dallas, TX

Commun Hospital, Indianapolis, IN

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Lyon, Craig, MD Open

Board Certified: American Board of Orthopaedic Surgery

Rush Medical College, Chicago, Il

Univ of Iowa Hospitals & Clinics, Iowa City, IA

Medical School:

Residency:

Podiatry Practice Status:

Loch, Archibald, DPM Open

Board Certified: American Board of Foot and Ankle Surgery

Rosalind Franklin Univ, North Chicago, IL

Massachusetts General Hospital, Boston, MA

Medical School:

Residency:

Mercyhealth Whitewater Urgent Care

507 W Main St

(262) 473-0401

Whitewater, WI 53190

Urgent Care Center Practice Status:

Mercyhealth Whitewater UC, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Williams Bay, WI

Mercyhealth Behavioral Health Clinic - Walworth

N2846 State Road 67

(262) 245-5608

Williams Bay, WI 53191

Advanced Practice Nurse Prescriber Practice Status:

Bunnell, Ann, APNP Open

Board Certified: American Nurses Credentialing Center (Child and Adolescent Mental

Health),

,

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

Mercyhealth BH Clinic - Walworth, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

DeGarmo-Haakenson, Karla, LCSW Open

Board Certified: Not Applicable

Univ of Wisconsin, Whitewater, WI

,

Medical School:

Residency:

Deller, Julia, LCSW Open

Board Certified: Not Applicable

Univ of Chicago, Chicago, IL

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 36 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Licensed Professional Counselor Practice Status:

Jedrzejczak, Darolyn, LPC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Littig, Karen, LPC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Rice, Julie, LPC Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Psychiatry Practice Status:

Callison, (Sue) Ann, MD Open

Board Certified: American Board of Psychiatry and Neurology (Child & Adolescent

Psychiatry)University of Arizona, Tucson, AZ

Univ. of Arizona, Tucson, AZ

Medical School:

Residency:

Kosnar, Tina, MD Open

Board Certified: American Board of Psychiatry and Neurology (Child & Adolescent

Psychiatry)Creighton Univ School of Medicine, Omaha, NE

Creighton-Nebraska Combined, Omaha, NE

Medical School:

Residency:

Algonquin, IL

Mercyhealth Algonquin

2401 Harnish Dr

(847) 458-5440

Algonquin, IL 60102

Family Medicine Practice Status:

Verzal, Rhonda, MD Open

Board Certified: American Board of Family Medicine

University of IL Chgo, Chicago, IL

Halifax Health Fam Med, Daytona Beach FL

Medical School:

Residency:

Otolaryngology Practice Status:

Cundiff, Jason, MD Open

Board Certified: American Board of Otolaryngology

Univ of Illinois at Chicago, Chicago, IL

Univ of Illinois at Chicago-Eye and Ear Infirmary, Chicago, IL

Medical School:

Residency:

Livingston, Gary, MD Open

Board Certified: American Board of Otolaryngology

Loyola Stritch School of Med., Maywood, IL

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Podiatry Practice Status:

Thorud, Jakob, DPM Open

Board Certified: American Board of Podiatric Medicine

Des Moines Univ, Des Moines, IA

Scott & White Memorial Hospital, Temple, TX

Medical School:

Residency:

Barrington, IL

Mercy Barrington ENT/Plastic Surgery Medical Ctr

500 W Hwy 22

(847) 381-3000

Barrington, IL 60010

Dermatology Practice Status:

Altman, Jeffrey, MD Open

Board Certified: American Board of Dermatology

Rush Medical College, Chicago, IL

Rush Univ Medical Center, Chicago, IL

Medical School:

Residency:

Mercyhealth Barrington

500 W Hwy 22

(847) 381-3000

Barrington, IL 60010

Allergy & Immunology Practice Status:

Vemuri, Preeti, MD Open

Board Certified: American Board of Allergy and Immunology AND American Board of

Internal MedicineBoston Univ School of Medicine, Boston, MA

McGaw Medical Center of Northwestern Univ, Chicago, IL

Medical School:

Residency:

Neurology Practice Status:

Dave, Amarish, DO Open

Board Certified: American Board of Psychiatry and Neurology

Chicago College of Osteopathic Medicine, Downers Grove, IL

University of Illinois at Chicago, Chicago, IL

Medical School:

Residency:

Otolaryngology Practice Status:

Cundiff, Jason, MD Open

Board Certified: American Board of Otolaryngology

Univ of Illinois at Chicago, Chicago, IL

Univ of Illinois at Chicago-Eye and Ear Infirmary, Chicago, IL

Medical School:

Residency:

Livingston, Gary, MD Open

Board Certified: American Board of Otolaryngology

Loyola Stritch School of Med., Maywood, IL

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Rheumatology Practice Status:

Frank, Benjamin, MD Open

Board Certified: American Board of Internal Medicine (Rheumatology)

Univ of Chicago Pritzker School of Medicine, Chicago, IL

Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Frank, Benjamin, MD Open

Board Certified: American Board of Internal Medicine (Rheumatology)

Univ of Chicago Pritzker School of Medicine, Chicago, IL

Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Belvidere, IL

Crusader Community Health - Belvidere

1050 Logan Ave

(815) 547-0282

Belvidere, IL 61108

Advanced Practice Nurse Practice Status:

Benters, Jennifer, APN Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse

Practitioner - Primary Care)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 37 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Family Medicine Practice Status:

Eddakkanambeth Varayil, Jinthiraj, MD Open

Board Certified:

Charles University Plzen, Czech Republic

Univ of IL College of Med, Rockford, IL

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Geiselhart, Christina, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Nurse-Midwife Practice Status:

Dobson, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Hahn, Amanda, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Keeney, Renee, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Oerkfitz, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Osborne, Victoria, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois - Chicago, Chicago, IL

,

Medical School:

Residency:

Rehberg, Stephanie, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Al Khabbaz, Antoun, MD Open

Board Certified: American Board of Obstetrics and Gynecology

American Univ of Beirut, New York, NY

Union Memorial Hospital, Baltimore, MD

Medical School:

Residency:

Arynova, Bakytbubu, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Ege Univ, Izmir, Turkey

Mount Sinai Hospital Medical Center, Chicago, IL

Medical School:

Residency:

Edwards, Vernee, MD Open

Board Certified: Not Board Certified

St. Georges Univ, School of Medicine, Great River, NY

Maimonides Medical Center, Brooklyn, NY

Medical School:

Residency:

Nanabawa, Zakera, MD Open

Board Certified:

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Mercyhealth Belvidere

1747 Henry Luckow Ln

(815) 971-3030

Belvidere, IL 61008

Family Medicine Practice Status:

Labak, Sandra, DO Open

Board Certified: American Board of Family Medicine

Chicago School of Osteopathic Medicine, Downers Grove, IL

UofI at Chicago Christ Hosp, Oak Lawn, IL

Medical School:

Residency:

Phoenix, James, MD Open

Board Certified: American Board of Family Medicine

Springfield Illinois Univ, Springfield, IL

UIC-Rockford, Rockford, IL

Medical School:

Residency:

Ulmer, Meredith, DO Open

Board Certified: American Osteopathic Board of Family Medicine/OMT

Michigan State Univ, East Lansing, MI

Resurrection Hospital, Chicago, IL

Medical School:

Residency:

Urgent Care Center Practice Status:

Mercyhealth Belvidere UC, , Open

Board Certified:

,

,

Medical School:

Residency:

Remedies Renewing Lives - Belividere

2028 N State St

(815) 547-4502

Belvidere, IL 61108

Adult Addictions Program Practice Status:

Remedies Renewing Lives - Belvidere, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Rosecrance Belvidere

915 Alexandra Dr

(815) 387-5600

Belvidere, IL 61008

Adult Addictions Program Practice Status:

Rosecrance Belvidere, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Adult Mental Health Program Practice Status:

Rosecrance Belvidere, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Addictions Program Practice Status:

Rosecrance Belvidere, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rosecrance Belvidere, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 38 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Byron, IL

Mercyhealth Byron

130 Kysor Dr

(815) 971-3000

Byron, IL 61010

Family Medicine Practice Status:

Ansari, Mohammed Sajid, MD Open

Board Certified: American Board of Family Medicine

Deccan College of Medical Sciences, Hyderabad, India

SIU Family Practice Residency, Decatur, IL

Medical School:

Residency:

Gellada, Karen Imma, MD Open

Board Certified: American Board of Family Medicine

Univ of the Philippines - Manila, Ermita, Manila

Univ of Illinois College of Medicine at Peoria, Peoria, IL

Medical School:

Residency:

McFadden, Jeffrey, DO Open

Board Certified: American Board of Family Medicine

Kansas City Univ of Medicine and Biosciences, Kansas City, KS

Univ of Kansas Medical Center, Kansas City, KS

Medical School:

Residency:

Urgent Care Center Practice Status:

Mercyhealth Byron UC, , Open

Board Certified:

,

,

Medical School:

Residency:

Cherry Valley, IL

Drake Healthcare, SC

1860 S Bell School Rd

(815) 580-8270

Cherry Valley, IL 61016

Chiropractic Practice Status:

Drake, James, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Jones Family Chiropractic, PC

706 E State St

(815) 332-5555

Cherry Valley, IL 61016

Chiropractic Practice Status:

Jones, Jason, DC Open

Board Certified: Not Applicable

National College of Chiropractic, Lombard, IL

,

Medical School:

Residency:

Crystal Lake, IL

Mercyhealth Crystal Lake Chiropractic

330 West Terra Cotta, Ste D

(815) 455-1751

Crystal Lake, IL 60014

Chiropractic Practice Status:

Gabbert, Rodney, DC Open

Board Certified: Not Applicable

Palmerc College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Mercyhealth Crystal Lake East

390 E Congress Pkwy, Ste M

(815) 455-0850

Crystal Lake, IL 60014

Advanced Practice Nurse Practice Status:

Ward, Ashley, APN Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

St. Joseph's College of Maine, Standish, ME

,

Medical School:

Residency:

Allergy & Immunology Practice Status:

Vemuri, Preeti, MD Open

Board Certified: American Board of Allergy and Immunology AND American Board of Internal MedicineBoston Univ School of Medicine, Boston, MA

McGaw Medical Center of Northwestern Univ, Chicago, IL

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Krcik, James, MD Open

Board Certified: American Board of Orthopedic Surgeons

Southern IL University, Springfield, IL

Rush University Medical Center, Chicago, IL

Medical School:

Residency:

Otolaryngology Practice Status:

Cundiff, Jason, MD Open

Board Certified: American Board of Otolaryngology

Univ of Illinois at Chicago, Chicago, IL

Univ of Illinois at Chicago-Eye and Ear Infirmary, Chicago, IL

Medical School:

Residency:

Livingston, Gary, MD Open

Board Certified: American Board of Otolaryngology

Loyola Stritch School of Med., Maywood, IL

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Pulmonary Disease Practice Status:

Mehta, Daksha, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care Medicine)NHL Municipal Medical College, Guyarat, India

St. Francis Hospital, Evanston, IL

Medical School:

Residency:

Mercyhealth Crystal Lake OB/GYN

750 E Terra Cotta Ave, Ste B

(815) 459-1212

Crystal Lake, IL 60014

Certified Nurse Practitioner Practice Status:

Hepperlen, Christine, CNP Open

Board Certified: The National Certification Corporation (Women's Health Care Nurse

Practitioner)The Catholic Univ of America, Washington, DC

Not Applicable,

Medical School:

Residency:

Mercyhealth Crystal Lake South

415 A Congress Pkwy, Ste E

(815) 356-7494

Crystal Lake, IL 60014

Family Medicine Practice Status:

Seneviratne, Krishanthi, MD Open

Board Certified: American Board of Family Medicine

Faculty of Medicine Univ of Kelaniya, Ragama, WP

Mount Sinai Hospital, Chicago, IL

Medical School:

Residency:

Shen, Emily, MD Open

Board Certified: American Board of Family Medicine

Beijing Medical University, Beijing, China

West Suburban Medical Center, Oak Park, IL 60302

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 39 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Gastroenterology Practice Status:

Hussain, Yasmin, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Univ of Punjab Fatima Jinnah Medical College, Lahore, Pakistan

Loyola Univ Medical Center/Hines VA Hospital, Maywood, IL

Medical School:

Residency:

Orthopedic Surgery Practice Status:

DeHaan, Paul, MD Open

Board Certified:

Abraham Lincoln School of Medicine Univ of IL, Chicago, IL

Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

Physician Assistant Practice Status:

Detloff, Scott, Pa-C Open

Board Certified: NCCPA

Western Michigan Univ, Kalamazoo, MI

,

Medical School:

Residency:

Larson, Don, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Rosalind Franklin Univ of Medicine & Science, North Chicago, IL

,

Medical School:

Residency:

Podiatry Practice Status:

Lisowsky, Mykola, DPM Open

Board Certified: American Board of Podiatric Medicine

Ohio College of Podiatric Medicine, Cleveland, OH

Loyola University Medical Center, Maywood, IL

Medical School:

Residency:

PRA - Crystal Lake Office

350 Congress Pkwy, Ste C

(815) 356-5050

Crystal Lake, IL 60014

Licensed Clinical Professional

CounselorPractice Status:

Westerberg, Shane, LCPC Open

Board Certified: Not Applicable

Argosy Univ, Schaumburg, Il

,

Medical School:

Residency:

Rosecrance - Crystal Lake

422 Tracy Ct

(815) 363-6132

Crystal Lake, IL 60039

Adult Addictions Program Practice Status:

Rosecrance - Crystal Lake, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Adult Mental Health Program Practice Status:

Rosecrance - Crystal Lake, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Addictions Program Practice Status:

Rosecrance - Crystal Lake, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rosecrance - Crystal Lake, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Harvard, IL

Mercyhealth at Home - Medical Equipment - Harvard

1819 N Division St

(815) 943-2071

Harvard, IL 60033

Durable Medical Equipment Supplier Practice Status:

Mercyhealth at Home - DME HVD, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Mercyhealth Harvard Hospital & Med Center

901 Grant St

(815) 943-5431

Harvard, IL 60033

Advanced Practice Nurse Practice Status:

Omiecinski, Amber, NP Open

Board Certified: AANP

Olivet Nazarene Univ, Bourbonnais, IL

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Isacson, Michelle, NP Open

Board Certified: AANP

Saint Louis Univ, St Louis, MO

,

Medical School:

Residency:

Emergency Department Practice Status:

Mercyhealth Harvard Hospital - Emergency, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Gastroenterology Practice Status:

Qazi, Baseer, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Declan College of Medical Sciences, Hyderabad, India

Advocate Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Hospital Practice Status:

Mercyhealth Hospital and Medical Center - Hvd, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 40 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth Harvard Hospital Clinic

1001 Grant St

(815) 943-8090

Harvard, IL 60033

Cardiovascular Disease Practice Status:

Khemani, Anil, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Patna Med College, Patna, India

All India Inst of Med Sciences, New Delhi, India

Medical School:

Residency:

Ophthalmology Practice Status:

Rhee, Jung, MD Open

Board Certified: American Board of Ophthalmology

Univ of Chicago Pritzker School of Medicine, Chicago, IL

Texas Tech University Health Science Center, Lubbock, TX

Medical School:

Residency:

Orthopedic Surgery Practice Status:

DeHaan, Paul, MD Open

Board Certified:

Abraham Lincoln School of Medicine Univ of IL, Chicago, IL

Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

Podiatry Practice Status:

Lisowsky, Mykola, DPM Open

Board Certified: American Board of Podiatric Medicine

Ohio College of Podiatric Medicine, Cleveland, OH

Loyola University Medical Center, Maywood, IL

Medical School:

Residency:

Pulmonary Disease Practice Status:

Balagani, Rajesh, DO Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease)(Critical Care

Medicine)Chicago College of Osteopathic Medicine, Midwestern Univ, Downers

Grove, IL

Evanston Northwestern Hospital, Evanston, IL

Medical School:

Residency:

Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

Greenberg, James, MD Open

Board Certified: American Board of Surgery

Univ of Missouri, Kansas City, MO

Loyola Univ Medical Center, Maywood, IL

Medical School:

Residency:

Vascular Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

Mercyhealth Harvard South

348 S Division St

(815) 943-1122

Harvard, IL 60033

Family Medicine Practice Status:

Khan-Mundozie, Viquar, MD Open

Board Certified: American Board of Family Medicine

Deccan College of Medical Sciences, Hyderabad, AP, India

St. Louis Univ School of Medicine, St. Louis, MO

Medical School:

Residency:

Family Medicine Practice Status:

Virani, Shailesh, MD Open

Board Certified: American Board of Family Medicine

Mahatma Gandhi Mission's Medical College, India

Rush Copley Family Practice Residency, Aurora, IL

Medical School:

Residency:

Pediatrics Practice Status:

Castillo, Allen, MD Open

Board Certified: Not Board Certified

Univ of Santo Tomas, Manila, Philippines

Medical City Hospital, Manila, Philippines

Medical School:

Residency:

Mercyhealth Hospital and Medical Center - Harvard

901 Grant St

(815) 943-2961

Harvard, IL 60033

Skilled Nursing Facility Practice Status:

Mercyhealth Harvard Care Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Loves Park, IL

Budzynski Counseling Services, Inc

7124 Windsor Lake Parkway, #10

(815) 633-8688

Loves Park, IL 61111

Behavioral Health Clinic Practice Status:

Budzynski Counseling Services, Inc., , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Budzynski, John, LCPC Open

Board Certified: Not Applicable

Trinity Evangelical Divinity School, Deerfield, IL

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Platzbecker, Karen, LPC Open

Board Certified: Not applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Crusader Community Health - Loves Park

6115 N 2nd St

(815) 490-1600

Loves Park, IL 61111

Advanced Practice Nurse Practice Status:

Benters, Jennifer, APN Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse

Practitioner - Primary Care)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Miller, Kimberly, MD Open

Board Certified: American Board of Family Medicine

Univ of Minnesota Medical School - Twin Cities, Minneapolis, MN

Ball Memorial Family Medicine Residency, Muncie, IN

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 41 of 65W9

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State of Wisconsin - 2020Licensed Clinical Professional

CounselorPractice Status:

Allen, Susan, LCPC Open

Board Certified: None

National Louis Univ, Wheeling, IL

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Geiselhart, Christina, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Nurse-Midwife Practice Status:

Dobson, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Hahn, Amanda, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Keeney, Renee, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Oerkfitz, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Osborne, Victoria, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois - Chicago, Chicago, IL

,

Medical School:

Residency:

Rehberg, Stephanie, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Al Khabbaz, Antoun, MD Open

Board Certified: American Board of Obstetrics and Gynecology

American Univ of Beirut, New York, NY

Union Memorial Hospital, Baltimore, MD

Medical School:

Residency:

Arynova, Bakytbubu, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Ege Univ, Izmir, Turkey

Mount Sinai Hospital Medical Center, Chicago, IL

Medical School:

Residency:

Edwards, Vernee, MD Open

Board Certified: Not Board Certified

St. Georges Univ, School of Medicine, Great River, NY

Maimonides Medical Center, Brooklyn, NY

Medical School:

Residency:

Nanabawa, Zakera, MD Open

Board Certified:

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Geiger Psychiatric Care LLC

1752 Windsor Rd, Ste 203

(815) 986-1113

Loves Park, IL 61111

Advanced Practice Nurse Practice Status:

Zahrndt, Eve, APN Open

Board Certified: American Nurses Credentialing Center (Psychiatric - Mental Health Nurse

Practitioner)Univ of Illinois - Chicago, Chicago, IL

Glenwood Associates, Rockford, IL

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

Geiger Psychiatric Care LLC, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Jarvi, Therese, LCPC Open

Board Certified:

Northern Illinoins, DeKalb, IL

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Person, Bruce, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Razbadouski, Susan, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Licensed Marriage & Family Therapist Practice Status:

Finnan, Kristi, LMFT Open

Board Certified: Not Applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Professional Counselor Practice Status:

Lindblade, Melanie, PC Open

Board Certified:

National Louis University, Wheeling, IL

,

Medical School:

Residency:

Psychiatry Practice Status:

Geiger, Marianne, MD Open

Board Certified: American Board of Psychiatry and Neurology

Univ of North Dakota School of Medicine, Grand Forks, ND

Univ of Iowa Hospitals & Clinics, Iowa City, IA

Medical School:

Residency:

Mercyhealth Alpine

7702 N Alpine Rd

(815) 971-2000

Loves Park, IL 61111

Advanced Practice Nurse Prescriber Practice Status:

Ostrander, LuAnn, NP Open

Board Certified: AANP

Northern IL Univ, DeKalb, IL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 42 of 65W9

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State of Wisconsin - 2020Internal Medicine Practice Status:

Glovsky, Robert, MD Open

Board Certified: American Board of Internal Medicine

Boston Univ School of Medicine, Boston, MA

Univ of Massachusetts Medical Center, Worcester, MA

Medical School:

Residency:

Petersen, Kenneth, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois College of Medicine, Rockford, IL

St. Joseph's Hospital & Medical Center, Phoenix, AZ

Medical School:

Residency:

Pediatrics Practice Status:

Kaskavage, Jillian, MD Open

Board Certified: American Board of Pediatrics

Univ of Illinois College of Medicine-Rockford, Rockford, IL

Johns Hopkins Hospital, Baltimore, MD

Medical School:

Residency:

Ortega, Romulo, MD Open

Board Certified: American Board of Pediatrics

Univ of Costa Rica, San Jose, Costa Rico

Univ of Illinois Chicago Medical Center, Chicago, IL

Medical School:

Residency:

Mercyhealth Dermatology

7402 E Riverside

(815) 226-9642

Loves Park, IL 61111

Dermatology Practice Status:

Hartsough, Nicole, MD Open

Board Certified: American Board of Dermatololgy

University of Illinois College of Medicine, Rockford, IL

Univ of Chicago Medical Center, Chicago

Medical School:

Residency:

Rockford Eye and Laser Center

4301 N Mulford Road

(815) 227-0077

Loves Park, IL 61111

Ophthalmology Practice Status:

Choi, John, MD Open

Board Certified: American Board of Ophthalmology

Harvard Medical School, Boston, MA

Doheny Eye Institute, USC, Los Angeles, CA

Medical School:

Residency:

Yoon, Woosuk, MD Open

Board Certified:

New York Medical College, Valhalla, NY

St. Vincent Hospital & Med Ctr, New York, NY

Medical School:

Residency:

Optometry Practice Status:

Miller, Christina, OD Open

Board Certified: American Board of optometry

Pennsylvania College of Optometry, Elkins Park, PA

Seidenberg Protzko Eye Assoc, Havre de grace, MD

Medical School:

Residency:

Tylka, Barbara, OD Open

Board Certified:

Illinois College of Optometry, Chicago, IL

VA Northern Indiana, Fort Wayne, IL

Medical School:

Residency:

Machesney Park, IL

Cornerstone Clinic Ltd

9721 N Alpine Rd

(815) 484-6300

Machesney Park, IL 61115

Advanced Practice Nurse Practice Status:

Carey, Rebekah, APN Open

Board Certified: National Certification Corporation (Women's Health Care Nurse

Practitioner)Univ of Alabama, Tuscaloosa, AL

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Holbrook, Jodi, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Iowa College of Medicine, Iowa City, IA

Univ of South Florida, Tampa, FL

Medical School:

Residency:

Kayla A. Clayton, LCSW

9853 North Alpine Rd

(815) 708-7411

Machesney Park, IL 61115

Licensed Clinical Social Worker Practice Status:

Clayton, Kayla, LCSW Open

Board Certified:

Aurora University, Aurora, IL

,

Medical School:

Residency:

McHenry, IL

Mercyhealth Eye Center - McHenry

406 N Front St, Ste C

(815) 363-2021

McHenry, IL 60050

Ophthalmology Practice Status:

Rhee, Jung, MD Open

Board Certified: American Board of Ophthalmology

Univ of Chicago Pritzker School of Medicine, Chicago, IL

Texas Tech University Health Science Center, Lubbock, TX

Medical School:

Residency:

Mercyhealth Immediate Care - McHenry

3922 Mercy Dr

(815) 578-2020

McHenry, IL 60050

Immediate Care Center Practice Status:

Mercyhealth Immediate Care Center - McHenry, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Mercyhealth McHenry

3922 Mercy Dr

(815) 344-4499

McHenry, IL 60050

Cardiovascular Disease Practice Status:

Khemani, Anil, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Patna Med College, Patna, India

All India Inst of Med Sciences, New Delhi, India

Medical School:

Residency:

Family Medicine Practice Status:

Ahmed, Muhammad, MD Open

Board Certified: American Board of Family Medicine

Dow Medical College, Karachi, Pakistan

SIU Decatur Family Medical Residency, Decatur, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 43 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Family Medicine Practice Status:

Hassan, Syed, MD Open

Board Certified: American Board of Family Medicine

Baqai Medical College, Karachi, Pakistan

MetroHealth Hospital Case Western Reserve Univ, Cleveland, OH

Medical School:

Residency:

Gastroenterology Practice Status:

Qazi, Baseer, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Declan College of Medical Sciences, Hyderabad, India

Advocate Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Internal Medicine Practice Status:

Fojtik, Joseph, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Medical School:

Residency:

Orthopedic Surgery Practice Status:

DeHaan, Paul, MD Open

Board Certified:

Abraham Lincoln School of Medicine Univ of IL, Chicago, IL

Medical College of Wisconsin Affiliated Hospitals, Milwaukee, WI

Medical School:

Residency:

Otolaryngology Practice Status:

Cundiff, Jason, MD Open

Board Certified: American Board of Otolaryngology

Univ of Illinois at Chicago, Chicago, IL

Univ of Illinois at Chicago-Eye and Ear Infirmary, Chicago, IL

Medical School:

Residency:

Livingston, Gary, MD Open

Board Certified: American Board of Otolaryngology

Loyola Stritch School of Med., Maywood, IL

Univ of Illinois, Chicago, IL

Medical School:

Residency:

Pediatrics Practice Status:

Klawitter, Karen, MD Open

Board Certified: American Board of Pediatrics

Loyola University, Mayeood, IL

Wright Patterson Air Force base, Dayton, OH

Medical School:

Residency:

Physician Assistant Practice Status:

Larson, Don, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Rosalind Franklin Univ of Medicine & Science, North Chicago, IL

,

Medical School:

Residency:

Podiatry Practice Status:

Thorud, Jakob, DPM Open

Board Certified: American Board of Podiatric Medicine

Des Moines Univ, Des Moines, IA

Scott & White Memorial Hospital, Temple, TX

Medical School:

Residency:

Pulmonary Disease Practice Status:

Balagani, Rajesh, DO Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease)(Critical Care

Medicine)Chicago College of Osteopathic Medicine, Midwestern Univ, Downers

Grove, IL

Evanston Northwestern Hospital, Evanston, IL

Medical School:

Residency:

Rosecrance - McHenry

4501 Prime Pkwy

(815) 363-6132

McHenry, IL 60050

Adult Addictions Program Practice Status:

Rosecrance - McHenry, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Adult Mental Health Program Practice Status:

Rosecrance - McHenry, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Addictions Program Practice Status:

Rosecrance - McHenry, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rosecrance - McHenry, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Northbrook, IL

Autism Home Support Services, Inc.

5 Revere Dr, Ste 120

(844) 247-7222

Northbrook, IL 60062

Autism Treatment Practice Status:

Autism Home Support Services, Inc., , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Richmond, IL

Mercyhealth Richmond

9715 Prairie Ridge

(815) 678-4528

Richmond, IL 60071

Family Medicine Practice Status:

Hassan, Syed, MD Open

Board Certified: American Board of Family Medicine

Baqai Medical College, Karachi, Pakistan

MetroHealth Hospital Case Western Reserve Univ, Cleveland, OH

Medical School:

Residency:

Rockford, IL

Ann James Counseling, LLC

1639 N Alpine Rd, Ste 204

(779) 423-0275

Rockford, IL 61107

Licensed Clinical Social Worker Practice Status:

DeRango, Peggy, LCSW Open

Board Certified: Not Applicable

Univ of Chicago, Chicago, IL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 44 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Licensed Clinical Social Worker Practice Status:

James, Ann, LCSW Open

Board Certified: Not Applicable

Univ of St. Thomas, St. Paul, MN

,

Medical School:

Residency:

Turek, Marcy, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Anthony B. D'Souza, MD

6072 Brynwood Dr, Ste 205

(815) 282-9606

Rockford, IL 61101

Psychiatry Practice Status:

D'Souza, Anthony, MD Open

Board Certified: American Board of Psychiatry and Neurology

R.G. Kar Medical College, Calcutta, India

Univ Hospitals & Clinics, Columbia, MO

Medical School:

Residency:

Caraotta Chiropractic Orthopedics

4921 E State St

(815) 398-4004

Rockford, IL 61108

Chiropractic Practice Status:

Caraotta, Jacob, DC Open

Board Certified: Not Applicable

National College of Chiropractic, Lombard, IL

,

Medical School:

Residency:

Cluchey, Agnieszka, DC Open

Board Certified: Not Applicable

National College of Chiropractic, Lombard, IL

,

Medical School:

Residency:

McAfee, Jason, DC Open

Board Certified: National Board of Chiropractic Exminers

Logan College of Chiropractic, Chesterfield, MO

Not Applicable,

Medical School:

Residency:

Micka, Nicholas, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Myers, Lance, DC Open

Board Certified: Not Applicable

National College of Chiropractic, Lombard, IL

,

Medical School:

Residency:

Crusader Community Health - Alpine

1215 N Alpine Rd

(815) 490-1600

Rockford, IL 61107

Pediatrics Practice Status:

Anaene, Mutimbwa, MD Open

Board Certified: American Board of Pediatrics

Univ of Birmingham, UK

John H Stroger Hosp, Chicago, IL

Medical School:

Residency:

Crusader Community Health - Broadway

1100 Broadway

(815) 490-1601

Rockford, IL 61104

Advanced Practice Nurse Practioner Practice Status:

Cummins, Kerin, NP Open

Board Certified: PNCB

Univ of IL at Chgo, Chgo IL

,

Medical School:

Residency:

Advanced Practice Nurse Practitioner Practice Status:

Bhamra, Amber, NP Open

Board Certified: AANP

maryville Univ, St Louis, MO

,

Medical School:

Residency:

Advanced Practice Nurse Practitoner Practice Status:

Gonzalez, Marie, NP Open

Board Certified: NCC

Univ of IL at Chicago, Chicago, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Eddakkanambeth Varayil, Jinthiraj, MD Open

Board Certified:

Charles University Plzen, Czech Republic

Univ of IL College of Med, Rockford, IL

Medical School:

Residency:

Miller, Kimberly, MD Open

Board Certified: American Board of Family Medicine

Univ of Minnesota Medical School - Twin Cities, Minneapolis, MN

Ball Memorial Family Medicine Residency, Muncie, IN

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Geiselhart, Christina, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Nurse-Midwife Practice Status:

Dobson, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Hahn, Amanda, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Keeney, Renee, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Oerkfitz, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Osborne, Victoria, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois - Chicago, Chicago, IL

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 45 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Obstetrics and Gynecology Practice Status:

Al Khabbaz, Antoun, MD Open

Board Certified: American Board of Obstetrics and Gynecology

American Univ of Beirut, New York, NY

Union Memorial Hospital, Baltimore, MD

Medical School:

Residency:

Arynova, Bakytbubu, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Ege Univ, Izmir, Turkey

Mount Sinai Hospital Medical Center, Chicago, IL

Medical School:

Residency:

Edwards, Vernee, MD Open

Board Certified: Not Board Certified

St. Georges Univ, School of Medicine, Great River, NY

Maimonides Medical Center, Brooklyn, NY

Medical School:

Residency:

Nanabawa, Zakera, MD Open

Board Certified:

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Crusader Community Health - Pierpont

1002 N Pierpont Ave

(815) 490-1600

Rockford, IL 61101

Advanced Practice Nurse Practice Status:

Benters, Jennifer, APN Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse

Practitioner - Primary Care)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Eddakkanambeth Varayil, Jinthiraj, MD Open

Board Certified:

Charles University Plzen, Czech Republic

Univ of IL College of Med, Rockford, IL

Medical School:

Residency:

Miller, Kimberly, MD Open

Board Certified: American Board of Family Medicine

Univ of Minnesota Medical School - Twin Cities, Minneapolis, MN

Ball Memorial Family Medicine Residency, Muncie, IN

Medical School:

Residency:

Crusader Community Health - State Street

1200 W State St

(815) 490-1601

Rockford, IL 61102

Advanced Practice Nurse Practice Status:

Benters, Jennifer, APN Open

Board Certified: Pediatric Nursing Certification Board (Certified Pediatric Nurse

Practitioner - Primary Care)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Advanced Practice Nurse Practitoner Practice Status:

Meyer, Debra, NP Open

Board Certified: PNCB

Vanderbilt Univ, Nashville, TN

,

Medical School:

Residency:

Family Medicine Practice Status:

Bethune, Serene, DO Open

Board Certified: American Osteopathic Board of Family Medicine

Arizona College of Osteopathic Med, Glendale, AZ

The Monroe Clinic, Monroe, WI

Medical School:

Residency:

Family Medicine Practice Status:

Eddakkanambeth Varayil, Jinthiraj, MD Open

Board Certified:

Charles University Plzen, Czech Republic

Univ of IL College of Med, Rockford, IL

Medical School:

Residency:

Miller, Kimberly, MD Open

Board Certified: American Board of Family Medicine

Univ of Minnesota Medical School - Twin Cities, Minneapolis, MN

Ball Memorial Family Medicine Residency, Muncie, IN

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Geiselhart, Christina, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Midwifery Practice Status:

Piper, Heather, CNM Open

Board Certified: American Midwifery Certification Board

Ohio State Univ, Columbus, OH

,

Medical School:

Residency:

Nurse-Midwife Practice Status:

Dobson, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Hahn, Amanda, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Keeney, Renee, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Oerkfitz, Jennifer, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Osborne, Victoria, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Illinois - Chicago, Chicago, IL

,

Medical School:

Residency:

Rehberg, Stephanie, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Rehberg, Stephanie, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Al Khabbaz, Antoun, MD Open

Board Certified: American Board of Obstetrics and Gynecology

American Univ of Beirut, New York, NY

Union Memorial Hospital, Baltimore, MD

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 46 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Obstetrics and Gynecology Practice Status:

Arynova, Bakytbubu, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Ege Univ, Izmir, Turkey

Mount Sinai Hospital Medical Center, Chicago, IL

Medical School:

Residency:

Edwards, Vernee, MD Open

Board Certified: Not Board Certified

St. Georges Univ, School of Medicine, Great River, NY

Maimonides Medical Center, Brooklyn, NY

Medical School:

Residency:

Nanabawa, Zakera, MD Open

Board Certified:

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Physican Assistant Practice Status:

Harding, James, PA-C Open

Board Certified: National Commission on Certfication of Physician Assistants

,

,

Medical School:

Residency:

Physician Assistant Practice Status:

Adamson, John, Pa-C Open

Board Certified: NCCPA

Northwestern University, Chicago, IL

,

Medical School:

Residency:

Brunner, Jeremy, PA-C Open

Board Certified: National Commission of Certification of Physician Assistants

,

,

Medical School:

Residency:

Hitz, Leonard, PA Open

Board Certified: ANCC

Univ of Colorado School of Nursing, Colorado Springs, CO

,

Medical School:

Residency:

Dale Gray, MD SC

2829 Glenwood Ave

(815) 962-0633

Rockford, IL 61101

Internal Medicine Practice Status:

Gray, Dale, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois, Rockford, IL

Rochester General Hospital, Rochester, NY

Medical School:

Residency:

Errol C. Baptist, MD

461 N Mulford Rd, Ste 4

(815) 397-2400

Rockford, IL 61107

Pediatrics Practice Status:

Baptist, Errol, MD Open

Board Certified: American Board of Pediatrics

Faculty of Medicine, Colombo, Sri Lanka

Univ of Medicine and Dentistry of NJ, Newark, NJ

Medical School:

Residency:

Hulsebus Rockford Chiropractic, LLC

1877 Daimler Rd

(815) 398-3434

Rockford, IL 61112

Chiropractic Practice Status:

Berven, Joshua, DC Open

Board Certified: None

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Callahan, Christopher, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Hays, Nathaniel, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Hulsebus, Brant, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Stear, Jr, Craig, DC Open

Board Certified: Not Applicable

Palmer College of Chiropractic, Davenport, IA

,

Medical School:

Residency:

Ignacio U. Omengan, MD

461 N Mulford Rd, Ste 10

(815) 394-1930

Rockford, IL 61107

Pediatrics Practice Status:

Omengan, Ignacio, MD Open

Board Certified: American Board of Pediatrics

St Louis Univ College of Medicine, Baguio City, Philippines

The Brookdale Univ Hospital and Medical Center, Brooklyn, NY

Medical School:

Residency:

Jack V. Rodriquez

6072 Brynwood Dr, Ste 205

(815) 636-0825

Rockford, IL 61114

Psychiatry Practice Status:

Rodriquez, Jack, MD Open

Board Certified: American Board of Psychiatry & Neurology

Universidad Autonoma De Chihuahua, Chihuahua, Mexico

Texas Tec Univ, Lubbock, TX

Medical School:

Residency:

Javon Bea Hospital Riverside

8201 E. Riverside Blvd

(815) 971-7000

Rockford, IL 61114

Advanced Practice Nurse Prescriber Practice Status:

Buchenau, Amy, NP Open

Board Certified: ANCC

,

,

Medical School:

Residency:

Gale, Rhonda, NP Open

Board Certified: NCC

Vanderbilt Univ School of Nursing, Nashville, TN

Univ of S Fl, Tampa, FL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 47 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Advanced Practice Nurse Prescriber Practice Status:

Hawkins, Angela, NP Open

Board Certified: ANCC

Olivet Nazarene University, Bourbonnais, IL

,

Medical School:

Residency:

Martin, Lucy, APN Open

Board Certified: American Nurses Credentialing Center

Northern Illinois University, Dekalb, IL

,

Medical School:

Residency:

Yeager, Stephanie, NP Open

Board Certified: ANCC

Olivet Nazarene Univ, Bourbonnais, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Konyak, Alhang, MD Open

Board Certified: American Board of Family Medicine

Jawaharlal Inst of PostGrad Med Ed, Puducherry

Bangalore Baptist Hosp, Bangalore

Medical School:

Residency:

Razzak, Saman, MD Open

Board Certified: American Board of Family Medicine

Saba University School of Med, Devena, MS

Tuscaloosa Family Med Res, Tuscaloosa, AL

Medical School:

Residency:

Genetics Practice Status:

Parsley, Lea, MD Open

Board Certified: American Board of Medical Genetics

UAB School of Medicine, Birminham, AL

,

Medical School:

Residency:

Hospital Practice Status:

Javon Bea Hospital Riverside, , Open

Board Certified: The Joint Commisiion

,

,

Medical School:

Residency:

Infectious Disease Practice Status:

Spier, Addie, MD Open

Board Certified: American Board of Infectious Disease

SUNY Stony Brooke School of Med, Stony Brook, NY

Harbor UCLA Med Ctr, Torrance, CA

Medical School:

Residency:

Maternal Fetal medicine Practice Status:

Robinson, Royland, MD Open

Board Certified: American Board of OB Gyne

New Jersey College of Med, Newark, NJ

New York medical College, New York NY

Medical School:

Residency:

Maternal-Fetal Medicine Practice Status:

Rogers, Dennie, MD Open

Board Certified: American Board of Obstetrics and Gynecology (Maternal-Fetal Medicine)

Univ of Illinois, Chicago, IL

Univ of Illinois @ Chicago, Chicago, IL

Medical School:

Residency:

Taylor, Funminiyi, MD Open

Board Certified: American Board of Obstetrics and Gynecology (Maternal-Fetal Medicine)

Howard Univ College of Medicine, Washington, DC

Mayo Clinic, Rochester, NY

Medical School:

Residency:

Maternal-Fetal Medicine Practice Status:

Yang, Lee, DO Open

Board Certified: American Osteopathic Association

Chicago College of Osteopathic Medicine, Downers Grove, IL

McLaren Greater Lansing Hospital, Lansing, MI

Medical School:

Residency:

Neonatal and Perinatal Medicine Practice Status:

Headley, Gillian, MD Open

Board Certified: American Board of Pediatrics

Univ of West Indies, Kingston

Newark Beth Israel Med Ctr, Newark, NJ

Medical School:

Residency:

Morales, Pablo, MD Open

Board Certified: American Board of Pediatrics

Univ Mayor De San Simon, Cochabamba

Cook Co Hosp, Chgo, IL

Medical School:

Residency:

Nurse-Midwife Practice Status:

Cascio, Paula, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Ephraim, Sonya, MD Open

Board Certified: American Board of Ob/Gyne

Univ of Buffalo School of Med, Buffalo, NY

Rush University Medical Center, Chicago, IL

Medical School:

Residency:

Peterson, Linda, MD Open

Board Certified: American Board of Obstetrics & Gynecology

Medical College of WI, Milwaukee, Wi

,

Medical School:

Residency:

Platt, Julie, MD Open

Board Certified: American Board of Obstetrics & Gynecology

Indiana Univ School of Med, Indianapolis, IN

National Capital Consortium, Bethesda, MD

Medical School:

Residency:

Pediatric Critical Care Practice Status:

Sapiega, Vytautas, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

Pediatric Gastroenterology Practice Status:

Rose, Fateema, MD Open

Board Certified: American Board of Pediatrics

Pennsylvania State Univ College of Medicine, Hershey, PA

Univ of S Florida, Tampa, FL

Medical School:

Residency:

Pediatric Hematology Oncology Practice Status:

Bercovitz, Rachel, MD Open

Board Certified: American board of Pediatrics

Univ of IL at Chicago, Chicago, IL

Seattle Childrens Hosp, Seattle, WA

Medical School:

Residency:

Pediatric Neonatology Practice Status:

Siddiqui, Khalid, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 48 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Pediatric Neonatology Practice Status:

Siddiqui, Khalid, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

Pediatric Urology Practice Status:

McKenna, Patrick, MD Open

Board Certified: American Board of Urology

George Washington Univ, Washington, DC

Naval regional Med Ctr, Portsmouth, VA

Medical School:

Residency:

Pediatrics Practice Status:

Akhtar, Mohammad, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

Smith Remedios, Kimberly, MD Open

Board Certified: American Board of Pediatrics

Univ de Medicina si Farmacie, Timisoara

Metropolitan Hosp, NY NY

Medical School:

Residency:

Radiation Oncology Practice Status:

Richards, Gregory, MD Open

Board Certified: American Board of Radiology

New Jersey Medical School, Newark, NJ

Univ of WI, Madison, WI

Medical School:

Residency:

Javon Bea Hospital Rockton

2400 N Rockton Ave

(815) 971-5000

Rockford, IL 61103

Advanced Practice Nurse Practice Status:

Rossow, Andrea, APN Open

Board Certified: American Nurses Credentialing Center

Northern Illinois University, Dekalb, IL

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Blaisdell, Constance, NP Open

Board Certified: AANP

Olivet Nazarene Univ, Boubonnais, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Goyal, Shami, MD Open

Board Certified: American Board of Family Medicine

Dr. D Y Patil Medical College, Mumbai, India

Forbes Regional Hospital, Monroeville, PA

Medical School:

Residency:

Hitt, Rockton, MD Open

Board Certified: American Board of Family Medicine

Rush Medical College,, Chicago, IL

Methodist Medical Center of Illinois, Peoria, IL

Medical School:

Residency:

Lupei, Nichole, DO Open

Board Certified:

,

,

Medical School:

Residency:

Family Medicine Practice Status:

Razzak, Saman, MD Open

Board Certified: American Board of Family Medicine

Saba University School of Med, Devena, MS

Tuscaloosa Family Med Res, Tuscaloosa, AL

Medical School:

Residency:

Hospital Practice Status:

Javon Bea Hospital Rockton, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Internal Medicine Practice Status:

Ciftci Olsen, Farah, MD Open

Board Certified: American Board of Internal Medicine

Univ of Ankara, Ankara, Turkey

John Stroger Hosp, Chicao, IL

Medical School:

Residency:

Krinochkin, Olexandr, MD Open

Board Certified: American Board of Internal Medicine

Crimean Medical Institute, Simferopol, Russia

St Louis Univ, Forest Park Hosp, St Louis, MO

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Lenox, Christine, LCPC Open

Board Certified: National Board for Certified Counselors

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Medical Oncology Practice Status:

McFarland, Thomas, MD OPEN

Board Certified: American Board of Internal Medicine

University of Illinois College of Medicine, Champaign, IL

New England Medical Center, Boston, MA

Medical School:

Residency:

Palliative Care Nurse Practitioner Practice Status:

Birmingham, Stephanie, NP Open

Board Certified: American Academy of Nurse Practitioners

Chamberlain University, Addison, IL

,

Medical School:

Residency:

Pediatric Surgery Practice Status:

Glynn, Loretto, MD Open

Board Certified: American Board of Surgery

Rush Medical School, Chicago, IL

University of Illinois, Chicago, IL

Medical School:

Residency:

Pediatrics Hematology & Oncology Practice Status:

Bhat, Rukhmi, MD Open

Board Certified: American Board of Pediatrics

Grant Medical College, Mumbai, India

SUNY Downstate Medical Center, Mumbai, India

Medical School:

Residency:

Radiation Oncology Practice Status:

Francis, David, MD Open

Board Certified:

Univ of Wisconsin, Madison, WI

University of Wisconsin, Madison, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 49 of 65W9

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State of Wisconsin - 2020Javon Bea Hospital Rockton ED

2400 N Rockton Ave

(815) 971-3333

Rockford, IL 61103

Emergency Department Practice Status:

Rockford Health Physicians ED, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Jody Striker, LCPC

2829 Glenwood Ave

(815) 962-0633

Rockford, IL 61101

Licensed Clinical Professional

CounselorPractice Status:

Striker, Jody, LCPC Open

Board Certified: Not Applicable

Trinity Evangelical Divinity School, Deerfield, IL

,

Medical School:

Residency:

KP Counseling

6392 Linden Rd

(779) 368-0060

Rockford, IL 61109

Advanced Practice Nurse Practice Status:

Wheeler, Lynn, APN Open

Board Certified: American Nurses Credentialing Center (Psychiatric-Mental Health Nurse

Practitioner)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

KP Counseling Center, , Open

Board Certified:

,

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Bruyn, Amy, LCPC Open

Board Certified:

National Louis University, Chicago, IL

,

Medical School:

Residency:

Parker, Gregory, LCPC Open

Board Certified: Not Applicable

Northern IL Univ, DeKalb, IL

,

Medical School:

Residency:

Spangler, (George) Pat, LCPC Open

Board Certified: Not Applicable

Northern IL Univ, DeKalb, IL

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Anderson, Kevin, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Benedict, Janice, LCSW Open

Board Certified: Not Applicable

Aurora Univ, Aurora, IL

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Bockelman, Ashley, LCSW Open

Board Certified:

Aurora University, Aurora, IL

,

Medical School:

Residency:

Fricke, Jennifer, LCSW Open

Board Certified: Not Applicable

Aurora Univ, Aurora, IL

,

Medical School:

Residency:

Grindle, Delinda, LCSW Open

Board Certified: Not Applicable

Univ of Illinois,

,

Medical School:

Residency:

Polky, Kevin, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Warden, Christina, LCSW Open

Board Certified: Not Applicable

Univ of IL at Urbana-Chapaign, Urbana, IL

,

Medical School:

Residency:

Licensed Marriage & Family Therapist Practice Status:

Johnson, Renae, LMFT Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Lauer, Karen, LMFT Open

Board Certified: Not Applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Logemann, Gail, LMFT Open

Board Certified: Not Applicable

Northern IL Univ, DeKalb, IL

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Nelson, Leila, LPC Open

Board Certified: Not Applicable

Argosy Univ, Schaumburg, IL

,

Medical School:

Residency:

Sage, Matthew, LPC Open

Board Certified:

Eastern Illinois University, Charleston, IL

,

Medical School:

Residency:

M. Asim Mustafa, MD

461 N Mulford Rd, #12

(815) 398-1009

Rockford, IL 61107

Pediatrics Practice Status:

Mustafa, Mohammad, MD Open

Board Certified: American Board of Pediatrics

Sind Medical College, Karachi, Pakistan

Rush-Presbyterian-St. Luke's Medical Center, Chicago, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 50 of 65W9

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MercyCare Health Plans Provider Directory

State of Wisconsin - 2020Mercyhealth - Convenient Care

2300 N Rockton Ave

(815) 971-2000

Rockford, IL 61103

Convenient Care Practice Status:

Rockford Health Physicians Convenient Care, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Mercyhealth at Home - Medical Equipment - Rockford

5970 Churchview Dr

(815) 971-3330

Rockford, IL 61107

Durable Medical Equipment Supplier Practice Status:

Mercyhealth at Home - DME Rkfd, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Mercyhealth Brain and Spine Center

2350 N Rockton Ave Ste 502

(815) 971-7600

Rockford, IL 61103

Advanced Practice Nurse Practice Status:

Cain, Maureen, APN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Northern Illinois Univ, Dekalb, IL

,

Medical School:

Residency:

Castronovo, Lynette, APN Open

Board Certified: American Nurses Credentialing Center (Gerontological Nurse Practitioner)

Univ of Michigan School of Medicine, Ann Arbor, MI

,

Medical School:

Residency:

Neurology Practice Status:

Khan, Moshin, MD Open

Board Certified: American Board of Psychiatry and Neurology (Sleep Medicine)

AYUB Medical College, Abbottabad, Pakistan

Univ of Chicago Hospital, Chicago, IL

Medical School:

Residency:

Orozco, Daniel, MD Open

Board Certified: American Board of Psychiatry and Neurology

Tuft's Medical School, Boston, MA

Univ of Chicago Hospital, Chicago, IL

Medical School:

Residency:

Raja, Faisal, MD Open

Board Certified: American Board of Psychiatry and Neurology

Rawalpindi Medical Center, Rawalpindi, Pakistan

Univ of Missouri, Columbia, MO

Medical School:

Residency:

Sergeant, Michael, MD Open

Board Certified: American Board of Psychiatry and Neurology

Northwestern Univ, Chicago, IL

Northwestern Univ Hospital, Chicago, IL

Medical School:

Residency:

Vascular Neurology Practice Status:

Qureshi, Adnan, MD Open

Board Certified: American Board of Psychiatry and Neurology (Vascular Neurology)

Quaid-e-Azam Univ, Rawalpindi, Pakistan

Emory Univ School of Medicine, Atlanta, GA

Medical School:

Residency:

Mercyhealth Cancer Center - Rockford

2400 N Rockton Rd

(815) 971-5000

Rockford, IL 61103

Advanced Practice Nurse Prescriber Practice Status:

Lask, Amy, NP Open

Board Certified: ANCC

Saint Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Medical Oncology Practice Status:

Shekhani, Shahid, MD Open

Board Certified: American Board of Internal Medicine (Medical Oncology)(Hospice & Palliative Care)Sind Medical College, Karachi, Pakistan

Prince Georges Hospital Center, Cheverly, MD

Medical School:

Residency:

Pediatric Hematology Oncology Practice Status:

Remiker, Allison, MD Open

Board Certified:

Univ of WI, Madison WI

Indiana Univ, Indianapolis IN

Medical School:

Residency:

Mercyhealth Cardiac Rehab Center -

Rockford

2350 N Rockton Ave

(815) 971-2200

Rockford, IL 61103

Advanced Practice Nurse Practice Status:

Hess, Meghan, APN Open

Board Certified: American Nurses Credentialing Center (Acute Care Nurse Practitioner)

Univ of Illinois, Oak Lawn, IL

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Anna, Manjusha, MD Open

Board Certified: American Board of Internal Medicine

Gandhi Medical College, Secunderbad, India

Newark Beth Isreal Medical Center, Newark, NJ

Medical School:

Residency:

Deveshwar, Sangita, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Government Medical College/Punjab Univ, Punjab, India

Univ of Oklahoma, Oklahoma City, OK

Medical School:

Residency:

Nowak, Gregory, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Academic Medical School, Gdansk Poland

Louis A Weiss Memorial Hospital, Chicago, IL

Medical School:

Residency:

Clinical Cardiac Electrophysiology Practice Status:

Narra, Leela, MD Open

Board Certified: American Board of Internal Medicine (Clinical Cardiac Elecrtophysiology)(Cardiovascular Disease)Guntur Medical College, Andhra Pradesh India

Cook County Hospital, Chicago, IL

Medical School:

Residency:

Clinical Cardiac-Electrophysiology Practice Status:

Smith, Jeffrey, MD Open

Board Certified: American Board of Internal Medicine (Clinical Cardiac

Electrophysiology)(Cardiovascular Disease)Univ of Illinois College of Medicine, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 51 of 65W9

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State of Wisconsin - 2020Mercyhealth Cherry Valley

6998 Redansa Dr

(815) 971-3110

Rockford, IL 61108

Family Medicine Practice Status:

Guenev, Perka, MD Open

Board Certified: American Board of Family Medicine

Univ of Pleven, Bulgaria

Sparks Regional Medical Center, Fort Smith, AR

Medical School:

Residency:

Michalsen, Brian, DO Open

Board Certified: American Board of Family Medicine (Sports Medicine)

Midwestern Univ, Downers Grove, IL

Advocate Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Immediate Care Center Practice Status:

Mercyhealth Cherry Valley UC, , Open

Board Certified:

,

,

Medical School:

Residency:

Mercyhealth Glenwood

2819 Glenwood Ave

(815) 971-4060

Rockford, IL 61101

Psychiatry Practice Status:

Irfan, Syed, MD Open

Board Certified: American Board of Psychiatry and Neurology (Child & Adolescent

Psychiatry)Dow Medical Collge, Karachi, Pakistan

WV Univ Charleston Area Medical Center, Charleston, WV

Medical School:

Residency:

Mercyhealth Heart and Vascular Center

2300 N Rockton Ave, Bldg #2 Rockford, IL 61103

Advanced Practice Nurse Practitioner Practice Status:

Padron, Laura, APNP Open

Board Certified: American nurses Credentialing Center

Walden University,

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Shah, Samir, MD Open

Board Certified: American Board of Internal Medicine

BJ Medical College, Ahmeabad, Gujar

Loise A Weiss Memorial Hospital, Chicago, IL

Medical School:

Residency:

Mercyhealth McFarland

2780 McFarland Rd

(815) 971-2000

Rockford, IL 61107

Obstetrics and Gynecology Practice Status:

Taylor, Bryan, MD Open

Board Certified: Not Board Certified

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Pediatrics Practice Status:

Garg, Seema, MD Open

Board Certified: American Board of Pediatrics

Loyola University, Maywood, IL

Univ of IL Chgo, Peoria, IL

Medical School:

Residency:

Pediatrics Practice Status:

Moody, Patricia, MD Open

Board Certified: American Board of Pediatrics

St. Georges Univ, Great River, NY

Brooklyn Hospital Center, Brooklyn, NY

Medical School:

Residency:

Phelan, Karen, MD Open

Board Certified: American Board of Pediatrics

Pennsylvania State Univ, Hershey, PA

Hershey Medical Center, Hershey, PA

Medical School:

Residency:

Potts, Michael, MD Open

Board Certified: American Board of Pediatrics

Univ of Illinois College of Medicine, Chicago, IL

Children's Hospital of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Mercyhealth Mulford

5970 Churchview Dr

(815) 971-2000

Rockford, IL 61107

Internal Medicine Practice Status:

Halvorson, Amanda, NP Open

Board Certified: ANCC

,

,

Medical School:

Residency:

Mitchell, David, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois College of Medicine, Chicago, IL

Blodgett Memorial Medical Center/St. Mary's Hospital, Grand Rapids, MI

Medical School:

Residency:

Monkemeyer, Jon, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois College of Medicine, Chicago, IL

Lutheran General Medical Center, Park Ridge, IL

Medical School:

Residency:

Norem, Dennis, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois College of Medicine, Chicago, IL

Illinois Masonic Medical Center, Chicago, IL

Medical School:

Residency:

Omer, Walid, MD Open

Board Certified: American Board of Internal medicine

Al-Arab Medical university, Banghazi, Libya

Morehouse School of Med, Atlanta, GA

Medical School:

Residency:

Nurse-Midwife Practice Status:

Huntley, Alicia, CNM Open

Board Certified: American Midwifery Certification Board

Univ of Southern California, Los Angeles, CA

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Macaulay, Nicole, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Northwestern Univ Medical School, Chicago, IL

Emory Univ Hospital, Atlanta, GA

Medical School:

Residency:

Wang, Jeannie, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Loyola Univ Chicago-Stritch Medical School, Maywood, IL

Columbus Hospital, Chicago, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 52 of 65W9

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State of Wisconsin - 2020Pediatrics Practice Status:

Martinez, Maria, MD Open

Board Certified: American Board of Pediatrics

Universyt of Santo Tomas, Manila, Philippines

Univ of Florida College of Medicine, Gainesvill, FL

Medical School:

Residency:

Patel, Nilam, MD Open

Board Certified: American Board of Pediatrics

,

,

Medical School:

Residency:

Rhodes, Sharon, MD Open

Board Certified: American Board of Pediatrics

Univ of Iowa College of Medicine, Iowa City, IA

Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Mercyhealth North Rockton Ave

2400 N Rockton Ave

(815) 971-6431

Rockford, IL 61103

Pain Management Practice Status:

Oteng-Bediako, Evelyn, MD Open

Board Certified:

Univ of Ghana Medical School, Ghana

Univ of Louisville, Dpt of Anesthesiology, Louisville, KY

Medical School:

Residency:

Singh, Ishmeet, MD Open

Board Certified: American Board of Anesthesiology (Pain Medicine)

Rush Medical College of Rush Univ, Chicago, IL

Rush-Presby-St Luke's Medical Center, Chicago, IL

Medical School:

Residency:

Mercyhealth North Rockton Ave, Bldg 1

2300 N Rockton Ave

(815) 971-2000

Rockford, IL 61103

Advanced Practice Nurse Practice Status:

Barr, Jessica, APN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Northern Illinois Univ, Dekalb, IL

,

Medical School:

Residency:

Bowmar, Andrea, APN Open

Board Certified: American Academy of Nurse Practitioners (Family Nurse Practitioner)

Olivet Nazarene Univ, Bourbannais, IL

,

Medical School:

Residency:

Evans, Lisa, APN Open

Board Certified: Pediatric Nursing Certification Board (Primary Care)

SUNY at Tony Brook, Stony Brook, NY

,

Medical School:

Residency:

Satterlee, Lindsay, NP Open

Board Certified: American Nurses Credentialing Center

Saint Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Schier, Andrea, APN Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse Practitioner)Univ of Illinois Chicago Medical Center, Chicago, IL

,

Medical School:

Residency:

Sternhagen, DeeAnn, APN Open

Board Certified:

,

,

Medical School:

Residency:

Advanced Practice Nurse Practitioenr Practice Status:

Moroz, Lori, APNP Open

Board Certified: American Nurses Credentialing Center

Concordia University, Mequon, WI

,

Medical School:

Residency:

Advanced Practice Nurse Practitioner Practice Status:

Thompson, LaQuisha, NP Open

Board Certified: AANP

Maryville Univ, St Louis, MO

,

Medical School:

Residency:

Weidner, Jaclyn, APNP Open

Board Certified: American Nurses Credentialing Center

Georgetown University, Washington DC

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Dahm, Renee, NP Open

Board Certified: ANCC

Univ of St Francis, Joliet, IL

,

Medical School:

Residency:

Hadie, Angela, APNP Open

Board Certified: American Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse Practitioner)Univ of Illinois at Chicago, Chicago, IL

,

Medical School:

Residency:

McCoy, Victoria, NP Open

Board Certified: ANCC

Saint Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Pearson, Angela, APNP Open

Board Certified: American Academy of Nurse Practitioners

,

,

Medical School:

Residency:

Zimmerman, Rebecca, NP Open

Board Certified: ANCC

Northern IL Univ, DeKalb, IL

,

Medical School:

Residency:

Allergy & Immunology Practice Status:

Cook, Marisha, MD Open

Board Certified: American Board of Internal Medicine

Rush Medical College, Chicago, IL

Johns Hopkins Hospital, Baltimore, MD

Medical School:

Residency:

Certified Nurse Midwife Practice Status:

Latsch, Amber, CNM Open

Board Certified: American Midwifery Certification Board

,

,

Medical School:

Residency:

Diagnoistic & Pediatric Radiology Practice Status:

Carrasco, Rosario, MD Open

Board Certified:

Univ of IL Urbana, Peoria, IL

Indiana Univ, Indianapolis, IN

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 53 of 65W9

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State of Wisconsin - 2020Endocrinology, Diabetes and

MetabolismPractice Status:

Hovis, John, MD Open

Board Certified: American Board of Internal Medicine (Endocrinology, Diabetes and Metabolism)Duke Univ School of Medicine, Durham NC

Univ of Iowa Hospital, Iowa City, IA

Medical School:

Residency:

Naseer, Aliya, MD Open

Board Certified: American Board of Internal Medicine (Endocrinology, Diabetes and

Metabolism)Dow Medical College, Karachi, Pakistan

Richland Memorial Hospital, Columbia, SC

Medical School:

Residency:

Family Medicine Practice Status:

Eckerstrom, Emily, MD Open

Board Certified: American Board of Family Medicine

Univ of Il Col of Med, Chicago, IL

Mercy, Janesville, WI

Medical School:

Residency:

Rizzo, Anthony, DO Open

Board Certified: American Board of Family Medicine

Midwestern Univ Chicago College of Osteopathic Medicine, Downers Grove, ILPresence Resurrection Medical Center, Chicago, IL

Medical School:

Residency:

Tripp, Marian, MD Open

Board Certified: American Board of Family Medicine

Rosalind Franklin Univeristy, North Chicago,IL

Univ of IL at Chgo, Chgo, IL

Medical School:

Residency:

Walsh, Jean, DO Open

Board Certified: American Osteopathic Board of Family Medicine

Midwestern Univ/Chicago College of Osteopathic Medicine, Downers

Grove, ILMidwestern Univ/Chicago College of Osteopathic Medicine, Downers

Grove, IL

Medical School:

Residency:

Gastroenterology Practice Status:

Bokhari, Syed Saeed, MD Open

Board Certified: American Board of Internal Medicine

King Edward Medical College, Pakistan

L A Weiss Memorial Hospital, Chicago, IL

Medical School:

Residency:

Foster, Jonathan, DO Open

Board Certified: American Osteopathic Board of Internal medicine

Philadelphia College of Osteopathic Med, Philadelphia, PA

Rowan Univ School of Osteo Med, Stratford, NJ

Medical School:

Residency:

Sherid, Muhammed, MD Open

Board Certified: Am Bd Int Med

Damascus University, Damascus, Syria

Presence St. Francis Hospital, Evanston, IL

Medical School:

Residency:

Gynecology & Oncology Practice Status:

Christie, Carl, DO Open

Board Certified:

NYIT College of Osteo Med, Old Westbury, NY

NYCOMEC-Wyekoff Hts Med Ctr, Brooklyn, NY

Medical School:

Residency:

Hospice and Palliative Care Practice Status:

Ahmed Khan, Mohammed Ilyas, MD Open

Board Certified: American Board of Internal Medicine (Hospice & Palliative Care)

Deccan College of Medical Sciences, Hyderabad, India

SUNY-Buffalo, Buffalo, NY

Medical School:

Residency:

Infectious Disease Practice Status:

Al Zoubi, Moamen, MD Open

Board Certified: American Board of Internal Medicine

The Private Univeristy of Kalamoon, Syria

Advocate Illinois Masonic Med Ctr, Chicago, IL

Medical School:

Residency:

Internal Medicine Practice Status:

Raskin, Leonid, MD Open

Board Certified: American Board of Internal Medicine

,

,

Medical School:

Residency:

Rogers, Craig, MD Open

Board Certified: American Board of Internal Medicine

Loyola Univ Chicago-Stritch Medical School, Maywood, IL

Baylor College of Medicine, Houston, TX

Medical School:

Residency:

Sadiq, Raja, MD Open

Board Certified:

Baqai Medical College, Karachi

Ball Memorial Hosp, Muncie, IN

Medical School:

Residency:

Yanamadala, Anusha, MD Open

Board Certified:

Government Medical College Anantapur, Anantapur

Loyola Med MacNeal Hosp, Berwyn, IL

Medical School:

Residency:

Internal medicine/Geriatric Med Practice Status:

Rao, Rani, MD Open

Board Certified: Americna Board of Int Med

Osmania Medical College, Hyderabad

St Joseph Hosp, Chgo, IL

Medical School:

Residency:

Interventional Cardiology Practice Status:

Taylor, Montoya, MD Open

Board Certified: American Board of Internal Medicine

Brown Medical School, Providence, RI

Ohio State University Medical Center,

Medical School:

Residency:

Interventional Neurology Practice Status:

Bansal, Vibhav, MD Open

Board Certified: American Board of Psychiatry and Neurology

Univ of Cincinnati College, Cincinnatti, OH

Univ of IL Chgo, Chgo, IL

Medical School:

Residency:

Neurology Practice Status:

Gorelik, Maxim, MD Open

Board Certified: American Board of Psychiatry and Neurology (Pain Medicine)

Rush Medical College of Rush Univ, Chicago, IL

Univ of California, Davis Medical Center, Sacramento, CA

Medical School:

Residency:

Khan, Atiq, MD Open

Board Certified:

King Edward Medical College, Pakistan

Univ of Tenn, Memphis, TN

Medical School:

Residency:

Strawn, Brandon, DO Open

Board Certified:

West Virginia School Of Osteopathic Medicine, Lewisburg, WV

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 54 of 65W9

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State of Wisconsin - 2020Neurology With Special qualifications in

Child NeurologyPractice Status:

Din, Farid, MD Open

Board Certified: American Board of Psychiatry & Neurology

Allama Iqbal Medical College, Lahore, Pakistan

Univ of Buffalo Sch of Med, Buffalo, NY

Medical School:

Residency:

Nurse Practitioner Practice Status:

Kiley, Martha, NP Open

Board Certified: National Credentialing Committee

Northern Illinois Univerdsity, DeKalb, IL

,

Medical School:

Residency:

Nurse Practitioner-Acute Care Practice Status:

Van Vleet, Stacy, NP Open

Board Certified: American Nurses Credentialing Center

Rush University Colleg eof Nursing, Chicago, IL

,

Medical School:

Residency:

Nurse-Midwife Practice Status:

Boettner, Karen, CNM Open

Board Certified: American Midwifery Certification Board

Marquette Univ, Milwaukee, WI

,

Medical School:

Residency:

Obstetrics & Gynecology Practice Status:

Lenox, Jack, MD Open

Board Certified: American Board of Obstetrics & Gynecology

Indiana University School of Med, Indianapolis IN

Univ of Chgo Hosp, Chgo, Il

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Johnson, Alan, MD Open

Board Certified: American Board of Obstetrics & Gynecology

,

,

Medical School:

Residency:

Kenyon, Diana, DO Open

Board Certified: American Board of Obstetrics & Gynecology

Des Moines University, Des Moines, IA

Madigan Armiy Medical Center, Tacoma, WA

Medical School:

Residency:

Ophthalmology Practice Status:

Boone, Diane, MD Open

Board Certified: American Board of Ophthalmology

Univ of Texas Medical School, San Antonio, TX

Univ of Iowa Hospital & Clinics, Iowa City, IA

Medical School:

Residency:

Luellwitz, David, DO Open

Board Certified: American Osteopathic Board of Ophthalmology

Western Univ of Health Sciences, Pomona, CA

Midwestern University, Olympia Fields, IL

Medical School:

Residency:

Mathew, Benjamin, MD Open

Board Certified: American Board of Ophthalmology

Univ of Manitoba Faculty of Medicine, Winnipeg, Canada

Univ of Ottawa Eye Institute, Ottawa, Canada

Medical School:

Residency:

Optometry Practice Status:

Alexander, John, OD Open

Board Certified: Not Board Certified

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Optometry Practice Status:

Alexander, Cathy, OD Open

Board Certified: Not Applicable

Pennsylvania College of Optometry, Philadelphia, PA

,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Konstantakos, Emmanuel, MD Open

Board Certified: Not Board Certified

Case Western Reserve Univ, Cleveland, OH

Wright State Univ Boonshoft SOM, Dayton, OH

Medical School:

Residency:

Leu, David, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of California, San Francisco, CA

John Hopkins Univ School of Medicine, Baltimore, MD

Medical School:

Residency:

Nielsen, David, DO Open

Board Certified: American Osteo Board of Ortho Surg

Kirksvill College of Osteo Med, Kirksville, MO

Ohio Univ, Dayton, OH

Medical School:

Residency:

Zlowodzki, Michal, MD Open

Board Certified: American Board of Surgery

Univ of Hamburg, Hamburg, Germany

Univ of Minnesota Medical School, Minneapolis, MN

Medical School:

Residency:

Palliative Care Practice Status:

Patel, Velisa, NP Open

Board Certified: American Nurses Credentialing Center

,

,

Medical School:

Residency:

Pediatric Cardiology Practice Status:

Kazmouz, Suhaib, MD Open

Board Certified: American Board of Pediatrics (Pediatric Cardiology)

Aleppo Univ, Aleppo, Syria

Crozer Chester Medical Center, Chester, PA

Medical School:

Residency:

Masood, Syed, MD Open

Board Certified: American Board of Pediatrics

Dow Medical Univ - Pakistan, Karachi Sindh Pakistan

Louisiana State Univ Health Science Center, Shreveport, LA

Medical School:

Residency:

Pediatric Endocrinology Practice Status:

Carrion, Francisco, MD Open

Board Certified: American Board of Pediatrics (Pediatric Endocrinology)

Univ of Puerto Rico, San Juan, Puerto Rico

Caguas Regional Hospital, Caguas, Puerto Rico

Medical School:

Residency:

Grosvenor, Molly, NP Open

Board Certified: American Academy of Nurse Practitioners

Olivet Nazarene University, Bourbonnais, IL

,

Medical School:

Residency:

Pediatric Gastroenterology Practice Status:

Burress, Glendon, MD Open

Board Certified: American Board of Pediatrics (Pediatric Gastroenterology)

Univ of Illinois College of Medicine, Champaign, IL

Univ of Chicago Hospital, Chicago, IL

Medical School:

Residency:

Deutsch, David, MD Open

Board Certified: American Board of Pediatrics (Pediatric Gastroenterology)

Univ of Illinois College of Medicine - Rockford, Rockford, IL

Columbus Children's Hospital/The Ohio State Univ, Columbus, OH

Medical School:

Residency:

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State of Wisconsin - 2020Pediatric Gastroenterology Practice Status:

Nguyen, Kim-Doan, MD Open

Board Certified: American Board of Internal Medicine AND American Board of Pediatrics

(Pediatric Gastroenterology)American Univ of the Caribbean School of Medicine, Coral Gables, FL

Univ of Missouri-Columbia, Columbia, MO

Medical School:

Residency:

Vortia, Eugene, MD Open

Board Certified: American Board of Pediatrics (Pediatric Gastroenterology) and American

Board of Internal MedicineUniv of Ghana Medical School, Korle Bu, ACCRA Ghanna

MI State Univ - Kalamazoo Ctr for Medical Studies, Kalamazoo, MI

Medical School:

Residency:

Pediatric Pulmonology Practice Status:

Shoberg, David, MD Open

Board Certified: American Board of Pediatrics (Pediatric Pulmonology)

Univ of Illinois College of Medicine, Chicago, IL

Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Pediatrics Practice Status:

Allen, Rudy, MD Open

Board Certified: American Board of Pediatrics

Loyola University, Maywood, IL

, Danville, PA

Medical School:

Residency:

Beaves, Sarah, MD Open

Board Certified: American Board of Pediatrics

Univ of Iowa College of Medicine, Iowa City, IA

Univ of Iowa Hospital, Iowa City, IA

Medical School:

Residency:

Davis, Raymond, MD Open

Board Certified: American Board of Pediatrics (Child Abuse Pediatrics)

Univ of Illinois College of Medicine, Peoria, IL

St. Francis Medica Center, Peoria, IL

Medical School:

Residency:

Hornbach, Mark, MD Open

Board Certified: American Board of Pediatrics

Rush Medical College, Chicago, IL

Wyler Children's Hospital, Chicago, IL

Medical School:

Residency:

Physician Assistant Practice Status:

Magoon, Kelly, Pa-C Open

Board Certified: NCCPA

Rosalind Franklin University, North Chicago, IL

,

Medical School:

Residency:

Taylor, Shannon, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Military Interservice PA Program, Univ of Nebraska, San Antonio, TX

,

Medical School:

Residency:

Plastic Surgery Practice Status:

Frye, Aaron, MD Open

Board Certified: American Board of Surgery

St Georges Univ, Great Rivers, NY

New York Medical College Sound Shore, New Rochelle, NY

Medical School:

Residency:

Podiatry Practice Status:

Chase, Kari, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine at Rosalind Franklin Univ of

Medicine & Sciences, North Chicago, ILWeiss Memorial Hospital, Chicago, IL

Medical School:

Residency:

Podiatry Practice Status:

Holmbeck, Ryan, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine, North Chicago, IL

Sts Mary and Elizabeth Medical Center, Chicago, IL

Medical School:

Residency:

Norem, Nathan, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine at Rosalind Franklin Univ, North

Chicago, ILHahnemann Univ Hospital/Drexel Univ College of Medicine, Philadelphia,

PA

Medical School:

Residency:

Psychiatry Practice Status:

Vaid, Khatija, MD Open

Board Certified: American Board of Psychiatry and Neurology

Sindh Medical College,

Jinnah Medical Center,

Medical School:

Residency:

Psychology Practice Status:

Griffith, Daniel, PhD Open

Board Certified:

,

,

Medical School:

Residency:

Rheumatology Practice Status:

Hovis, Robin, MD Open

Board Certified: American Board of Internal Medicine (Rheumatology)

Univ of Iowa College of Medicine, Iowa City, OA

Univ of Iowa Hospital, Iowa City, IA

Medical School:

Residency:

Kozlowski, Stephen, MD Open

Board Certified: American Board of Internal Medicine

Loyola University, Maywood, Illinois

Northwestern School of Medicine, Chicago, IL

Medical School:

Residency:

Surgery Practice Status:

Chaudhuri, Rishi, MD Open

Board Certified: None

Wayne State Univ, Detroit, Mi

,

Medical School:

Residency:

Cowden, William, MD Open

Board Certified: American Board of Surgery

Univ of Illinois College of Medicine-Rockford, Rockford, IL

Synergy Medical Education Alliance, Saginaw, MI

Medical School:

Residency:

McCarthy, Michael, DO Open

Board Certified:

Des Moines Univ, College of Osteopathic Medicine, Des Moines, IA

St James Hospitals & Health Centers, Olympia Fields, IL

Medical School:

Residency:

Michelotti, Michael, MD Open

Board Certified: American Board of Surgery

Northwestern Univ Medical School, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Medical School:

Residency:

Santiago-Gonzalez, Juan, MD Open

Board Certified: American Board of Surgery

Univ of Puerto Rico School of Med, San Juan, PR

Univ of Puerto Rico, San Juan, PR

Medical School:

Residency:

Zarnke, Mark, MD Open

Board Certified:

Univ of Wisconsin Medical School, Madison, WI

Medical College of Ohio, Toledo, OH

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 56 of 65W9

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State of Wisconsin - 2020Surgical Critical Care Practice Status:

Hollister, Hadyn, MD Open

Board Certified: American Board of Surgery

University of Coolege of Nursing, Rockford, IL

Rush University, Chicago, IL

Medical School:

Residency:

Kaminsky, Matthew, MD Open

Board Certified: Royal College

Univ of Manitoba, Winnipeg, Manitoba

Univ of Maitoba, Winnipeg, Mannitoba

Medical School:

Residency:

Thoracic and Cardiac Surgery Practice Status:

Konstantakos, Anastasios, MD Open

Board Certified: American Board of Surgery

Univeristy of Miami, Miami, FL

Case Western Reserve Univ, Cleveland, OH

Medical School:

Residency:

Thoracic Surgery - Pediatric Practice Status:

Forbess, Joseph, MD Open

Board Certified: American Bd Thoracic Surg

Harvard Medical School, Boston, MA

Duke University Medical Center, Durham, NC

Medical School:

Residency:

Urology Practice Status:

Matoka, Derek, MD Open

Board Certified: American Board of Urology

Loyola University, Maywood, IL

University of Pittsburgh Medical Center, Pittsburgh, PA

Medical School:

Residency:

Vascular Surgery Practice Status:

Wanamaker, Keenan, DO Open

Board Certified:

Michigan State University, East Lansing, MI

Michigan State Univ-Genesys Regional med Ctr, Grand Blanc, MI

Medical School:

Residency:

Mercyhealth North Rockton Avenue - PT

2300 N Rockton Ave

(815) 971-2290

Rockford, IL 61103

Urgent Care Center Practice Status:

Mercyhealth Rockton Ave Bldg 1 UC, , Open

Board Certified:

,

,

Medical School:

Residency:

Mercyhealth Orthopedic Specialists

2350 N Rockton Ave

(815) 971-7400

Rockford, IL 61108

Orthopedic Surgery Practice Status:

Fochios, Dean, MD Open

Board Certified: American Board of Orthopaedic Surgery

George Washington Univ School of Medicine, Washington, DC

Maimonides Medical Centr, Brooklyn, NY

Medical School:

Residency:

Krpan, Marko, DO Open

Board Certified: American Osteopathic Board of Orthopaedic Surgeons

Univ of Oseopathic Medicine & Health Services, Des Moines, IA

Michigan State U, Oakland General Hospital, Madison Heights, MI

Medical School:

Residency:

Pickvance, Elizabeth, MD Open

Board Certified: American Board of Orthopaedic Surgery

Univ of Texas Medical Branch, Galveston, TX

Univ of Minnesota, Minnapolis, MN

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Plucknette, Benjamin, DO Open

Board Certified:

Touro College of Osteo Med, New York, NY

San Antonio Uniformed Serv, Houston, TX

Medical School:

Residency:

Mercyhealth Perryville

3401 N Perryville Rd

(815) 971-2000

Rockford, IL 61114

Advanced Practice Nurse Practice Status:

Koch, Laura, APN Open

Board Certified:

,

,

Medical School:

Residency:

Pinawin, Maxita, APN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Northern Illinois Univ, Dekalb, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Ansari, Mohammed Sajid, MD Open

Board Certified: American Board of Family Medicine

Deccan College of Medical Sciences, Hyderabad, India

SIU Family Practice Residency, Decatur, IL

Medical School:

Residency:

Diamond, Steven, MD Open

Board Certified: Americal Board of Family Medicine

Univ of Pennsylvania Medical School, Philadelphia, PA

,

Medical School:

Residency:

Nowak, Magdalena, MD Open

Board Certified: American Board of Family Medicine

Pmeraniam Medical Univ, Szczecnin, Poland

Univ of IL at Chicago, Chicago, IL

Medical School:

Residency:

Rohrbacher, Melissa, DO Open

Board Certified: American Board of Family Medicine

Midwestern Univ, Chicago College of Osteopathic Medicine, Downers Grove, ILChrist Hospital & Medical Center, Oak Lawn, IL

Medical School:

Residency:

Schermer, Ian, MD Open

Board Certified: American Board of Family Medicine

Univ of Iowa College of Medicine, Iowa City, IA

Univ of Illinois Chicago Medical Center, Chicago, IL

Medical School:

Residency:

Schroeder, Paul, MD Open

Board Certified: American Board of Family Medicine

Univ of Illinois College of Medicine at Rockford, Rockford, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Internal Medicine Practice Status:

Brito, Tracy, MD Closed

Board Certified: American Board of Internal Medicine

Inov pf Cape Town, Faculty of Medicine, Cape Town, South Africa

North Shore Univ Hospital, Manhasset, NY

Medical School:

Residency:

Coates, Aaron, MD Open

Board Certified: American Board of Internal Medicine

MCP Hahnemann Univ College of Medicine, Philadelphia, PA

St. Joseph Mercy Health System, Ann Arbor, MI

Medical School:

Residency:

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State of Wisconsin - 2020Internal Medicine Practice Status:

Muhammad, Tracy, MD Open

Board Certified: American Board of Internal Medicine

Rosalind Franklin Univ, North Chicago, IL

Rosalind Franklin Univ, North Chicago, IL

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Bhattacharya, Sumoulindra, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Tennessee College of Medicine, Memphis, TN

Cook County Hospital, Chicago, IL

Medical School:

Residency:

Higgins, Phillip, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Univ of Floriday College of Medicine, Gainesville, FL

Rush-Presby-St Luke's Medical Center, Chicago, IL

Medical School:

Residency:

Optometry Practice Status:

Johnson, Justin, OD Open

Board Certified:

Southern College of Optometry, Memphis, TN

,

Medical School:

Residency:

Otolaryngology Practice Status:

Severson, James, MD Open

Board Certified: American Board of Otolaryngology

Southern Illinois Univ School of Medicine, Springfield, IL

Medical College of Wisconsin, Milwaukee, WI

Medical School:

Residency:

Zahurullah, Fazlur, MD Open

Board Certified: American Board of Otolaryngology

Univ of Michigan Medical School, Ann Arbor, MI

Albert Einstein College of Medicine, Bronx, NY

Medical School:

Residency:

Physician Assistant Practice Status:

Rozeboom, Molly, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

South College, Knoxville, TN

,

Medical School:

Residency:

Urgent Care Center Practice Status:

Mercyhealth Perryville UC, Open

Board Certified:

,

,

Medical School:

Residency:

Mercyhealth Physicians

2350 N Rockton Ave

(815) 971-2000

Rockford, IL 61103

Physician Assistant Practice Status:

Schenzel, Alyssa, PA-C Open

Board Certified: NCCPA

Carroll University, Waukesha, WI

,

Medical School:

Residency:

Mercyhealth Pulmonary Rehab Center -

Rockford

2350 N Rockton Ave

(815) 971-2000

Rockford, IL 61103

Pulmonary Disease Practice Status:

Qassem, Zaher, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine) (Geriatric Medicine)Damascus Univ of Medicine, Damascus, Syria

Morehouse School of Medicine, Atlanta, GA

Medical School:

Residency:

Roy, Bharati, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Sleep Medicine)Baroda Medical Univ, Baroda, India

Georgetown Univ Hospital, Washington, DC

Medical School:

Residency:

Mercyhealth Strathmoor

5727 Strathmoor Dr, #1

(815) 971-3160

Rockford, IL 61107

Pediatric Cardiology Practice Status:

Foran, Ronald, MD Open

Board Certified:

Dalhousie University Faculty of Medicine, Halifax, Nova Scotia

Dalhousie University School of Medicine, Nova Scotia

Medical School:

Residency:

Pediatrics Practice Status:

Hart, John, MD Open

Board Certified: American Board of Pediatrics

New York Medical College, Valhalla,

,

Medical School:

Residency:

Panzica, Patricia, MD Open

Board Certified: American Board of Pediatrics

Univ of Illinois - Chicago, Chicago, IL

Rainbow Babies & Child Hospital, Cleaveland, OH

Medical School:

Residency:

Mercyhealth Visiting Nurses Association, Inc.

4223 E State St

(815) 971-3550

Rockford, IL 61108

Home Health Provider Practice Status:

Mercyhealth Visiting Nurses Asso, Inc., , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Hospice Care Practice Status:

Mercyhealth Visiting Nurses Asso, Inc., , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Mercyhealth Women's Center - Rockford

7180 Spring Brook Rd

(815) 971-2299

Rockford, IL 61114

Advanced Practice Nurse Practice Status:

Cain, Joyce, APN Open

Board Certified: National Certification Corporation (Women's Health Care Nurse Practitioner)Univ of Cincinnati, Cincinnati, OH

,

Medical School:

Residency:

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State of Wisconsin - 2020Surgery Practice Status:

Mahatme, Arvind, MD Open

Board Certified: American Board of Surgery

Univ of South Florida College of Medicine, Tampa, FL

Univ of Nebraska Medical Center, Omaha, NE

Medical School:

Residency:

Mercyhealth Wound Center - Rockford

2300 N Rockton Ave

(815) 971-7454

Rockford, IL 61103

Family Medicine Practice Status:

Gellada, Karen Imma, MD Open

Board Certified: American Board of Family Medicine

Univ of the Philippines - Manila, Ermita, Manila

Univ of Illinois College of Medicine at Peoria, Peoria, IL

Medical School:

Residency:

Plastic Surgery Practice Status:

Frye, Aaron, MD Open

Board Certified: American Board of Surgery

St Georges Univ, Great Rivers, NY

New York Medical College Sound Shore, New Rochelle, NY

Medical School:

Residency:

Podiatry Practice Status:

Chase, Kari, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine at Rosalind Franklin Univ of

Medicine & Sciences, North Chicago, ILWeiss Memorial Hospital, Chicago, IL

Medical School:

Residency:

Holmbeck, Ryan, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine, North Chicago, IL

Sts Mary and Elizabeth Medical Center, Chicago, IL

Medical School:

Residency:

Norem, Nathan, DPM Open

Board Certified: Not Board Certified

Scholl College of Podiatric Medicine at Rosalind Franklin Univ, North Chicago, ILHahnemann Univ Hospital/Drexel Univ College of Medicine, Philadelphia, PA

Medical School:

Residency:

New Vision of Illinois, LLC

2929 McFarland Rd

(815) 654-2020

Rockford, IL 61107

Ophthalmology Practice Status:

Ericson, Eric, MD Open

Board Certified: American Board of Ophthalmology

Univ of Illinois, Chicago, IL

Univ of Illinois Eye and Ear Infirmary, Chicago, IL

Medical School:

Residency:

Romaniv, Natalya, MD Open

Board Certified: American Board of Ophthalmology

Washington Univ, St. Louis, MO

Louisiana State Univ/Ochsner Clinic Foundation, New Orleans, LA

Medical School:

Residency:

Vakharia, Mitul, MD Open

Board Certified: American Board of Ophthalmology

Weill Medical College of Cornell Univ, New York, NY

Univ of Michigan, Ann Arbor, MI

Medical School:

Residency:

Optometry Practice Status:

Hahn, Paul, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Optometry Practice Status:

Shumaker, Douglas, OD Open

Board Certified: Not Applicable

Illinois College of Optometry, Chicago, IL

,

Medical School:

Residency:

Northern Illinois Retina

1235 N Mulford Rd, Ste 100

(815) 226-4990

Rockford, IL 61107

Ophthalmology Practice Status:

Fowell, Susan, MD Open

Board Certified: American Board of Ophthalmology

Northwestern Univ Medical School, Chicago, IL

Northwestern Memorial Hospital, Chicago, IL

Medical School:

Residency:

Oman & Oman Counseling

5055 Spring Creek Road

(815) 639-9405

Rockford, IL 61114

Behavioral Health Clinic Practice Status:

McClanathan, Lindsey, LCSW Open

Board Certified:

,

,

Medical School:

Residency:

Oman, Randall, LPC, PhD Open

Board Certified: National Board of Certified Counselors

,

,

Medical School:

Residency:

Oman, Mariene, PC Open

Board Certified: National Board for Certified Counselors

,

,

Medical School:

Residency:

Staege, Erin, PC Open

Board Certified: National Board for Certified Counselors

,

,

Medical School:

Residency:

Remedies Renewing Lives - Rockford

220 Easton Pkwy

(815) 962-0871

Rockford, IL 61108

Adult Addictions Program Practice Status:

Remedies Renewing Lives - Rockford, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Reproductive Health & Fertility Center

973 Fetherstone Rd

(877) 373-7552

Rockford, IL 61107

Obstetrics and Gynecology Practice Status:

Deutch, Todd, MD Open

Board Certified: American Board of Obstetrics & Gynecology

Tulane Univ School of Med, New Orleans, LA

Univ of Chgo Hosp, Chgo, IL

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 59 of 65W9

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State of Wisconsin - 2020RNA of Rockford, LLC

612 Roxbury Rd

(815) 227-8300

Rockford, IL 61107

Advance Practice Nurse Practitioner Practice Status:

Mulasmajic, Muamer, NP Open

Board Certified: American Nurses Credentialing Center

St Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Advanced Practice Nurse Practice Status:

Avila, Lilia, NP Open

Board Certified: AANP

Northern Illinois University, Dekalb, IL

,

Medical School:

Residency:

Capriola, Kathleen, APN Open

Board Certified: American Nurses Credentialing Center (Clinical Nurse Specialist in Adult

Health)Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

Gile, Stephanie, NP Open

Board Certified: AANP

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Medical Oncology Practice Status:

Ahmed, Syed, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Deccan College of Medical Schiences, Hyderabad

Harbor Hospital Center, Baltimore, MD

Medical School:

Residency:

Nephrology Practice Status:

Ahmad, Mashood, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Dow Medical College, Karachi

Civil Hospital & Usman Memorial Hospital, Karachi

Medical School:

Residency:

Maynard, John, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Univ of Illinois College of Medicine at Chicago, Chicago, IL

Henry Ford Hospital, Detroit, MI

Medical School:

Residency:

Murdakes, Charlene, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Rusch Univ College of Medicine, Chicago, IL

Rush Univ Medical Center, Chicago, IL

Medical School:

Residency:

Niemiec, Joanna, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Jagiellonian Univ Medical College, Krakow

St. Joseph Hospital/Northwestern Univ Feinberg School of Medicine, Chicago, IL

Medical School:

Residency:

Pavithran, Bindu, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Medical College of Trivandrum, Kerala, India

Mercy Hospital of Pittsburgh, Pittsburgh, PA

Medical School:

Residency:

Robertson, Michael, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Univ of Illinois College of Medicine at Chicago, Chicago, IL

Univ of Chicago, Chicago, IL

Medical School:

Residency:

Nephrology Practice Status:

Sankaran, Krishna, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Univ of Illinois College of Medicine at Rockford, Rockford, IL

Illinois Masonic Medical Center, Chicago, IL

Medical School:

Residency:

Stim, James, MD Open

Board Certified: American Board of Internal Medicine (Nephrology)

Univ of Illinois College of Medicine, Chicago, IL

Univ of Illinois at Chicago, Chicago, IL

Medical School:

Residency:

Rockford Health Physicians Family Practice

2350 N Rockton Ave

(815) 971-2000

Rockford, IL 61103

Family Medicine Practice Status:

Soufan, Bassam, MD Open

Board Certified: American Board of Family Medicine

Damascus Univ of Medicine, Damascus, Syria

St. Mary of Nazareth Hospital, Chicago, IL

Medical School:

Residency:

Washington, Charles, MD Open

Board Certified: American Board of Family Medicine

Univ of Illinois College of Medicine, Chicago, IL

Rockford Medical Education Foundation, Rockford, IL

Medical School:

Residency:

Licensed Clinical Psychologist Practice Status:

Soriano, Jason, PsyD Open

Board Certified:

Adler University, Chicago, IL

,

Medical School:

Residency:

Rockford Health Physicians Internal Medicine

2350 N Rockton Ave

(815) 971-7210

Rockford, IL 61103

Gastroenterology Practice Status:

Gentile, Nicole, MD Open

Board Certified: American Board of Internal Medicine

Rosalind Frankling Univ, N Chgo, IL

Mayo Clinic, Rochester, MN

Medical School:

Residency:

Internal Medicine Practice Status:

Rone, Jr., Arthur, MD Open

Board Certified: American Board of Internal Medicine

Univ of Illinois College of Medicine, Chicago, IL

Illinois Masonic Medical Center, Chicago, IL

Medical School:

Residency:

Rockford Oral & Maxillofacial Surgery

449 Roxbury Rd

(815) 226-4700

Rockford, IL 61107

Oral & Maxillofacial Surgery Practice Status:

Bruksch, Matthew, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Univ of Illinois at Chicago College of Dentistry, Chicago, IL

Vanderbilt Univ Hospital, Nashville, TN

Medical School:

Residency:

Rentschler, Edward, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Univ of Louisville, Louisville, KY

Univ of Louisville School of Dentistry, Louisville, KY

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 60 of 65W9

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State of Wisconsin - 2020Rockford Orthopedics Asso, LTD d/b/a

Orthoillinois

324 Roxbury Road

(815) 398-9491

Rockford, IL 61107

Durable Medical Equipment Supplier Practice Status:

Rockford Orthopedic Appliance, , Open

Board Certified: Not Applicable

,

,

Medical School:

Residency:

Rockford Psychiatric Medical Services, SC

1639 N Alpine Rd, Ste 260

(815) 395-1500

Rockford, IL 61107

Advanced Practice Nurse Practice Status:

Brechlin, Angeline, APN Open

Board Certified: American Nurses Credentialing Center (Adult Psychiatric & Mental Health

Clinical Nurse Specialist)Univ of Illinois College of Medicine at Rockford, Rockford, IL

,

Medical School:

Residency:

Odefadehan, Adewumi, NP Open

Board Certified:

Chamberlin College of Nursing, Addison, IL

,

Medical School:

Residency:

Advanced Practice Nurse Prescriber Practice Status:

DeHaven, Misty, APN Open

Board Certified: ANCC

St Anthony College of Nursing, Rockford, IL

,

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

Carter, Colette, APN Open

Board Certified: merican Nurses Credentialing Center (Adult-Gerontology Primary Care

Nurse Practitioner)University of Cincinnati, Cincinnati, Ohio

,

Medical School:

Residency:

Rockford Psychiatric Medical Serv, SC, , Open

Board Certified:

,

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Pottinger, Sara, LCPC Open

Board Certified: Not Applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Thomas-Bua, Anita, LCPC Open

Board Certified: Not Applicable

UW-Whitewater, Whitewater, WI

,

Medical School:

Residency:

Whitson, Gena, PC Open

Board Certified:

,

Not Applicable,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Beard, Brenda, LCSW Open

Board Certified: Not Applicable

Aurora Univ, Aurora, IL

,

Medical School:

Residency:

Seerup, Wendy, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Sommer, Daniel, LCSW Open

Board Certified:

Univ of Southern Indiana, Evansville, IN

,

Medical School:

Residency:

Licensed Marriage & Family Therapist Practice Status:

DeMatthews, Maryann, MFT Open

Board Certified: American Association for Marriage and Family Therapy

California State Univ, Northridge, CA

,

Medical School:

Residency:

Rothermel, Rachel, LMFT Open

Board Certified: Not Applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Psychiatry Practice Status:

Giakas, William, MD Open

Board Certified: American Board of Psychiatry and Neurology (Geriatric and Forensic Psychiatry)UMDNJ, New Jersey Medical School, Newark, NJ

Yale New Haven Hospital, New Haven, CT

Medical School:

Residency:

Rockford Spine Center

2902 McFarland Rd, Ste 300

(815) 316-2100

Rockford, IL 61107

Advanced Practice Nurse Practice Status:

Johnson, Angela, APN Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

St. Anthony's College of Nursing, Rockford, IL

,

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Roh, Michael, MD Open

Board Certified: American Board of Orthopaedic Surgery

Brown Medical School, Providence, RI

New York Orthopaedic Hospital, New York, NY

Medical School:

Residency:

Sliva, Christopher, MD Open

Board Certified: American Board of Orthopaedic Surgery

Rush Medical College of Rush Univ, Chicago, IL

Univ of Iowa Hospitals & Clinics, Iowa City, IA

Medical School:

Residency:

Sweet, Fred, MD Open

Board Certified: American Board of Orthopaedic Surgery

Rush Medical College of Rush Univ, Chicago, IL

Barnes-Jewish Hospital, St. Louis, MO

Medical School:

Residency:

Physical Medicine & Rehabilitation Practice Status:

Walker, Marie, MD Open

Board Certified: American Board of Physicial Medicine and Rehabilitation

Univ of Wisconsin, Eau Claire

Mayo Medical Clinic, Rochester, MN

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 61 of 65W9

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State of Wisconsin - 2020Physician Assistant Practice Status:

Schwabero, Matthew, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Medical College of Ohio, Toledo, OH

,

Medical School:

Residency:

Soare, Sean, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Rocky Mountain College, Billings, MT

,

Medical School:

Residency:

Wolf, Bradley, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Chapman College, Pittsburgh, PA

,

Medical School:

Residency:

Rockford Urological Associates

351 Executive Pkwy

(815) 398-4057

Rockford, IL 61107

Urology Practice Status:

Cormier, Mark, MD Open

Board Certified: American Board of Urology

Rush Medical College of Rush Univ, Chicago, IL

Univ Hospital, Cincinnati, OH

Medical School:

Residency:

Eden, Catherine, MD Open

Board Certified:

Georgetown University School of Medicine, Washington, DC

Loyola, Maywood, IL

Medical School:

Residency:

Frederick, Luke, MD Open

Board Certified: American Board of Urology

Southern Illinois Univ School of Medicine, Springfield, IL

Southern Illinois Univ School of Medicine, Springfield, IL

Medical School:

Residency:

Fumo, Michael, MD Open

Board Certified: American Board of Urology

Univ of Chicago, The Pritzker School of Medicine, Chicago, IL

Henry Ford Hospital, Detroit, MI

Medical School:

Residency:

Houlihan, Daniel, DO Open

Board Certified: American Board of Urology

Chicago College of Osteopathic Medicine, Chicago, IL

Michael Reese Hospital & Medical Center, Chicago, IL

Medical School:

Residency:

Roegner, Douglas, MD Open

Board Certified: American Board of Urology

Rush Medical College of Rush Univ, Chicago, IL

Naval Medical Center, Portsmouth, VA

Medical School:

Residency:

Taylor, Eric, MD Open

Board Certified: American Board of Urology

Univ of Illinois College of Medicine, Chicago, IL

Southern Illinois Univ School of Medicine, Springfield, IL

Medical School:

Residency:

Valadez, Richard, MD Open

Board Certified: American Board of Urology

Loyola Univ Chicago, Stritch School of Medicine, Maywood, IL

Loyola Strich School of Medicine, Maywood, IL

Medical School:

Residency:

Whelan, Christopher, MD Open

Board Certified: American Board of Urology

Southern Illinois Univ School of Medicine, Springfield, IL

St. John's Hospital, Springfield, IL

Medical School:

Residency:

Rosecrance Berry Campus

8616 Northern Avenue

(815) 391-1000

Rockford, IL 61107

Child & Adolescent Addictions Program Practice Status:

Rosecrance Berry Campus, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rosecrance Berry Campus, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Rosecrance Griffin Williamson Campus

1601 University Dr

(815) 391-1000

Rockford, IL 61107

Child & Adolescent Addictions Program Practice Status:

Rosecrance Griffin Williamson Campus, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Rosecrance Mulberry Center

605 Mulberry Street

(815) 391-1000

Rockford, IL 61103

Adult Addictions Program Practice Status:

Rosecrance Mulberry Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Rosecrance on Harrison-Adult Facility

3815 W Harrison St

(815) 391-1000

Rockford, IL 61104

Adult Addictions Program Practice Status:

Rosecrance on Harrison, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Rosecrance Ware Center

2704 N Main Street

(815) 391-1000

Rockford, IL 61103

Adult Addictions Program Practice Status:

Rosecrance Ware Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Adult Mental Health Program Practice Status:

Rosecrance Ware Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 62 of 65W9

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State of Wisconsin - 2020Child & Adolescent Addictions Program Practice Status:

Rosecrance Ware Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Child & Adolescent Mental Health

ProgramPractice Status:

Rosecrance Ware Center, , Open

Board Certified: The Joint Commission

Not Applicable,

Not Applicable,

Medical School:

Residency:

Van Matre HealthSouth Rehab Hosp

950 S Mulford Rd

(815) 381-8500

Rockford, IL 61108

Rehabilitation Center Practice Status:

Van Matre HealthSouth Rehab, , Open

Board Certified: The Joint Commission

,

,

Medical School:

Residency:

Roscoe, IL

HOPE Child & Family Counseling, Inc

11447 2nd St, Ste 9b

(815) 601-4673

Roscoe, IL 61073

Advanced Practiced Social Worker Practice Status:

Conkle, Krystal, LCSW Open

Board Certified: Not Applicable

Aurora University, Aurora, IL

,

Medical School:

Residency:

Behavioral Health Clinic Practice Status:

HOPE Child & Family Counseling, Inc, , Open

Board Certified:

,

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Kavran, Alix, PC Open

Board Certified: National Board for Certified Counselors

Illinois School of Professional Psychology, Schaumburg, IL

,

Medical School:

Residency:

Petty, Michelle, LCPC Open

Board Certified: Not Applicable

National-Louis Univ, Wheeling, IL

,

Medical School:

Residency:

Schroepfer, Stacy, LCPC Open

Board Certified: Not Applicable

Univ of Wisconsin - Stout, Menomonie, WI

,

Medical School:

Residency:

Varghese, Grace, LCPC Open

Board Certified: Not Applicable

Rosalind Franklin Univ, North Chicago, IL

,

Medical School:

Residency:

Licensed Clinical Professional

CounselorPractice Status:

Wagner, Jamie, LCPC Open

Board Certified: Not Applicable

Mildred Berry Center, Rockford, IL

,

Medical School:

Residency:

Licensed Clinical Social Worker Practice Status:

Bates, Suzanne, LCSW Open

Board Certified: Not Applicable

Aurora University, Aurora, IL

,

Medical School:

Residency:

Garrison, James, LSW Open

Board Certified:

Aurora University, Aurora, IL

,

Medical School:

Residency:

Kroening, Elizabeth, LCSW Open

Board Certified:

,

,

Medical School:

Residency:

Marcum, Vicki, LCSW Open

Board Certified: Not Applicable

Univ of Illinois at Urbana-Champaign, Urbana, IL

,

Medical School:

Residency:

Matz, Hanah, LCSW Open

Board Certified: Not Applicable

Aurora Univ, Aurora, IL

,

Medical School:

Residency:

Licensed Professional Counselor Practice Status:

Ebert, Marissa, LPC Open

Board Certified: Not Applicable

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Kerno, Vanessa, LPC Open

Board Certified:

Concordia University, Mequon, WI

,

Medical School:

Residency:

McKinney, Mary, LPC Open

Board Certified:

National Louis University, Chicago, Il

,

Medical School:

Residency:

Weymer, Jean, LPC Open

Board Certified: Not Applicable

National Louis Univ, Elgin, IL

,

Medical School:

Residency:

Licensed Professional Counsleor Practice Status:

Valler, Julie, LPC Open

Board Certified:

Univ of WI Whitewater, Whitewater, WI

,

Medical School:

Residency:

Licensed Social Worker Practice Status:

Friemuth, Katelyn, MSW Open

Board Certified:

UW Madison, Madison, WI

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 63 of 65W9

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State of Wisconsin - 2020Nurse Practitioner Practice Status:

Powers, Brielle, NP Open

Board Certified:

George Williams College of Aurora Univ, Williams Bay, WI

,

Medical School:

Residency:

Professional Counselor Practice Status:

Lakis, Karen, PC Open

Board Certified: None

Capella University, Minneapolis, MN

,

Medical School:

Residency:

Mercyhealth Roscoe

5000 Prairie Rose Dr

(815) 971-2000

Roscoe, IL 61073

Internal Medicine Practice Status:

Hansen, David, MD Open

Board Certified: American Board of Internal Medicine

Univ of Chicago-Pritzker School of Medicine, Chicago, IL

Milwaukee Medical Complex, Milwaukee, WI

Medical School:

Residency:

Sekulic, Dusica, MD Open

Board Certified: American Board of Internal Medicine

Univ of Pristina, Pristian Yugoslavia

Medical Clinic Center, Titograd Medical Center, Danilovgrad, Yugoslavia

Medical School:

Residency:

Sy, Larry, MD Open

Board Certified: American Board of Internal Medicine

,

,

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Granzeier, Gregory, DO Open

Board Certified: American Board of Obstetrics and Gynecology

New York College of Osteopathic Medicine, Old Westbury, NY

Lutheran Medical Center, Brooklyn, NY

Medical School:

Residency:

Taylor, Bryan, MD Open

Board Certified: Not Board Certified

St. Matthews Univ, Orlando, FL

Central Michigan Univ, Saginaw, MI

Medical School:

Residency:

Pediatrics Practice Status:

Perryman, John, MD Open

Board Certified: American Board of Pediatrics

Univ of Michigan Medical School, Ann Arbor, MI

Children's Memorial Hospital, Chicago, IL

Medical School:

Residency:

Taylor, Jane, MD Open

Board Certified: American Board of Pediatrics

Univ of IL College of Medicine, Chicago, IL

Southern IL Univ School of Medicine, Springfield, IL

Medical School:

Residency:

Urgent Care Center Practice Status:

Mercyhealth Roscoe Urgent Care, , Open

Board Certified:

,

,

Medical School:

Residency:

Premier Oral & Maxillofacial Surgery

5606 E Rockton Road

(815) 525-4700

Roscoe, IL 61073

Oral & Maxillofacial Surgery Practice Status:

Meister, Richard, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

Marquette Univ School of Dentistry, Milwaukee, WI

Hosp of St Raphael, New Haven, CT

Medical School:

Residency:

Swantek, Jason, DDS Open

Board Certified: American Board of Oral & Maxillofacial Surgery

UIC College of Dentistry, Chicago, IL

Woodhull Medical Center, Brooklyn, NY

Medical School:

Residency:

Schaumburg, IL

PRA - Schaumburg Office

1701 E Woodfield Rd, Ste 1000

(847) 240-2211

Schaumburg, IL 60173

Licensed Clinical Professional

CounselorPractice Status:

Westerberg, Shane, LCPC Open

Board Certified: Not Applicable

Argosy Univ, Schaumburg, Il

,

Medical School:

Residency:

Winnebago, IL

Mercyhealth Winnebago

102 Landmark Dr

(815) 971-3200

Winnebago, IL 61088

Advanced Practice Nurse Practice Status:

Dinges, Jennifer, APN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

,

,

Medical School:

Residency:

Thompson, Beth Ann, APN Open

Board Certified: American Nurses Credentialing Center (Family Nurse Practitioner)

Northern Illinois Univ, Dekalb, IL

,

Medical School:

Residency:

Family Medicine Practice Status:

Rudolph, Hahn, DO Open

Board Certified: American Board of Family Medicine

Univ of Osteopathic Medicine and Health Sciences, Des Moines, IA

St. Elizabeth Bassett Hospital, Utica, NY

Medical School:

Residency:

Strutzenberg, Jon, DO Open

Board Certified: American Osteopathic Association (Family Medicine and OMT)

Univ of Oseopathic Med and Health Sciences, Des Moines, IA

Davenport Medical Center, Davenport, IA

Medical School:

Residency:

Urgent Care Center Practice Status:

Mercyhealth Winnebago UC, , Open

Board Certified:

,

,

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 64 of 65W9

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State of Wisconsin - 2020Woodstock, IL

Mercy Woodstock Orthopedics

715 West Judd

(815) 338-7950

Woodstock, IL 60098

Physician Assistant Practice Status:

Larson, Don, PA-C Open

Board Certified: National Commission on Certification of Physician Assistants

Rosalind Franklin Univ of Medicine & Science, North Chicago, IL

,

Medical School:

Residency:

Mercyhealth Woodstock

2000 Lake Ave

(815) 337-7100

Woodstock, IL 60098

Advanced Practice Nurse Practice Status:

Winkelman, Kelly, ANP Open

Board Certified: American Nurses Credentialing Center (Adult Nurse Practitioner)

Northern Illinois Univ, DeKalb, IL

,

Medical School:

Residency:

Cardiovascular Disease Practice Status:

Khemani, Anil, MD Open

Board Certified: American Board of Internal Medicine (Cardiovascular Disease)

Patna Med College, Patna, India

All India Inst of Med Sciences, New Delhi, India

Medical School:

Residency:

Dermatology Practice Status:

Altman, Jeffrey, MD Open

Board Certified: American Board of Dermatology

Rush Medical College, Chicago, IL

Rush Univ Medical Center, Chicago, IL

Medical School:

Residency:

Family Medicine Practice Status:

Saikh, Shahariar, MD Open

Board Certified: American Board of Family Medicine

International Univ of the Health Sciences, Basseterre, St. Kitts & Nevis

Mid Michigan Medical Center, Midland Family Med Residency Program, Midland, MI

Medical School:

Residency:

Than, Baby, MD Open

Board Certified: American Board of Family Medicine

Univeristy of Medicine, Yangon

New Hampshire Hosp, Concord, NH

Medical School:

Residency:

Gastroenterology Practice Status:

Hussain, Yasmin, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Univ of Punjab Fatima Jinnah Medical College, Lahore, Pakistan

Loyola Univ Medical Center/Hines VA Hospital, Maywood, IL

Medical School:

Residency:

Qazi, Baseer, MD Open

Board Certified: American Board of Internal Medicine (Gastroenterology)

Declan College of Medical Sciences, Hyderabad, India

Advocate Lutheran General Hospital, Park Ridge, IL

Medical School:

Residency:

Gynecology Practice Status:

Osipova, Anastasia, MD Open

Board Certified: American Board of Obstetrics and Gynecology

Russian State Medical Univ, Moscow, Russia

Russian State Medical Academy of Postgraduate Education, Moscow, Russia

Medical School:

Residency:

Immediate Care Center Practice Status:

Mercyhealth Woodstock - Immediate Care, , Open

Board Certified: Not Applicable

Not Applicable,

Not Applicable,

Medical School:

Residency:

Neurology Practice Status:

Dave, Amarish, DO Open

Board Certified: American Board of Psychiatry and Neurology

Chicago College of Osteopathic Medicine, Downers Grove, IL

University of Illinois at Chicago, Chicago, IL

Medical School:

Residency:

Obstetrics and Gynecology Practice Status:

Cook, Richard, MD Open

Board Certified: American Board of Obstetrics and Gynecology AND American Board of

Family MedicineUniv of Iowa, Iowa City, IA

Univ of Iowa Hosp and Clinics, Iowa City, IA

Medical School:

Residency:

Ophthalmology Practice Status:

Kershaw, Jeffrey, MD Open

Board Certified: Not Board Certified

Northwestern Univ Medical School, Chicago, IL

Indiana Univ Medical Center, Indianapolis, IN

Medical School:

Residency:

Orthopedic Surgery Practice Status:

Tarandy, Dana, MD Open

Board Certified:

Rush Medical College, Chicago, IL

Univ of Ilinois at Chicago Medical Center, Chicago, IL

Medical School:

Residency:

Podiatry Practice Status:

Lisowsky, Mykola, DPM Open

Board Certified: American Board of Podiatric Medicine

Ohio College of Podiatric Medicine, Cleveland, OH

Loyola University Medical Center, Maywood, IL

Medical School:

Residency:

Pulmonary Disease Practice Status:

Mehta, Daksha, MD Open

Board Certified: American Board of Internal Medicine (Pulmonary Disease) (Critical Care

Medicine)NHL Municipal Medical College, Guyarat, India

St. Francis Hospital, Evanston, IL

Medical School:

Residency:

Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

Urology Practice Status:

DeBartolo, Merrit, MD Open

Board Certified: American Board of Urology

Chicago Medical School-Rosalind Franklin, North Chicago, IL

State University of New York, Stony Brook, NY

Medical School:

Residency:

Vascular Surgery Practice Status:

Bryan, Douglas, MD Open

Board Certified: American Board of Surgery (Vascular Surgery)

State Univ of New York HSC & Brooklyn, Brooklyn, NY

Harlem Hospital Medical Center, New York, NY

Medical School:

Residency:

8/13/2019 Practice Status: Open = Accepting New Patients; Closed = Not Accepting New Patients Page 65 of 65W9

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