First Medicare Direct 2018 Medicare Advantage Provider Directory

336 Pages·2017·3.11 MB·English

2018 Medicare Advantage
Provider Directory
FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a
Medicare contract. Enrollment in FirstMedicare Direct plans depend on contract renewal.
This document is available in other formats such as large print.
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2018 Medicare Advantage Provider Directory
This directory is current as of August 1, 2018.
This directory provides a list of FirstMedicare Direct’s current network providers.
This directory is for members residing in the following North Carolina counties:
Chatham, Hoke, Lee, Montgomery, Moore, Richmond, and Scotland
Buncombe, Henderson, Madison, McDowell, Transylvania, Yancey
Wake
The provider network may change at any time. You will receive notice when necessary.
To access FirstMedicare Direct’s online provider directory, you can visit www.FirstMedicare.com. For
any questions about the information contained in this directory (hardcopy or online), please call our
Member Service Department at 844-201-4957. We are available for phone calls October 1- February
14, 7 days a week, 8:00a.m. – 8:00p.m. Eastern and February 15-September 30, Monday – Friday
8:00a.m. – 8:00p.m. Eastern. Calls to these numbers are free. TTY users should call 711.
This document is available in other formats such as large print.
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Table of Contents
Table of Contents
Section 1 – Introduction ............................................................................................................. 3
What is the service area for FirstMedicare Direct? ................................................................ 4
How do you find FirstMedicare Direct providers in your area? ............................................ 4
Section 2 – List of Network Providers ....................................................................................... 5
Part I ...................................................................................................................................... 9
This section includes network providers convenient to members enrolled in FirstMedicare
Direct HMO Plus, FirstMedicare Direct HMO Standard and FirstMedicare Direct PPO Plus
residing in the following counties: Chatham, Hoke, Lee, Montgomery, Moore, Richmond
and Scotland.
Part II ..................................................................................................................................137
This section includes network providers convenient to members enrolled in FirstMedicare
Direct Healthy State HMO Plus and FirstMedicare Direct Healthy State Prime residing in
the following counties: Buncombe, Henderson, Madison, McDowell, Transylvania and
Yancey.
Part III .................................................................................................................................165
This section includes network providers convenient to members enrolled in FirstMedicare
Direct smartHMO and FirstMedicare Direct preferredPLUS (HMO) residing in the
following county: Wake.
ALPHABETICAL INDEX…………………………………….........………………………270
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Section 1 – Introduction
This directory provides a list of FirstMedicare Direct’s network providers. To get detailed information
about your health care coverage, please see your Evidence of Coverage.
You will have to choose one of our network providers listed in this directory to be your Primary Care
Provider (PCP). Generally, you must get your health care coverage from your PCP. Your PCP can
help you arrange or coordinate your covered services. This includes x-rays, laboratory tests, therapies,
specialists, hospital admissions, and follow-up care. Your PCP also contacts other plan providers for
updates about your care and/or treatment. In some cases, your PCP or provider will need to get prior
authorization (prior approval). Since your PCP will provide and coordinate your health care, you
should have all of your past medical records sent to your new PCP’s office.
The law requires us to protect your privacy of medical records and personal health information. For
more information about privacy, see your Evidence of Coverage.
The network providers listed in this directory have agreed to provide you with your health care, vision
and/or dental services. You may go to any of our network providers listed in this directory; however,
some services may require prior-authorization. If you have been going to one network provider, you
are not required to continue going to that same provider. In some cases, you may get covered services
from non-network providers.
If you are a member of one of the following plans - FirstMedicare Direct HMO Plus,
FirstMedicare Direct HMO Standard plan, FirstMedicare Direct Healthy State HMO Plus,
FirstMedicare Direct Healthy State HMO Prime, FirstMedicare Direct smartHMO or
FirstMedicare Direct preferredPLUS (HMO) you must use network providers except in emergency
or urgent care situations. If you obtain routine care from out-of-network providers neither Medicare
nor FirstMedicare Direct will be responsible for the costs.
If you are a member of the FirstMedicare Direct PPO Plus plan, you do not need prior authorization
to use non-network (out-of- network) providers. Out-of-network providers are under no obligation to
treat FirstMedicare Direct enrollees. With the exception of emergencies or urgent care, it may cost you
more to get care from out-of-network providers. For a decision about whether we will cover an out-of-
network service, we encourage you or your provider to ask us for a pre-service organization
determination before you receive the service. Please call our Member Services Department at 844-201-
4957. We are available for phone calls October 1- February 14, 7 days a week, 8:00a.m. – 8:00p.m.
Eastern and February 15 - September 30, Monday – Friday 8:00a.m. – 8:00p.m. Eastern. Calls to these
numbers are free. TTY users should call 711.
If an out of network provider sends you a bill, you should not pay the bill; you should submit the bill
to the plan for processing and determination of enrollee liability, if any.
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If you have a medical emergency, get help as quickly as possible. Call 911 for help or go to the
nearest emergency room, hospital, or urgent care center. Call for an ambulance if you need it. You do
not need to get approval or a referral first from your PCP. As soon as possible, make sure that our
plan has been told about your emergency. You or someone else should call to tell us about your
emergency care, usually within 48 hours. The number to call is located on the back of your
membership identification card.
What is the service area for FirstMedicare Direct HMO Plus, PPO Plus and HMO Standard?
Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland counties
What is the service area for FirstMedicare Direct Healthy State HMO Plus and HMO Prime?
Buncombe, Henderson, Madison, McDowell, Transylvania and Yancey counties
What is the service area for FirstMedicare Direct smartHMO and FirstMedicare Direct
preferredPLUS (HMO)?
Wake County
How do you find FirstMedicare Direct’s providers in your area?
This directory is divided into three sections as described below:
PART I is for members enrolled in FirstMedicare Direct HMO Plus, FirstMedicare Direct HMO
Standard and FirstMedicare Direct PPO Plus residing in the following counties:
a. Chatham,
b. Hoke,
c. Lee,
d. Montgomery
e. Moore
f. Richmond, and
g. Scotland.
PART II is for members enrolled in FirstMedicare Direct Healthy State HMO Plus and
FirstMedicare Direct Healthy State HMO Prime residing in the following counties:
a. Buncombe
b. Henderson
c. Madison
d. McDowell
e. Transylvania, and
f. Yancey.
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PART III is for members enrolled in FirstMedicare Direct smartHMO and FirstMedicare Direct
preferredPLUS (HMO) residing in the following county:
Wake.
To find the section of the directory that contains network providers convenient to you, you
can use the plan name information printed on the right edge of the pages to find the section
of providers in your area. Check the plan name on your ID card if you do not know your
FirstMedicare Direct plan name.
Once you find your section, providers are listed by County and then by Specialty as described below
in Section 2. You may also find provider information on the Web at www.FirstMedicare.com.
If you have questions about FirstMedicare Direct or require assistance in selecting a PCP, please call
our Member Service Department at 844-201-4957. We are available for phone calls October 1-
February 14, 7 days a week, 8:00 a.m. -8:00 p.m. Eastern and February 15- September 30, Monday,
Tuesday, Wednesday, Thursday and Friday 8:00 a.m.- 8:00 p.m. Eastern. Calls to these numbers are
free. TTY users should call 711. Or, visit www.FirstMedicare.com.
Section 2 – List of Network Providers
Once you are in the section of the directory corresponding to your plan name, you can find a
provider within your service area by searching by Specialty, County, Practice name, or Provider
name. If you know the name of a provider, you also can search in the index by name to find the
page number. Our provider directory is organized as follows:
Primary Care Providers
County (Listed
alphabetically)
Practice Name
Street Address
City, State and Zip
Code Phone Number
Individual providers affiliated with the practice (Listed alphabetically)
OB/GYN Providers
County (Listed
alphabetically)
Practice Name
Street Address
City, State and Zip
Code Phone Number
Individual providers affiliated with the practice (Listed alphabetically)
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Behavioral Health Providers County (Listed alphabetically)
Provider or Practice Name
Street Address
City, State and Zip
Code Phone Number
Individual providers affiliated with the practice (Listed alphabetically)
Specialist Providers
County (Listed
alphabetically)
Practice Name
Street Address
City, State and Zip
Code Phone Number
Individual providers affiliated with the practice (Listed alphabetically)
Hospitals
County (Listed
alphabetically)
Hospital Name
Street Address
City, State and Zip
Code Phone Number
Medical Equipment and Supplies
County (Listed alphabetically)
Provider Name
Street Address
City, State and Zip Code
Phone Number
Home Health
County (Listed alphabetically)
Agency Name
Street Address
City, State and Zip Code
Phone Number
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Other Outpatient Services
County (Listed
alphabetically) Provider Name
Street Address
City, State and Zip Code
Phone Number
Laboratory Providers
County (Listed
alphabetically) Provider Name
Street Address
City, State and Zip Code
Phone Number
Skilled Nursing Facilities
County (Listed
alphabetically) Provider Name
Street Address
City, State and Zip Code
Phone Number
Home Infusion
County (Listed
alphabetically) Provider Name
Street Address
City, State and Zip Code
Phone Number
Please note that providers who are not accepting new primary care patients or who have
limitations to their scope of practice are indicated with information in italics directly under
their name.
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Number of Providers in this Directory by Type:
Part I
Primary Care Providers – 713
OB/GYN Providers – 142
Specialist Providers – 1751
Hospitals - 12
Skilled Nursing Facilities - 19
Outpatient Mental Health Providers - 323
Other Providers – 106
Part II
Primary Care Providers – 373
OB/GYN Providers – 60
Specialist Providers – 461
Hospitals - 14
Skilled Nursing Facilities - 15
Outpatient Mental Health Providers - 30
Other Providers – 2
Part III
Primary Care Providers – 242
OB/GYN Providers – 373
Specialist Providers – 3953
Hospitals - 21
Skilled Nursing Facilities - 12
Outpatient Mental Health Providers - 417
Other Providers – 1064
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Medicare Advantage Provider Directory

PART I

PART I is for members enrolled in FirstMedicare Direct HMO Plus, HMO Standard and PPO Plus
residing in the following counties:
a. Chatham,
b. Hoke,
c. Lee,
d. Montgomery,
e. Moore,
f. Richmond, and
g. Scotland.

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