Table Of Content

Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Hacienda La Puente Unified School District Self- 15959 E. Gale Avenue Insured 3109 City Of Industry, CA 91716 HLPUSD MPN Employer 09/07/2018 www.talispoint.com/intermed/haciendampn.com Baldwin Park Unified School District Self- 3699 Holly Avenue Insured 3110 Baldwin Park, CA 91706 Baldwin Park USD MPN Employer 08/29/2018 www.talispoint.com/intermed/baldwinparkusdmpn Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 Medex Advantage-Casa Pacifica Dba network 3116 Newport Beach, CA 92660 Freedom Village MPN services 08/28/2018 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3115 Newport Beach, CA 92660 Medex Advantage-Filtration Group MPN services 08/28/2018 www.medexhco.com San Jose Unified School District Self- 855 Lenzen Avenue, Suite 205 Insured 3092 San Jose, CA 95126 San Jose USD MPN Employer 08/23/2018 www.talispoint.com/intermed/sanjoseusdmpn Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 Medex Advantage-Food Products Of CA network 3114 Newport Beach, CA 92660 MPN services 08/20/2018 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3113 Newport Beach, CA 92660 Medex Advantage-Parking Concepts MPN services 08/17/2018 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 Medex Advantage- Freedom Properties- network 3112 Newport Beach, CA 92660 Hemet MPN services 08/17/2018 www.medexhco.com San Francisco Unified School District Self- 135 Van Ness Avenue - Room 312 Insured 3111 San Francisco, CA 94102 SFUSD MPN Employer 08/17/2018 https://www.netbyd.com/SFUSDMPN/ Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 1 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Rd, North Tower, #3000 network 3108 Newport Beach, CA 92660 TRISTAR Premier MPN services 08/17/2018 https://search.harborsys.com/TristarPremierMPN Entity that Coventry Health Care Workers Compensation, provides INC. physician 750 Riverpoint Drive network 3117 West Sacramento, CA 95605 FirstGroup MPN services 08/16/2018 http://www.talispoint.com/cvty/fga Entity that provides CSAC Excess Insurance Authority physician 75 Iron Point Circle, Ste. 200 network 3106 Folsom, CA 95630 EIA Medical Provider Network services 07/25/2018 www.eiampn.csac-eia.org NETFLIX, INC. Self- 100 Winchester Circle Insured 3107 Los Gatos, CA 95032 First Health Comp America HCO Select Employer 07/18/2018 www.talispoint.com/cvty/mandb Farmington Casualty Company One Tower Square, Main South 12 3105 Hartford, CT 06183 CorVel MPN Insurer 07/05/2018 www.corvel.com Entity that provides Pitman Family Farms physician 1075 North Ave network 3102 Sanger, CA 93657 Pitman Family Farms MPN services 06/21/2018 www.netbyd.com/pitmanfamilyfarmsmpn/ Advantage Workers Compensation Insurance Company PO Box 57198 3104 Salt Lake City, UT 84157 WCF Insurance / Advantage MPN Insurer 06/20/2018 www.wcfmpn.com Property And Casualty Insurance Company Of Hartford One Hartford Plaza HO-1-09 3103 Hartford, CT 06155 CorVel/PCIH/BB&T MPN Insurer 06/14/2018 www.corvel.com Entity that provides MEDEX Healthcare physician 1201 Dove Street, Ste 300 network 3101 Newport Beach, CA 92660 MEDEX Advantage-CR&R MPN services 05/01/2018 www.medexhco.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 2 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides MEDEX Healthcare physician 1201 Dove Street, Ste 300 network 3100 Newport Beach, CA 92660 MEDEX Advantage Plus-DART MPN services 05/01/2018 www.medexhco.com Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road North Tower Suite 3000 network 3098 Newport Beach, CA 92660 ICW Group Premier MPN services 04/26/2018 http://www.harborsys.com/ICWGroup Entity that provides Berkley Insurance Company physician 10851 Mastin Blvd., Suite 200 network 3076 Overland Park, KS 66210 Berkley Care Network Select services 04/18/2018 http://www.talispoint.com/cvty/bmms City Of Los Angeles Self- 700 E Temple Street, RM 210 Los Angeles Police Protective League ADR Insured 3096 Los Angeles , CA 90012 Medical Provider Network Employer 04/13/2018 www.cityoflampn.com City Of Los Angeles Self- 700 E Temple Street, RM 210 City Of Los Angeles Medical Provider Insured 3097 Los Angeles, CA 90012 Network Employer 04/10/2018 www.cityoflampn.com City Of Los Angeles Self- 700 E Temple Street, RM 210 City Of Los Angeles ADR Medical Provider Insured 3095 Los Angeles, CA 90012 Network Employer 04/10/2018 www.cityoflampn.com Entity that provides Matrix Absence Management, Inc. physician 2421 W. Peoria Avenue, Suite 200 network 3099 Phoenix, AZ 85029 Matrix KOJ MPN services 03/29/2018 http://www.talispoint.com/cvty/matkoj Children's Hospital Of Orange County Self- 1201 W. La Veta Ave Insured 3094 Orange, CA 92868 Children's Hospital Of Orange County MPN Employer 03/26/2018 http://choc.employermpn.com Entity that provides Networks By Design, Inc. physician 231 W Tenth Street network 3093 Tracy, CA 95376 Healthcare Services Group MPN services 03/26/2018 http://HCSG.employermpn.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 3 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road, North Tower, Suite 3000 network 3091 Newport Beach, CA 92660 Sedgwick/Harbor MPN - Kroger services 03/15/2018 http://www.SedgwickProviders.com/Kroger Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road, North Tower, Suite 3000 network 3090 Newport Beach, CA 92660 Sedgwick/Harbor MPN - Verizon services 03/15/2018 http://www.sedgwickproviders.com/verizon Entity that provides North American Risk Services, Inc. physician 240 East Central Parkway, Suite 4010 network 3082 Altamonte Springs, FL 32701 NARS Select MPN services 03/13/2018 www.talispoint.com/cvty/nrs Entity that provides Allianz Global Risks US Insurance Company physician 225 W Washington Street, Suite 1800 network 3089 Chicago, IL 60606 Allianz Global Risk US Select services 03/07/2018 http://www.talispoint.com/cvty/agcs Entity that provides Pacific Secured Equities, Inc. physician PO Box 358 network 3056 Roseville, CA 95661 InterMed Select MPN services 03/01/2018 www.talispoint.com/intermed/InterMedSelectMPN Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3087 Newport Beach, CA 92660 Medex Advantage Plus-Hilton MPN services 02/28/2018 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3086 Newport Beach, CA 92660 Medex Advantage Plus-Best Buy MPN services 02/28/2018 www.medexhco.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 4 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3085 Newport Beach, CA 92660 Medex Advantage-City Of Long Beach MPN services 02/27/2018 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3088 Newport Beach, CA 92660 Medex Advantage-Walmart MPN services 02/26/2018 www.medexhco.com Entity that provides Genex Services, LLC physician 440 E Swedesford Road network 3084 Wayne, PA 19087 Genex services 02/05/2018 http://www.genexservices.com Entity that provides Hartford Fire Insurance Company physician One Hartford Plaza HO-1-09 network 3083 Hartford, CT 06155 Hartford Choice MPN services 02/02/2018 www.hartfordchoicempn.com Entity that provides Alternative Service Concepts, L.L.C. physician 5620 Birdcage Tree Road network 3073 Citrus Heights, CA 95610 Alternative Service Concepts Select MPN services 01/26/2018 www.talispoint.com/cvty/asc The Travelers Indemnity Company Of Connecticut One Tower Square Main South, 12 3081 Hartford, CT 06183 CorVel MPN Insurer 01/09/2018 www.corvel.com Kern County Hospital Authority Self- 1700 Mt. Vernon Ave. Foundation For Medical Care Of Kern Insured 3068 Bakersfied, CA 93306 County MPN Employer 01/08/2018 http://www.kernmedicalmpn.kernfmc.com Entity that provides Matrix Absence Management, Inc. physician 2421 W. Peoria Ave., Ste 200 network 3049 Phoenix, AZ 85029 Matrix MPN services 01/04/2018 http://www.talispoint.com/cvty/matmpn Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 5 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road, North Tower, Suite 3000 network 3079 Newport Beach, CA 92660 Sedgwick/Harbor MPN - American Airlines services 12/29/2017 www.IODMedical.com Entity that provides Paladin Managed Care Services, Inc. physician 770 The City Drive, Suite 3000 Allianz Resolution Management Coventry network 3078 Orange, CA 92868 Select MPN services 12/21/2017 http://www.paladinmc.com/providers.html Sompo America Insurance Company 11405 N Community House Rd Suite 600 Sompo/Global Risk Solutions GBMCS KOJ 3077 Charlotte, NC 28277 MPN Insurer 12/19/2017 www.talispoint.com/cvty/gbkoj Entity that provides Gallagher Bassett Services, Inc. physician 2850 Golf Road network 3075 Rolling Meadows, IL 60008 GB Care MPN services 12/19/2017 www.talispoint.com/cvty/gbmpn The Pep Boys Manny Moe & Jack Of California Self- 3111 West Allegheny Avenue Insured 3080 Philadelphia, PA 19132 CorVel MPN Employer 12/14/2017 www.corvel.com Entity that provides Genex Services, LLC physician 440 E. Swedesford Road network 3074 Wayne, PA 19087 Genex services 12/13/2017 http://www.genexservices.com Entity that provides AIG Claims, Inc. physician 175 Water Street network 3072 New York, NY 10039 AIG JCP MPN services 12/11/2017 www.talispoint.com/aig/jcp Entity that provides Omaha National Underwriters, LLC physician 11128 John Galt Blvd Ste. 500 network 3064 Omaha, NE 68137 Omaha National MPN services 12/04/2017 http://mpn.omahanational.com Swift Transportation Services, LLC Self- 2200 S 75th Avenue Insured 3071 Phoenix, AZ 85043 CorVel MPN Employer 12/02/2017 www.corvel.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 6 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Swift Transportation Co. Of Arizona, LLC Self- 2200 S 75th Avenue Insured 3070 Phoenix, AZ 85043 CorVel MPN Employer 12/01/2017 www.corvel.com Prospect Medical Holdings, Inc. Self- 3415 S. Sepulveda Blvd., 9th Floor Insured 3069 Los Angeles, CA 90034 CorVel MPN Employer 12/01/2017 www.corvel.com Safety National Casualty Corporation 15509 Collections Center Drive 3053 Chicago, IL 60693 Glidewell Dental MPN Insurer 11/22/2017 www.talispoint.com/intermed/glidewelldentalmpn Entity that provides Paladin Managed Care Services, Inc. physician 770 The City Drive, Suite 3000 Paladin Primary Medical Provider Network network 3066 Orange, CA 92868 (CA) services 11/08/2017 http://www.paladinmc.com/providers.html Nationwide Mutual Insurance Company N2128-Nationwide/Three Nationwide Plaza 3058 Columbus, OH 43214 CorVel MPN Insurer 11/07/2017 www.corvel.com Nationwide Mutual Fire Insurance Company N2128-Nationwide/Three Nationwide Plaza 3057 Columbus , OH 43214 CorVel MPN Insurer 11/06/2017 www.corvel.com AMCO Insurance Company N2128-Nationwide/Three Nationwide Plaza 3062 Columbus, OH 43214 CorVel MPN Insurer 10/31/2017 www.corvel.com Nationwide Property And Casualty Insurance Company N2128-Nationwide/Three Nationwide Plaza 3061 Columbus, OH 43214 CorVel MPN Insurer 10/31/2017 www.corvel.com W XL Insurance America, Inc. 70 Seaview Avenue 3055 Stamford, CT 06902 Agricultura MPN Insurer 10/30/2017 http://www.talispoint.com/intermed/agriculturampn Entity that provides AIG Claims, Inc. physician 175 Water Street network 3054 New York, NY 10039 AIG EP MPN services 10/27/2017 www.talispoint.com/aig/EP Nationwide Insurance Company Of America N2128-Nationwide/Three Nationwide Plaza 3060 Columbus , OH 43214 CorVel MPN Insurer 10/20/2017 www.corvel.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 7 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Allied Property And Casualty Insurance Company N2128-Nationwide/Three Nationwide Plaza 3059 Columbus, OH 43214 CorVel MPN Insurer 10/20/2017 www.corvel.com Entity that Coventry Health Care Workers Compensation, provides INC physician 750 Riverpoint Drive network 3065 West Sacramento, CA 95605 CVTY Aramark Custom MPN services 10/10/2017 http://www.talispoint.com/cvty/arampn National Union Fire Insurance Company Of Pittsburgh, PA 175 Water Street, 18th Floor 3052 New York, NY 10038 CareFirst MPN Insurer 10/02/2017 http://www.talispoint.com/cvty/care1 Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3051 Newport Beach, CA 92660 Medex Advantage Plus - CFINS MPN services 09/25/2017 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3050 Newport Beach, CA 92660 Medex Advantage - Grimmway MPN services 09/25/2017 www.medexhco.com Entity that provides MWIA Insurance Services, LLC physician 3333 Camino Del Rio South, Suite 235 network 3030 San Diego, CA 92108 Midwestern Insurance Alliance Select MPN services 09/19/2017 www.talispoint.com/cvty/mia Community Hospitals Of Central California Self- 7370 N. Palm CorVel/Community Hospitals Of Central CA Insured 3048 Fresno, CA 93711 MPN Employer 09/18/2017 www.corvel.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3027 Newport Beach, CA 92660 Medex Advantage-SHARP MPN services 09/14/2017 www.medexhco.com The Eggo Company Self- One Kellogg Square Insured 3046 Battle Creek, MI 49017 CorVel MPN Employer 08/25/2017 www.corvel.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 8 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Save Mart Supermarkets Self- 1800 Standiford Avenue Insured 3047 Modesto , CA 95350 CorVel MPN Employer 08/18/2017 www.corvel.com City Of San Jose Self- 200 E. Santa Clara Street Insured 3038 San Jose, CA 95113 City Of San Jose MPN Employer 08/18/2017 www.talispoint.com/intermed/sanjosempn Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3045 Newport Beach, CA 92660 Medex Advantage-Goodwill MPN services 08/04/2017 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3043 Newport Beach, CA 92660 Medex Advantage-Servicon MPN services 08/04/2017 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove St., Ste. 300 network 3042 Newport Beach, CA 92660 Medex Advantage Plus-Republic MPN services 08/04/2017 www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3041 Newport Beach, CA 92660 Medex Advantage-DMS MPN services 08/04/2017 http://www.medexhco.com Entity that provides Medex Healthcare physician 1201 Dove Street, Ste 300 network 3040 Newport Beach, CA 92660 Medex Advantage-ACIG MPN services 08/04/2017 http://www.medexhco.com Hartford Fire Insurance Company One Hartford Plaza HO-1-09 3044 Hartford, CT 06155 The Hartford Select Network Insurer 07/20/2017 http://thehartfordselectnetworkmpn.com/ Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road North Tower, Suite 3000 network 3029 Newport Beach, CA 92660 Sedgwick/Harbor MPN - LZB services 07/10/2017 www.SedgwickProviders.com/LZB T Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 9 Medical Provider Networks Approved by DWC (Sorted by Date of Approval) NOTE: The status of the MPNs on this list were produced and processed from information known to DWC as of 10/01/2018. However, changes may have been made since that date. Please contact the DWC Medical Unit to verify the information provided for a specific MPN. MPN MPN Type of Date of Name of Applicant with Mailing Address Name of MPN Internet Website Address of MPN Approval ID # Applicant Approval Status * Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road, North Tower, Suite 3000 network 3028 Newport Beach, CA 92660 Sedgwick/Harbor MPN - Irvine Company services 07/06/2017 www.SedgwickProviders.com/IrvineCompany Valley Harvesting & Packing, Inc. Self- 101 East Main Street Insured 3016 Heber, CA 92249 First Health Comp America HCO Select Employer 07/03/2017 https://www.talispoint.com/cvty/mandb Travelers Property Casualty Company Of America One Tower Square Main South, 12 3039 Hartford, CT 06183 CorVel/Express MPN Insurer 06/29/2017 www.corvel.com Entity that provides OCM Coastal Acquisition Co., LLC physician 3501 Jamboree Road North Tower, Suite 3000 network 3026 Newport Beach, CA 92660 Kaiser/Harbor MPN services 06/27/2017 www.sedgwickproviders.com/Kaiser Entity that provides Rising Medical Solutions, LLC physician 325 N. LaSalle St., Suite 600 network 3025 Chicago, IL 60654 Rising FHSelect MPN services 06/15/2017 https://www.risingms.com/risingmpn/ Entity that provides Rising Medical Solutions, LLC physician 325 N. LaSalle St., Suite 600 network 3024 Chicago, IL 60654 Rising FHSelectKOJ MPN services 06/15/2017 https://www.risingms.com/risingmpn/ Entity that provides Rising Medical Solutions, LLC physician 325 N. LaSalle St., Suite 600 network 3023 Chicago, IL 60654 Rising Select MPN services 05/24/2017 https://www.risingms.com/risingmpn/ Entity that provides Genex Services, LLC physician 440 E. Swedesford Road network 3021 Wayne, PA 19087 Genex/United Airlines services 05/01/2017 genexservices.com Approved MPN Applications: 2426 *MPN Approval Status Legend BLANK = MPN status has not changed after approval;  = MPN coverage period should be verified with the DWC Medical Unit; P = MPN is on Probation; R = MPN was revoked after approval; S = MPN is currently Suspended; T = MPN was terminated after approval; W = MPN was withdrawn after approval 10

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0072 Hartford Insurance Company of the Midwest First Health CompAmerica Select HCO Network New York NY 10038 T 0902 Catholic Mutual TRISTAR/First Health
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194 Pages·2016·0.92 MB·English
by  Jeanne Lum
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0072 Hartford Insurance Company of the Midwest First Health CompAmerica Select HCO Network New York NY 10038 T 0902 Catholic Mutual TRISTAR/First Health

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