County of Orange HMO B Provider Listing - Primary Care Num PCP TIN PCP Name PCP Specialty PCP Zip Yes No 1 020590591 HSU GOETHE I INTERNAL MEDICINE 90242 2 200376966 SUNSHINE SAMUEL E FAMILY PRACTICE 92656 3 200800446 STEARNS LAUREN M FAMILY PRACTICE 92821 4 208123449 LE NGUYET B FAMILY PRACTICE 92801 5 300395653 CHAU MARY C FAMILY PRACTICE 92586 6 330059651 JIGJINNI MADHUKAR B INTERNAL MEDICINE 92705 7 330108261 FORD LISA M FAMILY PRACTICE 92658 8 330108261 GREATER NEWPORT PHYSICIANS GENERAL PRACTICE 92658 9 330123502 JONES ELAINE K INTERNAL MEDICINE 90501 10 330123502 SWIFT ROBERT D FAMILY PRACTICE 90501 11 330185031 ING ARLENE FAMILY PRACTICE 92869 12 330185031 TSAI JERRY F INTERNAL MEDICINE 92869 13 330185031 LUECHA ANGSUMARN FAMILY PRACTICE 91765 14 330204654 PINZON FIDEL F FAMILY PRACTICE 91710 15 330587175 NGO VINH T INTERNAL MEDICINE 90822 16 330587175 HOPP SUSAN A INTERNAL MEDICINE 90822 17 330587175 RICK JAMES H INTERNAL MEDICINE 90822 18 330587175 DRAINE QUIDA D INTERNAL MEDICINE 90822 19 330633002 TRAN NGO M GENERAL PRACTICE 92703 20 330633863 COHEN GERALD A INTERNAL MEDICINE 90813 21 330668929 AMIN MUKESH S INTERNAL MEDICINE 91786 22 330852851 GONZALEZ DAVID R FAMILY PRACTICE 92691 23 330867592 BANG MICHAEL C FAMILY PRACTICE 92606 24 330917559 DAO MICHAEL M INTERNAL MEDICINE 92844 25 330918168 BURNETT LEE A FAMILY PRACTICE 92691 26 330983650 LEONG JASMINE K INTERNAL MEDICINE 92879 27 341995975 NEWSOME ANN E FAMILY PRACTICE 92843 28 440584290 OLSON ROBERT P GENERAL PRACTICE 65616 29 568622647 PETERSON STEPHEN D GENERAL PRACTICE 95926 30 931172065 CHEU PHILIP INTERNAL MEDICINE 92708 31 931172065 BABEL KAREN L FAMILY PRACTICE 92799 Page 1 of 2
County of Orange HMO B Provider Listing - Primary Care Num PCP TIN PCP Name PCP Specialty PCP Zip Yes No 32 931172065 JACOMO JOHN R FAMILY PRACTICE 92799 33 931172065 BATHALA RAMA D FAMILY PRACTICE 92708 34 931172065 PATEL DEEPAK N FAMILY PRACTICE 92799 35 931172065 VARALLO MARK F FAMILY PRACTICE 92799 36 931172065 KEISNER SUSAN A FAMILY PRACTICE 90815 37 931172065 KOMANAPALLI LALITA M INTERNAL MEDICINE 92799 38 952653450 PRINCE KELLEY A FAMILY PRACTICE 92604 39 952696531 RUBINO FRANK G GENERAL PRACTICE 92843 40 952744523 FESKE WILLIAM I GENERAL PRACTICE 90680 41 952794408 HAUPTMAN MARK D INTERNAL MEDICINE 92691 42 952843439 SHAPIRO LEONARD INTERNAL MEDICINE 92801 43 952870308 TAM TACKSON INTERNAL MEDICINE 92801 44 953625072 FARAG BASEM R INTERNAL MEDICINE 92357 45 953625072 NASH DANIEL A FAMILY PRACTICE 92357 46 953625072 LOMARDA EVELYN GENERAL PRACTICE 92357 47 953625072 LOMARDA EVELYN GENERAL PRACTICE 92357 48 953625072 COLBURN KEITH K INTERNAL MEDICINE 92357 49 953625072 COLBURN KEITH K INTERNAL MEDICINE 92357 Page 2 of 2
County of Orange HMO B Provider Listing - Hospital Facilities Num Facility TIN Facility Name Facility Zip Yes No 1 4 FOREIGN PROVIDER 91470 2 141895416 CALLOWAY LABORATORIES INC 1801 3 201484668 REAGAN STREET SURGERY CENTER LLC 90720 4 203678259 THE SURGICAL CENTER AT SADDLEBACK 92653 5 205245674 WEST ANAHEIM MEDICAL CENTER 92804 6 262583411 GARDEN GROVE HOSPITAL AND MEDICAL CENTER 92843 7 262748804 MISSION ENDOSCOPY CENTER INC 92691 8 330292435 DIGESTIVE DISEASE CENTER 92653 9 330423318 THE CENTER FOR ENDOSCOPY 92056 10 330587175 V A MEDICAL CENTER-LONG BEACH 90822 11 330587175 V A MEDICAL CENTER-LONG BEACH 90822 12 330595220 GLENWOOD SURGICAL CENTER 92503 13 330687414 ORANGE COAST MEMORIAL MEDICAL CENTER 92708 14 330751869 RIVERSIDE COMMUNITY HOSPITAL 92501 15 330885760 AGMG ENDOSCOPY CENTER 92801 16 330937423 RIVERSIDE MEDICAL CLINIC SURGERY CENTER 92506 17 330968516 DESERT ADVANCED IMAGING MEDICAL CENTER 90024 18 432035443 CORONA REGIONAL MEDICAL CENTER 92882 19 550883862 WESTERN MEDICAL CENTER - SANTA ANA 92705 20 550883864 CHAPMAN MEDICAL CENTER 92869 21 621826301 MAGNOLIA SURGERY CENTER 92683 22 710897031 QUEST DIAGNOSTICS 90074 23 743048576 LAGUNA HILLS SURGERY CENTER 92637 24 752384024 NORTH ANAHEIM SURGICENTER 92801 25 752694137 DESERT REGIONAL MEDICAL CENTER 92262 26 752918773 PLACENTIA LINDA HOSPITAL 92870 27 752919839 LOS ALAMITOS MEDICAL CENTER 90720 28 840611484 LABORATORY CORPORATION OF AMERICA 27216 29 941397461 SIERRA VIEW DISTRICT HOSPITAL 93257 30 941534475 KAWEAH DELTA MEDICAL CENTER 93291 31 951643325 ST JUDE MEDICAL CENTER 92835 Page 1 of 2
County of Orange HMO B Provider Listing - Hospital Facilities Num Facility TIN Facility Name Facility Zip Yes No 32 951643327 HOAG MEMORIAL HOSPITAL PRESBYTERIAN 92663 33 951643359 ST JOSEPH HOSPITAL - ORANGE 92868 34 951643360 MISSION HOSPITAL REGIONAL MEDICAL CENTER 92691 35 951644042 TORRANCE MEMORIAL MEDICAL CENTER 90505 36 951903935 DOWNEY REGIONAL MEDICAL CENTER - HOSPITAL INC 90241 37 951966746 AHMC ANAHEIM REGIONAL MEDICAL CENTER LP 92801 38 952126937 TRI CITY MEDICAL CENTER 92056 39 952226406 UC IRVINE MEDICAL CENTER 92868 40 952585792 SADDLEBACK MEMORIAL MEDICAL CENTER 92653 41 952768729 FOUNTAIN VALLEY REGIONAL HOSPITAL AND MEDICAL CENTER 92708 42 952794408 MIMG ENDOSCOPY CENTER 92691 43 952821104 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 91355 44 953522679 LOMA LINDA UNIVERSITY MEDICAL CENTER 92354 45 953522679 LOMA LINDA UNIVERSITY MEDICAL CENTER 92354 46 953527031 LONG BEACH MEMORIAL MEDICAL CENTER 90806 47 953625072 JERRY L PETTIS MEMORIAL VA MEDICAL CENTER 92357 48 953625072 JERRY L PETTIS MEMORIAL VA MEDICAL CENTER 92357 49 954651287 BEVERLY RADIOLOGY MEDICAL GROUP 90024 50 954718446 ADVANCED MEDICAL ANALYSIS LLC 91016 51 956130458 EISENHOWER MEDICAL CENTER 92270 Page 2 of 2
County of Orange HMO B Provider Listing - Specialists Num Specialist TIN Specialist Name Specialty Specialist ZIP 1 200799988 KOTOMORI RICHARD T PSYCHIATRY 92506 2 202598461 VU ALAN D PSYCHIATRY 92660 3 202789887 MATHER DEBORAH G PSYCHOLOGY 90720 4 203007062 ABDISHOO SERGE PSYCHIATRY 92868 5 203249116 DIBELLA GEOFFREY A PSYCHIATRY 92660 6 203974645 REEVE ROBERT B OPHTHALMOLOGY 95926 7 204820187 COWAN BENJAMIN F DIAGNOSTIC RADIOLOGY 90720 8 205386244 MASSOUDIAN MOHAMAD T RADIOLOGY 90049 9 208136224 SIMON STEPHEN M DIAGNOSTIC RADIOLOGY 92691 10 208136224 KHORASHADI FARHAD RADIOLOGY 92691 11 260844287 MINUTECLINIC DIAGNOSTIC MEDICAL GROUP OF ORANGE COUNTY INC 4915 12 261916787 PRETORIUS EUGENE S DIAGNOSTIC RADIOLOGY 92201 13 277367806 KEAYS SANDY MARRIAGE FAMILY THER 92647 14 311714795 ANTHEM PRESCRIPTION MANAGEMENT DBA PRECISIONRX PHARMACY 44193 15 330057155 APRIA PHARMACY NETWORK MEDICAL VENDOR (DME) 60677 16 330080273 DUNBAR RICHARD D RADIOLOGY 90030 17 330180540 LE RICHARD D PULMONARY DISEASE 92801 18 330265036 PHUNG THANH G DIAGNOSTIC RADIOLOGY 92683 19 330266375 FOUNTAIN VALLEY ORTHOTICS & PROSTHETICS ORTHOTICS/PROSTHETIC 92708 20 330285170 KAVEGGIA LASZLO P DIAGNOSTIC RADIOLOGY 92711 21 330285453 CARE AMBULANCE SERVICE GROUND AMBULANCE 92868 22 330300562 URSINO JOHN J PSYCHIATRY 92705 23 330478043 ZACHARIAH SUSAN PSYCHIATRY 92647 24 330587175 PHAM HANH V DIAGNOSTIC RADIOLOGY 90822 25 330587175 ALT STEVEN J EMERGENCY MEDICINE 90822 26 330587175 YAMADA KAREN S NURSE PRACTITIONER 90822 27 330587175 BARGER CYNTHIA Q NURSE PRACTITIONER 90822 28 330587175 KELLEY LYNETTA J NURSE PRACTITIONER 90822 29 330587175 ODONNELL MICHAEL P RADIOLOGY 90822 30 330587175 WILLIAMS RUSSELL A GEN VASCULAR SURGERY 90822 31 330587175 VENKATESH HOSKOTE B EMERGENCY MEDICINE 90822 32 330648414 PUGH PEGGY A DIAGNOSTIC RADIOLOGY 92653 33 330648414 GUZALO ERICA A DIAGNOSTIC RADIOLOGY 92653 34 330909379 URSINO JOHN J PSYCHIATRY 92705 35 330990231 MAI DAVID T DIAGNOSTIC RADIOLOGY 92708 36 440584290 PORTER DEAN M EMERGENCY MEDICINE 65616 37 542119180 KHAJAVI SOHEILA S PSYCHIATRY 92626 38 545179626 WILLIES SPECIALTY SHOP MEDICAL VENDOR (DME) 92866 Yes No Page 1 of 3
County of Orange HMO B Provider Listing - Specialists Num Specialist TIN Specialist Name Specialty Specialist ZIP 39 551133940 MOORE JEANNE L PSYCHOLOGY 92677 40 551776604 ZACHARIAH SUSAN PSYCHIATRY 92691 41 552651794 MASSA CHRISTOPHER S CARDIOVASCU DISEASE 95926 42 568137290 PEREZ CLAUDIA S MARRIAGE FAMILY THER 92506 43 621771540 ANATOMICAL PATHOLOGY CONSORTIUM LLC PATHOLOGY 38148 44 680358482 STROMBERG GARY A RADIOLOGY 95926 45 753110554 THOMAS JULIE A PSYCHIATRY 92691 46 770083726 LI VICTOR ANESTH PAIN MANAGMNT 95065 47 810603296 PERSI ROXIE R PSYCHOLOGY 92821 48 911807160 PHILLIPS NABIL A HEMATOLOGY 92868 49 931172065 TURNER ALAN T RADIOLOGY 92799 50 931172065 LEVEN STEVEN B PULMONARY DISEASE 90815 51 931172065 MAYER FREDERICK A PODIATRIST 92646 52 942672771 JANIK ALICE K MARRIAGE FAMILY THER 92270 53 942672771 JANIK ANDREW S PSYCHIATRY 92270 54 951456616 SCHAEFER AMBULANCE SERVICE GROUND AMBULANCE 90004 55 951644042 TIEGS VERNA G DIAGNOSTIC RADIOLOGY 90505 56 952492427 MOORE DARLENE M MARRIAGE FAMILY THER 92831 57 952585792 SADDLEBACK MEDICAL CENTER INSTITUTIONAL 90074 58 952586432 MITCHELL RICHARD A RADIOLOGY 92886 59 952592769 TRAN THUAN T RADIOLOGY 92663 60 952667855 HANGER PROSTHETICS AND ORTHOTICS WEST INC ORTHOTICS/PROSTHETIC 92807 61 952699939 MILLER JEFFREY S DIAGNOSTIC RADIOLOGY 92056 62 952744523 SHARZER MARK A RADIOLOGY 90680 63 952871640 KNOHL HOWARD R NUCLEAR MEDICINE 90680 64 953327978 DOCTORS AMBULANCE SERVICE GROUND AMBULANCE 92653 65 953380997 RYU CHUN K PSYCHIATRY 92701 66 953514215 WESTERN DRUG MEDICAL SUPPLY MEDICAL VENDOR (DME) 91204 67 953625072 RO HONG I DIAGNOSTIC RADIOLOGY 92357 68 953625072 CHASE RESA L PATHOLOGY 92357 69 953625072 OWENS JOHN E PHYSICAL MED & REHAB 92357 70 953625072 SMITH JODI O OPHTHALMOLOGY 92357 71 953625072 TRAN CAROL L PODIATRIST 92357 72 953625072 FARGO RAMIZ A EMERGENCY MEDICINE 92357 73 953625072 CHON KENNETH S RADIOLOGY 92357 74 953625072 SPECHT NORMAN L CRITICAL CARE MED 92357 75 953625072 SPIELLER SUSAN G DIAGNOSTIC RADIOLOGY 92357 Yes No Page 2 of 3
County of Orange HMO B Provider Listing - Specialists Num Specialist TIN Specialist Name Specialty Specialist ZIP 76 954337839 OCULAR PROSTHETICS INC ORTHOTICS/PROSTHETIC 90004 77 954482087 HANFT ALAN C PSYCHIATRY 90054 78 954482087 PREDA ADRIAN PSYCHIATRY 90054 79 954482087 MYERS ROBERT F PSYCHOLOGY 90054 80 954482087 FERNANDEZ GAIL E PSYCHIATRY 90054 81 954605356 DUBIN MARK D RADIOLOGY 90241 82 954651287 MOLINA CARLOS RADIOLOGY 90024 83 956000723 CITY OF HUNTINGTON BEACH GROUND AMBULANCE 92648 Yes No Page 3 of 3