hospital contact list

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AGENCY FOR HEALTH CARE ADMINISTRATIONBureau of Managed Health Care

Health Care Responsibility Act (HCRA) Participating Hospital ContactsOctober 1, 2012 - September 30, 2013

Partcipating Hospital NameAVENTURA HOSPITAL & MEDICAL CENTER 10-0131

Name:Title:

Mailing Add:City,Zip:Phone:

Fax:Email:

BAPTIST HOSPITAL 10-0093Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

BAPTIST MEDICAL CENTER BEACHES 10-0117Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BAPTIST MEDICAL CENTER DOWNTOWN 10-0088Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BAPTIST MEDICAL CENTER NASSAU 10-0140Name:

Title:Mailing Add:

Hospital ID and AHCA File #

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Partcipating Hospital NameHospital ID and

AHCA File #City,Zip:Phone:

Fax:Email:

BAPTIST MEDICAL CENTER SOUTH 2396-0052Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BAY MEDICAL CENTER 10-0026Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BLAKE MEDICAL CENTER 10-0213Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BRANDON REGIONAL HOSPITAL 10-0243Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

BROOKSVILLE REGIONAL HOSPITAL 10-0071Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:

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AHCA File #Email:

CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

EMERALD COAST BEHAVIORAL HOSPITAL 11-0034Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

ENGLEWOOD COMMUNITY HOSPITAL 11-0004Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

FLAGLER HOSPITAL 10-0219Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

FLORIDA HOSPITAL 10-0007Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

FLORIDA HOSPITAL CARROLLWOOD 10-0069

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AHCA File #Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

FLORIDA HOSPITAL NORTH PINELLAS 10-0055Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

FLORIDA HOSPITAL TAMPA 10-0173Name:

Title:Mailing Add:

City,Zip:

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AHCA File #Phone:

Fax:Email:

FLORIDA HOSPITAL WAUCHULA 10-0282Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

H. LEE MOFFITT CANCER CENTER 11-0009Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

HALIFAX HEALTH MEDICAL CENTER 10-0017Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

Back-up Name:Title:

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AHCA File #Mailing Add:

City,Zip:Phone:

Fax:Email:

JAY HOSPITAL 10-0048Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

KENDALL REGIONAL HOSPITALMEDICAL CENTER 10-0209Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

LAKE BULTER HOSPITAL HAND SURGERY CENTER 10-0241Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

LARGO MEDICAL CENTER 10-0248Name:

Title:Mailing Add:

City,Zip:

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AHCA File #Phone:

Fax:Email:

LAWNWOOD REGIONAL MEDICAL CENTER 10-0246Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

LEE MEMORIAL HOSPITAL 10-0012Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

LEESBURG REGIONAL MEDICAL CENTER 10-0084Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

LIFESTREAM BEHAVIORAL CENTER 10-4018Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

MARTIN MEMORIAL MEDICAL CENTER 10-0044Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

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AHCA File #MEASE DUNEDIN HOSPITAL 10-0043

Name:Title:


Fax:Email:

MEDICAL CENTER OF TRINITY 10-0191Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

MORTON F. PLANT HOSPITAL 10-0127Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

MORTON PLANT NORTH BAY HOSPITAL 10-0063Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

MUNROE REGIONAL MEDICAL CENTER 10-0062Name:

Title:Mailing Add:

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AHCA File #City,Zip:Phone:

Fax:Email:

NORTHSIDE HOSPITAL 10-0238Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Back-up Name:Title:


Fax:Email:

NORTHWEST MEDICAL CENTER 10-0189Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

OAK HILL HOSPITAL 10-0264Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

ORANGE PARK MEDICAL CENTER 10-0226Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

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AHCA File #Back-up Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

OSCEOLA REGIONAL MEDICAL CENTER 10-0110Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

PALMS WEST HOSPITAL 11-0006Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

PLANTATION GENERAL HOSPITAL 10-0167Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

RAULERSON HOSPITAL 10-0252Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

REGIONAL MEDICAL CENTER BAYONET POINT 10-0256Name:

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AHCA File #Title:


Fax:Email:

SACRED HEART HOSPITAL ON THE GULF 2396-0084Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

SHANDS JACKSONVILLE MEDICAL CENTER 10-0001Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

SOUTH BAY HOSPITAL 10-0259Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

SOUTH FLORIDA BAPTIST HOSPITAL 10-0132Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

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AHCA File #ST. JOSEPH'S HOSPITAL 10-0075

Name:Title:


Fax:Email:

ST. LUCIE MEDICAL CENTER 10-0260Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

ST. LUKE'S - ST. VINCENT'S HEALTHCARE 2396-0088Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

ST. VINCENT'S MEDICAL CENTER RIVERSIDE 10-0040Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

TALLAHASSEE MEMORIAL HOSPITAL 10-0135Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

TAMPA GENERAL HOSPITAL 10-0128Name:

Title:

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AHCA File #Mailing Add:

City,Zip:Phone:

Fax:Email:

UNIVERSITY HOSPITAL AND MEDICAL CENTER 10-0224Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

WESTSIDE REGIONAL MEDICAL CENTER 10-0228Name:

Title:Mailing Add:

City,Zip:Phone:

Fax:Email:

Agency for Health Care Administration ContactsBureau of Managed Health Care

HCRA Liaison

Name:

Title:

Agency:

Mailing Add:

City,Zip

Phone:

Fax:

Email:Back-up Name:

Title:Agency:

Mailing Add:City,ZipPhone:

Fax:

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AHCA File #Email:

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Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Venise Craven Kris PanettaPublic Benefit Coordination Director, Medicaid Eligibility & Support Services20900 Biscayne Boulevard 31975 US Highway 19 NorthAventura, FL 33180 Palm Harbor, FL 34684(305) 937-3961 (727) 773-3410

(727) 773-3411

Roberta Thompson Roberta ThompsonPatient Account Representative Patient Account RepresentativeP.O. Box 17106 P.O. Box 17106Pensacola, FL 32522 Pensacola, FL 32522(850) 469-2023 (850) 469-2023(850) 434-4683 (850) 434-4683

David Pezewski David PezewskiReimbursement Director Reimbursement Director1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303Pensacola, FL 32522 Pensacola, FL 32522(850) 434-4651 (850) 434-4651(850) 434-4682 (850) 434-4682

Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201BJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073


Eileen Henderlite Eileen HenderliteDirector - Revenue Cycle Management Director - Revenue Cycle Management3563 Philips Highway, Building B, Suite 201B 3563 Philips Highway, Building B, Suite 201B

[email protected] [email protected]





mailto:[email protected]










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Date Last Revised:

HCRA Eligibility Determination HCRA Claims ProcessingJacksonville, FL 32207 Jacksonville, FL 32207(904) 376-4130 (904) 376-4130(904) 391-5073 (904) 391-5073


Sheila SteinzorUncompensated Care Analyst615 North Bonita AvenuePanama City, FL 32401(850) 747-6113(850) [email protected]

Debbie Pancake Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services2020 59th Street West 31975 US Highway 19 NorthBradenton, FL 34209 Palm Harbor, FL 34684(941) 798-6001 (727) 773-3410

(727) 773-3411

Ana Almodovar Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services119 Oakfield Drive 31975 US Highway 19 NorthBrandon, FL 33511 Palm Harbor, FL 34684(813) 681-5551, ext. 3366 (727) 773-3410

(727) 773-3411

Rick Carlton Vickie NorrisDirector of Financial Planning Business Office ManagerP.O. Box 37 P.O. Box 37Brooksville, FL 34605 Brooksville, FL 34605(352) 544-6156 (352) 796-5151(352) 754-3210 (352) 754-3210













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Date Last Revised:


Ivellys Gonzalez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1401 West Seminole Boulevard 31975 US Highway 19 NorthSanford, FL 32771 Palm Harbor, FL 34684(407) 321-4500, ext. 5259 (727) 773-3410

(727) 773-3411

Ruth Jenkins Donna DozierChief Financial Officer Biller1940 Harrison Avenue 1940 Harrison AvenuePanama City, FL 32405 Panama City, FL 32405(850) 532-6463 (850) 763-0017, ext. 117(850) 785-0580 (850) 785-0580

Katherine Weinmann Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services700 Medical Boulevard 31975 US Highway 19 NorthEnglewood, FL 34223 Palm Harbor, FL 34684(941) 629-1181, ext. 6890 (727) 773-3410

(727) 773-3411

Lynda Kirker Lynda KirkerChief Financial Officer Chief Financial Officer400 Health Park Blvd. 400 Health Park Blvd.St. Augustine, FL 32086 St. Augustine, FL 32086(904) 819-4400 (904) 819-4400(904) 819-4472 (904) 819-4472

Michelle MoralesDepartment Secretary for Patient Financial Services900 Winderly Place, Suite 2100Maitland, FL 32751(407) 200-2307(407) 200-4965






[email protected]












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Date Last Revised:

HCRA Eligibility Determination HCRA Claims ProcessingCoy IngramRegional Director of Patient Financial Services7171 North Dale Mabry HighwayTampa, FL 33514(813) 615-7219(813) 615-7704

Tracy Goodwin Tracy GoodwinManager - MEDS Manager - MEDS4200 Sun 'N Lake Boulevard 4200 Sun 'N Lake BoulevardSebring, FL 33872 Sebring, FL 33872(863) 402-5329 (863) 402-5329(863) 402-3197 (863) 402-3197

Kelly Smith Coy IngramPatient Access Manager Director of Patient Financial Services1395 South Pinellas Avenue 1395 South Pinellas AvenueTarpon Springs, FL 34689 Tarpon Springs, FL 34689(727) 942-5126 (727) 942-5000(727) 942-5158 (727) 942-5161

Coy IngramRegional Director of Patient Financial Services3100 East Fletcher AvenueTampa, FL 33613

[email protected]








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Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing(813) 615-7219(813) 615-7704

Tracy Goodwin Tracy GoodwinManager - MEDS Manager - MEDS533 West Carlton Street 533 West Carlton StreetWauchula, FL 33873 Wauchula, FL 33873(863) 402-5329 (863) 402-5329(863) 402-3197 (863) 402-3197

Deborah Vicedo Jill MartinLead Funding Specialist Govt. Account Resource Specialist12902 Magnolia Drive 12902 Magnolia DriveTampa, FL 33612 Tampa, FL 33612(813) 745-4022 (813) 745-7825(813) 745-7166 (813) 449-8374

Alyson Capone Alyson CaponeCollector Collector303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 226-4590, ext. 12039 (386) 226-4590, ext. 12039(386) 232-2395 (386) 232-2395

Glen Stockhammer Glen StockhammerCollections Manager Collections Manager303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 425-4597 (386) 425-4597(386) 232-2395 (386) 232-2395

Joni Rahn Joni RahnDirector of Patient Financial Services Director of Patient Financial Services

[email protected]














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Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114(386) 425-2452 (386) 425-2452(386) 232-2395 (386) 232-2395

Roberta Thompson Roberta ThompsonPatient Account Representative Patient Account RepresentativeP.O. Box 17106 P.O. Box 17106Pensacola, FL 32522 Pensacola, FL 32522(850) 469-2023 (850) 469-2023(850) 434-4683 (850) 434-4683

David Pezewski David PezewskiReimbursement Director Reimbursement Director1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303Pensacola, FL 32522 Pensacola, FL 32522(850) 434-4651 (850) 434-4651(850) 434-4682 (850) 434-4682

Rosa Canseco Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services11750 Bird Road 31975 US Highway 19 NorthMiami, FL 33175 Palm Harbor, FL 34684(305) 227-5576 (727) 773-3410

(727) 773-3411

Marta YarleyPatient Account RepresentativeP.O. Box 748Lake Butler, FL 32054(386) 496-2323, ext. 9203(386) 496-4734

Beth Weekes Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services201 14th Street Southwest 31975 US Highway 19 NorthLargo, FL 33770 Palm Harbor, FL 34684





[email protected]










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Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing(727) 588-5489 (727) 773-3410

(727) 773-3411

Guadelupe Deloera Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1700 South 23rd Street 31975 US Highway 19 NorthFort Pierce, FL 34950 Palm Harbor, FL 34684(772) 467-2851 (727) 773-3410

(727) 773-3411

Courtney Murray Debbie YeaterRegistration Services Director Central Business Office SupervisorP.O. Box 2218 224 Santa Barbara Boulevard, Suite 203Fort Myers, FL 33902-2218 Cape Coral, FL 33991(239) 343-2036 (239) 242-6015(239) 343-3967

Carol Lewis Gerald LiparitoMEDS Holdings Manager PFS Billing Manager600 East Dixie Avenue PO Box 490717Leesburg, FL 34748 Leesburg, FL 34749(352) 323-5052 (352) 323-5520(352) 323-5439 (352) 323-5239

Vickie Anderson Vickie AndersonBilling Supervisor Billing SupervisorP.O. Box 491000 P.O. Box 491000Leesburg, FL 34749-1000 Leesburg, FL 34749-1000(352) 315-7537 (352) 315-7537(352) 315-7587 (352) 315-7587

John Creider Carol PlatoReimbursement Specialist Administrative Director301 SE Hospital Avenue 301 SE Hospital AvenueStuart, FL 34995 Stuart, FL 34995(772) 223-2828 (772) 223-5656(772) 223-5621 (772) 223-5622



[email protected]















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Date Last Revised:


Jessica Villafana Opyd Jessica Villafana OpydSupervisor- Financial Assistance Department Supervisor- Financial Assistance Department3986 Tampa Road 3986 Tampa RoadOldsmar, FL 34677 Oldsmar, FL 34677(813) 852-3305 (813) 852-3305(813) 635-7731 (813) 635-7731

Pat Cooper Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services9330 State Road 54 31975 US Highway 19 NorthTrinity, FL 34655 Palm Harbor, FL 34684(727) 834-5720 (727) 773-3410

(727) 773-3411



Michelle Smith Traci BrysonDirector of Patient Accounting & Admitting1500 SW 1st Avenue 1500 SW 1st Avenue













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Date Last Revised:

HCRA Eligibility Determination HCRA Claims ProcessingOcala, FL 34471 Ocala, FL 34471(352) 368-3419 (352) 351-7259(352) 671-2125 (352) 671-2119

Cynthia Bacon Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services6000 49th Street North 31975 US Highway 19 NorthSt. Petersburg, FL 33709 Palm Harbor, FL 34684(727) 521-5558 (727) 773-3410

(727) 773-3411

Robb Hurlock Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services2801 North State Road 7 31975 US Highway 19 NorthMargate, FL 33063 Palm Harbor, FL 34684(954) 956-3060 (727) 773-3410

(727) 773-3411

Linda Murphy Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services11375 Cortez Boulevard 31975 US Highway 19 NorthBrooksville, FL 34613 Palm Harbor, FL 34684(352) 597-6371 (727) 773-3410

(727) 773-3411

Mark Redditt Lisa PrinceRegional Director, HFMI Director of Patient Account Services1202 Washington Street 335 Crossing BoulevardWilliamston, NC 27892 Orlando, FL 32073(800) 584-5545 (904) 688-6614(954) 513-2058 (904) 688-7614
















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Date Last Revised:

HCRA Eligibility Determination HCRA Claims ProcessingArdra JonesPublic Benefit Cooridnator2001 Kingsley AvenueOrange Park, FL 32073(904) 276-8715

Maria Celebre Kris PanettaPublic Benefit Cooridnator Director, Medicaid Eligibility & Support Services700 West Oak Street 31975 US Highway 19 NorthKissimmee, FL 34741 Palm Harbor, FL 34684(407) 518-3658 (727) 773-3410

(727) 773-3411

Maria Cortes-Bolivar Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services13001 Southern Boulevard 31975 US Highway 19 NorthLoxahatchee, FL 33470 Palm Harbor, FL 34684(561) 798-6078 (727) 773-3410

(727) 773-3411

Fabiola Dickson Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services401 Northwest 42nd Avenue 31975 US Highway 19 NorthPlantation, FL 33317 Palm Harbor, FL 34684(954) 587-5010, ext. 6650 (727) 773-3410

(727) 773-3411

Marla Wandrum Kris PanettaPublic Benefit Cooridnator Director, Medicaid Eligibility & Support Services1796 Highway 441 North 31975 US Highway 19 NorthOkeechobee, FL 34972 Palm Harbor, FL 34684(863) 824-2870 (727) 773-3410

(727) 773-3411

Kathleen Troutwine Kris Panetta

[email protected]














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Date Last Revised:

HCRA Eligibility Determination HCRA Claims ProcessingPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services14000 Fivay Road 31975 US Highway 19 NorthHudson, FL 34667 Palm Harbor, FL 34684(727) 819-2929, ext. 5365 (727) 773-3410

(727) 773-3411

Kaycee KrumPatient Access Supervisor3801 East Highway 98Port St. Joe, FL 32456(850) 229-5738(850) 229-5719

Shakawn Jones Shakawn JonesManager Manager655 West 8th Street 655 West 8th StreetJacksonville, FL 32209 Jacksonville, FL 32209(904) 244-1877 (904) 244-1877

Veronica Vargas Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services4016 Sun City Boulevard 31975 US Highway 19 NorthSun City Center, FL 33573 Palm Harbor, FL 34684(813) 634-0488 (727) 773-3410

(727) 773-3411



[email protected]













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Date Last Revised:



Placida Suarez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services1800 SE Tiffany Avenue 31975 US Highway 19 NorthPort St. Lucie, FL 34952 Palm Harbor, FL 34684(727) 341-4929 (727) 773-3410

(727) 773-3411

Thomas Duncan Juquanda GeorgeSenior Director Medicaid Billing Specialist4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216(313) 309-2143 (312) 462-6085(586) 698-0071 (312) 462-6293

Thomas Duncan Juquanda GeorgeSenior Director Medicaid Billing Specialist4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216(313) 309-2143 (312) 462-6085(586) 698-0071 (312) 462-6293

George MacLafferty LaTrenda CooperAssistant Director, Patient Financial Services Business Office Manager1309 Miccosukee Road 1309 Miccosukee RoadTallahassee, FL 32303 Tallahassee, FL 32303(850) 431-7210 (850) 431-6205(850) 431-6951 (850) 431-6900

Kim ShepherdER and FAS Manager
















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Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing1 Tampa General CircleTampa, FL 33601(813) 844-7406(813) 844-4391

Jose Martinez Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services7201 North University Drive 31975 US Highway 19 NorthTamarac, FL 33321 Palm Harbor, FL 34684(954) 724-6144 (727) 773-3410

(727) 773-3411

Zac Williams Kris PanettaPublic Benefit Coordinator Director, Medicaid Eligibility & Support Services8201 West Broward Boulevard 31975 US Highway 19 NorthPlantation, FL 33324 Palm Harbor, FL 34684(954) 916-5458 (727) 773-3410

(727) 773-3411

Agency for Health Care Administration ContactsBureau of Managed Health Care Bureau of Certificate of Need/Financial Analysis

HCRA Liaison Hospital Eligibility

Kirsten Jacobson Mills Smith

Medical Health Care Program Analyst Regulatory Analyst Supervisor

Bureau Chief's Office Bureau of Certificate of Need/Financial Analysis

2727 Mahan Drive, Mail Stop Code 26Tallahassee, FL 32308 Tallahassee, FL 32308

(850) 412-4333 (850) 412-4353

(850) 414-6912 (850) 922-6964

Karin Boatwright Felton BradleyMedical Health Care Program Analyst Economic AnalystMedicaid Compliance Unit II Bureau of Certificate of Need/Financial Analysis

Tallahassee, FL 32308 Tallahassee, FL 32308(850) 412-4312 (850) 412-4350(850) 414-6912 (850) 922-6964

[email protected]



2727 Mahan Drive, Mail Stop Code 28


2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28








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Date Last Revised:

HCRA Eligibility Determination HCRA Claims [email protected] [email protected]



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April 12, 2013

Administrator

Heather J. Rohan Chief Executive Officer20900 Biscayne Boulevard Aventura, FL 33180(305) 682-7000

David WildebrandtAdministrator1000 W. Moreno StreetPensacola, FL 32501(850) 434-4011

Joseph MitrickHospital President1350 13th Avenue SouthJacksonville Beach, FL 32250(904) 627-2905(904) 627-1008

Michael MayoHospital President800 Prudential Drive, Howard 1st FloorJacksonville, FL 32202(904) 202-2001(904) 202-2285

Stephen LeeHospital President1250 South 18th Street

[email protected]

[email protected]

[email protected]

[email protected]





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April 12, 2013

AdministratorFernandina Beach, FL 32034(904) 321-3502(904) 321-3511

Ron RobinsonHospital President14550 Old St. Augustine RoadJacksonville, FL 32258(904) 271-6002(904) 271-6650

Steven JohnsonChief Executive Officer615 N. Bonita AvenuePanama City, FL 32401(850) 747-6045(850) [email protected]

Daniel FriedrichChief Executive Officer2020 59th Street WestBradenton, FL 34209(941) 792-6611

Bland EngChief Executive Officer119 Oakfield Drive Brandon, FL 33511(813) 681-5551

Patrick MaloneyChief Executive OfficerP.O. Box 37Brooksville, FL 34605(352) 688-8200

[email protected]

[email protected]

[email protected]

[email protected]





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April 12, 2013

Administrator

Wendy H. BrandonChief Executive Officer1401 West Seminole BoulevardSanford, FL 32771(407) 321-4500

Tim BedfordChief Executive Officer1940 Harrison AvenuePanama City, FL 32405(850) 763-0017, ext. 147(850) 785-0580

Thomas RiceChief Executive Officer700 Medical BoulevardEnglewood, FL 34223(941) 475-6571

Joseph GordyChief Executive Officer400 Health Park Blvd.St. Augustine, FL 32086(904) 819-4400(904) 819-4472

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]






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April 12, 2013

AdministratorShane CoxChief Financial Officer7171 North Dale Mabry HighwayTampa, FL 33514(813) 558-8001

Tim CookChief Executive Officer4200 Sun 'N Lake BoulevardSebring, FL 33872(863) 402-3366(863) 402-3415

Dima DidenkoChief Financial Officer4200 Sun 'N Lake BoulevardSebring, FL 33872(863) 402-3366(863) 402-3415

Bruce BerghermPresident / Chief Executive Officer1395 South Pinellas AvenueTarpon Springs, FL 34689(727) 942-5107(727) 942-5161

Michael MewhirterVice President / Chief Financial Officer1395 South Pinellas AvenueTarpon Springs, FL 34689(727) 942-5022(727) 942-5161

Janice HagensickerMarket Chief Financial Officer3100 East Fletcher AvenueTampa, FL 33613

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]






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April 12, 2013

Administrator(813) 615-7129

Tim CookChief Executive Officer533 West Carlton StreetWauchula, FL 33873(863) 402-3366(863) 402-3415

Dima DidenkoChief Financial Officer533 West Carlton StreetWauchula, FL 33873(863) 402-3366(863) 402-3415

Dr. Alan ListCenter Director12902 Magnolia DriveTampa, FL 33612(813) 745-7101(813) 745-3090

Jeff FeaselPresident and Chief Executive Officer303 N. Clyde Morris BoulevardDaytona Beach, FL 32114(386) 254-4000, ext. 54771

Arvin LewisChief Revenue Officer303 N. Clyde Morris BoulevardDaytona Beach, FL 32114(386) 258-4826(386) 239-2325

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]






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April 12, 2013

Administrator

Mike HutchinsAdministrator14114 Alabama StreetJay, FL 32565(850) 675-8015

Scott A. CihakChief Executive Officer11750 Bird RoadMiami, FL 33175(305) 223-3000

Pamela HowardChief Executive OfficerP.O. Box 748Lake Butler. FL 32054(386) 496-2323 Ext. 225(386) 496-1611

Anthony DeginaChief Executive Officer201 14th Street SouthwestLargo, FL 33770

[email protected]

[email protected]

[email protected]




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April 12, 2013

Administrator(727) 588-5200

Rodney SmithChief Executive Officer1700 South 23rd StreetFort Pierce, FL 34950(772) 461-4000

Lisa SgarlataChief Administrative Officer2776 Cleveland AvenueFort Myers, FL 33901(239) 343-2000

Grant GlinesDirector of Financial Planning & AnalysisPO Box 490717Leesburg, FL 34749(352) 323-5695(352) 323-5039

Rick HankeySenior Vice PresidentP.O. Box 491000Leesburg, FL 34749-1000(352) 315-7800(352) 360-6656

Mark E. RobitailleChief Executive Officer301 SE Hospital AvenueStuart, FL 34995

[email protected]

[email protected]

[email protected]

[email protected]

Mark.Robitaille@martinhealth,org





mailto:Mark.Robitaille@martinhealth,org

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April 12, 2013

Administrator

Louis GaldieriChief Operating Officer601 Main StreetDunedin, FL 34698(727) 734-6395(727) 734-6887

Leigh MassengillChief Executive Officer9330 State Road 54Trinity, FL 34655(727) 834-4000

Kristopher HoceAdministrator300 Pinellas StreetClearwater, FL 33756(727) 462-7100(727) 461-8101

Neil HoceChief Operating Officer300 Pinellas StreetClearwater, FL 33756(727) 462-7100(727) 461-8101

Harrell ZiecheckChief Operating Officer6600 Madison StreetNew Port Richey, FL 34652(727) 843-4599(727) 848-8762

Stephen A. PurvesPresident & Chief Executive Officer1500 SW 1st Avenue

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]






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April 12, 2013

AdministratorOcala, FL 34471(352) 351-7393(352) 368-3433

Stephen DaughertyChief Executive Officer6000 49th Street NorthSt. Petersburg, FL 33709(727) 521-4411

Gary SearlsChief Financial Officer6000 49th Street NorthSt. Petersburg, FL 33709(727) 521-5004(727) 521-5007

Dianne GoldenbergChief Executive Officer2801 North State Road 7Margate, FL 33063(954) 974-0400

Mickey SmithChief Executive Officer11375 Cortez BoulevardBrooksville, FL 34613(352) 596-6632

Thomas R. PentzChief Executive Officer2001 Kingsley AvenueOrange Park, FL 32073(904) 276-8500

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]







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April 12, 2013

Administrator

Kathryn J. GilletteChief Executive Officer700 West Oak StreetKissimmee, FL 34741(407) 846-2266

Eric GoldmanChief Executive Officer13001 Southern BoulevardLoxahatchee, FL 33470(561) 798-3300

Barbara SimmonsChief Executive Officer401 Northwest 42nd AvenuePlantation, FL 33317(954) 587-5010

Robert LeeChief Executive Officer1796 Highway 441 NorthOkeechobee, FL 34972(863) 763-2151

Shayne George

[email protected]

[email protected]

[email protected]

[email protected]





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April 12, 2013

AdministratorChief Executive Officer14000 Fivay RoadHudson, FL 34667(727) 819-2929

Roger HallPresident7800 West highway 98Miramar Beach, FL 32550(850) 278-3000(850) 278-3201

James BurkhartPresident655 West 8th StreetJacksonville, FL 32209(904) 244-4000

Sharon RoushChief Executive Officer4016 Sun City BoulevardSun City Center, FL 33573(813) 634-3301

Stephen NiermanChief Operating Officer301 North Alexander StreetPlant City, FL 33566(813) 757-1205(813) 757-8204

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]






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April 12, 2013

Administrator

Lorraina LuttonChief Operating Officer3001 W. Dr. M.L. King, Jr. Blvd.Tampa, FL 33607(813) 870-4020(813) 870-4639

Gary CantrellChief Executive Officer1800 SE Tiffany AvenuePort St. Lucie, FL 34952(772) 335-4000

G. Mark O'BryantPresident and Chief Executive Officer1300 Miccosukee RoadTallahassee, FL 32308(850) 431-5380(850) 431-5883

Ronald A. HytoffPresident, Chief Executive Officer

[email protected]

[email protected]

[email protected]




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April 12, 2013

Administrator1 Tampa General CircleTampa, FL 33601(813) 844-7662(813) 844-4144

W. Mark RaderChief Executive Officer7201 North University DriveTamarac, FL 33321(954) 724-2200 ext. 6101(954) 724-6567

Lee B. ChaykinChief Executive Officer8201 West Broward BoulevardPlantation, FL 33324(954) 473-6600

Agency for Health Care Administration Contacts

[email protected]

[email protected]

[email protected]




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Health Care Responsibility Act (HCRA)October 1, 2011 - September 30, 2012

Last Updated:

March 20, 2012Hospital Name HCRA Contact Hospital Administrator

Kempton Smith Kris Panetta Heather J. Rohan Hosp. Code: 10-0131 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 20900 Biscayne Blvd. Palm Harbor, FL 34684 Aventura, FL 33180

Phone: (727) 773-3410 (305) 682-7100Fax: (727) 773-3411 (305) 682-7105

Email:

All Children's Hospital Kathryn B. Forbes Gary A. CarnesHosp. Code: 10-0250 Title: Reimbursement Manager President/CEO

Mailing Add: 501 6th Avenue S., Dept. 1950 501 6th Avenue S., Dept. 1950St. Petersburg, FL 33701 St. Petersburg, FL 33701

Phone: (727) 767-8210 (727) 767-4474Fax: (727) 767-4191 (727) 767-8944

Email:

BAPTIST HOSPITAL Kempton Smith David Pezewski David WildebrandtHosp. Code: 10-0093 Title: Corporate Director Reimbursement Administrator

Mailing Add: 1000 W. Moreno Street, Tower 1 Ste. 303 1000 W. Moreno StreetPensacola, FL 32501 Pensacola, FL 32501

Phone: (850) 434-4651 (850)469-2319Fax: (850) 454-4682 (850) 469-2307

Email:

Eileen Henderlite Michael MayoHosp. Code: 10-0088 Title: Director - Revenue Cycle Management Hospital President

Mailing Add: 3563 Phillips Hwy, Suite 201 800 Prudential DriveJacksonville, FL 32207 Jacksonville, FL 32207

Phone: (904) 376-4130 (904) 202-2001Fax: (904) 391-5073 (904) 202-2285

Email:

BAPTIST MEDICAL CENTER BEACHESEileen Henderlite Joe Mitrick

Hosp. Code: 10-0117 Title: Director - Revenue Cycle Management Hospital PresidentMailing Add: 3563 Phillips Hwy, Suite 201 1350 13th Avenue South

Jacksonville, FL 32207 Jacksonville Beach, FL 32250Phone: (904) 376-4130 (904) 627-2901

Fax: (904) 391-5073 (904) 627-1008Email:

BAPTIST MEDICAL CENTER NASSAUEileen Henderlite Jim L. Mayo

Hosp. Code: 10-0140 Title: Director - Revenue Cycle Management AdministratorMailing Add: P.O. Box 45094 1250 S. 18th Street

Jacksonville, FL 32207 Fernandina Beach, FL 32034Phone: (904) 376-4130 (904) 321-3501

Fax: (904) 391-5073 (904) 321-3511Email: [email protected]

BAY MEDICAL CENTER Sheila Steinzor Steven JohnsonHosp. Code: 10-0026 Title: Uncompensated Care Analyst Chief Executive Officer

ADVENTURA HOSPITAL AND MEDICAL CENTER

Certified - 9/27/11 City,Zip






BAPTIST MEDICAL CENTER JACKSONVILLE






[email protected]












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Last Updated:


Mailing Add: 615 N. Bonita Avenue 615 N. Bonita AvenueCity,Zip Panama City, FL 32401 Panama City, FL 32401Phone: (850) 747-6113 (850) 747-6045

Fax: (850) 747-6258 (850) 763-8827Email: [email protected] [email protected]

BAYFRONT MEDICAL CENTER Christopher Kroker Sue G. BrodyHosp. Code: 10-0032 Title: Patient Financial Counseling Coordinator President/CEO

Mailing Add: 701 6th Street South 701 6th Street SouthSt. Petersburg, FL 33701 St. Petersburg, FL 33701

Phone: (727) 893-3611 (727) 893-6015Fax: (727) 893-6914 (727) 893-6910

Email:

BRANDON REGIONAL HOSPITALKris Panetta Michael M. Fencel

Hosp. Code: 10-0243 Title: Director of Patient Account Services Chief Executive OfficerMailing Add: 31975 US Highway 19 North 119 Oakfield Drive

Palm Harbor, FL 34684 Brandon, FL 33511Phone: (727) 773-3410 (813) 681-5551 ext. 5100

Fax: (727) 773-3411 (813) 654-7203Email:

BROOKSVILLE REGIONAL HOSP Rick Carlton Patrick MahoneyHosp. Code: 10-0071 Title: Director of Financial Planning Chief Executive Officer

Mailing Add: 17240 Cantez Blvd. 17240 Cantez Blvd.Brooksville, FL 34601 Brooksville, FL 34601

Phone: (352) 544-6156 (352) 544-6020Fax: (352) 754-3210

Email:

CAPE CORAL HOSPITAL Same Scott KashmanHosp. Code: 10-0244 Title: Chief Administrative Officer

Mailing Add: 636 Del Prado Blvd.Cape Coral, FL 33990

Phone: (239) 424-3851Fax: (239) 424-4004

Email:

Lisa Prince Wendy H. BrandonHosp. Code: 10-0161 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 335 Crossing Blvd. 1401 West Seminole Blvd.City,Zip Orlando, FL 32073 Sanford, FL 32771Phone: (904) 688-6614 (407) 302-7392

Fax: (904) 688-7614 (407) 324-4790Email:

DESOTO MEMORIAL HOSPITAL Vincent A. Sica Robert WinklerHosp. Code: 10-0175 Title: President/ CEO President/ CEO

Mailing Add: P.O. Box 2180 P.O. Box 2180City,Zip Arcadia, FL 34265 Arcadia, FL 34265Phone: (863) 494-8402 (863) 494-8402

Fax: (863) 494-8400 (863) 494-8400






[email protected]


[email protected]

CENTRAL FLORIDA REGIONAL HOSPITAL










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Last Updated:


Email:

DOCTORS HOSPITAL OF SARASOTAKris Panetta Robert C. Meade

Hosp. Code: 10-0166 Title: Director Chief Executive OfficerMailing Add: 31975 US Highway 19 North 5731 Bee Ridge Road

Palm Harbor, FL 34684 Sarasota, FL 34233Phone: (727) 773-3410 (941) 342-1100

Fax: (727) 773-3411 (941) 379-8342Email:

DOCTORS MEMORIAL HOSPITALSara Grambling Richard Huth

Hosp. Code: 10-0106 Title: Patient Financial Services Director CEOMailing Add: PO Box 1847 PO Box 1847

Perry, FL 32348 Perry, FL 32348Phone: (850) 584-0800 ext. 860 (850) 584-0800 ext. 885

Fax: (850) 584-0679 (850) 223-2308Email:

Donna Boroughs JoAnn BakerHosp. Code: 10-0078 Title: Business Office Manager Administrator

Mailing Add: Post Office Box 188 Post Office Box 188Bonifay, FL 32425 Bonifay, FL 32425

Phone: (850) 547-8015 (850) 547-8001Fax: (850) 547-8025 (850) 547-8006

Email:

EDWARD WHITE HOSPITAL Kris Panetta Roland MetivierHosp. Code: 10-0239 Title: Director of Patient Account Services President, Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 2323 9th Avenue NorthCity,Zip Palm Harbor, FL 34684 St. Petersburg, FL 33713Phone: (727) 773-3410 (727) 328-6133

Fax: (727) 773-3411 (727) 328-6135Email:

ENGLEWOOD COMMUNITY HOSPITAL Kris Panetta Mary Ann Conroy

Hosp. Code: 11-0004 Title: Director CEOMailing Add: 31975 US Highway 19 North 700 Medical Blvd.

Palm Harbor, FL 34684 Englewood, FL 34223Phone: (727) 773-3410 (941) 473-5043

Fax: (727) 773-3411 (941) 473-5015Email:

FLAGLER HOSPITAL-WEST Lynda Kirker Joseph GordyHosp. Code: 10-0219 Title: CFO CEO

Mailing Add: 400 Health Park Blvd. 400 Health Park Blvd.St. Augustine, FL 32086 St. Augustine, FL 32086

Phone: (904) 819-4400 (904) 819-4400Fax: (904) 819-4472 (904) 819-4472

Email:

[email protected]



City,Zip


DOCTORS MEMORIAL HOSPITAL- BONIFAY



[email protected] roland.metivier@hcahealthcare,com













mailto:roland.metivier@hcahealthcare,com





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Last Updated:


FLORIDA HOSPITAL Tammie Rikansrud Lars HoumannHosp. Code: 10-0007 Title: Assistant Vice President, PFS President, Chief Executive Officer

Mailing Add: 6010 E. Rollins Street 601 E. Rollins StreetOrlando, FL 32805 Orlando, FL 32805

Phone: (407) 200-2307 (407) 303-6611Fax: (407) 200-4965 (407) 303-1755

Email:

FLORIDA HOSPITAL HEARTLANDRyan Willis Dima Didenko

Hosp. Code: 10-0109 Title: Controller CFOMailing Add: 4200 Sun 'N Lake Boulevard 4200 Sun 'N Lake Boulevard

Sebring, FL 33872 Sebring, FL 33872Phone: (863) 386-6392 (863) 402-3366

Fax: (863) 386-6432 (863) 402-3110Email:

FLORIDA HOSPITAL - WAUCHULARyan Willis Linda B. Adler

Hosp. Code: 10-0282 Title: Controller AdministratorMailing Add: 4200 Sun 'N Lake Boulevard 533 West Carlton Street

Sebring, FL 33872 Wauchula, FL 33873Phone: (863) 386-6392 (863) 773-3101 ext. 8342

Fax: (863) 386-6432 (863) 773-0126Email:

GULF COAST MEDICAL CENTER Yuriy Kukin Barbara MelbyHosp. Code: 10-0220 Title: Sr. Financial Analyst Controller

Mailing Add: P.O Box 151247 P.O Box 151247Cape Coral, FL 33991 Cape Coral, FL 33991

Phone: (239) 242-6227 (239) 242-6200Fax: (239) 242-6248 (239) 242-6248

Email:H. LEE MOFFITT Deborah Vicedo William S. Dalton, Phd.

Hosp. Code: 11-0009 Title: Title-Lead Funding Specialist Chief Executive OfficerMailing Add: 12902 Magnolia Drive 12902 Magnolia Drive

Tampa, FL 33612 Tampa, FL 33612Phone: (800) 456-3434, ext. 4022 (813) 972-4673

Fax: (813) 745-7166 (813) 979-3090Email:

HALIFAX MEDICAL CENTER Joni Rahn Arvin LewisHosp. Code: 10-0017 Title: Director, Patient Financial Services Chief Revenue Officer

Mailing Add: 303 N. Clyde Morris Boulevard 303 N. Clyde Morris BoulevardDaytona Beach, FL 32114 Daytona Beach, FL 32114

Phone: (386) 425-2452 (386) 258-4826Fax: (386) 239-2325 (386) 239-2325

Email:

HELEN ELLIS MEMORIAL HOSPITAL Kelly Smith Bruce BerghermHosp. Code: 10-0055 Title: Interim Director President/CEO

Mailing Add: 1395 South Pinellas Avenue 1395 South Pinellas Avenue









Certified -11/15/10 City,Zip

[email protected]














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Last Updated:


Tarpon Springs, FL 34689 Tarpon Springs, FL 34689Phone: (727) 942-5126 (727) 942-5107

Fax: (727) 942-5161 (727) 942-5161Email:

John Beltz Lynn BeasleyHosp. Code: 10-0098 Title: CFO CEO

Mailing Add: 524 W. Sagamore Ave 524 W. Sagamore AveClewiston, FL 33440 Clewiston, FL 33440

Phone: (863) 902-3076 (863) 902-3076Fax: (863) 983-1809 (863) 983-1809

Email:

JACKSON MEMORIAL HOSPITALTelisa Lyons Carmen Pla

Hosp. Code: 10-0022 Title: Corporate Director, Access Management Vice President, Revenue CycleMailing Add: 1801 NW 9th Avenue, Room 212F 1801 NW 9th Avenue, Room 200D

Miami, FL 33136 Miami, FL 33136Phone: (305) 355-5364 (305) 355-5354

Fax: (305) 355-5386 (305) 355-5380Email:

JAY HOSPITAL Vickie Baxley Michael T. HutchinsHosp. Code: 10-0048 Title: Patient Access Manager Administrator

Mailing Add: 14114 Alabama Street 14114 Alabama StreetJay, FL 32565 Jay, FL 32565

Phone: (850) 675-8021 (850) 675-8015Fax: (850) 675-8203 (850) 675-8070

Email: [email protected]

JFK Medical Center Kris Panetta Gina A. MelbyHosp. Code: 10-0080 Title: Director CEO

Mailing Add: 31975 US Highway 19 North 5301 S. Congress Ave.Palm Harbor, FL 34684 Atlantis, FL 33462

Phone: (727) 773-3410 (561) 548-3850Fax: (727) 773-3411 (561) 548-3685

Email:

KENDALL REGIONAL HOSPITAL Ricardo PavonKris Panetta Scott A. CihakHosp. Code: 10-0209 Title: Director Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 11750 Bird RoadPalm Harbor, FL 34684 Miami, FL 33175

Phone: (727) 773-3410 (305) 227-5500Fax: (727) 773-3411 (305) 229-2444

Email:

Lorna Boyce-Lowe Pamela HowardHosp. Code: 10-0241 Title: Patient Accounts Director Chief Executive Officer

Mailing Add: P.O. Box 748 P.O. Box 748Lake Butler, FL 32054 Lake Butler. FL 32054

Phone: (386) 496-3540 (386) 496-2323 Ext. 225



HENDRY REGIONAL MEDICAL CENTER






[email protected]





LAKE BULTER HOSPITAL/ HAND SURGERY CENTER













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Last Updated:


Fax: (386) 496-4734 (386) 496-1611Email:

LARGO MEDICAL CENTER Kris Panetta Richard H. SathcerHosp. Code: 10-0248 Title: Director, Medicaid Eligibility & Support Service President/CEO

Mailing Add: 31975 US Highway 19 North 201 14th Street S.W.Palm Harbor, FL 34684 Largo, FL 33770

Phone: (727) 773-3410 (727) 588-5801Fax: (727) 773-3411 (727) 588-5906

Email:

Kris Panetta Rodney SmithHosp. Code: 10-0246 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 1700 S. 23rd StreetPalm Harbor, FL 34684 Fort Pierce, FL 34950

Phone: (727) 773-3410 (772) 468-4500 Fax: (727) 773-3411 (772) 460-1353

Email:

LEE MEMORIAL HOSPITAL Cindy Boots Jim NathanHosp. Code: 10-0012 Title: Director, Central Insurance Verification President/CEO

Mailing Add: Post Office Box 150107 8300 College Parkway, Suite 200Cape Coral, FL 33915-0107 Ft. Myers, FL 33919

Phone: (239) 242-6016 (239) 332-1111Fax: (239) 242-6116 (239) 437-5276


James Ward Timothy F. HawkinsHosp. Code: 10-0084 Title: Senior Reimbursement Analyst EVP/COO

Mailing Add: 600 East Dixie Avenue 600 East Dixie AvenueLeesburg, FL 34748 Leesburg, FL 34748

Phone: (352) 323-4284 (352) 751-8002Fax: (352) 323-5039 (352) 751-8011

Email:

LIFESTREAM BEHAVIORAL CENTER

Vickie Parr Rick HankeyHosp. Code: 10-4018 Title: Billing Supervisor Senior Vice President/Hospital Adminstrator

Mailing Add: P.O. Box 491000 P.O. Box 491000Leesburg, FL 34749 Leesburg, FL 34749

Phone: (352) 315-7500 (352) 315-7800Fax: (352) 315-7587 (352) 315-7893

Email:

MARTIN MEMORIAL HOSPITAL Carol Plato Nicosia Mark RobitailleHosp. Code: 10-0044 Title: Director Corporate Business Serv. Chief Executive Officer

Mailing Add: Post Office Box 9033 300 Hospital AvenueStuart, FL 34995 Stuart, FL 34994

Phone: (772) 223-5656 (772) 287-5200Fax: (772) 223-5946

Email:




LAWNWOOD REGIONAL MEDICAL CENTER




LEESBURG REGIONAL MEDICAL CENTER



















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Last Updated:


MAYO CLINIC FLORIDA Robert Howey Hilary MathewsHosp. Code: 10-0151 Title: Manager Reimbursement Hospital Administrator

Mailing Add: 4500 San Pablo Road 4500 San Pablo RoadJacksonville, FL 32224 Jacksonville, FL 32224

Phone: (904) 953-2698 (904) 953-0444Fax: (904) 953-0885

Email:

MEASE HEALTH CARE Jessica Villafana Opyd Louis GaldieriHosp. Code: 10-0043 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer

Mailing Add: 3986 Tampa Road 601 Main StreetOldsmar, FL 34677 Dunedin, FL 34698

Phone: (813) 852-3305 (727) 734-6395Fax: (813) 635-7731 (727) 734-6887

Email:

MEDICAL CENTER OF TRINITY Kris Panetta Leigh MassengillHosp. Code: 10-0191 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 5637 Marine ParkwayPalm Harbor, FL 34684 New Port Richey, FL 34652

Phone: (727) 773-3410 (727) 848-1733Fax: (727) 773-3411 (727) 848-5136

Email:

MUNROE REG. MED. CENTER Michelle Smith Stephen A. PurvesHosp. Code: 10-0062 Title: Director of Patient Accounting and Admitting President, Chief Executive Officer

Mailing Add: 1500 S.W. 1st Avenue 1500 S.W. 1st AvenueCity,Zip Ocala, FL 34471 Ocala, FL 34471Phone: (352) 368-3419 (352) 351-7393

Fax: (352) 671-2125 (352)368-3433Email:

MORTON PLANT HOSPITAL Jessica Villafana Opyd Neil HoceHosp. Code: 10-0127 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer

Mailing Add: 3986 Tampa Road 300 Pinellas StreetOldsmar, FL 34677 Clearwater, FL 33756

Phone: (813) 852-3305 (727) 462-7100Fax: (813) 635-7731 (727) 461-8101

Email:

MORTON PLANT NORTH BAY Jessica Villafana Opyd Harrell ZiecheckHosp. Code: 10-0063 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer

Mailing Add: 3986 Tampa Road 6600 Madison StreetOldsmar, FL 34677 New Port Richey, FL 34652

Phone: (813) 852-3305 (727) 843-4599Fax: (813) 635-7731 (727) 848-8762

Email:

MOUNT SINAI MEDICAL CENTERHosp. Code: 10-0034 Title:

Mailing Add:

Phone:Fax:

























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Last Updated:


Email:

NATURE COAST REG. HOSPITAL Barbie Miller Alan BirdHosp. Code: 10-0139 Title: Business Manager Chief Executive Officer

Mailing Add: 125 S.W. Seventh Street 125 S.W. Seventh StreetWilliston, FL 32696 Williston, FL 32696

Phone: (352) 528-2801 (352) 528-2801 ext. 425Fax: (352) 528-3824 (352) 528-3824

Email: [email protected] [email protected] Krueger

Title: Account Rep.Mailing Add: 125 S.W. Seventh Street

City,Zip Williston, FL 32696Phone: (352) 528-2801

Fax: (352) 528-3824Email:

NORTHSIDE HOSPITAL Kris Panetta Stephen DaughertyHosp. Code: 10-238 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 6000 49th Street NorthPalm Harbor, FL 34684 St. Petersburg, FL 33709

Phone: (727) 773-3410 (727) 521-5004Fax: (727) 773-3411 (727) 521-5007

Email:

Kathy Mitchell Patrick A. SchlenkerHosp. Code: 10-0147 Title: Patient Financial Services Manager President/CEO

Mailing Add: 1360 Brickyard Road, PO Box 889 1360 Brickyard Road, PO Box 889Chipley, FL 32428 Chipley, FL 32428

Phone: (850) 415-8184 (850) 415-8103Fax: (850) 415-638-0622 (850) 638-5764

Email:

NORTHWEST MEDICAL CENTER Kris Panetta Dianne GoldbergHosp. Code: 10-0189 Title: Director - PAS Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 2801 N. State RoadPalm Harbor, FL 34684 Margate, FL 33063

Phone: (727) 773-3410 (954) 978-4000Fax: (727) 773-3411 (954) 978-4183

Email:OAK HILL HOSPITAL Kris Panetta Mickey Smith

Hosp. Code: 10-0264 Title: Director - PAS Chief Executive OfficerMailing Add: 31975 US Highway 19 North 11375 Cortez Blvd.

Palm Harbor, FL 34684 Brooksville, FL 34613Phone: (727) 773-3410 (352) 597-3023

Fax: (727) 773-3411 (352) 597-3024Email:

OCALA REGIONAL MEDICAL CENTER Lisa Prince H. Rex EtheredgeHosp. Code: 10-0212 Title: Director - PAS Chief Executive Officer

City,Zip

[email protected]



NORTHWEST FLORIDA COMMUNITY HOSPITAL
















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Last Updated:


Mailing Add: 335 Crossing Blvd. 1431 SW First AveneuOrange Park, FL 32073 Ocala, FL 34471

Phone: (904) 688-6614 (352) 401-1101Fax: (904) 688-7614 (352) 401-1198

Email:

Bridget Walters Keith EggerHosp. Code: 10-0006 Title: Billing/Government Manager Corporate Dir. Patient Financial Serv.

Mailing Add: 3090 Caruso Court 1414 Kuhl AvenueOrlando, FL 32806-2093 Orlando, FL 32806-2093

Phone: (407) 650-3771 (407) 237-6393Fax: (407) 650-5044 (407) 237-6328


Lisa W. Prince Thomas R. PentzHosp. Code: 10-0226 Title: Collections Director - PAS Chief Executive Officer

Mailing Add: 335 Crossing Blvd. 2001 Kingsley AvenueOrange Park, FL 32073 Orange Park, FL 32073

Phone: (904) 688-6614 (904) 276-8769Fax: (904) 688-7614 (904) 276-8610

Email:

ORLANDO REGIONAL MED. CNTR. Mari Anne Moore Sherrie SitarikHosp. Code: 10-0006 Title: Manager Patient Financial Services President/CEO

Mailing Add: 3090 Caruso Court 1414 Kuhl AvenueOrlando, FL 32806 Orlando, FL 32806

Phone: (407) 650-3750 (321) 841-5111 ext. 6308Fax: (321) 843-6129 (321) 843-6797

Email:

PALMS WEST HOSPITAL Kris Panetta Bland EngHosp. Code: 11-0006 Title: Director of Patient Account Services Chief Operating Officer

Mailing Add: 31975 US Highway 19 North 13001 Southern Blvd.Palm Harbor, FL 34684 Loxhatchee, FL 33470

Phone: (727) 773-3410 (561) 798-3300Fax: (727) 773-3411 (561) 791-8108

Email:

PLANTATION GENERAL HOSPITAL Kris Panetta Barbara J. SimmonsHosp. Code: 11-0167 Title: Director RN, CEO

Mailing Add: 31975 US Highway 19 North 401 NW 42nd AvenuePalm Harbor, FL 34684 Plantation, FL 33317

Phone: (727) 773-3410 (954) 513-6006Fax: (727) 773-3411 (954) 587-3220

Email:

RAULERSON HOSPITAL Lisa Prince Robert LeeHosp. Code: 10-0252 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 335 Crossing Blvd. 1796 Highway 441 North City,Zip Orlando, FL 32073 Okeechobee, FL 34972

City,Zip


ORLANDO REGIONAL MEDICAL CENTER

City,Zip

[email protected]

ORANGE PARK MEDICAL CENTER, INC.




















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Phone: (904) 688-6614 (863) 824-2760Fax: (904) 688-7614 (863) 824-2991

Email:

Kris Panetta Steve RectorHosp. Code: 10-0256 Title: Director of Patient Account Services CEO

Mailing Add: 31975 US Highway 19 North 14000 Fivay RoadPalm Harbor, FL 34684 Hudson, FL 34667

Phone: (727) 773-3410 (727) 869-5414Fax: (727) 773-3411 (727) 869-5491

Email:

Rick Hess Roger HallHosp. Code: 2396-0041 Title: Director of Reimbursement CEO

Mailing Add: 5130 Bayou Blvd. 7800 US Highway 98 WestPensacola, FL 32504 Miramar Beach, FL 32550

Phone: (850) 416-7029 (850) 278-30014Fax: (850) 416-7014

Email:

Rick Hess Carol SchmidtHosp. Code: 10-0025 Title: Director of Reimbursement President

Mailing Add: 5130 Bayou Blvd. 5151 North 9th AvenuePensacola, FL 32504 Pensacola, FL 32504

Phone: (850) 416-7029 (850) 416-6497Fax: (850) 416-7014 (850) 416-6119

Email:


REGIONAL MEDICAL CENTER BAYONET POINT



SACRED HEART HOSPITAL - EMERALD COAST



SACRED HEART HOSPITAL - PENSACOLA











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ST. JOSEPH'S HOSPITAL Jessica Villafana Opyd Lorraina LuttonHosp. Code: 10-0075 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer

Mailing Add: 3986 Tampa Road 3001 W. Dr. M.L. King, Jr. Blvd.Oldsmar, FL 34677 Tampa, FL 33607

Phone: (813) 852-3305 (813) 870-4020Fax: (813) 635-7731 (813) 870-4639

Email:

ST. LUCIE MEDICAL CENTER Lisa Prince Gary CantrellHosp. Code: 10-0260 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 335 Crossing Blvd. 1800 SE Tiffany Avenue City,Zip Orlando, FL 32073 Port St. Lucie, FL 34952

Phone: (904) 688-6614 (772) 335-4000 ext. 3100Fax: (904 688-7614 (772) 398-3670

Email:

ST. LUKE'S HOSPITAL Mike Duclos Donnie RomineHosp. Code: 2396-0088 Title: Director President

Mailing Add: 4201 Belfort Road 4201 Belfort RoadJacksonville, FL 32216 Jacksonville, FL 32216

Phone: (904) 450-6020 (904) 296-4368Fax: (904) 296-3760 (904) 296-3760

Email:

Kris Panetta Robert B. Conroy, Jr. Hosp. Code: 10-0180 Title: Director of Patient Account Services Chief Executive Officer

Mailing Add: 31975 US Highway 19 North 6500 38th Avenue NorthPalm Harbor, FL 34684 St. Petersburg, FL 33710

Phone: (727) 773-3410 (727) 341-4801Fax: (727) 773-3411 (727) 341-4889

Email:

ST. VINCENT'S HOSPITAL Susan Lindahl Mark DoyleHosp. Code: 10-0040 Title: Financial Analyst III EVP/CFO

Mailing Add: 4201 Belfor Rd., Joe Adams Bldg, 4th Flr 1 Shircliff WayJacksonville, FL 32216 Jacksonville, FL 32204(904) 450-6029 (904) 308-1258

Fax: (904) 281-5461 (904) 308-1233Email:

Wendy Martin Steven SalyerHosp. Code: 10-0113 Title: Chief Financial Officer Chief Executive Officer

Mailing Add: 922 East Call Street 922 East Call StreetStarke, FL 32091 Starke, FL 32091

Phone: (904) 368-2374 (904) 368-2351Fax: (904) 368-2306 (904) 368-2306

Email:

Shakawn Jones James R. BurkhartHosp. Code: 10-0001 Title: Manager, Patient Financial Services President & CEO

Mailing Add: 655 West 8th Street 655 West 8th Street






ST. PETERSBURG GENERAL HOSPITAL



Certified - 11/2/11 City,Zip Phone:


SHANDS TEACHING HOSPITAL AND CLINICS



SHANDS JACKSONVILLE MEDICAL CENTER













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Jacksonville, FL 32209 Jacksonville, FL 32209Phone: (904) 244-1877 (904) 244-4000

Fax: (904) 244-1957 (904) 244-4027Email:

SHANDS HOSPITAL @ Lakeshore

Vivian Pearson Rhonda SherrodHosp. Code: 10-0102 Title: Patient Access Director Chief Executive Officer

Mailing Add: 368 N.E. Franklin Street 368 N.E. Franklin StreetLake City, FL 32055 Lake City, FL 32055

Phone: (386) 292-8029 (386) 292-8120Fax: (386) 292-8070 (386) 292-8121

Email:


[email protected]






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SHANDS HOSPITAL @ Live Oak Neysa Lewis Ricardo DiazHosp. Code: 10-0146 Title: Business Office Manager CEO

Mailing Add: 1100 S.W. 11th Street 1100 S.W. 11th StreetLive Oak, FL 32064 Live Oak, FL 32064

Phone: (386) 362-0830 (386) 362-0840Fax: (386) 362-0829 (386) 362-0841

Email:

SHANDS HOSPITAL @ StarkeFaye Swilley Jeannie Baker

Hosp. Code: 10-0103 Title: Financial Counselor AdministratorMailing Add: 922 E. Call Street 922 E. Call Street

Starke, FL 32091 Starke, FL 32091Phone: (904) 368-2300 ext. 236 (904) 368-2300 ext. 345

Fax: (904) 964-3451 (904) 964-3451Email:

SOUTH FLORIDA BAPTIST HOSPITAL

Jessica Villafana Opyd Stephen NiermanHosp. Code: 10-0132 Title: Supervisor- Financial Assistance Dept. Chief Operating Officer

Mailing Add: 3986 Tampa Road 301 North Alexander StreetOldsmar, FL 34677 Plant City, FL 33566

Phone: (813) 852-3305 (813) 757-1205Fax: (813) 635-7731 (813) 757-8204

Email:SUN CITY HOSPITAL, INC. Kris Panetta Sharon L. Roush

Hosp. Code: 10-0259 Title: Director, Patient Account Services Chief Executive OfficerMailing Add: 31975 US Hwy 19 North 4016 Sun City Center Blvd

Palm Harbor, FL 34684 Sun City Center, FL 33573Phone: (727) 773-3410 (813) 634-3301 ext. 1101

Fax: (727) 773-3411 (813) 634-8712Email:

TALLAHASSEE MEMORIAL HOSPITALJulie Burnett G. Mark O'Bryant

Hosp. Code: 10-0135 Title: Director, Medical Data Systems President, Chief Executive OfficerMailing Add: 1309 Thomasville Road 1300 Miccosukee Road

Tallahassee, FL 32303 Tallahassee, FL 32308Phone: (850) 431-5781 (850) 431-5380

Fax: (850) 431-6915 (850) 431-5883Email:

TAMPA GENERAL HOSPITAL Kimberly Shepherd Ronald A. HytoffHosp. Code: 10-0128 Title: Manager, ED Registrations and Financial Ass President, Chief Executive Officer

Mailing Add: 1 Tampa General Circle 1 Tampa General CircleTampa, FL 33606 Tampa, FL 33606

Phone: (813) 844-7406 (813) 844-7662Fax: (813) 844-4391 (813) 844-4144

Email:

THE VILLAGES REGIONAL HOSPITALGrant L. Glines Timothy F. Hawkins

























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Hosp. Code: 2396-0032 Title: Assistant Controller EVP/COOMailing Add: 600 East Dixie Avenue 1351 El Camino Real

Leesburg, FL 34748 The Villages, FL 32159Phone: (352) 323-5695 (352) 751-8002

Fax: (352) 323-5039 (352) 751-8011Email:





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UNIVERSITY COMMUNITY HOSPITALJed Chilton Janice Hagensicker

Hosp. Code: 10-0173 Title: Manager, Medical Finance Assistance CFOMailing Add: 3102 East 183th Avenue 3100 E. Fletcher Avenue

Tampa, FL 33613 Tampa, FL 33613Phone: (813) 615-7481 (813) 615-7853

Fax: (813) 615-7704 (813) 615-7339Email:

Vertie Nail Donald EvansHosp. Code: 10-0069 Title: Patient Accounting Support Rep. Chief Executive Officer

Mailing Add: 7171 N. Dale Mabry Hwy. 7171 N. Dale Mabry Hwy.Tampa, FL 33614 Tampa, FL 33614-2670

Phone: (813) 558-8006 (813) 932-2222, ext. 8001Fax: (813) 558-8007 (813) 558-8011

Email:

UNIVERSITY HOSPITAL, LTD Kris Panetta William Mark RaderHosp. Code: 10-0224 Title: Director, Patient Access Services Tampa Chief Executive Officer

Mailing Add: 31975 US Hwy. 19 North 7201 N. University DrivePalm Harbor, FL 34684 Tamarac, FL 33321

Phone: (727) 773-3410 (954) 724-2200 ext. 6101Fax: (727) 773-3411 (954) 724-6567

Email:

Kris Panetta Kevin CorcoranHosp. Code: 10-0228 Title: Director of Patient Account Services CFO

Mailing Add: 31975 US Highway 19 North 8201 West Broward Blvd.Palm Harbor, FL 34684 Plantation, FL 33324

Phone: (727) 773-3410 (954) 476-3987Fax: (727) 773-3411 (954) 452-2133

Email:

WINTER HAVEN HOSPITAL Kim Kinney Lance AnatasioHosp. Code: 10-0052 Title: Reimbursement Coordinator Chief Executive Officer

Mailing Add: 200 Avenue F NE 200 Avenue F NEWinter Haven, FL 33881 Winter Haven, FL 33881

Phone: (863) 293-1121 ext. 3054 (863) 297-1899Fax: (863) 291-6757 (863) 297-1867

Email:



UNIVERSITY COMMUNITY HOSPITAL @ CARROLWOOD


Certified -9/9/11 City,Zip


WESTSIDE REGIONAL MEDICAL CENTER













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