AGENCY FOR HEALTH CA

Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
ADVENTHEALTH ORLANDO (File # 100007) 4369
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ADVENTHEALTH SEBRING (File # 100109) 4171
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION SACRED HEART PENSACOLA (File #
100025) 4433
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION ST VINCENT'S MEDICAL CENTER - CLAY
COUNTY (File # 23960117) 4515
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 1 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
ASCENSION ST VINCENT'S MEDICAL CENTER -
RIVERSIDE (File # 100040) 4376
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION ST VINCENT'S MEDICAL CENTER -
SOUTHSIDE (File # 23960088) 4494
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
AVENTURA HOSPITAL AND MEDICAL CENTER (File #
100131) 4430
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER - BEACHES (File #
100117) 4304
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 2 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE (File #
100088) 4448
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

BAPTIST MEDICAL CENTER - NASSAU (File # 100140) 4355

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BARTOW REGIONAL MEDICAL CENTER (File #
100121) 4428
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BETHESDA HOSPITAL EAST (File # 100002) 4452
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 3 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Email:
BLAKE MEDICAL CENTER (File # 100213) 4323
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

BRANDON REGIONAL HOSPITAL (File # 100243) 4403

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CENTRAL FLORIDA REGIONAL HOSPITAL (File #
100161) 4032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

CITRUS MEMORIAL HOSPITAL (File # 100023) 4233

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 4 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Email:
HIGHLANDS REGIONAL MEDICAL CENTER (File #
100049) 4321
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

JACKSON MEMORIAL HOSPITAL (File # 100022) 3998

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER (File # 100248) 4398
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

MEASE COUNTRYSIDE HOSPITAL (File # 110001) 4378

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 5 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Email:
MEDICAL CENTER OF TRINITY (File # 100191) 4400
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEMORIAL HOSPITAL OF JACKSONVILLE (File #
100179) 4447
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

MEMORIAL HOSPITAL OF TAMPA (File # 100206) 4112

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL (File # 100127) 4064
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 6 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
MORTON PLANT NORTH BAY HOSPITAL (File #
100063) 4216
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHSIDE HOSPITAL (File # 100238) 4324
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
OAK HILL HOSPITAL (File # 100264) 4315
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ORLANDO HEALTH ORLANDO REGIONAL MEDICAL
CENTER (File # 100006) 4393
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 7 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #

PLANTATION GENERAL HOSPITAL (File # 100167) 4384

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

POINCIANA MEDICAL CENTER (File # 23960111) 4513

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PUTNAM COMMUNITY MEDICAL CENTER (File #
100232) 4350
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL (File # 100252) 4320
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 8 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
REGIONAL MEDICAL CENTER BAYONET POINT (File #
100256) 4312
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST (File # 23960041) 4470
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF (File #
23960084) 4502
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH BAY HOSPITAL (File # 100259) 4198
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 9 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #

SOUTH FLORIDA BAPTIST HOSPITAL (File # 100132) 4056

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL (File # 100075) 4292
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL (File #
100180) 3942
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HEALTHCARE (File #
100135) 4080
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 10 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
TAMPA GENERAL HOSPITAL (File # 100128) 4044
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TWIN CITIES HOSPITAL (File # 100054) 4052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UNIVERSITY HOSPITAL AND MEDICAL CENTER (File #
100224) 4402
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UF HEALTH SHANDS (File # 100113) 4286
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER HAVEN HOSPITAL (File # 100052) 3974
Name:

Page 11 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2020 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Email:

Page 12 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Daryl Tol Coy Ingram

President and CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderly Place, 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Randall Surber Ira Arnan

CEO Regional Director, Patient Financial Services
4200 Sun N' Lake Boulevard 1200 West Anon Blvd, Suite 201
Sebring, FL 33872 Avon Park, FL 33825
(863) 402-3366 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
5151 N. 9th Avenue 5151 N. 9th Avenue
Pensacola, FL 32504 Pensacola, FL 32504
(850) 416-7010 (850) 416-7099
(850) 416-6119 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

Page 13 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

David Lemonte Ana Banegas

CEO Public Benefit Coordinator
20900 Biscayne Boulevard 20900 Biscayne Boulevard
Aventura, FL 33180 Aventura, FL 33180
(305) 682-7000 (305) 937-3961
(305) 682-7042
[email protected] [email protected]

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096

Page 14 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

[email protected] [email protected]

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096
[email protected] [email protected]

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096
[email protected] [email protected]

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
2200 Osprey Blvd 2985 Drew Street, Mail Stop 1049
Bartow, FL 33830 Clearwater, FL 33759
(863) 519-1402 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Nelson Lazo Shelli Luckey

CEO Patient Financial Services Manager
2815 S. Seacrest Blvd. 2815 S. Seacrest Blvd.
Boynton Beach, FL 33435 Boynton Beach, FL 33435
(561) 737-7733, ext. 84400 (561) 737-7733, ext. 84010

Page 15 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

[email protected] [email protected]

Randal B. Currin, Jr. Lupe Melendez

CEO Public Benefit Coordinator
2020 59th Street West 2020 59th Street West
Bradenton, FL 34209 Bradenton, FL 34209
(941) 792-6611 (941) 798-6001
(941) 798-6209
[email protected] [email protected]

D. Bland Eng Ana Almodovar

CEO Public Benefit Coordinator
119 Oakfield Drive 119 Oakfield Drive
Brandon, FL 33511 Brandon, FL 33511
(813) 682-5551 (813) 681-5551, ext. 3366
(813) 571-5125
[email protected] [email protected]

Earl R. Abshier III Sonia Marerro

CEO Public Benefit Coordinator
1401 West Seminole Boulevard 1401 West Seminole Boulevard
Sanford, FL 32771 Sanford, FL 32771
(407) 321-4500 (407) 321-4500, ext. 5259
(407) 324-2155
[email protected] [email protected]

Ginger Carroll Denise Morales

CEO Public Benefit Coordinator
502 West Highland Boulevard 502 West Highland Boulevard
Inverness, FL 34452 Inverness, FL 34452
(352) 726-1551 (727) 773-3001
(352) 344-6565

Page 16 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

[email protected] [email protected]

Jason Kimbrell Daniela Delgado

CEO Public Benefit Coordinator
3600 South Highlands Avenue 3600 South Highlands Avenue
Sebring, FL 33870 Sebring, FL 33870
(863) 385-6101 (863) 314-3198
(863) 314-5865
[email protected] [email protected]

Carlos Migoya Denise Don

President / CEO Associated Director Uncompensated Care
1611 NW 12 Ave - West Wing # 117 1611 NW 12 Ave - Park Plaza East, 1st Floor, Suite K
Miami, FL 33136 Miami, FL 33136
(305) 585-6754 (305) 585-7231

[email protected] [email protected]

Adam C. Rudd Beth Weekes

CEO Public Benefit Coordinator
201 14th Street SW 201 14th Street SW
Largo, FL 33770 Largo, FL 33770
(727) 588-5200 (727) 588-5489
(727) 588-5906
[email protected] [email protected]

Matthew Novak Jessica Villafana Opyd

President Financial Assistance Coordinator
601 Main Street 2985 Drew Street, Mail Stop 1049
Dunedin, FL 34698 Clearwater, FL 33759
(727) 725-6222 (727) 281-9084
(813) 635-7731

Page 17 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

[email protected] [email protected]

Leigh Massengill Wilfredo Gonzalez

CEO Public Benefit Coordinator
9330 State Road 54 9330 State Road 54
Trinity, FL 34655 Trinity, FL 34655
(727) 834-4000 (727) 834-5720
(727) 834-4912
[email protected] [email protected]

Bradley S. Talbert Scharhonda Williams-Etzey

CEO Public Benefit Coordinator
3625 University Boulevard South 3625 University Boulevard South
Jacksonville, FL 32216 Jacksonville, FL 32216
(904) 702-6111 (904) 391-1518
(904) 399-6849
[email protected] [email protected]

Sonia I. Wellman Robert Alcantara

CEO Public Benefit Coordinator
2901 West Swann Avenue 2901 West Swann Avenue
Tampa, FL 33609 Tampa, FL 33609
(813) 873-6400 (813) 512-5851
(813) 873-6486
[email protected] [email protected]

Lou Galdieri Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
300 Pinellas Street 2985 Drew Street, Mail Stop 1049
Clearwater, FL 33756 Clearwater, FL 33759
(727) 462-7101 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Page 18 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Brandon May Jessica Villafana Opyd

President Financial Assistance Coordinator
660 Madison Street 2985 Drew Street, Mail Stop 1049
New Port Richey, FL 34652 Clearwater, FL 33759
(727) 843-4509 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Valerie Powell-Stafford Cynthia Bacon

CEO Public Benefit Coordinator
6000 49th Street North 6000 49th Street North
St. Petersburg, FL 33709 St. Petersburg, FL 33709
(727) 521-4411 (727) 521-5558
(727) 521-5007
Valerie.Powell-Stafford#HCAHealthcare.com [email protected]

Jesse Smith Nicholas Hernandez

CEO Public Benefit Coordinator
11375 Cortez Boulevard 11375 Cortez Boulevard
Brooksville, FL 34613 Brooksville, FL 34613
(352) 596-6632 (352) 597-6371
(352) 597-3024
[email protected] [email protected]

David Strong Lee Weston

President Financial Clearance
1414 Kuhl Avenue 3160 Southgate Commerce Blvd, Suite 40
Orlando, FL 32806 Orlando, FL 32806
(321) 841-5111 (407) 340-4122
(321) 843-6358 (321) 843-1820
[email protected] [email protected]

Page 19 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Madeline Nava Fabiola Dickson

CEO Public Benefit Coordinator
401 Northwest 42nd Avenue 401 Northwest 42nd Avenue
Plantation, FL 33317 Plantation, FL 33317
(954) 587-5010 (954) 587-5010, ext. 6650
(954) 587-3220
[email protected] [email protected]

Christopher Cosby Dulce Gorostieta

CEO Public Benefit Coordinator
325 Cypress Parkway 325 Cypress Parkway
Kissimmee, FL 34758 Kissimmee, FL 34758
(407) 530-2000 (407) 530-2454
(407) 530-2020
[email protected] [email protected]

Mark Dooley Alicia English

CEO Public Benefit Coordinator
611 Zeagler Drive 611 Zeagler Drive
Palatka, FL 32177 Palatka, FL 32177
(386) 328-5711 (386) 326-7889
(386) 325-8178
[email protected] [email protected]

Brian Melear Crystal Perez

CEO Public Benefit Coordinator
1796 Highway 441 North 1796 Highway 441 North
Okeechobee, FL 34972 Okeechobee, FL 34972
(863) 763-2151 (863) 824-2870
(863) 824-2991
[email protected] [email protected]

Page 20 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Regina Temple Kathleen Alvelo

CEO Public Benefit Coordinator
14000 Fivay Road 14000 Fivay Road
Hudson, FL 34667 Hudson, FL 34667
(727) 819-2929 (727) 819-2929, ext. 5365
(727) 869-5491
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
7800 US Hwy 98 West c/o Sacred Heart Emerald Coast 5151 N. 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7066
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
7800 US Hwy 98 West c/o Sacred Heart Emerald Coast 5151 N. 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7066
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Daniel Bender Veronica Vargas

CEO Public Benefit Coordinator
4016 Sun City Center Blvd 4016 Sun City Center Blvd
Sun City Center, FL 33573 Sun City Center, FL 33573
(813) 634-3301 (813) 634-0488
(813) 634-8712
[email protected] [email protected]

Page 21 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
301 North Alexander Street 2985 Drew Street, Mail Stop 1049
Plant City, FL 33563 Clearwater, FL 33759
(813) 757-1205 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Kimberly Guy Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
3001 W. Dr Martin Luther King Jr. Blvd 2985 Drew Street, Mail Stop 1049
Tampa, FL 33607 Clearwater, FL 33759
(813) 870-4097 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Kenneth Wicker Annette Fazio

CEO Public Benefit Coordinator
6500 38th Avenue North 6500 38th Avenue North
St. Petersburg, FL 33710 St. Petersburg, FL 33710
(727) 384-1414 (727) 341-4829
(727) 341-4889
[email protected] [email protected]

Mark O'Bryant Latasha McDowell

President / CEO Disability Specialist
1300 Miccosukee Road 1300 Miccosukee Road
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 431-5380 (850) 431-5912
(850) 432-6929 (850) 656-9836
[email protected] [email protected]

Page 22 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

John Couris Anthony Escobio

President / CEO VP, Patient Financial Services
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-4520 (813) 844-4764
(813) 844-4144 (813) 844-4144
[email protected] [email protected]

David A. Whalen Michelle Castro

CEO Public Benefit Coordinator
2190 Highway 85 North 2190 Highway 85 North
Niceville, FL 32578 Niceville, FL 32578
(850) 678-4131 (850) 729-9423
(850) 729-9306
[email protected] [email protected]

Benjamin Harris Jose Martinez

CEO Public Benefits Coordinator
7201 North University Drive 7201 North University Drive
Tamarac, FL 33321 Tamarac, FL 33321
(954) 721-2200 (954) 724-6144
(954) 724-6567
[email protected] [email protected]

Edward Jimenez Grace Chesser

CEO Admissions Director
1600 SW Archer Road 1600 SW Archer Road
Gainesville, FL 32610-3003 Gainesville, FL 32610-3003
(352) 733-1500 (352) 594-4727
(352) 265-0231 (352) 265-0624
[email protected] [email protected]

Stephen Nierman Jessica Villafana Opyd

Page 23 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2020 - September 30, 2021

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

President Financial Assistance Coordinator
200 Ave F NE 2985 Drew Street, Mail Stop 1049
Winter Haven, FL 33881 Clearwater, FL 33759
(863) 297-1890 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Barrett Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
[email protected] [email protected]

Page 24 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Angela Durham
Director, Self-Pay Management
900 Winderly Place, 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
[email protected]

Dillon Sebastian
Operations Manager
26533 Evergreen Road, Suite 700
Southfield, MI 48076
(248) 327-1050

[email protected]

Shawndria Hill
OPS Billing Supervisor
26533 Evergreen Road, Suite # 700
Southfield, MI 48076
(248) 327-1308

[email protected]

Page 25 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Shawndria Hill
OPS Billing Supervisor
26533 Evergreen Road, Suite # 700
Southfield, MI 48076
(248) 327-1308

[email protected]

Shawndria Hill
OPS Billing Supervisor
26533 Evergreen Road, Suite # 700
Southfield, MI 48076
(248) 327-1308

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Krista Harrison
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 393-2997

Page 26 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

[email protected]

Krista Harrison
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 393-2997
[email protected]

Krista Harrison
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 393-2997
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Pamela Abbott
Patient Financial Services Director
2815 S. Seacrest Blvd.
Boynton Beach, FL 33435
(561) 737-7733, ext. 67751

Page 27 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411

Page 28 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Yorka Faldrage
Associate Administrator
1500 NW 12 Ave - Jackson Medical Towers West, 10th Floor
Miami, FL 33136
(786) 466-8135

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731

Page 29 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 30 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jamille Winters
Manager, Patient Accouting
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3741
(321) 843-6837
[email protected]

Page 31 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Page 32 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Dillon Sebastian
Operations Manager
26533 Evergreen Road, Suite 700
Southfield, MI 48076
(248) 327-1050

[email protected]

Dillon Sebastian
Operations Manager
26533 Evergreen Road, Suite 700
Southfield, MI 48076
(248) 327-1050

[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Page 33 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Latrenda Cooper
Medicaid Billing Manager
1607-1 St. James Court
Tallahassee, FL 32308
(850) 432-6205
(850) 432-6929
[email protected]

Page 34 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Anthony Escobio
VP, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Cindy Charyulu
VP, Revenue Cycle
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 265-9022
(352) 265-9012
[email protected]

Jessica Villafana Opyd

Page 35 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

November 13, 2020

HCRA Claims Processing

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 36 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #

ADVENTHEALTH CARROLLWOOD (File # 100069) 4179

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ADVENTHEALTH NORTH PINELLAS (File # 100055) 4333

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ADVENTHEALTH ORLANDO (File # 100007) 4369
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ADVENTHEALTH SEBRING (File # 100109) 4171
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ADVENTHEALTH TAMPA (File # 100173) 4035

Page 37 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ADVENTHEALTH WAUCHULA (File # 100282) 4239
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ADVENTHEALTH WESLEY CHAPEL (File # 23960099) 4508

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ADVENTHEALTH ZEPHYRHILLS (File # 100046) 4445

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION SACRED HEART PENSACOLA (File #
100025) 4433

Page 38 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION ST VINCENT'S MEDICAL CENTER - CLAY
COUNTY (File # 23960117) 4515
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION ST VINCENT'S MEDICAL CENTER -
RIVERSIDE (File # 100040) 4376
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ASCENSION ST VINCENT'S MEDICAL CENTER -
SOUTHSIDE (File # 23960088) 4494
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 39 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
AVENTURA HOSPITAL AND MEDICAL CENTER (File #
100131) 4430
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST HOSPITAL INC (File # 100093) 4456
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER - BEACHES (File #
100117) 4304
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE (File #
100088) 4448
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 40 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #

BAPTIST MEDICAL CENTER - NASSAU (File # 100140) 4355

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BARTOW REGIONAL MEDICAL CENTER (File #
100121) 4428
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BETHESDA HOSPITAL EAST (File # 100002) 4452
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

BETHESDA HOSPITAL WEST (File # 23960098) 4452

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 41 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
BLAKE MEDICAL CENTER (File # 100213) 4323
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

BRANDON REGIONAL HOSPITAL (File # 100243) 4403

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CENTRAL FLORIDA REGIONAL HOSPITAL (File #
100161) 4032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

CITRUS MEMORIAL HOSPITAL (File # 100023) 4233

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 42 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
FLAGLER HOSPITAL (File # 100219) 3665
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
GULF COAST REGIONAL MEDICAL CENTER (File #
100242) 4337
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

HALIFAX HEALTH MEDICAL CENTER (File # 100017) 4181

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

HENDRY REGIONAL MEDICAL CENTER (File # 100098) 3995

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 43 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
HIGHLANDS REGIONAL MEDICAL CENTER (File #
100049) 4321
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

JACKSON MEMORIAL HOSPITAL (File # 100022) 3998

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL (File # 100048) 4036
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JFK MEDICAL CENTER (File # 100080) 4368
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 44 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
KENDALL REGIONAL MEDICAL CENTER (File #
100209) 4344
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER (File # 100248) 4398
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEESBURG REGIONAL MEDICAL CENTER (File #
100084) 4000
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

MEASE COUNTRYSIDE HOSPITAL (File # 110001) 4378

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 45 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
MEDICAL CENTER OF TRINITY (File # 100191) 4400
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

MEMORIAL HOSPITAL OF TAMPA (File # 100206) 4112

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL (File # 100127) 4064
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL (File #
100063) 4216
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHSIDE HOSPITAL (File # 100238) 4324

Page 46 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

NORTHWEST MEDICAL CENTER (File # 100189) 4383

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
OAK HILL HOSPITAL (File # 100264) 4315
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ORLANDO HEALTH ORLANDO REGIONAL MEDICAL
CENTER (File # 100006) 4393
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
OVIEDO MEDICAL CENTER (File # 23960121) 4523
Name:

Page 47 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

PALMS OF PASADENA HOSPITAL (File # 100126) 4317

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PALMS WEST HOSPITAL (File # 110006) 4164
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

PLANTATION GENERAL HOSPITAL (File # 100167) 4384

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

POINCIANA MEDICAL CENTER (File # 23960111) 4513

Name:

Page 48 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL (File # 100252) 4320
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
REGIONAL MEDICAL CENTER BAYONET POINT (File #
100256) 4312
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST (File # 23960041) 4470
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF (File #
23960084) 4502
Name:

Page 49 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SHANDS LAKESHORE (File # 100102) 4268
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH BAY HOSPITAL (File # 100259) 4198
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

SOUTH FLORIDA BAPTIST HOSPITAL (File # 100132) 4056

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL (File # 100075) 4292
Name:
Title:
Mailing Add:

Page 50 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL (File #
100180) 3942
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HEALTHCARE (File #
100135) 4080
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL (File # 100128) 4044
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
THE VILLAGES REGIONAL HOSPITAL (File #
23960032) 4464
Name:
Title:
Mailing Add:

Page 51 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
City,Zip:
Phone:
Fax:
Email:
TWIN CITIES HOSPITAL (File # 100054) 4052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UF HEALTH JACKSONVILLE (File # 100001) 4063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UF HEALTH SHANDS (File # 100113) 4286
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UNIVERSITY HOSPITAL AND MEDICAL CENTER (File #
100224) 4402
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 52 of 322
 AGENCY FOR HEALTH CA
Bureau of Cent
Health Care Responsibility Act (HCRA
October 1, 2019 - Sep

Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to a
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be ab
not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from the
from collection agency) responsible for eligibility determinations and claims processing in regards to the HCRA program m

Partcipating Hospital Name (Hospital ID and AHCA File

#) AHCA License #
Fax:
Email:
WINTER HAVEN HOSPITAL (File # 100052) 3974
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:

Page 53 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Erika Skula Kamron Lachney

CEO/President VP, Revenue Cycle Management
7171 North Dale Mabry Hwy 12470 Telecom Drive, Suite 500
Carrollwood, FL 33614 Temple Terrace, FL 33637
(813) 558-8001 (813) 615-7765
(813) 558-8011 (813) 615-7704
[email protected] [email protected]

Jason Dunkel Kamron Lachney

CEO/President VP, Revenue Cycle Management
1395 South Pinellas Avenue 12470 Telecom Drive, Suite 500
Tarpon Springs, FL 34689 Temple Terrace, FL 33637
(727) 942-5107 (813) 615-7765
(727) 942-5161 (813) 615-7704
[email protected] [email protected]

Daryl Tol Coy Ingram

President and CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderly Place, 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Randall Surber Ira Arnan

CEO Regional Director, Patient Financial Services
4200 Sun N' Lake Boulevard 1200 West Anon Blvd, Suite 201
Sebring, FL 33872 Avon Park, FL 33825
(863) 402-3366 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Page 54 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Denyse Bales-Chubb Kamron Lachney
CEO/President VP, Revenue Cycle Management
3100 E Fletcher Avenue 12470 Telecom Drive, Suite 500
Tampa, FL 33613 Temple Terrace, FL 33637
(813) 615-7203 (813) 615-7765
(813) 615-7580 (813) 615-7704
[email protected] [email protected]

Randall Surber Ira Arnan

CEO Regional Director, Patient Financial Services
4200 Sun N' Lake Boulevard 1200 West Anon Blvd, Suite 201
Sebring, FL 33872 Avon Park, FL 33825
(863) 402-3366 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Erik Wangsness Kamron Lachney

CEO/President VP, Revenue Cycle Management
2600 Bruce B Downs Blvd 12470 Telecom Drive, Suite 500
Wesley Chapel, FL 33544 Temple Terrace, FL 33637
(813) 929-5483 (813) 615-7765
(813) 929-5475 (813) 615-7704
[email protected] [email protected]

Amanda Maggard Kamron Lachney

CEO/President VP, Revenue Cycle Management
7050 Gall Blvd 12470 Telecom Drive, Suite 500
Zephyrhills, FL 33541 Temple Terrace, FL 33637
(813) 779-6201 (813) 615-7765
(813) 783-6196 (813) 615-7704
[email protected] [email protected]

Page 55 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Tom VanOsdol Michele Nelson
CEO Patient Accounts Manager
5151 N. 9th Avenue 5151 N. 9th Avenue
Pensacola, FL 32504 Pensacola, FL 32504
(850) 416-7010 (850) 416-7099
(850) 416-6119 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

Tom VanOsdol Shiela Brent

CEO HCRA Representative
1 Shircliff Way 26533 Evergreen Road, Suite # 700
Jacksonville, FL 32204 Southfield, MI 48076
(904) 308-4027 (877) 348-7063
(904) 308-2947 (248) 436-0773
[email protected] [email protected]

Page 56 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Lee Chaykin Ana Banegas

CEO Public Benefit Coordinator
20900 Biscayne Boulevard 20900 Biscayne Boulevard
Aventura, FL 33180 Aventura, FL 33180
(305) 682-7000 (305) 937-3961
(305) 682-7042
[email protected] [email protected]

Scott Raynes Lindsey Stidham Knowles

President Eligibility Supervisor
1000 West Moreno Street P.O. Box 17106
Pensacola, FL 32501 Pensacola, FL 32522-7106
(850) 434-4011 (850) 434-4103
(850) 469-7255
[email protected] [email protected]

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096
[email protected] [email protected]

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096
[email protected] [email protected]

Page 57 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Philip Boyce Sonya Petrohovich

Chief Revenue Cycle Officer Manager of Patient Financial Services
841 Prudential Drive # 1602 P.O. Box 45094
Jacksonville, FL 32207 Jacksonville, FL 32232-5094
(904) 376-3760 (904) 376-4121
(904) 391-5556 (904) 391-5096
[email protected] [email protected]

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
2200 Osprey Blvd 2985 Drew Street, Mail Stop 1049
Bartow, FL 33830 Clearwater, FL 33759
(863) 519-1402 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Nelson Lazo Shelli Luckey

CEO Patient Financial Services Manager
2815 S. Seacrest Blvd. 2815 S. Seacrest Blvd.
Boynton Beach, FL 33435 Boynton Beach, FL 33435
(561) 737-7733, ext. 84400 (561) 737-7733, ext. 84010

[email protected] [email protected]

Nelson Lazo Shelli Luckey

CEO Patient Financial Services Manager
2815 S. Seacrest Blvd. 2815 S. Seacrest Blvd.
Boynton Beach, FL 33435 Boynton Beach, FL 33435
(561) 737-7733, ext. 84400 (561) 737-7733, ext. 84010

[email protected] [email protected]

Page 58 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Randal B. Currin, Jr. Lupe Melendez

CEO Public Benefit Coordinator
2020 59th Street West 2020 59th Street West
Bradenton, FL 34209 Bradenton, FL 34209
(941) 792-6611 (941) 798-6001
(941) 798-6209
[email protected] [email protected]

D. Bland Eng Ana Almodovar

CEO Public Benefit Coordinator
119 Oakfield Drive 119 Oakfield Drive
Brandon, FL 33511 Brandon, FL 33511
(813) 682-5551 (813) 681-5551, ext. 3366
(813) 571-5125
[email protected] [email protected]

Earl R. Abshier III Sonia Marerro

CEO Public Benefit Coordinator
1401 West Seminole Boulevard 1401 West Seminole Boulevard
Sanford, FL 32771 Sanford, FL 32771
(407) 321-4500 (407) 321-4500, ext. 5259
(407) 324-2155
[email protected] [email protected]

Rafael Aleman Denise Morales

CEO Public Benefit Coordinator
502 West Highland Boulevard 502 West Highland Boulevard
Inverness, FL 34452 Inverness, FL 34452
(352) 726-1551 (727) 773-3001
(352) 344-6565
[email protected] [email protected]

Page 59 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Jason Barrett Murray S. Marsh, Jr.

President and CEO CFO
400 Health Park Blvd. 400 Health Park Blvd.
St. Augustine, FL 32086 St. Augustine, FL 32086
(904) 819-4400 (904) 819-4069
(904) 819-4472 (904) 819-4472
[email protected] [email protected]

Bradley Griffin Gina Bacuss

CEO Public Benefit Coordinator
449 West 23rd Street 449 West 23rd Street
Panama City, FL 32405 Panama City, FL 32405
(850) 769-8341 (850) 747-7860
(850) 770-8938
[email protected] [email protected]

Jeff Feasel Ronda Kennedy

President & CEO Billing Manager
303 North Clyde Morris Boulevard 303 North Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
(386) 425-4771 (386) 425-2078
(386) 425-4772 (386) 425-7715
[email protected] [email protected]

Raymond Williams Elena Sandoval

Chief Executive Officer Eligibility Specialist
524 W Sagamore Avenue 524 W Sagamore Avenue
Clewiston, FL 33440 Clewiston, FL 33440
(863) 983-9121 (863) 983-9121
(863) 983-1809 (863) 983-0155
[email protected] [email protected]

Page 60 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Jason Kimbrell Daniela Delgado

CEO Public Benefit Coordinator
3600 South Highlands Avenue 3600 South Highlands Avenue
Sebring, FL 33870 Sebring, FL 33870
(863) 385-6101 (863) 314-3198
(863) 314-5865
[email protected] [email protected]

Carlos Migoya Denise Don

President / CEO Associated Director Uncompensated Care
1611 NW 12 Ave - West Wing # 117 1611 NW 12 Ave - Park Plaza East, 1st Floor, Suite K
Miami, FL 33136 Miami, FL 33136
(305) 585-6754 (305) 585-7231

[email protected] [email protected]

Michael T. Hutchins Lindsey Stidham Knowles

VP / Administrator Eligibility Supervisor
14114 Alabama Street P.O. Box 17106
Jay, FL 32565 Pensacola, FL 32522-7106
(850) 675-8015 (850) 434-4103
(850) 675-8070 (850) 469-7255
[email protected] [email protected]

Gina Melby Anne Johnson

CEO Public Benefit Coordinator
5301 South Congress Avenue 5301 South Congress Avenue
Atlantis, FL 33462 Atlantis, FL 33462
(561) 965-7300 (561) 548-1357
(561) 642-3685
[email protected] [email protected]

Page 61 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Brandon Haushalter Maria Chaverry

CEO Public Benefit Coordinator
11750 SW 40 Street 11750 SW 40 Street
Miami, FL 33175 Miami, FL 33175
(305) 223-3000 (305) 227-5576
(305) 229-2444
[email protected] [email protected]

Adam C. Rudd Beth Weekes

CEO Public Benefit Coordinator
201 14th Street SW 201 14th Street SW
Largo, FL 33770 Largo, FL 33770
(727) 588-5200 (727) 588-5489
(727) 588-5906
[email protected] [email protected]

Donald Henderson Nancy Wise

CEO Director, Patient Access
600 E. Dixie Avenue 600 E. Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5001 (352) 323-5042
(352) 323-5009 (352) 323-5439
[email protected] [email protected]

Matthew Novak Jessica Villafana Opyd

President Financial Assistance Coordinator
601 Main Street 2985 Drew Street, Mail Stop 1049
Dunedin, FL 34698 Clearwater, FL 33759
(727) 725-6222 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Page 62 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Leigh Massengill Wilfredo Gonzalez

CEO Public Benefit Coordinator
9330 State Road 54 9330 State Road 54
Trinity, FL 34655 Trinity, FL 34655
(727) 834-4000 (727) 834-5720
(727) 834-4912
[email protected] [email protected]

Sonia I. Wellman Robert Alcantara

CEO Public Benefit Coordinator
2901 West Swann Avenue 2901 West Swann Avenue
Tampa, FL 33609 Tampa, FL 33609
(813) 873-6400 (813) 512-5851
(813) 873-6486
[email protected] [email protected]

Lou Galdieri Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
300 Pinellas Street 2985 Drew Street, Mail Stop 1049
Clearwater, FL 33756 Clearwater, FL 33759
(727) 462-7101 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Brandon May Jessica Villafana Opyd

President Financial Assistance Coordinator
660 Madison Street 2985 Drew Street, Mail Stop 1049
New Port Richey, FL 34652 Clearwater, FL 33759
(727) 843-4509 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Page 63 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Valerie Powell-Stafford Cynthia Bacon
CEO Public Benefit Coordinator
6000 49th Street North 6000 49th Street North
St. Petersburg, FL 33709 St. Petersburg, FL 33709
(727) 521-4411 (727) 521-5558
(727) 521-5007
Valerie.Powell-Stafford#HCAHealthcare.com [email protected]

Erica Gulrich Chi Smarth

CEO Public Benefit Coordinator
2801 North State Road 7 2801 North State Road 7
Margate, FL 33063 Margate, FL 33063
(954) 974-0400 (954) 956-3060
(954) 978-4183
[email protected] [email protected]

Jesse Smith Linda Murphy

CEO Public Benefit Coordinator
11375 Cortez Boulevard 11375 Cortez Boulevard
Brooksville, FL 34613 Brooksville, FL 34613
(352) 596-6632 (352) 597-6371
(352) 597-3024
[email protected] [email protected]

David Strong Michelle Farrell

President Assiatnt VP
1414 Kuhl Avenue 3160 Southgate Commerce Blvd, Suite 40
Orlando, FL 32806 Orlando, FL 32806
(321) 841-5111 (321) 841-4805
(321) 843-6358 (321) 843-6356
[email protected] [email protected]

Kenneth Donahey Lindsey Maysonet

Page 64 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

CEO Public Benefit Coordinator
8300 Red Bug Lake Road 8300 Red Bug Lake Road
Oviedo, FL 32765 Oviedo, FL 32765
(407) 890-2273 (407) 890-2011
(407) 977-2998
[email protected] [email protected]

Jacob Fisher Annette Fazio

CEO Public Benefit Coordinator
1501 Pasadena Avenue South 1501 Pasadena Avenue South
St. Petersburg, FL 33707 St. Petersburg, FL 33707
(727) 381-1000 (727) 341-4929
(727) 341-7629
[email protected] [email protected]

Joshua Detillo Yuderkis Gonzalez

CEO Public Benefit Coordinator
13001 Southern Boulevard 13001 Southern Boulevard
Loxahatchee, FL 33470 Loxahatchee, FL 33470
(561) 798-3300 (561) 798-6078
(561) 791-8108
[email protected] [email protected]

Madeline Nava Fabiola Dickson

CEO Public Benefit Coordinator
401 Northwest 42nd Avenue 401 Northwest 42nd Avenue
Plantation, FL 33317 Plantation, FL 33317
(954) 587-5010 (954) 587-5010, ext. 6650
(954) 587-3220
[email protected] [email protected]

Christopher Cosby Daisy Longo

Page 65 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

CEO Public Benefit Coordinator
325 Cypress Parkway 325 Cypress Parkway
Kissimmee, FL 34758 Kissimmee, FL 34758
(407) 530-2000 (407) 530-2454
(407) 530-2020
[email protected] [email protected]

Brian Melear Crystal Perez

CEO Public Benefit Coordinator
1796 Highway 441 North 1796 Highway 441 North
Okeechobee, FL 34972 Okeechobee, FL 34972
(863) 763-2151 (863) 824-2870
(863) 824-2991
[email protected] [email protected]

Joseph Rudisill Kathleen Alvelo

Acting CEO Public Benefit Coordinator
14000 Fivay Road 14000 Fivay Road
Hudson, FL 34667 Hudson, FL 34667
(727) 819-2929 (727) 819-2929, ext. 5365
(727) 869-5491
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
7800 US Hwy 98 West c/o Sacred Heart Emerald Coast 5151 N. 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7066
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Michele Nelson

Page 66 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

CEO Patient Accounts Manager
7800 US Hwy 98 West c/o Sacred Heart Emerald Coast 5151 N. 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7066
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Rhonda Sherrod Shatonia Williams

CEO Patient Financial Counselor
368 NE Franklin Street 368 NE Franklin Street
Lake City, FL 32055 Lake City, FL 32055
(386) 292-8120 (386) 292-8150
(386) 292-8121 (386) 292-8047
[email protected] [email protected]

Daniel Bender Veronica Vargas

CEO Public Benefit Coordinator
4016 Sun City Center Blvd 4016 Sun City Center Blvd
Sun City Center, FL 33573 Sun City Center, FL 33573
(813) 634-3301 (813) 634-0488
(813) 634-8712
[email protected] [email protected]

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
301 North Alexander Street 2985 Drew Street, Mail Stop 1049
Plant City, FL 33563 Clearwater, FL 33759
(813) 757-1205 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Kimberly Guy Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
3001 W. Dr Martin Luther King Jr. Blvd 2985 Drew Street, Mail Stop 1049

Page 67 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Tampa, FL 33607 Clearwater, FL 33759
(813) 870-4097 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Janice Balzano Annette Fazio

CEO Public Benefit Coordinator
6500 38th Avenue North 6500 38th Avenue North
St. Petersburg, FL 33710 St. Petersburg, FL 33710
(727) 384-1414 (727) 341-4829
(727) 341-4889
[email protected] [email protected]

Mark O'Bryant Latasha McDowell

President / CEO Disability Specialist
1300 Miccosukee Road 1300 Miccosukee Road
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 431-5380 (850) 431-5912
(850) 432-6929 (850) 656-9836
[email protected] [email protected]

John Couris Anthony Escobio

President / CEO VP, Patient Financial Services
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-4520 (813) 844-4764
(813) 844-4144 (813) 844-4144
[email protected] [email protected]

Donald Henderson Nancy Wise

CEO Director, Patient Access
600 E. Dixie Avenue 600 E. Dixie Avenue

Page 68 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5001 (352) 323-5042
(352) 323-5009 (352) 323-5439
[email protected] [email protected]

David A. Whalen Michelle Castro

CEO Public Benefit Coordinator
2190 Highway 85 North 2190 Highway 85 North
Niceville, FL 32578 Niceville, FL 32578
(850) 678-4131 (850) 729-9423
(850) 729-9306
[email protected] [email protected]

Leon Haley Latrisha Starkes

President and CEO Admissions Director
655 West 8th Street 655 West 8th Street
Jacksonville, FL 32209 Jacksonville, FL 32209
(904) 244-3002 (904) 244-7129

[email protected] [email protected]

Edward Jimenez Grace Chesser

CEO Admissions Director
1600 SW Archer Road 1600 SW Archer Road
Gainesville, FL 32610-3003 Gainesville, FL 32610-3003
(352) 733-1500 (352) 594-4727
(352) 265-0231 (352) 265-0624
[email protected] [email protected]

Julie Dricks Jose Martinez

Interim CEO Public Benefits Coordinator
7201 North University Drive 7201 North University Drive
Tamarac, FL 33321 Tamarac, FL 33321
(954) 721-2200 (954) 724-6144

Page 69 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2019 - September 30, 2020

hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of tr
h time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calculate t
reimbursement of indigent emergency care from the counties until we receive contact information for hospital personnel. Hospit
ims processing in regards to the HCRA program must have an email address and internet access in order to receive any HCRA u

Date Last Revised:

CEO/President HCRA Eligibility Determination

(954) 724-6567
[email protected] [email protected]

Stephen Nierman Jessica Villafana Opyd

President Financial Assistance Coordinator
200 Ave F NE 2985 Drew Street, Mail Stop 1049
Winter Haven, FL 33881 Clearwater, FL 33759
(863) 297-1890 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Barrett Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 487-6240 (850) 922-6964
[email protected] [email protected]

Page 70 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
[email protected]

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
[email protected]

Angela Haggins
Director, Self-Pay Management
900 Winderly Place, 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
[email protected]

Page 71 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
[email protected]

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
[email protected]

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
[email protected]

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
[email protected]

Page 72 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Wendy Conklin
Sr. Director, Patient Financial Services
10330 N Meridian Street
Indianapolis, IN 46290
(317) 583-3883
(317) 583-4111
[email protected]

Dave Reitman
Senior Operations Lead
26533 Evergreen Road
Southfield, MI 48076
(484) 889-2423

[email protected]

Dave Reitman
Senior Operations Lead
26533 Evergreen Road
Southfield, MI 48076
(484) 889-2423

[email protected]

Dave Reitman
Senior Operations Lead
26533 Evergreen Road
Southfield, MI 48076
(484) 889-2423

[email protected]

Page 73 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 434-4683
[email protected]

Sonya Petrohovich
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 391-5096
[email protected]

Sonya Petrohovich
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 391-5096
[email protected]

Page 74 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Sonya Petrohovich
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 391-5096
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Pamela Abbott
Patient Financial Services Director
2815 S. Seacrest Blvd.
Boynton Beach, FL 33435
(561) 737-7733, ext. 67751

[email protected]

Pamela Abbott
Patient Financial Services Director
2815 S. Seacrest Blvd.
Boynton Beach, FL 33435
(561) 737-7733, ext. 67751

[email protected]

Page 75 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Page 76 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kaitia Coby
PFS Insurance and Reimbursement Manager
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4527
(904) 819-4906
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kathleen Mitchell
Billing Supervisor
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-3823
(386) 425-7715
[email protected]

Jennifer Lesley
PFS Director
524 W Sagamore Avenue
Clewiston, FL 33440
(863) 983-9121
(863) 983-3426
[email protected]

Page 77 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Tara Roberts
Associate Administrator
1611 NW 12 Ave - Jackson Medical Towers West, 10th Floor
Miami, FL 33136
(305) 585-7231

[email protected]

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 434-4683
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Page 78 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Melissa Jones
Manager, Patient Registration
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5434
(352) 323-5439
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 79 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 80 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jamille Winters
Manager, Patient Accouting
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3741
(321) 843-6837
[email protected]

James Griffith

Page 81 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith

Page 82 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Wendy Conklin
Sr. Director, Patient Financial Services
10330 N Meridian Street
Indianapolis, IN 46290
(317) 583-3883
(317) 583-4111
[email protected]

Wendy Conklin

Page 83 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Sr. Director, Patient Financial Services
10330 N Meridian Street
Indianapolis, IN 46290
(317) 583-3883
(317) 583-4111
[email protected]

Lori Parrish
Patient Financial Representative
368 NE Franklin Street
Lake City, FL 32055
(386) 292-8038
(386) 292-8047
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049

Page 84 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Latrenda Cooper
Medicaid Billing Manager
1607-1 St. James Court
Tallahassee, FL 32308
(850) 432-6205
(850) 432-6929
[email protected]

Anthony Escobio
VP, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
[email protected]

Melissa Jones
Manager, Patient Registration
600 E. Dixie Avenue

Page 85 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

Leesburg, FL 34748
(352) 323-5434
(352) 323-5439
[email protected]

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Tammy Brisbane
Billing Manager
655 West 8th Street
Jacksonville, FL 32209
(904) 244-1877

[email protected]

Joann Yohn
Executive Director, Patient Financial Services
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 265-9022
(352) 265-9012
[email protected]

Kris Panetta
Regional Director of Medicaid Eligibility Operations
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410

Page 86 of 322
acts

ayment of treatment of a certified resident who is a

o calculate the rate of reimbursement. The Agency will
nel. Hospital personnel (may NOT be representatives
ny HCRA updates, forms and/or other information.

March 19, 2020

HCRA Claims Processing

(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 87 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
BAPTIST HOSPITAL INC 10-0093
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE 10-0088
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER NASSAU 10-0140
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BARTOW REGIONAL MEDICAL CENTER 10-0121
Name:
Title:
Mailing Add:

Page 88 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ALTAMONTE 12-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL APOPKA 12-0003
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CELEBRATION HEALTH 2396-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL EAST ORLANDO 10-0021
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 89 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL KISSIMMEE 10-0089
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ORLANDO 10-0007
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WAUCHULA 10-0282
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HALIFAX HEALTH MEDICAL CENTER 10-0017
Name:
Title:

Page 90 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JACKSON HEALTH SYSTEM 10-0022
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL 10-0048
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER 10-0248
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEASE COUNTRYSIDE HOSPITAL 11-0001
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 91 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
MORTON PLANT HOSPITAL 10-0127
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL 10-0025
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST 2396-0041
Name:
Title:

Page 92 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL 10-0075

Page 93 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL 10-0128
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UF HEALTH SHANDS JACKSONVILLE 10-0001
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER HAVEN HOSPITAL 10-0052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:

Page 94 of 322
 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2018 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:

Page 95 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

Scott Raynes Norelis Vrablik

President Eligibility Supervisor
1000 West Moreno Street P.O. Box 17106
Pensacola, FL 32501 Pensacola, FL 32522-7106
(850) 434-4011 (850) 434-4103
(850) 469-7255
[email protected] [email protected]

Joseph Mitrick Eileen Henderlite

President Vice President - Revenue Cycle
1350 13th Avenue South 3563 Philips Highway, Ste. 201
Jacksonville Beach, FL 32250 Jacksonville, FL 32207
(904) 627-2901 (904) 376-4130
(904) 627-1008 (904) 391-5073
[email protected] [email protected]

Michael Mayo Eileen Henderlite

Hospital President Vice President - Revenue Cycle
800 Prudential Drive, Adult Tower 8th Floor 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 202-2001 (904) 376-4130
(904) 202-2285 (904) 391-5073
[email protected] [email protected]

Philip Bpyce Linda Watkins

Chief Revenue Officer Manager - Patient Financial Services
841 Prudential Drive # 1602 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-3760 (904) 376-4162
(904) 391-5556 (904) 391-5074
[email protected] [email protected]

Philip Minden Jessica Villafana Opyd

President Financial Assistance Coordinator
2200 Osprey Blvd 2985 Drew Street, Mail Stop 1049

Page 96 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

Bartow, FL 33830 Clearwater, FL 33759
(863) 519-1402 (727) 281-9159
(813) 635-7731
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Page 97 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

Bruce Bergherm Ira Arnan

CEO Patient Financial Services Director
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 314-4466 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Coy Ingram

President & CEO Vice President, Revenue Cycle
550 E. Rollins Street 900 Winderley Place Stuie 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-2270
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Bruce Bergherm Ira Arnan

CEO Patient Financial Services Director
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 314-4466 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Jeff Feasel Ronda Kennedy

Chief Executive Officer Manager, Billing

Page 98 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

303 North Clyde Morris Boulevard 303 North Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
(386) 425-4771 (386) 425-2078
(386) 425-4772 (386) 239-2325
[email protected] [email protected]

Carlos Migoya Denise Don

President CEO Associate Administrator
1611 NW 12 Ave West Wing #117 1611 NW 12th Ave Annex Bldg 2nd Floor #218
Miami, FL 33136 Miami, FL 33136
(305) 585-6754 (305) 585-7231
(305) 355-2273
[email protected] [email protected]

Michael T. Hutchins Norelis Vrablik

Administrator Eligibility Supervisor
14114 Alabama Street P.O. Box 17106
Jay, FL 32565 Pensacola, FL 32522-7106
(850) 675-8015 (850) 434-4103
(850) 675-8070 (850) 469-7255
[email protected] [email protected]

Anthony Degina Beth Weekes

Chief Executive Officer Public Benefit Coordinator
201 14th Street SW 201 14th Street SW
Largo, FL 33770 Largo, FL 33770
(727) 588-5200 (727) 588-5489
(727) 588-5906
[email protected] [email protected]

Lou Galdieri Jessica Villafana Opyd

President Financial Assistance Coordinator
601 Main Street 2985 Drew Street, Mail Stop 1049
Dunedin, FL 34698 Clearwater, FL 33759
(727) 725-6222 (727) 281-9084
(727) 725-6181 (813) 635-7731

Page 99 of 322
GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

[email protected] [email protected]

Kris Hoce Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
300 Pinellas Street 2985 Drew Street, Mail Stop 1049
Clearwater, FL 33756 Clearwater, FL 33759
(727) 462-7100 (727) 281-9084
(727) 461-8101 (813) 635-7731
[email protected] [email protected]

Sarah Naumowich Jessica Villafana Opyd

President Financial Assistance Coordinator
6600 Madison Street 2985 Drew Street, Mail Stop 1049
New Port Richey, FL 34652 Clearwater, FL 33759
(727) 843-4599 (727) 281-9084
(727) 848-8762 (813) 635-7731
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
7800 US HWY 98 West 5151 North 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7099
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager

Page 100 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

7800 US HWY 98 West 5151 North 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7099
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Tom VanOsdol Michele Nelson

CEO Patient Accounts Manager
7800 US HWY 98 West 5151 North 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7099
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
301 North Alexander Street 2985 Drew Street, Mail Stop 1049
Plant City, FL 33563 Clearwater, FL 33759
(813) 757-1205 (727) 281-9084
(813) 757-8204 (813) 635-7731
[email protected] [email protected]

Page 101 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

Kimberly Guy Jessica Villafana Opyd
Senior Vice President Financial Assistance Coordinator
3001 W. Dr Martin Luther King Jr. Blvd 2985 Drew Street, Mail Stop 1049
Tampa, FL 33607 Clearwater, FL 33759
(813) 870-4097 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

John Couris Anthony Escobio

President & CEO Vice President, Patient Financial Services
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-4520 (813) 844-4764
(813) 844-4144 (813) 844-4144
[email protected] [email protected]

Leon Haley Jason Hardwick

President & CEO Admissions Director
655 W 8th Street 655 W 8th Street
Jacksonville, FL 32209 Jacksonville, FL 32209
(904) 244-3002 (904) 244-7310

[email protected] [email protected]

Stephen Nierman Jessica Villafana Opyd

President Financial Assistance Coordinator
200 Ave F NE 2985 Drew Street, Mail Stop 1049
Winter Haven, FL 33881 Clearwater, FL 33759
(863) 297-1890 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Barrett Mills Smith

Page 102 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2018 - September 30, 2019
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

CEO HCRA Eligibility Determination

Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 487-6240 (850) 922-6964
[email protected] [email protected]

Page 103 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 469-7285
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4130
(904) 391-5074
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049

Page 104 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

Clearwater, FL 33759
(727) 281-9159
(813) 635-7731
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Page 105 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

Ira Arnan
Patient Financial Services Director
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 386-6362
(863) 386-6473
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
[email protected]

Ira Arnan
Patient Financial Services Director
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 386-6362
(863) 386-6473
[email protected]

Kathleen Mitchell
Supervisor, Billing

Page 106 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-3823
(386) 239-2325
[email protected]

Yorka Faldraga
Associate Administratior
1500 NW 12 Ave 10th Floor JMP-West
Miami, FL 33136
(786) 466-8135

[email protected]

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 469-7285
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731

Page 107 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Renica Johnson
Follow Up Manager
PO Box 2728
Pensacola, FL 32513
(317) 583-3835
(317) 583-4111
[email protected]
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
[email protected]

Renica Johnson
Follow Up Manager

Page 108 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

PO Box 2728
Pensacola, FL 32513
(317) 583-3835
(317) 583-4111
[email protected]
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
[email protected]

Renica Johnson
Follow Up Manager
PO Box 2728
Pensacola, FL 32513
(317) 583-3835
(317) 583-4111
[email protected]
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 109 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

September 11, 2019

HCRA Claims Processing

Jessica Villafana Opyd
Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Anthony Escobio
Vice President, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
[email protected]

Tammy Brisbane
Billing Manager
655 W 8th Street
Jacksonville, FL 32209
(904) 244-1877

[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 110 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
AVENTURA HOSPITAL & MEDICAL CENTER 10-0131
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST HOSPITAL 10-0093
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE 10-0088
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER NASSAU 10-0140
Name:
Title:
Mailing Add:

Page 111 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
BLAKE MEDICAL CENTER 10-0213
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BRANDON REGIONAL HOSPITAL 10-0243
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CITRUS MEMORIAL HOSPITAL 10-0023
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 112 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
DOCTORS HOSPITAL SARASOTA 10-0166
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTORS MEMORIAL HOSPITAL 10-0078
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLAGLER HOSPITAL 10-0219
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ALTAMONTE 12-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL APOPKA 12-0003
Name:
Title:
Mailing Add:

Page 113 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CARROLLWOOD 10-0069
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CELEBRATION HEALTH 2396-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL EAST ORLANDO 10-0021
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 114 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
FLORIDA HOSPITAL KISSIMMEE 10-0089
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL NORTH PINELLAS 10-0055
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ORLANDO 10-0007
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL TAMPA 10-0173
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WAUCHULA 10-0282
Name:

Page 115 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WESLEY CHAPEL 2396-0099
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WINTER PARK 10-0162
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ZEPHYRHILLS 10-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HALIFAX HEALTH MEDICAL CENTER 10-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 116 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
HENDRY REGIONAL MEDICAL CENTER 10-0098
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JACKSON HEALTH SYSTEM 10-0022
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL 10-0048
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
KENDALL REGIONAL MEDICAL CENTER 10-0209
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAKEWOOD RANCH MEDICAL CENTER 2396-0046
Name:

Page 117 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER 10-0248
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEESBURG REGIONAL MEDICAL CENTER 10-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LIFESTREAM BEHAVIORAL HEALTH 10-4018
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEASE COUNTRYSIDE HOSPITAL 11-0001
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 118 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
MEDICAL CENTER OF TRINITY 10-0191
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEMORIAL HOSPITAL OF TAMPA 10-0206
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL 10-0127
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHSIDE HOSPITAL 10-0238

Page 119 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHWEST MEDICAL CENTER 10-0189
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ORLANDO HEALTH 10-0006
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PALMS OF PASADENA HOSPITAL 10-0126
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PALMS WEST HOSPITAL 11-0006
Name:
Title:
Mailing Add:
City,Zip:

Page 120 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
PLANTATION GENERAL HOSPITAL 10-0167
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL 10-0252
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

REGIONAL MEDICAL CENTER OF BAYONET POINT 10-0256

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL 10-0025
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 121 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST 2396-0041
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 122 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
SHANDS JACKSONVILLE MEDICAL CENTER 10-0001
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH BAY HOSPITAL 10-0259
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL 10-0075
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL 10-0180
Name:

Page 123 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENT'S MEDICAL CENTER CLAY COUNTY 2396-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENTS MEDICAL CENTER RIVERSIDE 10-0040
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ST. VINCENT'S MEDICAL CENTER SOUTHSIDE 2396-0088

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HOSPITAL 10-0135
Name:
Title:
Mailing Add:
City,Zip:

Page 124 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
TAMPA COMMUNITY HOSPITAL 10-0255
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL 10-0128
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
THE VILLAGES REGIONAL HOSPITAL 2396-0032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UF HEALTH SHANDS HOSPITAL 10-0113
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 125 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #

UNIVERSITY HOSPITAL AND MEDICAL CENTER 10-0224

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WESTSIDE REGIONAL MEDICAL CENTER 10-0228
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER HAVEN HOSPITAL 10-0052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:

Page 126 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2017 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:

Page 127 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Alisa Bert Isabel Burgin

Interim CEO Public Benefit Coordinator
20900 Biscayne Boulevard 20900 Biscayne Boulevard
Aventura, FL 33180 Aventura, FL 33180
(305) 682-7000 (305) 937-3961
(305) 682-7042
[email protected] [email protected]

Scott Raynes Norelis Vrablik

President Eligibility Supervisor
1000 West Morino Street PO Box 17106
Pensacola, FL 32501 Pensacola, FL 32522
(850) 424-4011 (850) 434-4103
(850) 469-7255
[email protected] [email protected]

Joseph Mitrick Eileen Henderlite

President Vice President - Revenue Cycle
1350 13th Avenue South 3563 Philips Highway, Ste. 201
Jacksonville Beach, FL 32250 Jacksonville, FL 32207
(904) 627-2901 (904) 376-4130
(904) 627-1008 (904) 391-5073
[email protected] [email protected]

Michael Mayo Eileen Henderlite

Hospital President Vice President - Revenue Cycle
800 Prudential Drive, Adult Tower 8th Floor 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 202-2001 (904) 376-4130
(904) 202-2285 (904) 391-5073
[email protected] [email protected]

Ed Hubel Eileen Henderlite

Hospital President Vice President - Revenue Cycle
1250 South 18th Street 3563 Philips Highway, Ste. 201

Page 128 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Fernandina Beach, FL 32034 Jacksonville, FL 32207
(904) 321-3502 (904) 376-4130
(904) 321-3511 (904) 391-5073
[email protected] [email protected]

Daniel J. Friedrich, III Debbie Pancake

Chief Executive Officer Public Benefit Coordinator
2020 59th Street West 2020 59th Street West
Bradenton, FL 34209 Bradenton, FL 34209
(941) 792-6611 (941) 798-6001
(941) 798-6209
[email protected] [email protected]

Bland Eng Ana Almodovar

Chief Executive Officer Public Benefit Coordinator
119 Oakfield Drive 119 Oakfield Drive
Brandon, FL 33511 Brandon, FL 33511
(813) 681-5551 (813) 681-5551 Xt. 3366
(813) 571-5125
[email protected] [email protected]

Wendy H. Brandon Sonia Marerro

Chief Executive Officer Public Benefit Coordinator
1401 West Seminole Boulevard 1401 West Seminole Boulevard
Sanford, FL 32771 Sanford, FL 32771
(407) 321-4500 (407) 321-4500 Xt. 5259
(407) 324-2155
[email protected] [email protected]

Rafael Aleman Tammi Kampman

Chief Executive Officer Public Benefit Coordinator
502 West Highland Boulevard 502 West Highland Boulevard
Inverness, FL 34452 Inverness, FL 34452
(352) 726-1551 (727) 773-3001
(352) 344-6565
[email protected] [email protected]

Page 129 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Robert C. Meade Sandy Williams

Chief Executive Officer Public Benefit Coordinator
5731 Bee Ridge Road 5731 Bee Ridge Road
Sarasota, FL 34233 Sarasota, FL 34233
(941) 342-1100 (941) 342-1126
(941) 379-8342
[email protected] [email protected]

JoAnn Baker Donna Boroughs

Administrator Business Office Director
P.O. Box 188 P.O. Box 188
Bonifay, FL 32425-0188 Bonifay, FL 32425
(850) 547-8001 (850) 547-8015
(850) 547-8025 (850) 547-8025
[email protected] [email protected]

Joseph Gordy Murray S. March, Jr.

CEO CFO/EVP
400 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
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100

Page 130 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Joe Johnson Coy L. Ingram

President & CEO Vice President of Revenue Cycle Operations
7171 North Dale Mabry Highway 12470 Telecom Drive, Suite 500
Carrollwood, FL 33614 Temple Terrace, FL 33637
(813) 558-8001 (813) 615-7219
(813) 558-8011 (813) 615-7704
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Bruce Bergherm Ira Arnan

CEO Patient Financial Services Director
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 314-4466 (863) 386-6362
(863) 402-3110 (863) 386-6473

Page 131 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Patricia Williams Coy L. Ingram

Chief Executive Officer/President Vice President of Revenue Cycle Operations
1395 South Pinellas Avenue 12470 Telecom Drive, Suite 500
Tarpon Springs, FL 34689 Temple Terrace, FL 33637
(727) 942-5107 (813) 615-7219
(727) 942-5161 (813) 615-7704
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Brian Adams Coy L. Ingram

Chief Executive Officer/President Vice President of Revenue Cycle Operations
3100 East Fletcher Avenue 12470 Telecom Drive, Suite 500
Tampa, FL 33613 Temple Terrace, FL 33637
(813) 615-7203 (813) 615-7219
(813) 615-7580 (813) 615-7704
[email protected] [email protected]

Bruce Bergherm Ira Arnan

Page 132 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

CEO Patient Financial Services Director
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 314-4466 (863) 386-6362
(863) 402-3110 (863) 386-6473
[email protected] [email protected]

Denyse Bales-Chubb Coy L. Ingram

Chief Executive Officer/President Vice President of Revenue Cycle Operations
2600 Bruce B Downs Boulevard 12470 Telecom Drive, Suite 500
Wesley Chapel, FL 33544 Temple Terrace, FL 33637
(813) 929-5483 (813) 615-7219
(813) 929-5475 (813) 615-7704
[email protected] [email protected]

Daryl Tol Bonnie Hache

President Senior Director, Patient Access
550 East Rollins Street 900 Winderley Place, Suite 2100
Orlando, FL 32803 Maitland, FL 32751
(407) 303-1531 (407) 200-9259
(407) 303-7935 (407) 200-4965
[email protected] [email protected]

Amanda Maggard Coy L. Ingram

CEO/President Vice President, Revenue Cycle Operations
7050 Gall Boulevard 12470 Telecom Drive, Suite 500
Zephyrhills, FL 33541 Temple Terrace, FL 33637
(813) 779-6201 (813) 615-7219
(813) 783-6196 (813) 615-7704
[email protected] [email protected]

Jeff Feasel Ronda Kennedy

Chief Executive Officer Manager, Billing
303 North Clyde Morris Boulevard 303 North Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
(386) 425-4771 (386) 425-2078

Page 133 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

(386) 425-4772 (386) 239-2325
[email protected] [email protected]

Raymond D. Williams Jennifer Lesley

Chief Executive Officer PFS Director
524 W Sagamore Avenue 524 W Sagamore Avenue
Clewiston, FL 33440 Clewiston, FL 33440
(863) 983-9121 (863) 983-9121
(863) 983-1809 (863) 983-3426
[email protected] [email protected]

Carlos Migoya Denise Don

President CEO Associate Administrator
1611 NW 12 Ave West Wing #117 1611 NW 12th Ave Annex Bldg 2nd Floor #218
Miami, FL 33136 Miami, FL 33136
(305) 585-6754 (305) 585-7231
(305) 355-2273
[email protected] [email protected]

Michael Hutchins Norelis Vrablik

Administrator Eligibility Supervisor
14114 Alabama Street PO Box 17106
Jay, FL 32505 Pensacola, FL 32522
(850) 675-8015 (850) 434-4103
(850) 675-8070 (850) 469-7255
[email protected] [email protected]

Brandon Haushalter Rosa Canseco

Chief Executive Officer Public Benefit Coordinator
11750 Bird Road 11750 SW 40 Street
Miami, FL 33175 Miami, FL 33175
(305) 223-3000 (305) 227-5576
(305) 229-2444
[email protected] [email protected]

Andy Guz Tammy Grant

Page 134 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Chief Executive Officer Director, Patient Access
8330 Lakewood Ranch Boulevard 206 Second Street East
Lakewood Ranch, FL 34202 Bradenton, FL 34208
(941) 782-2104 (941) 745-7210
(941) 782-2119 (941) 782-3575
[email protected] [email protected]

Anthony Degina Beth Weekes

Chief Executive Officer Public Benefit Coordinator
201 14th Street SW 201 14th Street SW
Largo, FL 33770 Largo, FL 33770
(727) 588-5200 (727) 588-5489
(727) 588-5906
[email protected] [email protected]

Don Henderson Nancy Wise

President Admitting Director
600 East Dixie Drive 600 East Dixie Drive
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5001 (352) 323-5042
(352) 323-5009 (352) 323-5049
[email protected] [email protected]

Jon Cherry Tracy Cooper

CEO Supervisor
P.O. Box 491000 P.O. Box 491000
Leesburg, FL 34749-1000 Leesburg, FL 34749-1000
(352) 315-7500 (352) 315-7800
(352) 360-6610 (352) 360-6656
[email protected] [email protected]

Lou Galdieri Jessica Villafana Opyd

President Financial Assistance Coordinator
601 Main Street 2985 Drew Street, Mail Stop 1049
Dunedin, FL 34698 Clearwater, FL 33759
(727) 725-6222 (727) 281-9084

Page 135 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

(727) 725-6181 (813) 635-7731
[email protected] [email protected]

Leigh Massengill Pat Cooper

Chief Executive Officer Public Benefit Coordinator
9330 State Road 54 9330 State Road 54
Trinity, FL 34655 Trinity, FL 34655
(727) 834-4000 (727) 834-5720
(727) 834-4912
[email protected] [email protected]

Sonia Wellman Ananta Boodoosingh

Chief Executive Officer Public Benefit Coordinator
2901 West Swann Ave 2901 West Swann Ave
Tampa, FL 33609 Tampa, FL 33609
813-873-6400 813-512-4851
813-873-6486
[email protected] [email protected]

Kris Hoce Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
300 Pinellas Street 2985 Drew Street, Mail Stop 1049
Clearwater, FL 33756 Clearwater, FL 33759
(727) 462-7100 (727) 281-9084
(727) 461-8101 (813) 635-7731
[email protected] [email protected]

Sarah Naumowich Jessica Villafana Opyd

President Financial Assistance Coordinator
6600 Madison Street 2985 Drew Street, Mail Stop 1049
New Port Richey, FL 34652 Clearwater, FL 33759
(727) 843-4599 (727) 281-9084
(727) 848-8762 (813) 635-7731
[email protected] [email protected]

Page 136 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Dia Nichols Cynthia Bacon
Chief Executive Officer Public Benefit Coordinator
6000 49th Steet North 6000 49th Steet North
St. Petersburg, FL 33709 St. Petersburg, FL 33709
(727) 521-4411 (727) 521-5558
(727) 521-5007
[email protected] [email protected]

Erica Gulrich Chi Smarth

Chief Executive Officer Public Benefit Coordinator
2801 North State Road 7 2801 North State Road 7
Margate, FL 33063 Margate, FL 33063
(954) 974-0400 (954) 956-3060
(954) 978-4183
[email protected] [email protected]

David Strong John Gaspelin

President / CEO Finance Director
1414 Kuhl Avenue, MP #4 1414 Kuhl Avenue, MP #8
Orlando, FL 32806 Orlando, FL 32806
(321) 841-5015 (321) 841-6308
(407) 237-6328 (321) 843-6797
[email protected] [email protected]

Sharon D. Hayes Abbey Durrin

Chief Executive Officer Public Benefit Coordinator
1501 Pasandena Ave South 1501 Pasandena Ave South
St. Petersburg, FL 33707 St. Petersburg, FL 33707
(727) 381-1000 (727) 341-7543
(727) 341-7629
[email protected] [email protected]

Eric Goldman Maria Cortes-Bolivar

Chief Executive Officer Public Benefit Coordinator
13001 Southern Boulevard 13001 Southern Boulevard
Loxahatchee, FL 33470 Loxahatchee, FL 33470

Page 137 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

(561) 798-3300 (561) 798-6078
(561) 791-8108
[email protected] [email protected]

Joseph Melchiode Fabiola Dickson

Chief Executive Officer Public Benefit Coordinator
401 Northwest 42nd Avenue 401 Northwest 42nd Avenue
Plantation, FL 33317 Plantation, FL 33317
(954) 587-5010 (954) 587-5010, ext 6650
(954) 285-2173
[email protected] [email protected]

Brian Melear Melinda Hernandez

Chief Executive Officer Public Benefit Coordinator
1796 Highway 441 North 1796 Highway 441 North
Okeechobee, FL 34972 Okeechobee, FL 34972
(863) 763-2151 (863) 824-2870
(863) 824-2991
Brian.Melear@hca healthcare.com [email protected]

C. Shayne George Kathleen Alvelo

Chief Executive Officer Public Benefit Coordinator
14000 Fivay Road 14000 Fivay Road
Hudson, FL 34667 Hudson, FL 34667
(727) 819-2929 (727) 819-2929, ext. 5365
(727) 869-5491
[email protected] [email protected]

Susan Davis Michele Nelson

Presdient and CEO Patient Accounts Manager
5151 North 9th Avenue 5151 North 9th Avenue
Pensacola, FL 32504 Pensacola, FL 32504
(850) 416-7010 (850) 416-7099
(850) 416-7458 (850) 416-6192
[email protected] [email protected]

Page 138 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Roger Hall Michele Nelson

President and CEO Patient Accounts Manager
7800 US Hwy 98 West 5151 North 9th Avenue
Miramar Beach, FL 32550 Pensacola, FL 32504
(850) 278-3001 (850) 416-7099
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Roger Hall Michele Nelson

President and CEO Patient Accounts Manager
3801 East Hwy 98 5151 North 9th Avenue
Port St Joe, FL 32456 Pensacola, FL 32504
(850) 278-3001 (850) 416-7099
(850) 278-3010 (850) 416-6192
[email protected] [email protected]

Page 139 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Russell Armistead Jason Hardwick

Chief Executive Officer Director
655 West 8th Street 655 West 8th Street
Jacksonville, FL 32209 Jacksonville, FL 32209
(904) 244-4000 (904) 244-7310

[email protected] [email protected]

Sharon L. Roush Veronica Vargas

Chief Executive Officer Public Benefit Coordinator
4016 Sun City Center Blvd 4016 Sun City Center Blvd
Sun City Center, FL 33573 Sun City Center, FL 33573
(813) 634-3301 (813) 634-0488
(813) 634-8712
[email protected] [email protected]

Karen Kerr Jessica Villafana Opyd

President Financial Assistance Coordinator
301 North Alexander Street 2985 Drew Street, Mail Stop 1049
Plant City, FL 33563 Clearwater, FL 33759
(813) 757-1205 (727) 281-9084
(813) 757-8204 (813) 635-7731
[email protected] [email protected]

Kimberly Guy Jessica Villafana Opyd

Senior Vice President Financial Assistance Coordinator
3001 W. Dr Martin Luther King Jr. Blvd 2985 Drew Street, Mail Stop 1049
Tampa, FL 33607 Clearwater, FL 33759
(813) 870-4097 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Janice Balzano Abbey Durrin

Page 140 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Chief Executive Officer Public Benefit Coordinator
6500 38th Avenue North 6500 38th Avenue North
St. Petersburg, FL 33710 St. Petersburg, FL 33710
(727) 384-1414 (727) 341-4929
(727) 341-4889
[email protected] [email protected]

Thomas J. Vanosdol Sheila Brent

President and CEO HCRA Representative
1 Shircliff Way 5505 E 13 Mile Road, Ste 300
Jacksonville, FL 32204 Warren, MI 48092
(904) 308-4027 (855) 551-5715
(904) 308-2947 (312) 276-8630
[email protected] [email protected]

Thomas J. Vanosdol Sheila Brent

President and CEO HCRA Representative
1 Shircliff Way 5505 E 13 Mile Road, Ste 300
Jacksonville, FL 32204 Warren, MI 48092
(904) 308-4027 (855) 551-5715
(904) 308-2947 (312) 276-8630
[email protected] [email protected]

Thomas J. Vanosdol Sheila Brent

President and CEO HCRA Representative
1 Shircliff Way 5505 E 13 Mile Road, Ste 300
Jacksonville, FL 32204 Warren, MI 48092
(904) 308-4027 (855) 551-5715
(904) 308-2947 (312) 276-8630
[email protected] [email protected]

G. Mark O' Bryant Rina Milan

President/CEO Patient Access Manager
1300 Miccosukee Road 1300 Miccosukee Road
Tallahassee, FL 32308 Tallahassee, FL 32308

Page 141 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

850-431-5380 (850) 431-5220
850-431-5883 (850) 656-9836
[email protected] [email protected]

Jacob J. Fisher Robert Alcantara

Chief Executive Officer Public Benefit Coordinator
6001 Webb Road 6001 Webb Road
Tampa, FL 33615 Tampa, FL 33618
(813) 888-7060 (813) 512-5851
(813) 261-0813
[email protected] [email protected]

Steve Short Anthony Escobio

Acting President & CEO Vice President, Patient Financial Services
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-4805 (813) 844-4764
(813) 844-4144 (813) 844-4144
[email protected] [email protected]

Don Henderson Nancy Wise

President Admitting Director
1451 El Camino Road 1451 El Camino Road
The Villages, FL 32159 The Villages, FL 32159
(352) 323-5001 (352) 323-5042
(352) 323-5009 (352) 323-5049
[email protected] [email protected]

Edward Jimenez Grace Chesser

Chief Executive Officer Director, Admissions
1600 SW Archer Road 1600 SW Archer Road
Gainesville, FL 32610-3003 Gainesville, FL 32610-3003
(352) 733-1500 (352) 594-4727
(352) 265-0231 (352) 265-0624
[email protected] [email protected]

Page 142 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

Dana Oaks Jose Martinez

Chief Executive Officer Public Benefit Coordinator
7201 North Unjiversity Drive 7201 North Unjiversity Drive
Tamarac, FL 33321 Tamarac, FL 33321
(954) 721-2200 (954) 724-6144
(954) 724-6567
[email protected] [email protected]

Barbara J. Simmons Zac Williams

Chief Executive Officer Public Benefit Coordinator
8201 West Broward Boulevard 8201 West Broward Boulevard
Plantation, FL 33324 Plantation, FL 33324
(954) 473-6600 (954) 916-5458
(954) 452-2133
[email protected] [email protected]

Stephen Nierman Jessica Villafana Opyd

President Financial Assistance Coordinator
200 Ave F NE 2985 Drew Street, Mail Stop 1049
Winter Haven, FL 33881 Clearwater, FL 33759
(863) 297-1890 (727) 281-9084
(813) 635-7731
[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Barrett Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 487-6240 (850) 922-6964

Page 143 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2017 - September 30, 2018
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

Administrator HCRA Eligibility Determination

[email protected] [email protected]

Page 144 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Darlene Cyr
Followup Supervisor
PO Box 17106
Pensacola, FL 32522
(850) 469-2044
(850) 469-7285
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4130
(904) 391-5074
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
[email protected]

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201

Page 145 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Director, Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Page 146 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Diane Sanders
Patient Access Supervisor
P.O. Box 188
Bonifay, FL 32425
(850) 547-8030
(850) 547-8025
[email protected]

Kaitia Coby
Insurance/Reimbursement Manager
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4527
(904) 819-4906
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100

Page 147 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

Ira Arnan
Patient Financial Services Director
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 386-6362
(863) 386-6473

Page 148 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
[email protected]

Ira Arnan

Page 149 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Patient Financial Services Director
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 386-6362
(863) 386-6473
[email protected]

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
[email protected]

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
[email protected]

James Santana
Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
[email protected]

Kathleen Mitchell
Supervisor, Billing
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-3823

Page 150 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

(386) 239-2325
[email protected]

Jennifer Lesley
PFS Director
524 W Sagamore Avenue
Clewiston, FL 33440
(863) 983-9121
(863) 983-3426
[email protected]

Yorka Faldraga
Associate Administratior
1500 NW 12 Ave 10th Floor JMP-West
Miami, FL 33136
(786) 466-8135

[email protected]

Darlene Cyr
Followup Supervisor
PO Box 17106
Pensacola, FL 32522
(850) 469-2044
(850) 469-7285
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Tim Perrin

Page 151 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Manager, Patient Accounts
206 Second Street East
Bradenton, FL 34208
(941) 745-7505
(941) 745-6836
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Sherina Kanhai
Patient Access Manager
600 East Dixie Drive
Leesburg, FL 34748
(352) 323-5073
(352) 323-5439
[email protected]

Vickie Anderson
Billing Supervisor
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7537
(352) 315-7587
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084

Page 152 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

(813) 635-7731
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 153 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Mari Ann Moore

Patient Financial Services Director
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3750
(407) 650-5040
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Vendor Collection Management Director
335 Crossing Boulevard
Orange Park, FL 32073

Page 154 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

James Griffith
Vendor Collection Management Director
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
[email protected]

Page 155 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Emily Perkins
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3834
(317) 583-4148
[email protected]

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
[email protected]
Emily Perkins
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3834
(317) 583-4148
[email protected]

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
[email protected]
Emily Perkins
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3834

Page 156 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

(317) 583-4148
[email protected]

Tammy Brisbane
Billing Manager
655 West 8th Street
Jacksonville, FL 32209

[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Kris Panetta

Page 157 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Thomas Mott
Operations Lead
26533 Evergreen Road, 7th Floor
Southfield, MI 48706
(989) 859-4083

[email protected]

Thomas Mott
Operations Lead
26533 Evergreen Road, 7th Floor
Southfield, MI 48706
(989) 859-4083

[email protected]

Thomas Mott
Operations Lead
26533 Evergreen Road, 7th Floor
Southfield, MI 48706
(989) 859-4083

[email protected]

LaTrenda Cooper
Business Office Manager
1309 Thomasville Road
Tallahassee, FL 32303

Page 158 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

(850) 431-6205
(850) 431-6900
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Anthony Escobio
Vice President, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
[email protected]

Sherina Kanhai
Patient Access Manager
1451 El Camino Road
The Villages, FL 32159
(352) 323-5073
(352) 323-5439
[email protected]

Jacob Bruck
Director, Patient Financial Services
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 594-2263
(352) 265-9012
[email protected]

Page 159 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

December 14, 2017

HCRA Claims Processing

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
[email protected]

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
[email protected]

Page 160 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
AVENTURA HOSPITAL & MEDICAL CENTER 10-0131
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST HOSPITAL 10-0093
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE 10-0088
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER NASSAU 10-0140
Name:
Title:
Mailing Add:

Page 161 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
BLAKE MEDICAL CENTER 10-0213
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BRANDON REGIONAL HOSPITAL 10-0243
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BROWARD HEALTH MEDICAL CENTER 10-0039
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 162 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
DOCTORS HOSPITAL SARASOTA 10-0166
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTORS MEMORIAL HOSPITAL 10-0078
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ED FRASER MEMORIAL HOSPITAL 10-0134
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ENGLEWOOD COMMUNITY HOSPITAL 11-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FAWCETT MEMORIAL HOSPITAL 10-0236
Name:
Title:
Mailing Add:

Page 163 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
FLAGLER HOSPITAL 10-0219
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL 10-0007
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ALTAMONTE 12-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL APOPKA 12-0003
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 164 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
FLORIDA HOSPITAL CARROLLWOOD 10-0069
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CELEBRATION HEALTH 2396-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL EAST ORLANDO 10-0021
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL KISSIMMEE 10-0089
Name:
Title:

Page 165 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL NORTH PINELLAS 10-0055
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL TAMPA 10-0173
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WAUCHULA 10-0282
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WESLEY CHAPEL 2396-0099
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 166 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
FLORIDA HOSPITAL ZEPHYRHILLS 10-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
GULF COAST REGIONAL MEDICAL CENTER 10-0242
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HALIFAX HEALTH MEDICAL CENTER 10-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JACKSON MEMORIAL HOSPITAL 10-0022
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL 10-0048
Name:

Page 167 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JFK MEDICAI CENTER 10-0080
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
KENDALL REGIONAL MEDICAL CENTER 10-0209
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAKE BUTLER HOSPITAL 10-0241
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAKE CITY MEDICAL CENTER 10-0156
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 168 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
LAKEWOOD RANCH MEDICAL CENTER 2396-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER 10-0248
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARKIN COMMUNITY HOSPITAL 10-0181
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAWNWOOD REGIONAL MEDICAL CENTER & HEART
INSTITUTE 10-0246
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEE MEMORIAL HOSPITAL 10-0012

Page 169 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEESBURG REGIONAL MEDICAL CENTER 10-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LIFESTREAM BEHAVIORAL HEALTH 10-4018
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MARTIN MEDICAL CENTER 10-0044
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEASE COUNTRYSIDE HOSPITAL 11-0001
Name:
Title:
Mailing Add:
City,Zip:

Page 170 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
MEDICAL CENTER OF TRINITY 10-0191
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEMORIAL HOSPITAL OF TAMPA 10-0206
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL 10-0127
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHSIDE HOSPITAL 10-0238

Page 171 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHWEST MEDICAL CENTER 10-0189
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
OAK HILL HOSPITAL 10-0264
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ORLANDO HEALTH 10-0006
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PALMS OF PASADENA HOSPITAL 10-0126
Name:
Title:
Mailing Add:
City,Zip:

Page 172 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
PALMS WEST HOSPITAL 11-0006
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PLANTATION GENERAL HOSPITAL 10-0167
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
POINCIANA MEDICAL CENTER 2396-0111
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PUTNAM COMMUNITY MEDICAL CENTER 10-0232
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL 10-0252

Page 173 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

REGIONAL MEDICAL CENTER OF BAYONET POINT 10-0256

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL 10-0025
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Back-Up Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST 2396-0041
Name:
Title:
Mailing Add:

Page 174 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
Back-Up Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Back-Up Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

SHANDS HOSPITAL AT THE UNIVERSITY OF FLORIDA 10-0113

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SHANDS JACKSONVILLE MEDICAL CENTER 10-0001

Page 175 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH BAY HOSPITAL 10-0259
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL 10-0075
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL 10-0180
Name:
Title:
Mailing Add:
City,Zip:

Page 176 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
ST. VINCENT'S MEDICAL CENTER CLAY COUNTY 2396-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENTS MEDICAL CENTER RIVERSIDE 10-0040
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ST. VINCENT'S MEDICAL CENTER SOUTHSIDE 2396-0088

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HOSPITAL 10-0135
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 177 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
TAMPA COMMUNITY HOSPITAL 10-0255
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL 10-0128
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
THE VILLAGES REGIONAL HOSPITAL 2396-0032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TWIN CITIES HOSPITAL 10-0054
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

UNIVERSITY HOSPITAL AND MEDICAL CENTER 10-0224

Name:
Title:

Page 178 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WEST PALM HOSPITAL 10-0234
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WESTSIDE REGIONAL MEDICAL CENTER 10-0228
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINDMOOR 10-4017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER PARK MEMORIAL HOSPITAL 10-0162
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 179 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2015 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:
Back-up Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:

Page 180 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Isabel Burgin Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
20900 Biscayne Boulevard 6451 126th Avenue North
Aventura, FL 33180 Largo, FL 33773
(305) 937-3961 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Norelis Vrablik Darlene Cyr

Eligibility Supervisor Followup Supervisor
PO Box 17106 PO Box 17106
Pensacola, FL 32522 Pensacola, FL 32522
(850) 434-4013 (850) 469-2044
(850) 469-7255 (850) 469-7285
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201

Page 181 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4130 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Debbie Pancake Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2020 59th Street West 6451 126th Avenue North
Bradenton, FL 34209 Largo, FL 33773
(941) 798-6001 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Ana Almodovar Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
119 Oakfield Drive 6451 126th Avenue North
Brandon, FL 33511 Largo, FL 33773
(813) 681-5551 Xt. 3366 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jodi Halpine Janice Halpine

Assistant Patient Access Manager Administrative Director, Central Business Office
1600 S. Andrews Avenue 1608 SE 3rd Avenue, CBO 3rd Floor
Ft. Lauderdale, FL 33316 Ft. Lauderdale, FL 33316
(954) 355-5485 (954) 847-4540
(954) 888-3576 (954) 888-3540
[email protected] [email protected]

Sonia Marerro James Griffith

Public Benefit Coordinator Director, Vendor Collection Management
1401 West Seminole Boulevard 335 Crossing Boulevard
Sanford, FL 32771 Orange Park, FL 32073
(407) 321-4500 Xt. 5259 (904) 688-6488
(407) 302-7351 (904) 688-7488
[email protected] [email protected]

Page 182 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Sandy Williams Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
5731 Bee Ridge Road 6451 126th Avenue North
Sarasota, FL 34233 Largo, FL 33773
(941) 342-1126 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Donna Boroughs Diane Sanders

Business Office Director Patient Representative
P.O. Box 188 P.O. Box 188
Bonifay, FL 32464-0188 Bonifay, FL 32464-0188
(850) 547-8015 (850) 547-8030
(850) 547-8025 (850) 547-8024
[email protected] [email protected]

Leona Lowery Leona Lowery

Director PFS Director PFS
159 North 3rd Street 159 North 3rd Street
Macclenny, FL 32063 Macclenny, FL 32063
904-259-3151 904-259-3151
904-653-2102 904-653-2102
[email protected] [email protected]

Katherine Winemann Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
700 Medical Boulevard 6451 126th Avenue North
Englewood, FL 34223 Largo, FL 33773
(941) 629-1181 Xt.6890 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Katherine Winemann Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
21298 Olean Boulevard 6451 126th Avenue North

Page 183 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Port Charlotte, FL 33952 Largo, FL 33773
(941) 629-1181 Xt.6890 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Shay Miller Kaitia Coby

Patient Services Director Business Office Supervisor
400 Health Park Blvd. 400 Health Park Blvd.
St. Augustine, FL 32086 St. Augustine, FL 32086
(904) 819-4510 (904) 819-4527
(904) 819-4906 (904) 819-4906
[email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Page 184 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Coy L. Ingram Coy L. Ingram

Assistant Vice President of Patient Financial Services Assistant Vice President of Patient Financial Services
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Ira Arnan Ira Arnan

Patient Financial Services Director Patient Financial Services Director
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 386-6362 (863) 386-6362
(863) 386-6473 (863) 386-6473
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director

Page 185 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Assistant Vice President, Patient Financial Svcs. Assistant Vice President, Patient Financial Svcs.
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Assistant Vice President, Patient Financial Svcs. Assistant Vice President, Patient Financial Svcs.
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Ira Arnan Ira Arnan

Director of Financial Services Director of Financial Services
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 386-6362 (863) 386-6362
(863) 386-6473 (863) 386-6473
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Assistant Vice President, Patient Financial Svcs. Assistant Vice President, Patient Financial Svcs.
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704

Page 186 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Assistant Vice President, Patient Financial Svcs. Assistant Vice President, Patient Financial Svcs.
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Gina Bachuss James Griffith

Public Benefit Coordinator Director,Vendor Collection Management
449 West 23rd Street 335 Crossing Blvd
Panama City, FL 32405 Orange Park, FL 32073
(850)747-7860 904-688-6488
904-688-7488
[email protected] James. [email protected]

Glen Stockhammer Alysone Capone

Manager, Collection Services Collector
303 North Clyde Morris Boulevard 303 North Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
386-223-4590
386-232-2395 386-232-2395
[email protected] [email protected]

Denise Don Yorka Faldraga

Associate Administrator Associate Administratior
1611 NW 12th Ave Annex Bldg 2nd Floor Rm218 1500 NW 12 Ave 10th Floor JMP-West
Miami, FL 33136 Miami, FL 33136
305-585-7231 786-466-8135
305-355-2273
[email protected] [email protected]

Norelis Vrablik Darlene Cyr

Page 187 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Eligibility Supervisor Followup Supervisor
PO Box 17106 PO Box 17106
Pensacola, FL 32522 Pensacola, FL 32522
(850) 434-4013 (850) 469-2044
(850) 469-7255 (850) 469-7285
[email protected] [email protected]

Anne Johnson James Griffith

Public Benefit Coordinator Director, Vendor Collection Management
5301 South Congress 33462 335 Crossing Blvd
Atlantis, FL 33462 Orange Park, FL 32073
861-548-1357 904-688-6488
904-688-7488
[email protected] [email protected]

Rosa Canseco Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
11750 SW 40 Street 6451 126th Avenue North
Miami, FL 33175 Largo, FL 33773
305-223-3000 (727) 773-3410
305-229-2444 (727) 773-3411
[email protected] [email protected]

Ashlee Hodges Tina Gosebruch

Patient Access Supervisor Patient Accounts Supervisor
P.O. Box 748 P.O. Box 748
Lake Butler, FL 32054 Lake Butler, FL 32054
(386) 496-2323 (386) 496-9200
(386) 496-1611 (386) 496-4734
[email protected] [email protected]

James Griffith
Public Benefit Coordinatror Vendor Collection Management Director
340 Northwest Commerce Drive 335 Crossing Blvd
Lake City, FL 32055 Orange Park, 32073
904-688-6488

Page 188 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

904-688-7488
[email protected]

Tammy Grant Tim Perrin

Director, Patient Access Manager, Patient Accounts
206 Second Street East 206 Second Street East
Bradenton, FL 34208 Bradenton, FL 34208
(941) 745-7210 (941) 745-7505
(941) 782-3575 (941) 745-6836
[email protected] [email protected]

Beth Weekes Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
201 14th Street SW 6451 126th Avenue North
Largo, FL 33770 Largo, FL 33773
(727) 588-5489 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Kenia Mendoza Kenia Mendoza

Revenue Cycle Director Revenue Cycle Director
7031 SW 62nd Avenue 7031 SW 62nd Avenue
South Miami, FL 33143 South Miami, FL 33143
(305) 284-7623 (305) 284-7623
(305) 284-7545 (305) 284-7545
[email protected] [email protected]

Guadelupe Deloera James Griffith

Public Benefit Coordinator Vendor Collection Management Director
1700 South 23rd Street 335 Crossing Boulevard
Fort Pierce, FL 34950 Orange Park, FL 32073
(772) 467-2851 (904) 688-6488
904-688-7488
[email protected] [email protected]

Page 189 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Courtney Murray Debbie Yeater
Registration Services Director Central Business Office Supervisor
P.O. Box 2218 224 Santa Barbara Boulevard, Suite 203
Fort Myers, FL 33902-2218 Cape Coral, FL 33991
(239) 343-2036 (239) 424-1510
(239) 343-3967 239-424-1599
[email protected] [email protected]

Sherina Kanhai Phillip Hager

Patient Access Manager Administrative Director
600 East Dixie Avenue 600 East Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5905 (352) 323-5515
(352) 323-5439 (352) 323-5039
[email protected] [email protected]

Vickie Anderson Vickie Anderson

Business Office Supervisor Business Office Supervisor
P.O. Box 491000 P.O. Box 491000
Leesburg, FL 34749-1000 Leesburg, FL 34749-1000
(352) 315-7532 (352) 315-7537
(352) 360-6595 (352) 315-7587
[email protected] [email protected]

Carol Plato Carol Plato

Assistant Vice President Assistant Vice President
P.O. Box 9010 P.O. Box 9010
Stuart, FL 34995-9010 Stuart, FL 34995-9010
(772) 223-5656 (772) 223-5656
(772) 223-5622 (772) 223-5622
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677

Page 190 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Pat Cooper Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
9330 State Road 54 6451 126th Avenue North
Trinity, FL 34655 Largo, FL 33773
(727) 834-5720 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Ananta Boodoosingh Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2901 West Swann Ave 6451 126th Avenue North
Tampa, FL 33609 Largo, FL 33773
813-512-4851 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Page 191 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Cynthia Bacon Kris Panetta
Public Benefit Coordinator Medicaid Eligibility Director
6000 49th Steet North 6451 126th Avenue North
St. Petersburg, FL 33709 Largo, FL 33773
(727) 521-5558 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Robb Hurlock Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2801 North State Road 7 6451 126th Avenue North
Margate, FL 33063 Largo, FL 33773
(954) 956-3060 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Linda Murphy Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
11375 Cortez Boulevard 6451 126th Avenue North
Brooksville, FL 34613 Largo, FL 33773
(352) 597-6371 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

David Walker Bridget Walters

Financial Assistance Manager Patient Accounting Director
3090 Caruso Court, Suite 20 3090 Caruso Court, Suite 20
Orlando, FL 32806 Orlando, FL 32806
(407) 650-3760 (407) 650-3771
(321) 843-6427 (321) 843-6579
[email protected] [email protected]

Jennifer Tolisano Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
1501 Pasandena Ave South 6451 126th Avenue North
St. Petersburg, FL 33707 Largo, FL 33773

Page 192 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

727-341-7543 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Maria Cortes-Bolivar James Griffith

Public Benefit Coordinator Vendor Collection Management Director
13001 Southern Boulevard 335 Crossing Boulevard
Loxahatchee, FL 33470 Orange Park, FL 32073
(561) 798-6078 (904) 688-6488
904-688-7488
[email protected] [email protected]

Fabiola Dickson Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
401 Northwest 42nd Avenue 6451 126th Avenue North
Plantation, FL 33317 Largo, FL 33773
(954) 587-5010, ext 6650 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Wilfredo Gonzalez James Griffith

Public Benefit Coordinator Vendor Collection Management Director
325 Cypress Parkway 335 Crossing Boulevard
Kissimmee, FL 34758 Orange Park, FL 32073
(407) 518-3658 904-688-6488
904-688-7488
[email protected] [email protected]

VACANT James Griffith

Public Benefit Coordinator Vendor Collection Management Director
611 Zeagler Drive 335 Crossing Blvd
Palatka, FL 32177 Orange Park, FL 32073
904-688-6488
904-688-7488
[email protected]

Page 193 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Melinda Hernandez James Griffith
Public Benefit Coordinator Vendor Collection Management Director
1796 Highway 441 North 335 Crossing Boulevard
Okeechobee, FL 34972 Orange Park, FL 32073
(863) 824-2870 (904) 688-6488
904688-7488
[email protected] [email protected]

Kathleen Troutwine Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
14000 Fivay Road 6451 126th Avenue North
Hudson, FL 34667 Largo, FL 33773
(727) 819-2929, ext. 5365 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Financial Services Manager
5151 North 9th Avenue P.O. Box 2728
Pensacola, FL 32504 Pensacola, FL 32513-2728
(850) 416-7099 (850) 416-6961
(850) 416-6921 (850) 416-7453
[email protected] [email protected]
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
[email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Financial Services Manager
5151 North 9th Avenue P.O. Box 2728

Page 194 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Pensacola, FL 32504 Pensacola, FL 32513-2728
(850) 416-7099 (850) 416-6961
(850) 416-6921 (850) 416-7453
[email protected] [email protected]
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
[email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Financial Services Manager
5151 North 9th Avenue P.O. Box 2728
Pensacola, FL 32504 Pensacola, FL 32513-2728
(850) 416-7099 (850) 416-6961
(850) 416-6921 (850) 416-7453
[email protected] [email protected]
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
[email protected]

Grace Chesser Barabara Southwell

Director, Admissions Manager, Government Team
1600 SW Archer Road 4024 NW 22nd Drive
Gainesville, FL 32610 Gainesville, FL 32605
(352) 594-4727 (352) 594-2354
(352) 265-0624 (352) 265-9018
[email protected] [email protected]

Page 195 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Shakawn Jones Shakawn Jones
Patient Financial Services Manager Patient Financial Services Manager
655 West 8th Street-PFS Business Office 655 West 8th Street-PFS Business Office
Jacksonville, FL 32209 Jacksonville, FL 32209
904-244-1879 904-244-1879

[email protected] [email protected]

Veronica Vargas Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
4016 Sun City Center Blvd 6451 126th Ave North
Sun City Center, FL 33573 Largo, FL 33773
813-634-0488 727-773-3410
813-634-8712 727-773-3411
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Dawn Sandusky Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
6500 38th Avenue North 6451 126th Avenue North
St. Petersburg, FL 33710 Largo, FL 33773

Page 196 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(727) 341-4929 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706
(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706
(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706
(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Jeff Sherman Jeff Sherman

Director, Patient Fin.Svcs. Director, Patient Fin.Svcs.
1300 Miccosukee Road 1300 Miccosukee Road
Tallahassee, FL 32308 Tallahassee, FL 32308
850-431-6202 850-431-6202
850-431-6017 850-431-6017
[email protected] [email protected]

Page 197 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Robert Alcantara Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
6001 Webb Road 6451 126th Ave North
Tampa, FL 33618 Largo, FL 33773
813-512-5851 727-773-3410
727-773-3411
[email protected] [email protected]

Lindy Esposito Patricia Osborne

Financial Assistance Supervisor Billing Manager
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-8913 (813) 844-4798
(813) 844-8920 (813) 844-4799
[email protected] [email protected]

Sherina Kanhai Phillip Hager

Patient Access Manager Administrative Director
600 East Dixie Avenue 600 East Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5905 (352) 323-5515
(352) 323-5439 (352) 323-5039
[email protected] [email protected]

Lisa Wilson James Griffith

Public Benefit Coordinator Vendor Collection Management Director
2190 Highway 85 North 335 Crossing Blvd
Niceville, FL 32578 Orange Park, FL 32073
850-729-9423 904-688-6488
904-688-7488
[email protected] [email protected]

Jose Martinez Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director

Page 198 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

7201 North Unjiversity Drive 6451 126th Avenue North
Tamarac, FL 33321 Largo, FL 33773
(954) 724-6144 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Carol Palevoda James Griffith

Public Benefit Coordinator Vendor Collection Managerment Director
2201 45th Street 335 Crossing Boulevard
West Palm Beach, FL 33407 Orange Park, FL 32073
561-863-3842 904-688-6488
904-688-7488
[email protected] [email protected]

Zac Williams Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
8201 West Broward Boulevard 6451 126th Avenue North
Plantation, FL 33324 Largo, FL 33773
(954) 916-5458 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Mike Neumann Jeff Dale

Chief Executive Officer Bus Office Manager
1130 US Hwy 19 N 11300 US HWY 19 N
Clearwater, FL 33764 Clearwater, FL 33764
727-541-2646 727-541-2646
727-541-4402 727-541-4402
[email protected] [email protected]

James English Sharda Parsaram

VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965

Page 199 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2015 - September 30, 2016
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Jacobson Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 414-6912 (850) 922-6964
[email protected] [email protected]
Mia Westbrook Felton Bradley
Medical Health Care Program Analyst Economic Analyst
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
850412-4291 (850) 412-4350
(850) 414-6912 (850) 922-6964
[email protected] [email protected]

Page 200 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator

Dianne Goldenberg
Chief Executive Officer
20900 Biscayne Boulevard
Aventura, FL 33180
(305) 682-7000
(305) 682-7042
[email protected]

Scott Raynes
President
1000 West Morino Street
Pensacola, FL 32501
(850) 424-4011
(850) 434-4841
[email protected]

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
[email protected]

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
[email protected]

Stephen Lee
Hospital President
1250 South 18th Street

Page 201 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Fernandina Beach, FL 32034
(904) 321-3502
(904) 321-3511
[email protected]

Daniel J. Friedrich, III

Chief Executive Officer
2020 59th Street West
Bradenton, FL 34209
(941) 792-6611
(941) 798-6209
[email protected]

Bland Eng
Chief Executive Office
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
[email protected]

Calvin Glidewell
Chief Executive Office
1600 S. Andrews Avenue
Ft. Lauderdale, FL 33316
(954) 355-5610
(954) 355-4797
[email protected]

Wendy H. Brandon
Chief Executive Officer
1401 West Seminole Boulevard
Sanford, FL 32771
(407) 302-7392
(407) 324-4790
[email protected]

Page 202 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator

Robert C. Meade
Chief Executive Officer
5731 Bee Ridge Road
Sarasota, FL 34233
(941) 342-1100
(941) 379-8342
[email protected]

JoAnn Baker
CEO/Administrator
P.O. Box 188
Bonifay, FL 32464-0188
(850) 547-8001
(850) 547-8004
[email protected]

Dennis R. Markos
CEO
159 North 3rd Street
Macclenny, FL 32063
904-259-3151
904-653-2102
[email protected]

Dale F. Alward
Chief Executive Officer
700 Medical Boulevard
Englewood, FL 34223
(941) 475-6571
(941) 473-5015
[email protected]

William Hawley
Chief Executive Officer
21298 Olean Boulevard

Page 203 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Port Charlotte, FL 33952
(941) 629-1181
(941) 627-6142
[email protected]

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4400

[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Page 204 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator

Joe Johnson
President & CEO
7171 North Dale Mabry Highway
Carrollwood, FL 33614
(813) 558-8001
(813) 558-8011
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Bruce Bergherm
President/CEO
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3366
(863) 402-3110
[email protected]

Lars Houmann
President & CEO

Page 205 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Bruce Berghern
Chief Executive Officer/President
1395 South Pinellas Avenue
Tarpon Springs, FL 34689
(727) 942-5107
(727) 942-5161
[email protected]

Brian Adams
Chief Executive Officer/President
3100 East Fletcher Avenue
Tampa, FL 33613
(813) 615-7203
(813) 615-7580
[email protected]

Bruce Bergherm
CEO/President
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3366
(863) 402-3110
[email protected]

Denyse Bales-Chubb
Chief Executive Officer/President
2600 Bruce B Downs Boulevard
Wesley Chapel, FL 33544
(813) 929-5490
(813) 929-5475

Page 206 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
[email protected]

Randall Surber
President CEO
7050 Gall Boulevard
Zephyrhills, FL 33541
813-779-6201
813-783-6196
[email protected]

Carlton Ulmer
Chief Executive Officer
449 West 23rd Street
Panama City, FL 32405
850-769-8341
850-747-7107
[email protected]

Jeff Feasel
Chief Executive Officer
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
386-425-4771
386-425-4772
[email protected]

Carlos Migoya
President CEO
1611 NW 12 Ave West Wing 117
Miami, FL 33136
305-585-6754

[email protected]

Michael Hutchins

Page 207 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Administrator
14114 Alabama Street
Jay, FL 32505
(850) 675-8015
(850) 675-8070
[email protected]

Gina A. Melby
Chief Executive Officer
5301 South Congress Ave
Atlantis, FL 33462
561-965-7300
561-642-3685
[email protected]

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
[email protected]

Pam Howard
CEO
P.O. Box 748
Lake Butler, FL 32054
(386) 496-2323
(386) 496-1611
[email protected]

Mark A. Miller
Chief Executive Officer
340 Northwest Commerce Drive
Lake City, FL 32055
386-719-9000

Page 208 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
386-719-7787
[email protected]

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Boulevard
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
[email protected]

Anthony Degina
Chief Executive Officer
201 14th Street SW
Largo, FL 33770
(727) 588-5200
(727) 588-5906
[email protected]

Sondy Sosa-Guerrero
Chief Executive Officer
7031 SW 62nd Avenue
South Miami, FL 33143
(305) 284-7700
(305) 284-7545
[email protected]

Greg Lowe
Chief Executive Officer
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
[email protected]

Page 209 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
James Nathan
CEO
2776 Cleveland Avenue
Fort Myers, FL 33901
(239) 343-6502
(239) 343-6991
[email protected]

Don Henderson
President
410 Childs Street
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
[email protected]

Jonathan Cherry
President/CEO
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7500
(352) 360-6595
[email protected]

Robert L. Lord, Jr.

President and CEO
200 SE Hospital Avenue
Stuart, FL 34994
(772) 223-5955 ext. 13014
(772) 223-5946
[email protected]

Louis Galdieri
President
601 Main Street
Dunedin, FL 34698

Page 210 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
(727) 734-6365
(727) 734-6887
[email protected]

Leigh Massengill
Chief Executive Officer
9330 State Road 54
Trinity, FL 34655
(727) 834-4000
(727) 834-4912
[email protected]

Ward Boston lll

Chief Executive Officer
2901 West Swann Ave
Tampa, FL 33609
813-873-6400
813-873-6486
[email protected]

Kris Hoce
President
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
[email protected]

Kris Hoce
President
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
[email protected]

Page 211 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Dia Nichols
Chief Executive Officer
6000 49th Steet North
St. Petersburg, FL 33709
(727) 521-4411
(727) 521-5007
[email protected]

Erica Gulrich
Chief Executive Officer
2801 North State Road 7
Margate, FL 33063
(954) 974-0400
(954) 978-4183
[email protected]

Jesse G. Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
[email protected]

David Strong
President / CEO
65 Strurtevant Street
Orlando, FL 32806
(321) 841-5299
(321) 841-1280
[email protected]

Sharon D. Hayes
Chief Executive Officer
1501 Pasandena Ave South
St. Petersburg, FL 33707

Page 212 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
727-381-1000
727-341-7629
[email protected]

Eric Goldman
Chief Executive Officer
13001 Southern Boulevard
Loxahatchee, FL 33470
(561) 798-3300
(561) 791-8108
[email protected]

Randy Gross
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
[email protected]

Joanna Conley
Chief Executive Officer
325 Cypress Parkway
Kissimmee, FL 34758
(407) 530-2000
(407) 530-2020
Joanna.Conley@hca healthcare.com

Chris Mosley
Chief Executive Officer
611 Zeagler Drive
Palatka, FL 32177
386-328-5711
386-325-8178
[email protected]

Page 213 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Robert H. Lee
Chief Executive Officer
1796 Highway 441 North
Okeechobee, FL 34972
(863) 763-2151
(863) 824-2991
Robert.Lee@hca healthcare.com

C. Shayne George
Chief Executive Officer
14000 Fivay Road
Hudson, FL 34667
(727) 819-2929
(727) 869-5491
[email protected]

Susan Davis
CEO
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7010
(850) 416-6119
[email protected]

Roger Hall
CEO
7800 US Hwy 98 West

Page 214 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Miramar Beach, FL 32550
(850) 278-3001
(850) 278-3010
[email protected]

Roger Hall
CEO
7800 US Hwy 98 West
Miramar Beach, FL 32550
(850) 278-3001
(850) 278-3010
[email protected]

Edward Jimenez
Chief Operating Officer
1600 SW Archer Road
Gainesville, FL 32610
(352) 733-1500
(352) 265-0231
[email protected]

Page 215 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
Russell Armistead
Chief Executive Officer
655 West 8th Street
Jacksonville, FL 32209
904-244-4000

[email protected]

Sharon L. Roush
Chief Executive Officer
4016 Sun City Center Blvd
Sun City Center, FL 33573
813-634-3301
813-634-8712
[email protected]

Karen Kerr
Chief Operating Officer/President
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
[email protected]

Lorraine Lutton
Chief Operating Officer
6500 38th Ave North
St. Petersburg, FL 33710
727-384-1414
727-341-4889
[email protected]

Janice Balzano
Chief Executive Officer
6500 38th Avenue North
St. Petersburg, FL 33710

Page 216 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
(727) 384-1414
(727) 341-4889
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
[email protected]

G. Mark O' Bryant

President/CEO
1300 Miccosukee Road
Tallahassee, FL 32308
850-431-5380
850-431-5883
[email protected]

Page 217 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator

Jacob J. Fisher
Chief Executive Officer
6001 Webb Road
Tampa, FL 33615
813-888-7060
813-261-0813
[email protected]

James Burkhart
President & CEO
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
[email protected]

Don Henderson
President
410 Childs Street
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
[email protected]

David A. Whalen
Chief Executive Officer
2190 Highway 85 North
Niceville, FL 32578
850-678-4131
850-729-9306
[email protected]

Joseph Melchiode
Chief Executive Officer

Page 218 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
7201 North Unjiversity Drive
Tamarac, FL 33321
(954) 721-2200
(954) 724-6567
[email protected]

Dana C. Oaks
Chief Executive Officer
2201 45th Street
West Palm Beach, FL 33407
561-863-3842
561-844-8955
[email protected]

Barbara J. Simmons
Chief Executive Officer
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
[email protected]

Wendy Merson
Chief Executive Officer
11300 US HWY 19 N
Clearwater, FL 33764
727-541-2646
727-541-4402
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965

Page 219 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 29, 2016

Administrator
[email protected]

Page 220 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
AVENTURA HOSPITAL & MEDICAL CENTER 10-0131
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST HOSPITAL 10-0093
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE 10-0088
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER NASSAU 10-0140
Name:
Title:
Mailing Add:

Page 221 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER SOUTH 2396-0052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BLAKE MEDICAL CENTER 10-0213
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BRANDON REGIONAL HOSPITAL 10-0243
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BROWARD HEALTH MEDICAL CENTER 10-0039
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 222 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTORS MEMORIAL HOSPITAL 10-0078
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTORS MEMORIAL HOSPITAL, INC. 10-0106
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
EDWARD WHITE HOSPITAL 10-0239
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ENGLEWOOD COMMUNITY HOSPITAL 11-0004
Name:
Title:
Mailing Add:

Page 223 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
FAWCETT MEMORIAL HOSPITAL 10-0236
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLAGLER HOSPITAL 10-0219
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL 10-0007
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ALTAMONTE 12-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 224 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
FLORIDA HOSPITAL APOPKA 12-0003
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CARROLLWOOD 10-0069
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL CELEBRATION HEALTH 2396-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL EAST ORLANDO 10-0021
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109

Name:
Title:

Page 225 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL KISSIMMEE 10-0089
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL NORTH PINELLAS 10-0055
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL TAMPA 10-0173
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WAUCHULA 10-0282
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 226 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
FLORIDA HOSPITAL WESLEY CHAPEL 2396-0099
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ZEPHYRHILLS 10-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
H. LEE MOFFITT CANCER CENTER 11-0009
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HALIFAX MEDICAL CENTER 10-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HENDRY REGIONAL MEDICAL CENTER 10-0098
Name:

Page 227 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JACKSON MEMORIAL HOSPITAL 10-0022
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL 10-0048
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
KENDALL REGIONAL MEDICAL CENTER 10-0209
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

LAKE BUTLER HOSPITAL HAND SURGERY CENTER 10-0241

Name:
Title:
Mailing Add:
City,Zip:

Page 228 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
LAKEWOOD RANCH MEDICAL CENTER 2396-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER 10-0248
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAWNWOOD REGIONAL MEDICAL CENTER & HEART
INSTITUTE 10-0246
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEE MEMORIAL HOSPITAL 10-0012
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 229 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
LEESBURG REGIONAL MEDICAL CENTER 10-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LIFESTREAM BEHAVIORAL HEALTH Oct-18
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MARTIN MEMORIAL MEDICAL CENTER 10-0044
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEASE DUNEDIN HOSPITAL 10-0043
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEDICAL CENTER OF TRINITY 10-0191
Name:
Title:
Mailing Add:

Page 230 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL 10-0127
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MT. SINAI MEDICAL CENTER 10-0034
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NAPLES COMMUNITY HOSPITAL 10-0018
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 231 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
NORTHSIDE HOSPITAL 10-0238
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHWEST MEDICAL CENTER 10-0189
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
OAK HILL HOSPITAL 10-0264
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

PALMS WEST HOSPITAL 11-0006

Name:
Title:
Mailing Add:

Page 232 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
PLANTATION GENERAL HOSPITAL 10-0167
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
POINCIANA MEDICAL CENTER 2396-0111
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL 10-0252
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

REGIONAL MEDICAL CENTER OF BAYONET POINT 10-0256

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 233 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
SACRED HEART HOSPITAL 10-0025
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST 2396-0041
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

SHANDS HOSPITAL AT THE UNIVERSITY OF FLORIDA 10-0113

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SHANDS JACKSONVILLE MEDICAL CENTER 10-0001

Page 234 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. JOSEPH'S HOSPITAL 10-0075
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL 10-0180
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENT'S MEDICAL CENTER 2396-0117
Name:
Title:
Mailing Add:
City,Zip:

Page 235 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:

ST. VINCENT'S MEDICAL CENTER SOUTHSIDE 2396-0088

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENTS MEDICAL CENTER RIVERSIDE 10-0040
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HOSPITAL 10-0135
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL 10-0128
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 236 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
THE VILLAGES REGIONAL HOSPITAL 2396-0032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UNIVERSITY HOSPITAL 10-0224
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
UNIVERSITY OF MIAMI HOSPITAL 10-0009
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WESTSIDE REGIONAL MEDICAL CENTER 10-0228
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER PARK MEMORIAL HOSPITAL 10-0162
Name:
Title:
Mailing Add:

Page 237 of 322

 AGENCY FOR HEALTH CA
Bureau of Centr
Health Care Responsibility Act (HCRA
October 1, 2014 - Sep
Hospital participation in the HCRA program is voluntary. Participating hospitals shall have its billing systems in place to ac
qualified indigent patient or spend-down provision eligible patient, until such time as that hospital has met its obligation to be
will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care
representatives from collection agency) responsible for eligibility determinations and claims processing in regards to the HCR
informatio

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Enforcement Unit
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:
Back-up Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:

Page 238 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Isabel Burgin Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
20900 Biscayne Boulevard 6451 126th Avenue North
Aventura, FL 33180 Largo, FL 33773
(305) 937-3961 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Amy Purvis Robyn Mathews

Senior Manager AR Coordinator
100 West Garden Street, Ste. 200 100 West Garden Street, Ste. 200
Pensacola, FL 32502 Pensacola, FL 32502
(850) 469-2462 (850) 469-2011
(850) 469-7411 (850) 469-7285
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201

Page 239 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4153 (904) 376-4153
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Debbie Pancake Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2020 59th Street West 6451 126th Avenue North
Bradenton, FL 34209 Largo, FL 33773
(941) 798-6001 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Ana Almodovar Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
119 Oakfield Drive 6451 126th Avenue North
Brandon, FL 33511 Largo, FL 33773
(813) 681-5551 Xt. 3366 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jodi Halpine Janice Halpine

Assistant Patient Access Manager Administrative Director, Central Business Office
1600 S. Andrews Avenue 1608 SE 3rd Avenue, CBO 3rd Floor
Ft. Lauderdale, FL 33316 Ft. Lauderdale, FL 33316
(954) 355-5485 (954) 847-4540
(954) 888-3576 (954) 888-3540
[email protected] [email protected]

Page 240 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Sonia Marerro Lisa Prince

Public Benefit Coordinator Self Pay/Agency Director
1401 West Seminole Boulevard 335 Crossing Boulevard
Sanford, FL 32771 Orange Park, FL 32073
(407) 321-4500 Xt. 5259 (904) 688-6614

[email protected] [email protected]

Donna Boroughs Brandi Stewart

Business Office Director Patient Account Representative
2600 Hospital Drive 2600 Hospital Drive
Bonifay, FL 32425 Bonifay, FL 32425
(850) 547-8015 (850) 547-8016
(850) 547-8025 (850) 547-8025
[email protected] [email protected]

Debbie Howard Sara Grambling

Registration Coordinator PFS Director
333 N. Byron Butler Pkwy 333 N. Byron Butler Pkwy
Perry, FL 32347 Perry, FL 32347
(850) 584-0154 (850) 584-0860
(850) 584-2524 (850) 584-0679
[email protected] [email protected]

Milady Santana-Burgos Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2323 9th Avenue Notth 6451 126th Avenue North
St. Petersburg, FL 33713 Largo, FL 33773
(727) 328-6162 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Katherine Winemann Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
700 Medical Boulevard 6451 126th Avenue North

Page 241 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Englewood, FL 34223 Largo, FL 33773
(941) 629-1181 Xt.6890 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Katherine Winemann Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
21298 Olean Boulevard 6451 126th Avenue North
Port Charlotte, FL 33952 Largo, FL 33773
(941) 629-1181 Xt.6890 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Shay Miller Kaitia Coby

Patient Director Business Office Supervisor
400 Health Park Blvd. 400 Health Park Blvd.
St. Augustine, FL 32086 St. Augustine, FL 32086
(904) 819-4510 (904) 819-4527
(904) 819-4906 (904) 819-4906
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Page 242 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Assistant Vice President of Patient Financial Services Assistant Vice President of Patient Financial Services
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Maria Perez Maria Perez

Manager - MEDS Manager - MEDS

Page 243 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 402-3366 (863) 402-3366
(863) 402-3110 (863) 402-3110
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Regional Director Regional Director
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Regional Director Regional Director
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Maria Perez Maria Perez

Manager - MEDS Manager - MEDS
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 402-3366 (863) 402-3366
(863) 402-3110 (863) 402-3110

Page 244 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Regional Director Regional Director
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Coy L. Ingram Coy L. Ingram

Regional Director Regional Director
3100 East Fletcher Avenue 3100 East Fletcher Avenue
Tampa, FL 33613 Tampa, FL 33613
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Robert Coughlin Andy Taiford

Reimbursement Manager Director Patient Financial Services
12902 Magnolia Drive 12902 Magnolia Drive
Tampa, FL 33612 Tampa, FL 33612
(813) 745-7888 (813) 745-1668
(813) 745-7831 (813) 745-7831
[email protected] [email protected]

Glen Stockhammer Aylson Capone

Manager, Collection Services Collector
303 North Clyde Morris Boulevard 303 North Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
(386) 425-4597 (386) 226-4590
(386) 258-3887 (386) 232-2395
[email protected] [email protected]

Jennifer Lesley Jennifer Lesley

Page 245 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

PFS Director PFS Director
524 W Sagamore Ave 524 W Sagamore Ave
Clewiston, FL 33440 Clewiston, FL 33440
(863) 902-3069 (863) 902-3069
(863) 983-3426 (863) 983-3426
[email protected] [email protected]

Carmen Fernandez Pamela Fell

Director of Treasury and Reimbursement Corporate Director
169 E. Flagler Street, 5th Floor 169 E. Flagler Street, 4th Floor
Miami, FL 33131 Miami, FL 33131
(786) 466-8006 (786) 466-8595
(305) 372-0347
[email protected] [email protected]

Linda Pillar Megan Porter

Patient Service Representative Senior Manager Biller
14114 Alabama Street 1720 NE Street
Jay, FL 32505 Pensacola, FL 32501
(850) 675-8188 (850) 469-2109
(850) 675-8203 (850) 469-7477
[email protected] [email protected]

Rosa Canseco Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
11750 Bird Road 6451 126th Avenue North
Miami, FL 33175 Largo, FL 33773
(305) 227-5576 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Samantha Tillman Eva Atwood

Director of Financial Services/Patient Accounts Billing Specialist
P.O. Box 748 P.O. Box 748
Lake Butler, FL 32054 Lake Butler, FL 32054

Page 246 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(386) 496-9200 (386) 496-2323, ext. 9203
(386) 496-4734 (386) 496-4734
[email protected] [email protected]

Tammy Grant Tim Perrin

Director, Patient Access Manager, Patient Accounts
206 Second Street East 206 Second Street East
Bradenton, FL 34208 Bradenton, FL 34208
(941) 745-7210 (941) 745-7505
(941) 782-3575 (941) 745-6836
[email protected] [email protected]

Beth Weekes Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
201 14th Street SW 6451 126th Avenue North
Largo, FL 33770 Largo, FL 33773
(727) 588-5489 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Guadelupe Deloera Lisa Prince

Public Benefit Coordinator Self Pay/Agency Director
1700 South 23rd Street 335 Crossing Boulevard
Fort Pierce, FL 34950 Orange Park, FL 32073
(772) 467-2851 (904) 688-6614

[email protected] [email protected]

Courtney Murray Debbie Yeater

Registration Services Director Central Business Office Supervisor
P.O. Box 2218 224 Santa Barbara Boulevard, Suite 203
Fort Myers, FL 33902-2218 Cape Coral, FL 33991
(239) 343-2036 (239) 242-6015
(239) 343-3967 (239) 242-6088
[email protected] [email protected]

Page 247 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Lyz Bermudez Lyz Bermudez

Director, Patient Financial Services Director, Patient Financial Services
600 E. Dixie Avenue 600 E. Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5094 (352) 323-5094
(352) 323-5239 (352) 323-5239
[email protected] [email protected]

Carol Dozier Vickie Anderson

CFO Business Office Supervisor
P.O. Box 491000 P.O. Box 491000
Leesburg, FL 34749-1000 Leesburg, FL 34749-1000
(352) 315-7532 (352) 315-7537
(352) 360-6595 (352) 315-7587
[email protected] [email protected]

Karen Kennedy Carol Plato

Director of Revenue Cycle Assistant VP of Revenue Cycle
301 SE Hospital Avenue 301 SE Hospital Avenue
Stuart, FL 34995 Stuart, FL 34995
(772) 223-4903 (772) 223-5656
(772) 223-5622 (772) 223-5622
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Pat Cooper Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
9330 State Road 54 6451 126th Avenue North

Page 248 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Trinity, FL 34655 Largo, FL 33773
(727) 834-5720 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Linda Lujan Linda Lujan

Business Office Director Business Office Director
4300 Alton Road 4300 Alton Road
Miami Beach, FL 33140 Miami Beach, FL 33140
(305) 695-7607 (305) 695-7607
(305) 674-2118 (305) 674-2118
[email protected] [email protected]

Sandy Wood Sue O'Toole

Operations Director Revenue Cycle Lead Medicaid Biller
P.O. Box 8569 P.O. Box 8569
Naples, FL 34109 Naples, FL 34109
(239) 624-6407 (239) 624-6394
(239) 624-6411 (239) 624-6411
[email protected] Sue.O'toole.nchmd.org

Page 249 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Cynthia Bacon Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
6000 49th Steet North 6451 126th Avenue North
St. Petersburg, FL 33709 Largo, FL 33773
(727) 521-5558 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Robb Hurlock Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
2801 North State Road 7 6451 126th Avenue North
Margate, FL 33063 Largo, FL 33773
(954) 956-3060 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Linda Murphy Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
11375 Cortez Boulevard 6451 126th Avenue North
Brooksville, FL 34613 Largo, FL 33773
(352) 597-6371 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Maria Cortes-Bolivar Lisa Prince

Public Benefit Coordinator Self Pay/Agency Director
13001 Southern Boulevard 335 Crossing Boulevard

Page 250 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Loxahatchee, FL 33470 Orange Park, FL 32073
(561) 798-6078 (904) 688-6614

[email protected] [email protected]

Fabiola Dickson Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
401 Northwest 42nd Avenue 6451 126th Avenue North
Plantation, FL 33317 Largo, FL 33773
(954) 587-5010, ext 6650 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Wilfredo Gonzalez Lisa Prince

Public Benefit Coordinator Self Pay/Agency Director
325 Cypress Parkway 335 Crossing Boulevard
Kissimmee, FL 34758 Orange Park, FL 32073
(407) 518-3658 (904) 688-6614

[email protected] [email protected]

Melinda Hernandez Lisa Prince

Public Benefit Coordinator Self Pay/Agency Director
1796 Highway 441 North 335 Crossing Boulevard
Okeechobee, FL 34972 Orange Park, FL 32073
(863) 824-2870 (904) 688-6614

[email protected] [email protected]

Kathleen Alvelo Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
14000 Fivay Road 6451 126th Avenue North
Hudson, FL 34667 Largo, FL 33773
(727) 819-2929, ext. 5365 (727) 773-3410
(727) 773-3411

Page 251 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Accounts Manager
5130 Bayou Blvd 5130 Bayou Blvd
Pensacola, FL 32503 Pensacola, FL 32503
(850) 416-7099 (850) 416-6961
(850) 416-7453 (850) 416-7453
[email protected] [email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Accounts Manager
5130 Bayou Blvd 5130 Bayou Blvd
Pensacola, FL 32503 Pensacola, FL 32503
(850) 416-7099 (850) 416-6961
(850) 416-7453 (850) 416-7453
[email protected] [email protected]

Michele Nelson Linda Owens

Patient Accounts Manager Patient Accounts Manager
5130 Bayou Blvd 5130 Bayou Blvd
Pensacola, FL 32503 Pensacola, FL 32503
(850) 416-7099 (850) 416-6961
(850) 416-7453 (850) 416-7453
[email protected] [email protected]

Grace Chesser Barabara Southwell

Director, Admissions Manager, Government Team
1600 SW Archer Road 4024 NW 22nd Drive
Gainesville, FL 32610 Gainesville, FL 32605
(352) 594-4727 (352) 594-2354
(352) 265-0624 (352) 265-9018
[email protected] [email protected]

Page 252 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Jason Hardwick Shakawn Jones
Admissions Director Patient Financial Services Manager
655 West 8th Street 655 West 8th Street
Jacksonville, FL 32209 Jacksonville, FL 32209
(904) 244-7310 (904) 244-1878

[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Dawn Sandusky Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
6500 38th Avenue North 6451 126th Avenue North
St. Petersburg, FL 33710 Largo, FL 33773
(727) 341-4929 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706

Page 253 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706
(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Sheila Brent Thomas Mott

HCRA Representative Operations Lead
5505 E 13 Mile Road, Ste 300 26533 Evergreen Road, 7th Floor
Warren, MI 48092 Southfield, MI 48706
(855) 551-5715 (989) 859-4083
(312) 276-8630
[email protected] TMott@accretivehealth,com

Jeff Sherman Jeff Sherman

Director, Patient Financial Services Director, Patient Financial Services
1300 Miccosukee Road 1300 Miccosukee Road
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 431-6202 (850) 431-6202
(850) 431-6017 (850) 431-6017
[email protected] [email protected]

Lindy Esposito Patricia Osborne

Financial Assistance Supervisor Billing Manager
PO Box 1289 PO Box 1289
Tampa, FL 33601-1289 Tampa, FL 33601-1289
(813) 844-8913 (813) 844-4798
(813) 844-8920 (813) 844-4799
[email protected] [email protected]

Page 254 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Sherina Kanhai Elizabeth Bermudez

Patient Access Manager PFS System Director
600 East Dixie Avenue 600 East Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5905 (352) 323-5094
(352) 435-9042
[email protected] [email protected]

Jose Martinez Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
7201 North Unjiversity Drive 6451 126th Avenue North
Tamarac, FL 33321 Largo, FL 33773
(954) 724-6144 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Darryl Caulton Karen Fry

Chief Financial Officer Chief Operating Officer
1400 NW 12th Avenue 6451 126th Avenue North
Miami, FL 33136 Largo, FL 33733
(305) 689-4515 (727) 773-3024
(305) 689-4673 (727) 773-3025
[email protected] [email protected]

Zac Williams Kris Panetta

Public Benefit Coordinator Medicaid Eligibility Director
8201 West Broward Boulevard 6451 126th Avenue North
Plantation, FL 33324 Largo, FL 33773
(954) 916-5458 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

James English Sharda Parsaram

Asst. VP Adm. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100

Page 255 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Central Services
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2014 - September 30, 2015
hospitals shall have its billing systems in place to accommodate DRGs; therefore, the county shall not be liable for payment of t
uch time as that hospital has met its obligation to be able to provide the necessary information to the counties required to calcula
ogram for reimbursement of indigent emergency care from the counties until we receive contact information for hospital personn
inations and claims processing in regards to the HCRA program must have an email address and internet access in order to receiv
information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Agency for Health Care Administration Contacts

Enforcement Unit Financial Analysis Unit
HCRA Liaison Hospital Eligibility
Kirsten Jacobson Mills Smith
Medical Health Care Program Analyst Regulatory Analyst Supervisor
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 414-6912 (850) 922-6964
[email protected] [email protected]
Mia Westbrook Felton Bradley
Medical Health Care Program Analyst Economic Analyst
Enforcement Unit, Bureau of Central Services Financial Analysis Unit, Bureau of Central Services
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
850412-4291 (850) 412-4350
(850) 414-6912 (850) 922-6964
[email protected] [email protected]

Page 256 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Dianne Goldenberg
Chief Executive Officer
20900 Biscayne Boulevard
Aventura, FL 33180
(305) 682-7000
(305) 682-7042
[email protected]

Scott Raynes
President
1000 West Morino Street
Pensacola, FL 32501
(850) 469-2319
(850) 434-4841
[email protected]

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
[email protected]

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
[email protected]

Stephen Lee
Hospital President
1250 South 18th Street

Page 257 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Fernandina Beach, FL 32034
(904) 321-3502
(904) 321-3511
[email protected]

Ron Robinson
Hospital President
14550 Old St. Augustine Road
Jacksonville, FL 32258
(904) 271-6002
(904) 271-6650
[email protected]

Daniel J. Friedrich, III

Chief Executive Officer
2020 59th Street West
Bradenton, FL 34209
(941) 792-6611
(941) 798-6209
[email protected]

Bland Eng
Chief Executive Office
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
[email protected]

Calvin Glidewell
Chief Executive Office
1600 S. Andrews Avenue
Ft. Lauderdale, FL 33316
(954) 355-5610
(954) 355-4797
[email protected]

Page 258 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Wendy H. Brandon
Chief Executive Officer
1401 West Seminole Boulevard
Sanford, FL 32771
(407) 321-4500
(407) 324-2155
[email protected]

JoAnn Baker
Administrator
2600 Hospital Drive
Bonifay, FL 32425
(850) 547-8001
(850) 547-8025
[email protected]

Mary Lescafer
Interim CEO
333 N. Byron Butler Pkwy
Perry, FL 32347
(850) 584-0885
(850) 223-2308
[email protected]

Sharon D. Hayes
Chief Executive Officer
2323 9th Avenue Notth
St. Petersburg, FL 33713
(727) 323-1111
(727) 328-6159
[email protected]

Dale F. Alward
Chief Executive Officer
700 Medical Boulevard

Page 259 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Englewood, FL 34223
(941) 475-6571
(941) 473-5015
[email protected]

Thomas J. Rice
Chief Executive Officer
21298 Olean Boulevard
Port Charlotte, FL 33952
(941) 629-1181
(941) 627-6142
[email protected]

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 849-5155

[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Page 260 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Joe Johnson
President & CEO
7171 North Dale Mabry Highway
Carrollwood, FL 33614
(813) 558-8001
(813) 558-8011
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Eric Stevens
CEO

Page 261 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3366
(863) 402-3110
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Bruce Bergherm
President/Chief Executive Officer
1395 South Pinellas Avenue
Tarpon Springs, FL 34689
(727) 942-5107
(727) 942-5161
[email protected]

Brian Adams
Chief Executive Officer/President
3100 East Fletcher Avenue
Tampa, FL 33613
(813) 615-7203
(813) 615-7580
[email protected]

Denise Grimsley
Administrator
533 West Carlton Street
Wauchula, FL 33873
(863) 767-8342
(863) 773-0126

Page 262 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
[email protected]

Denyse Bales-Chubb
Chief Executive Officer/President
2600 Bruce B Downs Boulevard
Wesley Chapel, FL 33544
(813) 929-5490
(813) 929-5475
[email protected]

Bill Heinrich
Vice President/Chief Financial Officer
7050 Gall Boulevard
Zephyrhills, FL 33541
(813) 779-6201
(813) 783-6196
[email protected]

Jack Kolosky
President/CEO
12902 Magnolia Drive
Tampa, FL 33612
(813) 745-7222
(813) 745-3090
[email protected]

Jeff Feasel
Chief Executive Officer
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-4771
(386) 425-1575
[email protected]

Raymond Williams

Page 263 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Chief Executive Officer
524 W Sagamore Ave
Clewiston, FL 33440
(863) 902-3076
(863) 983-1809
[email protected]

Carlos Migoya
Chief Executive Officer
1611 NW 12th Avenue, WW 117
Miami, FL 33136
(305) 585-6754

[email protected]

Michael Hutchins
Administrator
14114 Alabama Street
Jay, FL 32505
(850) 675-8015
(850) 675-8070
[email protected]

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
[email protected]

Pam Howard
CEO
P.O. Box 748
Lake Butler, FL 32054

Page 264 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
(386) 496-2323
(386) 496-1611
[email protected]

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Boulevard
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
[email protected]

Anthony Degina
Chief Executive Officer
201 14th Street SW
Largo, FL 33770
(727) 588-5200
(727) 588-5906
[email protected]

Greg Lowe
Chief Executive Officer
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
[email protected]

James Nathan
CEO
2776 Cleveland Avenue
Fort Myers, FL 33901
(239) 343-6502
(239) 343-6991
[email protected]

Page 265 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Don Henderson
President and CEO
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
[email protected]

Jonathan Cherry
President/CEO
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7500
(352) 360-6595
[email protected]

Mark E. Robitaille
Chief Executive Officer
301 SE Hospital Avenue
Stuart, FL 34995

[email protected]

Louis Galdieri
President
601 Main Street
Dunedin, FL 34698
(727) 734-6365
(727) 734-6887
[email protected]

Leigh Massengill
Chief Executive Officer
9330 State Road 54

Page 266 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Trinity, FL 34655
(727) 834-4000
(727) 834-4912
[email protected]

Kristopher Hoce
Chief Operating Officer
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
[email protected]

Michael Yungmann
President
6600 Madison Street
New Port Richey, FL 34652
(727) 843-4599
(727) 848-8762
[email protected]

Wayne Chutkan
Senior VP of Finance
4300 Alton Road
Miami Beach, FL 33140
(305) 674-2662
(305) 674-2007
[email protected]

Allen S. Weiss, MD
Chief Executive Officer
350 7th Street North
Naples, FL 34102
(239) 624-4013
(239) 624-4001
[email protected]

Page 267 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Dia Nichols
Chief Executive Officer
6000 49th Steet North
St. Petersburg, FL 33709
(727) 521-4411
(727) 521-5007
[email protected]

W. Mark Rader
Chief Executive Officer
2801 North State Road 7
Margate, FL 33063
(954) 974-0400
(954) 978-4183
[email protected]

Jesse G. Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
[email protected]

Eric Goldman
Chief Executive Officer
13001 Southern Boulevard

Page 268 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Loxahatchee, FL 33470
(561) 798-3300
(561) 791-8108
[email protected]

Barbara Simmons
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
[email protected]

Joanna Conley
Chief Executive Officer
325 Cypress Parkway
Kissimmee, FL 34758
(407) 530-2000
(407) 530-2020
Joanna.Conley@hca healthcare.com

Robert H. Lee
Chief Executive Officer
1796 Highway 441 North
Okeechobee, FL 34972
(863) 763-2151
(863) 824-2991
Robert.Lee@hca healthcare.com

C. Shayne George
Chief Executive Officer
14000 Fivay Road
Hudson, FL 34667
(727) 819-2929
(727) 869-5491

Page 269 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
[email protected]

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
[email protected]

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
[email protected]

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
[email protected]

Edward Jimenez
Chief Operating Officer
1600 SW Archer Road
Gainesville, FL 32610
(352) 733-1500
(352) 265-0231
[email protected]

Page 270 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Russ Armistead
CEO
655 West 8th Street
Jacksonville, FL 32209
(904) 244-5013

[email protected]

Karen Kerr
Chief Operating Officer/President
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
[email protected]

Lorraine Lutton
Chief Operating Officer
3001 W. Dr. M.L. King Jr. Blvd.
Tampa, FL 33607
(813) 870-4020
(813) 870-4639
[email protected]

Robert Conroy, Jr.

Chief Executive Officer
6500 38th Avenue North
St. Petersburg, FL 33710
(727) 384-1414
(727) 341-4889
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447

Page 271 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
(904) 602-1151
(904) 602-2700
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
[email protected]

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
[email protected]

G. Mark O'Bryant
President and Chief Executive Officer
1300 Miccosukee Road
Tallahassee, FL 32308
(850) 431-5380
(850) 431-5883
[email protected]

James Burkhart
President & CEO
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
[email protected]

Page 272 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator

Don Henderson
Chief Executive Officer
1451 El Camino Real
The Villages, FL 32159
(352) 323-5001

[email protected]

Joseph Melchiode
Chief Executive Officer
7201 North Unjiversity Drive
Tamarac, FL 33321
(954) 721-2200
(954) 724-6567
[email protected]

David Zambrana
Chief Executive Officer
1400 NW 12th Avenue
Miami, FL 33136
(305) 689-4515
(305) 689-4673
[email protected]

Barbara J. Simmons
Chief Executive Officer
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
[email protected]

Lars Houmann
President & CEO
601 East Rollins Street

Page 273 of 322

acts

payment of treatment of a certified resident who is a

d to calculate the rate of reimbursement. The Agency
pital personnel. Hospital personnel (may NOT be
der to receive any HCRA updates, forms and/or other

August 3, 2015

Administrator
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Page 274 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
AVENTURA HOSPITAL & MEDICAL CENTER 10-0131
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST HOSPITAL 10-0093
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Back-up Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER BEACHES 10-0117
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER JACKSONVILLE 10-0088
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 275 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
BAPTIST MEDICAL CENTER NASSAU 10-0140
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAPTIST MEDICAL CENTER SOUTH 2396-0052
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAYFRONT HEALTH BROOKSVILLE 10-0071
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BAYFRONT HEALTH - ST PETERSBURG 10-0032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
BLAKE MEDICAL CENTER 10-0213
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 276 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
BRANDON REGIONAL HOSPITAL 10-0243
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
CENTRAL FLORIDA REGIONAL HOSPITAL 10-0161
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTORS MEMORIAL HOSPITAL 10-0078
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
DOCTOR'S MEMORIAL HOSPITAL 10-0106
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
EDWARD WHITE HOSPITAL 10-0239
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 277 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
ENGLEWOOD COMMUNITY HOSPITAL 11-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLAGLER HOSPITAL 10-0219
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL 10-0007
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL ALTAMONTE 12-0004
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL APOPKA 12-0003
Name:
Title:
Mailing Add:
City,Zip:

Page 278 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
FLORIDA HOSPITAL CELEBRATION HEALTH 2396-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL EAST ORLANDO 10-0021
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

FLORIDA HOSPITAL HEARTLAND MEDICAL CENTER 10-0109

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL KISSIMMEE 10-0089
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL NORTH PINELLAS 10-0055
Name:
Title:

Page 279 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
FLORIDA HOSPITAL WAUCHULA 10-0282
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HALIFAX HEALTH MEDICAL CENTER 10-0017
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
HENDRY REGIONAL MEDICAL CENTER 10-0098
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JAY HOSPITAL 10-0048
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Back-up Name:
Title:

Page 280 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
JFK MEDICAL CENTER 10-0080
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
KENDALL REGIONAL MEDICAL CENTER 10-0209
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

LAKE BUTLER HOSPITAL HAND SURGERY CENTER 10-0241

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAKEWOOD RANCH MEDICAL CENTER 2396-0046
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LARGO MEDICAL CENTER 10-0248

Page 281 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LAWNWOOD REGIONAL MEDICAL CENTER 10-0246
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEE MEMORIAL HOSPITAL 10-0012
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LEESBURG REGIONAL MEDICAL CENTER 10-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
LIFESTREAM BEHAVIORAL CENTER 10-4018
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 282 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
MARTIN MEMORIAL MEDICAL CENTER 10-0044
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEASE DUNEDIN HOSPITAL 10-0043
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT HOSPITAL 10-0127
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MORTON PLANT NORTH BAY HOSPITAL 10-0063
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
MEDICAL CENTER OF TRINITY 10-0191
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:

Page 283 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Email:
MT. SINAI MEDICAL CENTER 10-0034
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NAPLES COMMUNITY HOSPITAL 10-0018
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHSIDE HOSPITAL 10-0238
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

NORTHWEST FLORIDA COMMUNITY HOSPITAL 10-0147

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
NORTHWEST MEDICAL CENTER 10-0189
Name:
Title:
Mailing Add:
City,Zip:

Page 284 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Phone:
Fax:
Email:
OAK HILL HOSPITAL 10-0264
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ORLANDO REGIONAL 10-0006
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PALMS WEST HOSPITAL 11-0006
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
PLANTATION GENERAL HOSPITAL 10-0167
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
RAULERSON HOSPITAL 10-0252
Name:
Title:
Mailing Add:

Page 285 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:

REGIONAL MEDICAL CENTER BAYONET POINT 10-0256

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL 10-0025
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE EMERALD
COAST 2396-0041
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SACRED HEART HOSPITAL ON THE GULF 2396-0084
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Page 286 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #

SHANDS HOSPITAL AT THE UNIVERSITY OF FLORIDA 10-0113

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SHANDS JACKSONVILLE MEDICAL CENTER 10-0001
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH BAY HOSPITAL 10-0259
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SOUTH FLORIDA BAPTIST HOSPITAL 10-0132
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
SPRING HILL REGIONAL HOSPITAL 11-1525
Name:
Title:
Mailing Add:
City,Zip:
Phone:

Page 287 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Fax:
Email:
ST. JOSEPH'S HOSPITAL 10-0075
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. PETERSBURG GENERAL HOSPITAL 10-0180
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

ST. VINCENT'S MEDICAL CENTER SOUTHSIDE 2396-0088

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
ST. VINCENT'S MEDICAL CENTER RIVERSIDE 10-0040
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
TALLAHASSEE MEMORIAL HOSPITAL 10-0135
Name:
Title:
Mailing Add:

Page 288 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
City,Zip:
Phone:
Fax:
Email:
TAMPA GENERAL HOSPITAL 10-0128
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
Back-up Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
THE VILLAGES REGIONAL HOSPITAL 2396-0032
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

UNIVERSITY HOSPITAL AND MEDICAL CENTER 10-0224

Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WESTSIDE REGIONAL MEDICAL CENTER 10-0228
Name:
Title:

Page 289 of 322

 AGENCY FOR HEALTH CA
Bureau of Manage
Health Care Responsibility Act (HCRA
October 1, 2013 - Sep
Hospital participation in the HCRA program is voluntary. The Agency will not consider an eligible hospital as participatin
information for hospital personnel. Hospital personnel responsible for eligibility determinations and claims processing in regar
and/or other info

Hospital ID and
Partcipating Hospital Name AHCA File #
Mailing Add:
City,Zip:
Phone:
Fax:
Email:
WINTER PARK MEMORIAL HOSPITAL 10-0162
Name:
Title:
Mailing Add:
City,Zip:
Phone:
Fax:
Email:

Agency for Health Care Adm

Bureau of Managed Health Care
HCRA Liaison
Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:
Back-up Name:
Title:
Agency:
Mailing Add:
City,Zip
Phone:
Fax:
Email:

Page 290 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Venise Caven Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
20900 Biscayne Boulevard 6451 126th Avenue North
Aventura, FL 33180 Largo, FL 33773
(305) 937-3961 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Roberta Thompson Roberta Thompson

Patient Account Representative Patient Account Representative
P.O. Box 17106 P.O. Box 17106
Pensacola, FL 32522 Pensacola, FL 32522
(850) 469-2023 (850) 469-2023
(850) 434-4683 (850) 434-4683
[email protected] [email protected]
David Pezewski David Pezewski
Reimbursement Director Reimbursement Director
1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303
Pensacola, FL 32522 Pensacola, FL 32522
(850) 434-4651 (850) 434-4651
(850) 434-4682 (850) 434-4682
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4130 (904) 376-4130
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4130 (904) 376-4130
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Page 291 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4130 (904) 376-4130
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Eileen Henderlite Eileen Henderlite

Vice President - Revenue Cycle Vice President - Revenue Cycle
3563 Philips Highway, Ste. 201 3563 Philips Highway, Ste. 201
Jacksonville, FL 32207 Jacksonville, FL 32207
(904) 376-4130 (904) 376-4130
(904) 391-5073 (904) 391-5073
[email protected] [email protected]

Vickie Norris Beth Thomas

Business Office Director Business Office Manager
17240 Cortez Boulevard 17240 Cortez Boulevard
Brooksville, FL 34601 Brooksville, FL 34601
(352) 544-6183 (352) 544-6129
(352) 754-3215 (352) 754-3215
[email protected] [email protected]

Beata Mach Beata Mach

Medicaid Lead Medicaid Lead
101 Paramount Drive, Suite 320 101 Paramount Drive, Suite 320
Sarasota, FL 34232 Sarasota, FL 34232
(941) 444-8238 (941) 444-8238

[email protected] [email protected]

Debbie Pancake Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
2020 59th Street West 6451 126th Avenue North
Bradenton, FL 34209 Largo, FL 33773
(941) 798-6001 (727) 773-3410
(727) 773-3411

Page 292 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Ana Almodovar Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
119 Oakfield Drive 6451 126th Avenue North
Brandon, FL 33511 Largo, FL 33773
(813) 681-5551, ext. 3366 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Ivellys Gonzalez Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
1401 West Seminole Blvd 6451 126th Avenue North
Sanford, FL 32771 Largo, FL 33773
(407) 321-4500, ext. 5259 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Donna Boroughs Brandi Stewart

Business Office Director Billing
2600 Hospital Drive 2600 Hospital Drive
Bonifay, FL 32425 Bonifay, FL 32425
(850) 547-8015 (850) 547-8121
(850) 547-8025 (850) 547-8090
[email protected] [email protected]

Debbie Howard Debbie Howard

Registration Coordinator Registration Coordinator
333 North Byron Butler Parkway 333 North Byron Butler Parkway
Perry, FL 32347 Perry, FL 32347
(850) 584-0154 (850) 584-0154
(850) 584-2524 (850) 584-2524
[email protected] [email protected]

Milady Santana-Burgos Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
2323 9th Avenue North 6451 126th Avenue North
St. Petersburg, FL 33713 Largo, FL 33773
(727) 328-6162 (727) 773-3410

Page 293 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(727) 773-3411
[email protected] [email protected]

Katherine Weinmann Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
700 Medical Boulevard 6451 126th Avenue North
Englewood, FL 34223 Largo, FL 33773
(941) 629-1181, ext. 6890 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jackie Shugart Stephanie Smith

Patient Director Business Office Supervisor
400 Health Park Blvd. 400 Health Park Blvd.
St. Augustine, FL 32086 St. Augustine, FL 32086
(904) 849-5155 (904) 849-5155
(904) 819-4906 (904) 819-4906
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751

Page 294 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Tracy Goodwin Tracy Goodwin

Manager - MEDS Manager - MEDS
4200 Sun N' Lake Blvd 4200 Sun N' Lake Blvd
Sebring, FL 33872 Sebring, FL 33872
(863) 402-5329 (863) 402-5329
(863) 402-3197 (863) 402-3197
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Coy Ingram Coy Ingram

Regional Director Regional Director

Page 295 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

3102 East 138th Avenue 3102 East 138th Avenue
Tampa, FL 33612 Tampa, FL 33612
(813) 615-7219 (813) 615-7219
(813) 615-7704 (813) 615-7704
[email protected] [email protected]

Tracy Goodwin Tracy Goodwin

Manager - MEDS Manager - MEDS
533 West Carlton Street 533 West Carlton Street
Wauchula, FL 33873 Wauchula, FL 33873
(863) 402-5329 (863) 402-5329
(863) 402-3197 (863) 402-3197
[email protected] [email protected]

Doug Duncan Joni Rahn

Reimbursement Specialist Supervisor
303 N. Clyde Morris Boulevard 303 N. Clyde Morris Boulevard
Daytona Beach, FL 32114 Daytona Beach, FL 32114
(386) 226-4567 (386) 254-4000, ext. 12080
(386) 253-7593 (386) 253-7593
[email protected] [email protected]

Heather Giddens Nicole Green

Registration Supervisor Billing Supervisor
524 W Sagamore Ave 524 W Sagamore Ave
Clewiston, FL 33440 Clewiston, FL 33440
(863) 983-9121 (863) 983-9121
(863) 983-1809 (863) 983-1809
[email protected] [email protected]

Roberta Thompson Roberta Thompson

Patient Account Representative Patient Account Representative
P.O. Box 17106 P.O. Box 17106
Pensacola, FL 32522 Pensacola, FL 32522
(850) 469-2023 (850) 469-2023
(850) 434-4683 (850) 434-4683
[email protected] [email protected]
David Pezewski David Pezewski
Reimbursement Director Reimbursement Director

Page 296 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

1717 N E Street, Tower 1, Suite 303 1717 N E Street, Tower 1, Suite 303
Pensacola, FL 32522 Pensacola, FL 32522
(850) 434-4651 (850) 434-4651
(850) 434-4682 (850) 434-4682
[email protected] [email protected]

Anne Johnson Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
5301 South Congress Avenue 6451 126th Avenue North
Atlantis, FL 33462 Largo, FL 33773
(561) 548-1357 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Rosa Canseco Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
11750 Bird Road 6451 126th Avenue North
Miami, FL 33175 Largo, FL 33773
(305) 227-5576 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Maria Yarley Eva Atwood

Patient Account Representative Patient Account Insurance Biller
P.O. Box 748 P.O. Box 748
Lake Butler, FL 32054 Lake Butler, FL 32054
(386) 496-2323, ext. 9201 (386) 496-2323, ext. 9203
(386) 496-4734 (386) 496-4734
[email protected] [email protected]

Tammy Grant Tim Perrin

Director, Patient Access Manager, Patient Accounts
206 Second Street East 206 Second Street East
Bradenton, FL 34208 Bradenton, FL 34208
(941) 745-7210 (941) 745-7505
(941) 782-3575 (941) 745-6836
[email protected] [email protected]

Page 297 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Beth Weekes Kris Panetta
Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
201 14th Street Southwest 6451 126th Avenue North
Largo, FL 33770 Largo, FL 33773
(727) 588-5489 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Guadelupe Deloera Kris Panetta

Public Benefit Coordinator Director, Medicaid Eligibility & Support Services
1700 South 23rd Street 6451 126th Avenue North
Fort Pierce, FL 34950 Largo, FL 33773
(772) 467-2851 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Courtney Murray Debbie Yeater

Registration Services Director Central Business Office Supervisor
P.O. Box 2218 224 Santa Barbara Boulevard, Suite 203
Fort Myers, FL 33902-2218 Cape Coral, FL 33991
(239) 343-2036 (239) 242-6015
(239) 343-3967
[email protected]

Lyz Bermudez Lyz Bermudez

Director, Patient Financial Services Director, Patient Financial Services
600 E. Dixie Avenue 600 E. Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5094 (352) 323-5094
(352) 323-5239 (352) 323-5239
[email protected] [email protected]

Susan Gregory Vickie Anderson

Program Director - HIM Billing Office Supervisor
P.O. Box 491000 P.O. Box 491000
Leesburg, FL 34749-1000 Leesburg, FL 34749-1000
(352) 315-7462 (352) 315-7537
(352) 360-6610 (352) 315-7587
[email protected] [email protected]

Page 298 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Luis Cabrera Carol Plato

Senior Reimbursement Analyst Assistant Vice President, Revenue Cycle
301 SE Hospital Avenue 301 SE Hospital Avenue
Stuart, FL 34995 Stuart, FL 34995
(772) 223-2828 (772) 223-5656
(772) 223-5621 (772) 223-5622
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Deprtment Financial Assistance Deprtment
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Pat Cooper Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
9330 State Road 54 6451 126th Avenue North
Trinity, FL 34655 Largo, FL 33773
(727) 834-5720 (727) 773-3410
(727) 773-3411

Page 299 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

[email protected] [email protected]

Linda Lujan Linda Lujan

Business Office Director Business Office Director
4300 Alton Road 4300 Alton Road
Miami Beach, FL 33140 Miami Beach, FL 33140
(305) 695-7607 (305) 695-7607
(305) 674-2118 (305) 674-2118
[email protected] [email protected]

Lynn Thorn Sandy Wood

Patient Business Services Supervisor Operations Director - Revenue Cycle
PO Box 413001 PO Box 8569
Naples, FL 34101 Naples, FL 34109
(239) 624-3619 (239) 624-6407
(239) 624-3621 (239) 624-6411
[email protected] [email protected]

Cynthia Bacon Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
6000 49th Street North 6451 126th Avenue North
St. Petersburg, FL 33709 Largo, FL 33773
(727) 521-5558 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Chrissy Sims Dena Cooper

Financial Counselor Controller
PO Box 889 PO Box 889
Chipley, FL 32428 Chipley, FL 32428
(850) 415-8165 (850) 415-8188
(850) 415-8108 (850) 638-0622
[email protected] [email protected]

Robb Hurlock Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
2801 North State Road 7 6451 126th Avenue North
Margate, FL 33063 Largo, FL 33773

Page 300 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(954) 956-3060 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Linda Murphy Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
11375 Cortez Boulevard 6451 126th Avenue North
Brooksville, FL 34613 Largo, FL 33773
(352) 597-6371 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Bridget Walters Bridget Walters

Corporate Director, Patient Accounting Corporate Director, Patient Accounting
3090 Caruso Court, Suite 20 3090 Caruso Court, Suite 20
Orlando, FL 32806 Orlando, FL 32806
(407) 650-3771 (407) 650-3771
(321) 843-6579 (321) 843-6579
[email protected] [email protected]

Maria Cortes-Bolivar Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
13001 Southern Boulevard 6451 126th Avenue North
Loxahatchee, FL 33470 Largo, FL 33773
(561) 798-6078 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Fabiola Dickson Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
401 Northwest 42nd Avenue 6451 126th Avenue North
Plantation, FL 33317 Largo, FL 33773
(954) 587-5010, ext. 6650 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Melinda Hernandez Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
1796 Highway 441 North 6451 126th Avenue North

Page 301 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Okeechobee, FL 34972 Largo, FL 33773
(863) 824-2870 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Kathleen Troutwine Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
14000 Fivay Road 6451 126th Avenue North
Hudson, FL 34667 Largo, FL 33773
(727) 819-2929, ext. 5365 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Michele Nelson Ivette Vargas

Patient Accounts Manager Follow-up Specialist
5151 North 9th Avenue 2315 LaSalle
Pensacola, FL 32504 Chicago, IL 60604
(850) 416-7099 (312) 931-3028
(850) 416-6921 (312) 462-6291
[email protected] [email protected]

Michele Nelson Ivette Vargas

Patient Accounts Manager Follow-up Specialist
5151 North 9th Avenue 2315 LaSalle
Pensacola, FL 32504 Chicago, IL 60604
(850) 416-7099 (312) 931-3028
(850) 416-6921 (312) 462-6291
[email protected] [email protected]

Michele Nelson Ivette Vargas

Patient Accounts Manager Follow-up Specialist
5151 North 9th Avenue 2315 LaSalle
Pensacola, FL 32504 Chicago, IL 60604
(850) 416-7099 (312) 931-3028
(850) 416-6921 (312) 462-6291
[email protected] [email protected]

Page 302 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Barbara Southwell Nathaniel Thomas

Manager Claims Processor (Patient Financial Services)
P.O. Box 334 P.O. Box 100334
Gainesville, FL 32610 Gainesville, FL 32610
(352) 594-2354 (352) 265-0680, ext. 42137
(352) 265-9012 (352) 265-9018
[email protected] [email protected]

Shakawn Jones Shakawn Jones

Manager - PFS Manager - PFS
655 West 8th Street 655 West 8th Street
Jacksonville, FL 32209 Jacksonville, FL 32209
(904) 244-1877 (904) 244-1877
(904) 244-1874 (904) 244-1874
[email protected] [email protected]

Veronica Vargas Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
4016 Sun City Center Boulevard 6451 126th Avenue North
Sun City Center, FL 33573 Largo, FL 33773
(813) 634-0488 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Vickie Norris Beth Thomas

Business Office Director Business Office Manager
17240 Cortez Boulevard 17240 Cortez Boulevard
Brooksville, FL 34601 Brooksville, FL 34601
(352) 544-6183 (352) 544-6129

Page 303 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

(352) 754-3215 (352) 754-3215
[email protected] [email protected]

Jessica Villafana Opyd Jessica Villafana Opyd

Financial Assistance Department Supervisor Financial Assistance Department Supervisor
3986 Tampa Road 3986 Tampa Road
Oldsmar, FL 34677 Oldsmar, FL 34677
(813) 852-3305 (813) 852-3305
(813) 635-7731 (813) 635-7731
[email protected] [email protected]

Evelyn Noguez Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
6500 38th Avenue North 6451 126th Avenue North
St. Petersburg, FL 33710 Largo, FL 33773
(727) 341-4929 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Malik Salaam Molly Rodenbeck

Senior Operations Lead Billing Follow Up Manager
5505 E 13 Mile Road, Ste 300 231 LaSalle Street 5th Floor
Warren, MI 48092 Chicago, IL 60604
(855) 551-5715 (312) 931-3067
(586) 698-0071 (312) 462-6293
[email protected] [email protected]

Malik Salaam Molly Rodenbeck

Senior Operations Lead Billing Follow Up Manager
5505 E 13 Mile Road, Ste 300 231 LaSalle Street 5th Floor
Warren, MI 48092 Chicago, IL 60604
(855) 551-5715 (312) 931-3067
(586) 698-0071 (312) 462-6293
[email protected] [email protected]

Jeff Sherman Jeff Sherman

Director, Patient Financial Services Director, Patient Financial Services
1300 Miccosukee Road 1300 Miccosukee Road

Page 304 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 431-6202 (850) 431-6202
(850) 431-6017 (850) 431-6017
[email protected] [email protected]

Lindy Esposito Eugene Martineau

Financial Assistance Supervisor Patient Accounts Specialist
PO Box 1289 PO Box 1289
Tampa, FL 33601 Tampa, FL 33601
(813) 844-8913 (813) 844-4798
(813) 844-8920 (813) 844-4799
[email protected] [email protected]
Kim Shepherd Kim Shepherd
Patient Access Manager Patient Access Manager
PO Box 1289 PO Box 1289
Tampa, FL 33601 Tampa, FL 33601
(813) 844-7406 (813) 844-7406
(813) 844-4391 (813) 844-4391
[email protected] [email protected]

Lyz Bermudez Lyz Bermudez

Director, Patient Financial Services Director, Patient Financial Services
600 E. Dixie Avenue 600 E. Dixie Avenue
Leesburg, FL 34748 Leesburg, FL 34748
(352) 323-5094 (352) 323-5094
(352) 323-5239 (352) 323-5239
[email protected] [email protected]

Jose Martinez Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director
7201 North University Drive 6451 126th Avenue North
Tamarac, FL 33321 Largo, FL 33773
(954) 724-6144 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Zac Williams Kris Panetta

Public Benefit Coordinator Medicaid Eligibility & Support Services Director

Page 305 of 322

GENCY FOR HEALTH CARE ADMINISTRATION
Bureau of Managed Health Care
Responsibility Act (HCRA) Participating Hospital Contacts
October 1, 2013 - September 30, 2014
y will not consider an eligible hospital as participating in the HCRA program for reimbursement of indigent emergency care from
ibility determinations and claims processing in regards to the HCRA program must have an email address and internet access in
and/or other information.

Date Last Revised:

HCRA Eligibility Determination HCRA Claims Processing

8201 West Broward Boulevard 6451 126th Avenue North
Plantation, FL 33324 Largo, FL 33773
(954) 916-5458 (727) 773-3410
(727) 773-3411
[email protected] [email protected]

Tammie Rikansrud Sharda Parsaram

Asst. VP Asst. Director
900 Winderley Place, Suite 2100 900 Winderley Place, Suite 2100
Maitland, FL 32751 Maitland, FL 32751
(407) 200-2307 (407) 200-2644
(407) 200-4965 (407) 200-4965
[email protected] [email protected]

Agency for Health Care Administration Contacts

Bureau 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 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4333 (850) 412-4353
(850) 414-6912 (850) 922-6964
[email protected] [email protected]
Karin Jacobson Felton Bradley
Medical Health Care Program Analyst Economic Analyst
Medicaid Compliance Unit II Bureau of Certificate of Need/Financial Analysis
2727 Mahan Drive, Mail Stop Code 26 2727 Mahan Drive, Mail Stop Code 28
Tallahassee, FL 32308 Tallahassee, FL 32308
(850) 412-4312 (850) 412-4350
(850) 414-6912 (850) 922-6964
[email protected] [email protected]

Page 306 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator

Dianne Goldenberg
Chief executive Officer
20900 Biscayne Boulevard
Aventura, FL 33180
(305) 682-7000

[email protected]

David Wildebrandt
Administrator
1000 W. Moreno Street
Pensacola, FL 32501
(850) 434-4011

[email protected]

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
[email protected]

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
[email protected]

Page 307 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator

Stephen Lee
Hospital President
1250 South 18th Street
Fernandina Beach, FL 32034
(904) 321-3502
(904) 321-3511
[email protected]

Ron Robinson
Hospital President
14550 Old St. Augustine Road
Jacksonville, FL 32258
(904) 271-6002
(904) 271-6650
[email protected]

Kenneth Wicker
Chief Executive Officer
17240 Cortez Boulevard
Brooksville, FL 34601
(352) 799-5111
(352) 754-3215
[email protected]

Kathryn Gillette
CEO
701 6th Street South
St. Petersburg, FL 33701

Daniel Friedrich, III

Chief executive Officer
2020 59th Street West
Bradenton, FL 34209
(941) 792-6611
(941) 798-6209

Page 308 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
[email protected]

Bland Eng
Chief Executive Officer
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
[email protected]

Wendy Brandon
Chief Executive Officer
1401 West Seminole Blvd
Sanford, FL 32771
(407) 321-4500
(407) 324-2155
[email protected]

JoAnn Baker
Administrator
2600 Hospital Drive
Bonifay, FL 32425
(850) 547-8003
(850) 547-8006
[email protected]

Geri Forbes
CEO
333 North Byron Butler Parkway
Perry, FL 32347
(850) 584-0800
(850) 223-2308
[email protected]

Sharon Hayes
Chief Executive Officer
2323 9th Avenue North
St. Petersburg, FL 33713
(727) 323-1111

Page 309 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
(727) 328-6135
[email protected]

Dale F. Alward
Chief Executive Officer
700 Medical Boulevard
Englewood, FL 34223
(941) 475-6571
(941) 473-5015
[email protected]

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 849-5155

[email protected]

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
601 East Altamonte Drive
Altamonte Springs, FL 32701
(407) 303-4321
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
201 N. Park Avenue
Apopka, FL 32703

Page 310 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
(407) 889-1000
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
400 Celebration Place
Celebration, FL 34747
(407) 303-4000
(407) 200-4965
[email protected]

Lars Houmann
President & CEO
7727 Lake Underhill Drive
Orlando, FL 32822
(407) 303-8110
(407) 200-4965
[email protected]

Warren Santander
Interim CEO
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3108
(863) 402-3110
[email protected]

Lars Houmann
President & CEO
200 Hilda Street
Kissimmee, FL 34741
(407) 846-4343
(407) 200-4965
[email protected]

Bruce Bergherm
President & CEO

Page 311 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
1395 South Pinellas Avenue
Tarpon Springs, FL 34689
(727) 942-5107
(727) 942-5161
[email protected]

Denise Grimsley
Administrator
533 West Carlton Street
Wauchula, FL 33873
(863) 767-8342
(863) 773-0126
[email protected]

Eric Peburn
CFO
303 N. Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 254-4000
(386) 253-7593
[email protected]

RD Williams
CEO
524 W Sagamore Ave
Clewiston, FL 33440
(863) 983-9121
(863) 983-1809
[email protected]

Mike Hutchins
Administrator
14114 Alabama Street
Jay, FL 32565
(850) 675-8015

[email protected]

Page 312 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator

Gina A. Melby
Chief Executive Officer
5301 South Congress Avenue
Atlantis, FL 33462
(561) 965-7300
(561) 642-3685
[email protected]

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
[email protected]

Pam Howard
CEO
P.O. Box 748
Lake Butler, FL 32054
(386) 496-2323
(386) 496-1611
[email protected]

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Blvd.
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
[email protected]

Page 313 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
Anthony Degina
Chief Executive Officer
201 14th Street Southwest
Largo, FL 33770
(727) 588-5200
(727) 588-5906
[email protected]

Steve Daugherty
Chief Executive Officer - Interim
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
[email protected]

Lisa Sgarlata
Chief Administrative Officer
2776 Cleveland Avenue
Fort Myers, FL 33901
(239) 343-2000

Don Henderson
President and CEO
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
[email protected]

Rick Hankey
Senior Vice President
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7815
(352) 360-6610
[email protected]

Page 314 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator

Mark Robitaille
President & CEO
301 SE Hospital Avenue
Stuart, FL 34995

[email protected]

Louis Galderi
Chief Operating Officer
601 Main Street
Dunedin, FL 34698
(727) 734-6395
(727) 734-6887
[email protected]

Kristopher Hoce
Chief Operating Officer
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
[email protected]

Harrell Ziecheck
Chief Operating Officer
6600 Madison Street
New Port Richey, FL 34652
(727) 843-4599
(727) 848-8762
[email protected]

Leigh Massengill
Chief Executive Officer
9330 State Road 54
Trinity, FL 34655
(727) 834-4000
(727) 834-4912

Page 315 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
[email protected]

Wayne Chutkan
Senior VP of Finance
4300 Alton Road
Miami Beach, FL 33140
(305) 674-2662
(305) 674-2007
[email protected]

Dr. Allen Weiss

CEO
PO Box 413001
Naples, FL 34101
(239) 624-4002
(239) 624-4001
[email protected]

Dia Nichols
Chief Executive Officer
6000 49th Street North
St. Petersburg, FL 33709
(727) 521-4411
(727) 521-5007
[email protected]

Patrick Schlenker
CEO
PO Box 889
Chipley, FL 32428
(850) 415-8103
(850) 638-5764
[email protected]

W. Mark Rader
Chief Executive Officer
2801 North State Road 7
Margate, FL 33063

Page 316 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
(954) 974-0400
(954) 978-4183
[email protected]

Jesse Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
[email protected]

Thomas Yoesle
Chief Operating Officer, Revenue Management
3160 Southgate Commerce Blvd., Suite 40
Orlando, FL 32806
(407) 650-3768
(321) 843-6520
[email protected]

Eric Goldman
Chief Executive Officer
13001 Southern Boulevard
Loxahatchee, FL 33470
(561) 798-3300
(561) 791-8108
[email protected]

Randy Gross
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
[email protected]

Robert H. Lee
Chief Executive Officer
1796 Highway 441 North

Page 317 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
Okeechobee, FL 34972
(863) 763-2151
(863) 824-2991
[email protected]

C. Shayne George
Chief Executive Officer
14000 Fivay Road
Hudson, FL 34667
(727) 819-2929
(727) 869-5491
[email protected]

Henry Stovall
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-7618
[email protected]

Roger Hall
President
7800 U.S. Highway 98 West
Miramar Beach, FL 32550
(850) 278-3006
(850) 278-3010
[email protected]

Roger Hall
President
7800 U.S. Highway 98 West
Miramar Beach, FL 32550
(850) 278-3006
(850) 278-3010
[email protected]

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acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator

Tim Goldfarb
CEO
1600 SW Archer Road
Gainesville, FL 32606
(352) 265-0111

[email protected]

Russ Armistead
CEO
655 West 8th Street
Jacksonville, FL 32209
(904) 244-3002
(904) 244-4027
[email protected]

Sharon Roush
Chief Executive Officer
4016 Sun City Center Boulevard
Sun City Center, FL 33573
(813) 634-3301
(813) 634-8712
[email protected]

Karen Kerr
Chief Operating Officer - Interim
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
[email protected]

Kenneth Wicker
Chief Executive Officer
17240 Cortez Boulevard
Brooksville, FL 34601
(352) 799-5111

Page 319 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
(352) 754-3215
[email protected]

Lorraine Lutton
Chief Operating Officer
3001 W. Dr. M.L. King Jr. Blvd.
Tampa, FL 33607
(813) 870-4020
(813) 870-4639
[email protected]

Robert Conroy, Jr.

Chief Executive Officer
6500 38th Avenue North
St. Petersburg, FL 33710
(727) 384-1414
(727) 341-4889
[email protected]

Cathy Wambles
PFS Manager
PO Box 45167
Jacksonville, FL 32232
(904) 308-5919
(904) 308-2903
[email protected]

Cathy Wambles
PFS Manager
PO Box 45167
Jacksonville, FL 32232
(904) 308-5919
(904) 308-2903
[email protected]

G. Mark O'Bryant
President and Chief Executive Officer
1300 Miccosukee Road

Page 320 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
Tallahassee, FL 32308
(850) 431-5380
(850) 431-5883
[email protected]

James Burkhart
President & Chief Executive Officer
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
[email protected]

Don Henderson
President and CEO
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
[email protected]

Joseph D. Melchiode
Chief Executive Officer
7201 North University Drive
Tamarac, FL 33321
(954) 721-2200
(954) 724-6567
[email protected]

Lee B. Chaykin
Chief Executive Officer

Page 321 of 322

acts

ncy care from the counties until we receive contact

et access in order to receive any HCRA updates, forms

August 15, 2014

Administrator
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
[email protected]

Lars Houmann
President & CEO
200 N. Lakemont Avenue
Winter Park, FL 32792
(407) 646-7000
(407) 200-4965
[email protected]

Page 322 of 322