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
Daryl.Tol@adventhealth.com Coy.Ingram@adventhealth.com

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
Randy.Surber@AdventHealth.com Ira.Arnan@AdventHealth.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
David.Lemonte@HCAHealthcare.com Ana.Banegas@HCAHealthcare.com

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

Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Karen.Kerr@Baycare.org jessica.villafanaopyd@baycare.org

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

NelsonL@BaptistHealth.net ShelliAL@BaptistHealth.net

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
Randal.Currin@HCAHealthcare.com Guadalupe.Melendez@Parallon.com

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
Bland.Eng@HCAHealthcare.com Ana.Almodovar@HCAHealthcare.com

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
Try.Abshier@HCAHealthcare.com Sonia.Marerro@HCAHealthcare.com

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

Ginger.Carroll@HCAHealthcare.com Denise.Morales@HCAHealthcare.com

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
Jason.Kimbrell@HCAHealthcare.com Daniela.Delgado@Parallon.com

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

Carlos.Migoya@jhsmiami.org Denise.Don@jhsmiami.org

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
Adam.Rudd@HCAHealthcare.com Beth.Weekes@HCAHealthcare.com

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

Matthew.Novak@baycare.org jessica.villafanaopyd@baycare.org

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
Leigh.Massengill@HCAHealthcare.com Wilfredo.Gonzalez@HCAHealthcare.com

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
Bradley.Talbert@HCAHealthcare.com Scharhonda.Williams-Etzey@HCAHealthcare.com

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
Sonia.Wellman@HCAHealthcare.com Robert.Alcantara@parallon.com

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
Lou.Galdieri@baycare.org jessica.villafanaopyd@baycare.org

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
Brandon.May@baycare.org jessica.villafanaopyd@baycare.org

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 Cynthia.Bacon@HCAHealthcare.com

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
Mickey.Smith@HCAHealthcare.com Nicholas.Hernandez@Parallon.com

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
David.Strong@OrlandoHealth.com Lee.Weston@OrlandoHealth.com

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
Madeline.Nava@HCAHealthcare.com Fabiola.Dickson@HCAHealthcare.com

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
Chris.Cosby@HCAHealthcare.com Dulce.Gorostieta@Parallon.com

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
Mark.Dooley2@HCAHealthcare.com Alicia.English@HCAHealthcare.com

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
Brian.Melear@HCAHealthcare.com Crystal.Perez@HCAHealthcare.com

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
Regina.Temple@HCAHealthcare.com Kathleen.Alvelo@HCAHealthcare.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Daniel.Bender@HCAHealthcare.com Veronica.Vargas@HCAHealthcare.com

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
Karen.Kerr@baycare.org jessica.villafanaopyd@baycare.org

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
Kimberly.Guy@baycare.org jessica.villafanaopyd@baycare.org

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
Kenneth.Wicker@HCAHealthcare.com Annette.Fazio@HCAHealthcare.com

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
Mark.Obryant@tmh.org Latasha.McDowell@tmh.org

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
JCouris@tgh.org Aescobio@tgh.org

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
David.Whalen@HCAHealthcare.com Michelle.Castro@HCAHealthcare.com

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
Ben.Harris@HCAHealthcare.com Jose.Martinez@HCAHealthcare.com

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
JIMEDW@shands.ufl.edu chessg@shands.ufl.edu

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
Stephen.Nierman@baycare.org jessica.villafanaopyd@baycare.org

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
HCRA@ahca.myflorida.com Robert.Smith@ahca.myflorida.com

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
Angela.Durham@adventhealth.com

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
Ira.Arnan@AdventHealth.com

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

Dsebastian@R1RCM.com

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

SHill3@R1RCM.com

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

SHill3@R1RCM.com

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

SHill3@R1RCM.com

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

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

Krista.Harrison@bmcjax.com

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

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

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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

PamelaAbb@BaptistHealth.net

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

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

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

Kris.Panetta@Parallon.com

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

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

Yorka.Faldraga@jhsmiami.org

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

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

jessica.villafanaopyd@baycare.org

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

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org

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

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

Jamille Winters
Manager, Patient Accouting
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3741
(321) 843-6837
Jamille.Winters@OrlandoHealth.com

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
Kris.Panetta@Parallon.com

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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
Kris.Panetta@Parallon.com

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

Dsebastian@R1RCM.com

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

Dsebastian@R1RCM.com

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

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
jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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

Latrenda Cooper
Medicaid Billing Manager
1607-1 St. James Court
Tallahassee, FL 32308
(850) 432-6205
(850) 432-6929
Latrenda.Cooper@tmh.org

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
Aescobio@tgh.org

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

Cindy Charyulu
VP, Revenue Cycle
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 265-9022
(352) 265-9012
ccha0005@shands.ufl.edu

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
jessica.villafanaopyd@baycare.org

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
Erika.Skula@AdventHealth.com Kamron.Lachney@AdventHealth.com

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
Jason.Dunkel@AdventHealth.com Kamron.Lachney@AdventHealth.com

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
Daryl.Tol@adventhealth.com Coy.Ingram@adventhealth.com

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
Randy.Surber@AdventHealth.com Ira.Arnan@AdventHealth.com

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
Denyse.Bales-Chubb@AdventHealth.com Kamron.Lachney@AdventHealth.com

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
Randy.Surber@AdventHealth.com Ira.Arnan@AdventHealth.com

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
Erik.Wangsness@AdventHealth.com Kamron.Lachney@AdventHealth.com

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
Amanda.Maggard@AdventHealth.com Kamron.Lachney@AdventHealth.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
Thomas.VanOsdol@ascension.org Sbrent@R1RCM.com

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
Lee.Chaykin@HCAHealthcare.com Ana.Banegas@HCAHealthcare.com

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
scott.raynes@BHCpns.org Lindsey.Stidham@gomedassist.com

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
Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Philip.Boyce@bmcjax.com Sonya.Petrohovich@bmcjax.com

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
Karen.Kerr@Baycare.org jessica.villafanaopyd@baycare.org

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

NelsonL@BaptistHealth.net ShelliAL@BaptistHealth.net

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

NelsonL@BaptistHealth.net ShelliAL@BaptistHealth.net

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
Randal.Currin@HCAHealthcare.com Guadalupe.Melendez@Parallon.com

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
Bland.Eng@HCAHealthcare.com Ana.Almodovar@HCAHealthcare.com

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
Try.Abshier@HCAHealthcare.com Sonia.Marerro@HCAHealthcare.com

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
Ralph.Aleman@HCAHealthcare.com Denise.Morales@HCAHealthcare.com

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
Jason.Barrett@FlaglerHospital.org Skip.Marsh@FlaglerHospital.org

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
Bradley.Griffin@HCAHealthcare.com Gina.Bachuss@HCAHealthcare.com

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
jeff.feasel@halifax.org ronda.kennedy@halifax.org

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
RWilliams@HRMC.us ESandoval@HRMC.us

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
Jason.Kimbrell@HCAHealthcare.com Daniela.Delgado@Parallon.com

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

Carlos.Migoya@jhsmiami.org Denise.Don@jhsmiami.org

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
mike.hutchins@bhcpns.org Lindsey.Stidham@gomedassist.com

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
Gina.Melby@HCAHealthcare.com Anne.Johnson@HCAHealthcare.com

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
Brandon.Haushalter@HCAHealthcare.com Maria.Chaverry@HCAHealthcare.com

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
Adam.Rudd@HCAHealthcare.com Beth.Weekes@HCAHealthcare.com

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
DonHenderson@CentFLHealth.org NaWise@CentFLHealth.org

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
Matthew.Novak@baycare.org jessica.villafanaopyd@baycare.org

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
Leigh.Massengill@HCAHealthcare.com Wilfredo.Gonzalez@HCAHealthcare.com

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
Sonia.Wellman@HCAHealthcare.com Robert.Alcantara@parallon.com

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
Lou.Galdieri@baycare.org jessica.villafanaopyd@baycare.org

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
Brandon.May@baycare.org jessica.villafanaopyd@baycare.org

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 Cynthia.Bacon@HCAHealthcare.com

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
Erica.Gulrich@HCAHealthcare.com Chi.Smarth@HCAHealthcare.com

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
Mickey.Smith@HCAHealthcare.com Linda.Murphy@HCAHealthcare.com

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
David.Strong@OrlandoHealth.com Michelle.Farrell@OrlandoHealth.com

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
Kenneth.Donahey@HCAHealthcare.com Lindsey.Maysonet@HCAHealthcare.com

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
Jacob.Fisher@HCAHealthcare.com Annette.Fazio@HCAHealthcare.com

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
Joshua.Detillo@HCAHealthcare.com Yuderkis.Gonzalez@HCAHealthcare.com

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
Madeline.Nava@HCAHealthcare.com Fabiola.Dickson@HCAHealthcare.com

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
Chris.Cosby@HCAHealthcare.com Daisy.Longo@Parallon.com

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
Brian.Melear@HCAHealthcare.com Crystal.Perez@HCAHealthcare.com

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
Joseph.Rudisill@HCAHealthcare.com Kathleen.Alvelo@HCAHealthcare.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Thomas.VanOsdol@ascension.org Mnelson@R1RCM.com

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
Rhonda.Sherrod@ShandsLakeshore.com Shatonia.Williams@ShandsLakeshore.com

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
Daniel.Bender@HCAHealthcare.com Veronica.Vargas@HCAHealthcare.com

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
Karen.Kerr@baycare.org jessica.villafanaopyd@baycare.org

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
Kimberly.Guy@baycare.org jessica.villafanaopyd@baycare.org

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
Janice.Balzano@HCAHealthcare.com Annette.Fazio@HCAHealthcare.com

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
Mark.Obryant@tmh.org Latasha.McDowell@tmh.org

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
JCouris@tgh.org Aescobio@tgh.org

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
DonHenderson@CentFLHealth.org NaWise@CentFLHealth.org

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
David.Whalen@HCAHealthcare.com Michelle.Castro@HCAHealthcare.com

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

Leon.Haley@Jax.ufl.edu Latrisha.Starkes@jax.ufl.edu

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
JIMEDW@shands.ufl.edu chessg@shands.ufl.edu

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
Julie.Dricks@HCAHealthcare.com Jose.Martinez@HCAHealthcare.com

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
Stephen.Nierman@baycare.org jessica.villafanaopyd@baycare.org

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
HCRA@ahca.myflorida.com Robert.Smith@ahca.myflorida.com

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
James.Santana@AdventHealth.com

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
James.Santana@AdventHealth.com

Angela Haggins
Director, Self-Pay Management
900 Winderly Place, 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
Angela.Haggins@adventhealth.com

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
Ira.Arnan@AdventHealth.com

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
James.Santana@AdventHealth.com

Ira Arnan
Regional Director, Patient Financial Services
1200 West Anon Blvd, Suite 201
Avon Park, FL 33825
(863) 386-6362
(863) 386-6473
Ira.Arnan@AdventHealth.com

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
James.Santana@AdventHealth.com

James Santana
Regional Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7765
(813) 615-7704
James.Santana@AdventHealth.com

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
Wconklin@R1RCM.com

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

DReitman@R1RCM.com

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

DReitman@R1RCM.com

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

DReitman@R1RCM.com

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
Kris.Panetta@Parallon.com

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 434-4683
darlene.cyr@BHCpns.org

Sonya Petrohovich
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 391-5096
Sonya.Petrohovich@bmcjax.com

Sonya Petrohovich
Manager of Patient Financial Services
P.O. Box 45094
Jacksonville, FL 32232-5094
(904) 376-4121
(904) 391-5096
Sonya.Petrohovich@bmcjax.com

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
Sonya.Petrohovich@bmcjax.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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

PamelaAbb@BaptistHealth.net

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

PamelaAbb@BaptistHealth.net

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
Kris.Panetta@Parallon.com

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

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

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
Kaitia.Coby@FlaglerHospital.org

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

Kathleen Mitchell
Billing Supervisor
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-3823
(386) 425-7715
kathleen.mitchell@halifax.org

Jennifer Lesley
PFS Director
524 W Sagamore Avenue
Clewiston, FL 33440
(863) 983-9121
(863) 983-3426
JLesley@HRMC.us

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
Kris.Panetta@Parallon.com

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

Tara.Roberts@jhsmiami.org

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 434-4683
darlene.cyr@bhcpns.org

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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
Kris.Panetta@Parallon.com

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

Melissa Jones
Manager, Patient Registration
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5434
(352) 323-5439
MeJones@CentFLHealth.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
Kris.Panetta@Parallon.com

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

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
Kris.Panetta@Parallon.com

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

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

Jamille Winters
Manager, Patient Accouting
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3741
(321) 843-6837
Jamille.Winters@OrlandoHealth.com

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
James.Griffith@Parallon.com

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

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

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
James.Griffith@Parallon.com

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

Wendy Conklin
Sr. Director, Patient Financial Services
10330 N Meridian Street
Indianapolis, IN 46290
(317) 583-3883
(317) 583-4111
Xconklin@R1RCM.com

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
Xconklin@R1RCM.com

Lori Parrish
Patient Financial Representative
368 NE Franklin Street
Lake City, FL 32055
(386) 292-8038
(386) 292-8047
Lori.Parrish@ShandsLakeshore.com

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

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org

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

Latrenda Cooper
Medicaid Billing Manager
1607-1 St. James Court
Tallahassee, FL 32308
(850) 432-6205
(850) 432-6929
Latrenda.Cooper@tmh.org

Anthony Escobio
VP, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
Aescobio@tgh.org

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
MeJones@CentFLHealth.org

James Griffith
Director of Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@Parallon.com

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

Tammy.Brisbane@jax.ufl.edu

Joann Yohn
Executive Director, Patient Financial Services
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 265-9022
(352) 265-9012
jyoh0001@shands.ufl.edu

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
Kris.Panetta@Parallon.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
scott.raynes@bhcpns.org norelis.vrablik@medassistsolutions.com

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
joe.mitrick@bmcjax.com eileen.henderlite@bmcjax.com

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
michael.mayo@bmcjax.com eileen.henderlite@bmcjax.com

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
Philip.Boyce@bmcjax.com linda.watkins@bmcjax.com

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
Philip.Minden@Baycare.org jessica.villafanaopyd@baycare.org

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
bruce.bergherm@ahss.org ira.arnan@ahss.org

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
daryl.tol@adventhealth.com coy.ingram@adventhealth.com

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
bruce.bergherm@ahss.org ira.arnan@ahss.org

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
jeff.feasel@halifax.org ronda.kennedy@halifax.org

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
carlos.migoya@jhsmiami.org denise.don@jhsmiami.org

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
mike.hutchins@bhcpns.org norelis.vrablik@medassistsolutions.com

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
Anthony.Degina@hcahealthcare.com Beth.Weekes@hcahealthcare.com

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

Lou.Galdieri@baycare.org jessica.villafanaopyd@baycare.org

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
kris.hoce@baycare.org jessica.villafanaopyd@baycare.org

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
Sarah.Naumowich@baycare.org jessica.villafanaopyd@baycare.org

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
Thomas.VanOsdol@ascension.org mnelson@ascension.org

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
Thomas.VanOsdol@ascension.org mnelson@ascension.org

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
Thomas.VanOsdol@ascension.org mnelson@ascension.org

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
Karen.Kerr@baycare.org jessica.villafanaopyd@baycare.org

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
Kimberly.Guy@baycare.org jessica.villafanaopyd@baycare.org

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
jcouris@tgh.org aescobio@tgh.org

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

Leon.HaleyCEO@jax.ufl.edu Jason.Hardwick@jax.ufl.edu

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
Stephen.Nierman@baycare.org jessica.villafanaopyd@baycare.org

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
Kirsten.Barrett@ahca.myflorida.com Robert.Smith@ahca.myflorida.com

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
darlene.cyr@bhcpns.org

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4130
(904) 391-5074
linda.watkins@bmcjax.com

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
linda.watkins@bmcjax.com

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
linda.watkins@bmcjax.com

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
jessica.villafanaopyd@baycare.org

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

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
ira.arnan@ahss.org

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

Angela Durham
Director, Self-Pay Management
900 Winderley Place Stuie 2100
Maitland, FL 32751
(407) 200-2322
(407) 200-4965
angela.durham@adventhealth.com

Ira Arnan
Patient Financial Services Director
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 386-6362
(863) 386-6473
ira.arnan@ahss.org

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
kathleen.mitchell@halifax.org

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

Yorka.Faldraga@jhsmiami.org

Darlene Cyr
Folluw-up Supervisor
P.O. Box 17106
Pensacola, FL 32522-7106
(850) 469-2044
(850) 469-7285
darlene.cyr@bhcpns.org

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

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

jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

Renica Johnson
Follow Up Manager
PO Box 2728
Pensacola, FL 32513
(317) 583-3835
(317) 583-4111
RJohnson@r1rcm.com
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
BMays@r1rcm.com

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
RJohnson@r1rcm.com
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
BMays@r1rcm.com

Renica Johnson
Follow Up Manager
PO Box 2728
Pensacola, FL 32513
(317) 583-3835
(317) 583-4111
RJohnson@r1rcm.com
Brandee Mays

PO Box 2728
Pensacola, FL 32513
(317) 583-3938
(317) 583-4111
BMays@r1rcm.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org

Anthony Escobio
Vice President, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
aescobio@tgh.org

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

Tammy.Brisbane@jax.ufl.edu

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
Alisa.Bert@hcahealthcare.com isabel.burgin@hcahealthcare.com

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
Scott.Raynes@bhcpns.org Norelis.Vrablik@medassistsolutions.com

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
joe.mitrick@bmcjax.com eileen.henderlite@bmcjax.com

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
michael.mayo@bmcjax.com eileen.henderlite@bmcjax.com

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
ed.hubel@bmcjax.com eileen.henderlite@bmcjax.com

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
Daniel.Friedrich@hcahealthcare.com Deborah.Pancake@hcahealthcare.com

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
Bland.Eng@hcahealthcare.com Ana.Almodovar@hcahealthcare.com

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
Wendy.Brandon@hcahealthcare.com Sonia.Marerro@hcahealthcare.com

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
Ralph.Aleman@hcahealthcare.com Tammi.Kampman@hcahealthcare.com

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
robert.meade@hcahealthcare.com sandra.williams2@hcahealthcare.com

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
joann.baker@doctorsmemorial.org donna@doctorsmemorial.org

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
Joe.Gordy@flaglerhospital.org Skip.Marsh@flaglerhospital.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
joe.johnson@ahss.org coy.ingram@ahss.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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

bruce.bergherm@ahss.org ira.arnan@ahss.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
patricia.williams@ahss.org coy.ingram@ahss.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
brian.adams@ahss.org coy.ingram@ahss.org

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
bruce.bergherm@ahss.org ira.arnan@ahss.org

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
denyse.bales-chubb@ahss.org coy.ingram@ahss.org

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
Daryl.Tol@flhosp.org Bonnie.Hache@flhosp.org

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
amanda.maggard@ahss.org coy.ingram@ahss.org

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
jeff.feasel@halifax.org ronda.kennedy@halifax.org

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
rwilliams@hrmc.us jlesley@hrmc.us

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
carlos.migoya@jhsmiami.org denise.don@jhsmiami.org

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
Mike.Hutchins@bhcpns.org Norelis.Vrablik@medassistsolutions.com

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
Brandon.Haushalter@hcahealthcare.com Rosa.Canseco@hcahealthcare.com

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
andy.guz@uhsinc.com tammy.grant@mmhhs.com

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
Anthony.Degina@hcahealthcare.com Beth.Weekes@hcahealthcare.com

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
DonHenderson@centflhealth.org NaWise@centflhealth.org

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
jcherry@lsbc.net tcooper@lsbc.net

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
Lou.Galdieri@baycare.org jessica.villafanaopyd@baycare.org

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
Leigh.Massengill@hcahealthcare.com Patsy.Cooper@hcahealthcare.com

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
Sonia.Wellman@hcahealthcare.com Ananta.Boodoosingh@hcahealthcare.com

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
kris.hoce@baycare.org jessica.villafanaopyd@baycare.org

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
Sarah.Naumowich@baycare.org jessica.villafanaopyd@baycare.org

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
Dia.Nichols@hcahealthcare.com Cynthia.Bacon@hcahealthcare.com

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
William.Rader@hcahealthcare.com Chi.Smarth@hcahealthcare.com

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
david.strong@orlandohealth.com john.gaspelin@orlandohealth.com

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
Sharon.Hayes@hcahealthcare.com Abbey.Durrin@hcahealthcare.com

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
Eric.Goldman@hcahealthcare.com Maria.Bolivar@hcahealthcare.com

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
Joseph.Melchiode@hcahealthcare.com Fabiola.Dickson@hcahealthcare.com

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 Melinda.Hernandez@hcahealthcare.com

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
Shayne.George@hcahealthcare.com Kathleen.Alvelo@hcahealthcare.com

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
Susan.Davis2@ascension.org mnelson@ascension.org

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
rhall@ascension.org mnelson@ascension.org

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
rhall@ascension.org mnelson@ascension.org

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

Russell.Armistead@jax.ufl.edu Jason.Hardwick@jax.ufl.edu

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
sharon.roush@hcahealthcare.com Veronica.Vargas@hcahealthcare.com

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
Karen.Kerr@baycare.org jessica.villafanaopyd@baycare.org

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
Kimberly.Guy@baycare.org jessica.villafanaopyd@baycare.org

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
Janice.Balzano@hcahealthcare.com Abbey.Durrin@parallon.com

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
Thomas.Vanosdol@ascension.org SBrent@RIRCM.com

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
Thomas.Vanosdol@ascension.org SBrent@RIRCM.com

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
Thomas.Vanosdol@ascension.org SBrent@RIRCM.com

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
Mark.obryant@thm.org Rina.milan@tmh.org

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
Jacob.Fisher@hcahealthcare.com Robert.Alcantara@parallon.com

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
sshort@tgh.org aescobio@tgh.org

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
DonHenderson@centflhealth.org NaWise@centflhealth.org

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
jimedw@shands.ufl.edu chessg@shands.ufl.edu

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
Dana.Oaks@hcahealthcare.com Jose.Martinez@hcahealthcare.com

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
Barbara.Simmons@hcahealthcare.com Zachary.Williams@hcahealthcare.com

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
Stephen.Nierman@baycare.org jessica.villafanaopyd@baycare.org

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

Kirsten.Barrett@ahca.myflorida.com Robert.Smith@ahca.myflorida.com

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
Kris.Panetta@parallon.com

Darlene Cyr
Followup Supervisor
PO Box 17106
Pensacola, FL 32522
(850) 469-2044
(850) 469-7285
Darlene.Cyr@bhcpns.org

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4130
(904) 391-5074
linda.watkins@bmcjax.com

Linda Watkins
Manager - Patient Financial Services
3563 Philips Highway, Ste. 201
Jacksonville, FL 32207
(904) 376-4162
(904) 391-5074
linda.watkins@bmcjax.com

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
linda.watkins@bmcjax.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

James Griffith
Director, Vendor Collection Management
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

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
Kris.Panetta@parallon.com

Diane Sanders
Patient Access Supervisor
P.O. Box 188
Bonifay, FL 32425
(850) 547-8030
(850) 547-8025
diane.sanders@doctorsmemorial.org

Kaitia Coby
Insurance/Reimbursement Manager
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4527
(904) 819-4906
Kaitia.Coby@flaglerhospital.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

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
Henderson.Peter@flhosp.org

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
james.santana@ahss.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

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

ira.arnan@ahss.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
james.santana@ahss.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
james.santana@ahss.org

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
ira.arnan@ahss.org

James Santana
Regional Director of Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
james.santana@ahss.org

Hendo Peter
Senior Director, Patient Financial Services
900 Winderley Place, Suite 2100
Maitland, FL 32751
(407) 200-9281
(407) 200-4965
Henderson.Peter@flhosp.org

James Santana
Director, Patient Financial Services
12470 Telecom Drive, Suite 500
Temple Terrace, FL 33637
(813) 615-7893
(813) 615-7704
james.santana@ahss.org

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
kathleen.mitchell@halifax.org

Jennifer Lesley
PFS Director
524 W Sagamore Avenue
Clewiston, FL 33440
(863) 983-9121
(863) 983-3426
jlesley@hrmc.us

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

Yorka.Faldraga@jhsmiami.org

Darlene Cyr
Followup Supervisor
PO Box 17106
Pensacola, FL 32522
(850) 469-2044
(850) 469-7285
Darlene.Cyr@bhcpns.org

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

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
tim.perrin@mmhhs.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Sherina Kanhai
Patient Access Manager
600 East Dixie Drive
Leesburg, FL 34748
(352) 323-5073
(352) 323-5439
SKanhai@centflhealth.org

Vickie Anderson
Billing Supervisor
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7537
(352) 315-7587
vmilliner@lsbc.net

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
jessica.villafanaopyd@baycare.org

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
Kris.Panetta@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Mari Ann Moore

Patient Financial Services Director
3090 Caruso Court, Suite 20
Orlando, FL 32806
(407) 650-3750
(407) 650-5040
mari.moore@orlandohealth.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

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
James.Griffith@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

James Griffith
Vendor Collection Management Director
335 Crossing Boulevard
Orange Park, FL 32073
(904) 688-6488
(904) 688-7488
James.Griffith@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
sglazer@r1rcm.com

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
Emily.Perkins@ascension.org

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
sglazer@r1rcm.com
Emily Perkins
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3834
(317) 583-4148
Emily.Perkins@ascension.org

Suzanne Glazer
Office Supervisor
10330 N. Meridian Street, Suite 200
Indianapolis, IN 46290
(317) 583-3561
(317) 583-4111
sglazer@r1rcm.com
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
Emily.Perkins@ascension.org

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

Tammy.Brisbane@jax.ufl.edu

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
Kris.Panetta@parallon.com

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

TMott@RIRCM.com

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

TMott@RIRCM.com

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

TMott@RIRCM.com

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
Latrenda.cooper@thm.org

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Anthony Escobio
Vice President, Patient Financial Services
PO Box 1289
Tampa, FL 33601-1289
(813) 844-4764
(813) 844-4144
aescobio@tgh.org

Sherina Kanhai
Patient Access Manager
1451 El Camino Road
The Villages, FL 32159
(352) 323-5073
(352) 323-5439
SKanhai@centflhealth.org

Jacob Bruck
Director, Patient Financial Services
4024 NW 22nd Drive
Gainesville, FL 32605
(352) 594-2263
(352) 265-9012
bruckj@shands.ufl.edu

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
Kris.Panetta@parallon.com

Kris Panetta
Medicaid Eligibility Director
6451 126th Avenue North
Largo, FL 33773
(727) 773-3410
(727) 773-3411
Kris.Panetta@parallon.com

Jessica Villafana Opyd

Financial Assistance Coordinator
2985 Drew Street, Mail Stop 1049
Clearwater, FL 33759
(727) 281-9084
(813) 635-7731
jessica.villafanaopyd@baycare.org

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
isabel.burgin@hcahealthcare.com Kris.Panetta@parallon.com

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
Norelis.Vrablik@medassistsolutions.com Darlene.Cyr@bhcpns.org

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
Deborah.Pancake@hcahealthcare.com Kris.Panetta@parallon.com

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
Ana.Almodovar@hcahealthcare.com Kris.Panetta@parallon.com

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
Jhalpine@browardhealth.org Jmitchell@browardhealth.org

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
Sonia.Marerro@hcahealthcare.com James.Griffith@parallon.com

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
sandra.williams2@hcahealthcare.com Kris.Panetta@parallon.com

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
donna@doctorsmemorial.org diane.sanders@doctorsmemorial.org

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
llowery@bcmedsvcs.com llowery@bcmedsvcs.com

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
Katherine.Weinmann@hcahealthcare.com Kris.Panetta@parallon.com

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
Katherine.Weinmann@hcahealthcare.com Kris.Panetta@parallon.com

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
Shay.Miller@flaglerhospital.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
ira.arnan@ahss.org ira.arnan@ahss.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
ira.arnan@ahss.org ira.arnan@ahss.org

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

coy.ingram@ahss.org coy.ingram@ahss.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
Gina.Bachuss@hcahealthcare.com James. Griffith@parallon.com

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
Glen.Stockhammer@halifax.org alysone.Capone@halifax.org

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
denise.don@jhsmiami.org Yorka.Faldraga@jhsmiami.org

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
Norelis.Vrablik@medassistsolutions.com Darlene.Cyr@bhcpns.org

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
Anne.Johnson@hcahealth.com james.Griffith@parallon.com

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
Rosa.Canseco@hcahealthcare.com Kris.Panetta@parallon.com

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
AHodges@lakebutlerhospital.com TGosebruch@lakebutlerhospital.com

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
James.Griffith@parallon.com

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
tammy.grant@mmhhs.com tim.perrin@mmhhs.com

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
Beth.Weekes@hcahealthcare.com Kris.Panetta@parallon.com

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
Kmendoza@larkinhospital.com Kmendoza@larkinhospital.com

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
Guadelupe.Deloera@hcahealthcare.com james.griffith@parallon.com

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
courtney.murray@leememorial.com debbie.yeater@leememorial.org

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
Skanhai@CFHalliance.org PHager@CFHalliance.org

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
vmilliner@lsbc.net vmilliner@lsbc.net

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
carol.plato@martinhealth.org carol.plato@martinhealth.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
Patsy.Cooper@hcahealthcare.com Kris.Panetta@parallon.com

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
Ananta.Boodoosingh@hcahealthcare.com Kris.Panetta@parallon.com

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
Cynthia.Bacon@hcahealthcare.com Kris.Panetta@parallon.com

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
Robert.Hurlock@hcahealthcare.com Kris.Panetta@parallon.com

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
Linda.Murphy@hcahealthcare.com Kris.Panetta@parallon.com

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
david.walker@orlandohealth.com bridget.walters@orlandohealth.com

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
Jennifer.Tolisano@hcahealthcare.com Kris.Panetta@parallon.com

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
Maria.Bolivar@hcahealthcare.com James.Griffith@parallon.com

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
Fabiola.Dickson@hcahealthcare.com Kris.Panetta@parallon.com

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
Wilfredo.Gonzalez@hcahealthcare.com James.Griffith@parallon.com

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
James.Griffith@parallon.com

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
Melinda.Hernandez@hcahealthcare.com James.Griffith@parallon.com

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
Kathleen.Troutwine@hcahealthcare.com Kris.Panetta@parallon.com

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
mnelson@shhpens.org lrowens@shhpens.org
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
vmcclell@shhpens.org

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
mnelson@shhpens.org lrowens@shhpens.org
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
vmcclell@shhpens.org

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
mnelson@shhpens.org lrowens@shhpens.org
Vivian McClelland
Patient Financial Services Representative
P.O. Box 2728
Pensacola, FL 32513-2728
(850) 416-4097
(850) 416-7453
vmcclell@shhpens.org

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
chessg@shands.ufl.edu southb@shands.ufl.edu

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

Shakawn.Jones@jax.ufl.edu Shakawn.Jones@jax.ufl.edu

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
Sharon.Roush@hcahealthcare.com Kris.Panetta@parallon.com

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
Dawn.Sandusky@hcahealthcare.com Kris.Panetta@parallon.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
SBrent@accretivehealth.com 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
SBrent@accretivehealth.com 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
SBrent@accretivehealth.com 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
Jeff.sherman@tmh.org Jeff.sherman@tmh.org

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
Robert.Alcantara@hcahealthcare.com Kris.Panetta@parallon.com

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
lesposito@tgh.org posborne@tgh.org

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
Skanhai@CFHalliance.org PHager@CFHalliance.org

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
lisa.wilson@hcahealthcare.com James.Griffith@parallon.com

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
Jose.Martinez@hcahealthcare.com Kris.Panetta@parallon.com

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
Carol.Palevoda@hcahealthcare.com James.Griffith@parallon.com

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
Zachary.Williams@hcahealthcare.com Kris.Panetta@parallon.com

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
Mike.Neumann@uhsinc.com Jeff.Dale@uhsinc.com

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

James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
Kirsten.Jacobson@ahca.myflorida.com Robert.Smith@ahca.myflorida.com
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
Mia.Westbrook@ahca.myflorida.com Felton.Bradley@ahca.myflorida.com

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
Dianne.Goldenberg@hcahealthcare.com

Scott Raynes
President
1000 West Morino Street
Pensacola, FL 32501
(850) 424-4011
(850) 434-4841
Scott.Raynes@bhcpns.org

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
joe.mitrick@bmcjax.com

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
michael.mayo@bmcjax.com

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
stephen.lee@bmcjax.com

Daniel J. Friedrich, III

Chief Executive Officer
2020 59th Street West
Bradenton, FL 34209
(941) 792-6611
(941) 798-6209
Daniel.Friedrich@hcahealthcare.com

Bland Eng
Chief Executive Office
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
Bland.Eng@hcahealthcare.com

Calvin Glidewell
Chief Executive Office
1600 S. Andrews Avenue
Ft. Lauderdale, FL 33316
(954) 355-5610
(954) 355-4797
Cglidewell@browardhealth.org

Wendy H. Brandon
Chief Executive Officer
1401 West Seminole Boulevard
Sanford, FL 32771
(407) 302-7392
(407) 324-4790
Wendy.Brandon@hcahealthcare.com

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
robert.meade@hcahealthcare.com

JoAnn Baker
CEO/Administrator
P.O. Box 188
Bonifay, FL 32464-0188
(850) 547-8001
(850) 547-8004
joann.baker@doctorsmemorial.org

Dennis R. Markos
CEO
159 North 3rd Street
Macclenny, FL 32063
904-259-3151
904-653-2102
drmarkos@bcmedsvcs.com

Dale F. Alward
Chief Executive Officer
700 Medical Boulevard
Englewood, FL 34223
(941) 475-6571
(941) 473-5015
Dale1.Alward@hcahealthcare.com

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
bill.hawley@hcahealthcare.com

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 819-4400

Joe.Gordy@flaglerhospital.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

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
joe.johnson@ahss.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Bruce Bergherm
President/CEO
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3366
(863) 402-3110
bruce.bergherm@ahss.org

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
Lars.Houmann@flhosp.org

Bruce Berghern
Chief Executive Officer/President
1395 South Pinellas Avenue
Tarpon Springs, FL 34689
(727) 942-5107
(727) 942-5161
bruce.berghern@ahss.org

Brian Adams
Chief Executive Officer/President
3100 East Fletcher Avenue
Tampa, FL 33613
(813) 615-7203
(813) 615-7580
brian.adams@ahss.org

Bruce Bergherm
CEO/President
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3366
(863) 402-3110
bruce.bergherm@ahss.org

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
denyse.bales-chubb@ahss.org

Randall Surber
President CEO
7050 Gall Boulevard
Zephyrhills, FL 33541
813-779-6201
813-783-6196
randy.surber@ahss.org

Carlton Ulmer
Chief Executive Officer
449 West 23rd Street
Panama City, FL 32405
850-769-8341
850-747-7107
Carlton.Ulmer@hcahealthcare.com

Jeff Feasel
Chief Executive Officer
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
386-425-4771
386-425-4772
jeff.feasel@halifax.org

Carlos Migoya
President CEO
1611 NW 12 Ave West Wing 117
Miami, FL 33136
305-585-6754

carlos.migoya@jhsmiami.org

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
Mike.Hutchins@bhcpns.org

Gina A. Melby
Chief Executive Officer
5301 South Congress Ave
Atlantis, FL 33462
561-965-7300
561-642-3685
Gina.Melby@hcahealthcare.com

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
Scott.Cihak@hcahealthcare.com

Pam Howard
CEO
P.O. Box 748
Lake Butler, FL 32054
(386) 496-2323
(386) 496-1611
PHoward@lakebutlerhospital.com

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
Mark.Miller@hcahealthcare.com

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Boulevard
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
richard.fletcher@uhsinc.com

Anthony Degina
Chief Executive Officer
201 14th Street SW
Largo, FL 33770
(727) 588-5200
(727) 588-5906
Anthony.Degina@hcahealthcare.com

Sondy Sosa-Guerrero
Chief Executive Officer
7031 SW 62nd Avenue
South Miami, FL 33143
(305) 284-7700
(305) 284-7545
Ssosag@larkinhospital.com

Greg Lowe
Chief Executive Officer
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
Greg.Lowe@hcahealthcare.com

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
Jim.Nathan@leememorial.org

Don Henderson
President
410 Childs Street
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
DonHenderson@CFHalliance.org

Jonathan Cherry
President/CEO
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7500
(352) 360-6595
jcherry@lsbc.net

Robert L. Lord, Jr.

President and CEO
200 SE Hospital Avenue
Stuart, FL 34994
(772) 223-5955 ext. 13014
(772) 223-5946
rob.lord@martinhealth.org

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
Louis.Galdieri@baycare.org

Leigh Massengill
Chief Executive Officer
9330 State Road 54
Trinity, FL 34655
(727) 834-4000
(727) 834-4912
Leigh.Massengill@hcahealthcare.com

Ward Boston lll

Chief Executive Officer
2901 West Swann Ave
Tampa, FL 33609
813-873-6400
813-873-6486
Ward.Boston@hcahealthcare.com

Kris Hoce
President
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
kris.hoce@baycare.org

Kris Hoce
President
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
kris.hoce@baycare.org

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
Dia.Nichols@hcahealthcare.com

Erica Gulrich
Chief Executive Officer
2801 North State Road 7
Margate, FL 33063
(954) 974-0400
(954) 978-4183
William.Rader@hcahealthcare.com

Jesse G. Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
Mickey.Smith@hcahalthcare.com

David Strong
President / CEO
65 Strurtevant Street
Orlando, FL 32806
(321) 841-5299
(321) 841-1280
david.strong@orlandohealth.com

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
Sharon.Hayes@hcahealthcare.com

Eric Goldman
Chief Executive Officer
13001 Southern Boulevard
Loxahatchee, FL 33470
(561) 798-3300
(561) 791-8108
Eric.Goldman@hcahealthcare.com

Randy Gross
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
Randy.Gross@hcahealthcare.com

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
Chris.Mosley@hcahealthcare.com

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
Shayne.George@hcahealthcare.com

Susan Davis
CEO
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7010
(850) 416-6119
davis.susan2@shhpens.org

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
rhall@shhpens.org

Roger Hall
CEO
7800 US Hwy 98 West
Miramar Beach, FL 32550
(850) 278-3001
(850) 278-3010
rhall@shhpens.org

Edward Jimenez
Chief Operating Officer
1600 SW Archer Road
Gainesville, FL 32610
(352) 733-1500
(352) 265-0231
jimedw@shands.ufl.edu

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

Russell.Armistead@jax.ufl.edu

Sharon L. Roush
Chief Executive Officer
4016 Sun City Center Blvd
Sun City Center, FL 33573
813-634-3301
813-634-8712
sharron.roush@hcahealthcare.com

Karen Kerr
Chief Operating Officer/President
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
Karen.Kerr@baycare.org

Lorraine Lutton
Chief Operating Officer
6500 38th Ave North
St. Petersburg, FL 33710
727-384-1414
727-341-4889
lorraine.lutton@baycare.org

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
Janice.Balzano@hcahealthcare.com

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
Kim.Hodgkinson@jaxhealth.com

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
Kim.Hodgkinson@jaxhealth.com

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
Kim.Hodgkinson@jaxhealth.com

G. Mark O' Bryant

President/CEO
1300 Miccosukee Road
Tallahassee, FL 32308
850-431-5380
850-431-5883
Mark.obryant@thm.org

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
Jacob.Fisher@hcahealthcare.com

James Burkhart
President & CEO
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
jburkhart@tgh.org

Don Henderson
President
410 Childs Street
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
DonHenderson@CFHalliance.org

David A. Whalen
Chief Executive Officer
2190 Highway 85 North
Niceville, FL 32578
850-678-4131
850-729-9306
David.Whalen@hcahealthcare.com

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
Joseph.Melchiode@hcahealthcare.com

Dana C. Oaks
Chief Executive Officer
2201 45th Street
West Palm Beach, FL 33407
561-863-3842
561-844-8955
Dana.Oaks@hcahealthcare.com

Barbara J. Simmons
Chief Executive Officer
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
Barbara.Simmons@hcahealthcare.com

Wendy Merson
Chief Executive Officer
11300 US HWY 19 N
Clearwater, FL 33764
727-541-2646
727-541-4402
Wendy.Merson@uhsinc.com

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
Lars.Houmann@flhosp.org

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
isabel.burgin@hcahealthcare.com Kris.Panetta@parallon.com

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
Amy.Purvis@bhcpns.org Robyn.Mathews@bhcpns.org

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
Deborah.Pancake@hcahealthcare.com Kris.Panetta@parallon.com

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
Ana.Almodovar@hcahealthcare.com Kris.Panetta@parallon.com

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
Jhalpine@browardhealth.org Jmitchell@browardhealth.org

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

Sonia.Marerro@hcahealthcare.com Lisa.Prince@parallon.com

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
donna.boroughs@doctorsmemorial.org brandi.stewart@doctorsmemorial.org

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
dhoward@doctorsmemorial.com sgrambling@doctorsmemorial.com

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
Milady.Santan-Burgos@hcahealthcare.com Kris.Panetta@parallon.com

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
Katherine.Weinmann@hcahealthcare.com Kris.Panetta@parallon.com

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
Katherine.Weinmann@hcahealthcare.com Kris.Panetta@parallon.com

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
shay.miller@flaglerhospital.org kaitia.coby@flaglerhospital.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
maria.perez@ahss.org maria.perez@ahss.org

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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

maria.perez@ahss.org maria.perez@ahss.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
Robert.Coughlin@moffitt.org Andy.Taiford@moffitt.org

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
glen.stockhammer@halifax.org alyson.capone@halifax.org

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
jlesley@hrmc.us jlesley@hrmc.us

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
cfernandez@jhsmiami.org pamela.fell@jhsmiami.org

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
Linda.Pillar@na.firstsource.com Megan.Porter@bhcpns.org

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
Rosa.Canseco@hcahealthcare.com Kris.Panetta@parallon.com

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
STillman@lakebutlerhospital.com EAtwood@lakebutlerhospital.com

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
tammy.grant@mmhhs.com tim.perrin@mmhhs.com

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
Beth.Weekes@hcahealthcare.com Kris.Panetta@parallon.com

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

Guadelupe.Deloera@hcahealthcare.com Lisa.Prince@Parallon.com

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
courtney.murray@leememorial.com debbie.yeater@leememorial.org

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
ebermudez@cfhalliance.org ebermudez@cfhalliance.org

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
cdozier@lsbc.net vmilliner@lsbc.net

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
Karen.Kennedy@MartinHealth.org Carol.Plato@MartinHealth.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
Patsy.Cooper@hcahealthcare.com Kris.Panetta@parallon.com

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
linda.lujan@msmc.com linda.lujan@msmc.com

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
Sandy.Wood@nchmd.org 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
Cynthia.Bacon@hcahealthcare.com Kris.Panetta@parallon.com

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
Robert.Hurlock@hcahealthcare.com Kris.Panetta@parallon.com

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
Linda.Murphy@hcahealthcare.com Kris.Panetta@parallon.com

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

Maria.Bolivar@hcahealthcare.com Lisa.Prince@Parallon.com

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
Fabiola.Dickson@hcahealthcare.com Kris.Panetta@parallon.com

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

Wilfredo.Gonzalez@hcahealthcare.com Lisa.Prince@parallon.com

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

Melinda.Hernandez@hcahealthcare.com Lisa.Prince@parallon.com

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

Kathleen.Alvelo@hcahealthcare.com Kris.Panetta@parallon.com

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
mnelson@shhpens.org lrowens@shhpens.org

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
mnelson@shhpens.org lrowens@shhpens.org

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
mnelson@shhpens.org lrowens@shhpens.org

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
chessg@shands.ufl.edu southb@shands.ufl.edu

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

jason.hardwick@jax.ufl.edu shakawn.jones@jax.ufl.edu

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
Dawn.Sandusky@hcahealthcare.com Kris.Panetta@parallon.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

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
SBrent@accretivehealth.com 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
SBrent@accretivehealth.com 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
SBrent@accretivehealth.com 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
jeff.sherman@tmh.org jeff.sherman@tmh.org

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
lesposito@tgh.org posborne@tgh.org

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
Skanhai@CFHalliance.org EBermudez@CFHalliance.org

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
Jose.Martinez@hcahealthcare.com Kris.Panetta@parallon.com

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
dcaulton@med.miami.edu Karen.Fry@parallon.com

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
Zachary.Williams@hcahealthcare.com Kris.Panetta@parallon.com

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
James.English@flhosp.org Sharda.Parsaram@flhosp.org

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
Kirsten.Jacobson@ahca.myflorida.com Robert.Smith@ahca.myflorida.com
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
Mia.Westbrook@ahca.myflorida.com Felton.Bradley@ahca.myflorida.com

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
Dianne.Goldenberg@hcahealthcare.com

Scott Raynes
President
1000 West Morino Street
Pensacola, FL 32501
(850) 469-2319
(850) 434-4841
Scott.Raynes@bhcpns.org

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
joe.mitrick@bmcjax.com

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
michael.mayo@bmcjax.com

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
stephen.lee@bmcjax.com

Ron Robinson
Hospital President
14550 Old St. Augustine Road
Jacksonville, FL 32258
(904) 271-6002
(904) 271-6650
ron.robinson@bmcjax.com

Daniel J. Friedrich, III

Chief Executive Officer
2020 59th Street West
Bradenton, FL 34209
(941) 792-6611
(941) 798-6209
Daniel.Friedrich@hcahealthcare.com

Bland Eng
Chief Executive Office
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
Bland.Eng@hcahealthcare.com

Calvin Glidewell
Chief Executive Office
1600 S. Andrews Avenue
Ft. Lauderdale, FL 33316
(954) 355-5610
(954) 355-4797
Cglidewell@browardhealth.org

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
Wendy.Brandon@hcahealthcare.com

JoAnn Baker
Administrator
2600 Hospital Drive
Bonifay, FL 32425
(850) 547-8001
(850) 547-8025
joann.baker@doctorsmemorial.org

Mary Lescafer
Interim CEO
333 N. Byron Butler Pkwy
Perry, FL 32347
(850) 584-0885
(850) 223-2308
mlescafer@doctorsmemorial.com

Sharon D. Hayes
Chief Executive Officer
2323 9th Avenue Notth
St. Petersburg, FL 33713
(727) 323-1111
(727) 328-6159
Sharon.Hayes@hcahealthcare.com

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
Dale1.Alward@hcahealthcare.com

Thomas J. Rice
Chief Executive Officer
21298 Olean Boulevard
Port Charlotte, FL 33952
(941) 629-1181
(941) 627-6142
Tom.Rice@hcahealthcare.com

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 849-5155

joe.gordy@flaglerhospital.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

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
Lars.Houmann@flhosp.org

Joe Johnson
President & CEO
7171 North Dale Mabry Highway
Carrollwood, FL 33614
(813) 558-8001
(813) 558-8011
joe.johnson@ahss.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

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
eric.stevens@ahss.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Bruce Bergherm
President/Chief Executive Officer
1395 South Pinellas Avenue
Tarpon Springs, FL 34689
(727) 942-5107
(727) 942-5161
bruce.bergherm@ahss.org

Brian Adams
Chief Executive Officer/President
3100 East Fletcher Avenue
Tampa, FL 33613
(813) 615-7203
(813) 615-7580
brian.adams@ahss.org

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
denise.grimsley@ahss.org

Denyse Bales-Chubb
Chief Executive Officer/President
2600 Bruce B Downs Boulevard
Wesley Chapel, FL 33544
(813) 929-5490
(813) 929-5475
denyse.bales-chubb@ahss.org

Bill Heinrich
Vice President/Chief Financial Officer
7050 Gall Boulevard
Zephyrhills, FL 33541
(813) 779-6201
(813) 783-6196
bill.heinrich@ahss.org

Jack Kolosky
President/CEO
12902 Magnolia Drive
Tampa, FL 33612
(813) 745-7222
(813) 745-3090
Jack.Kolosky@moffitt.org

Jeff Feasel
Chief Executive Officer
303 North Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 425-4771
(386) 425-1575
jeff.feasel@halifax.org

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
rwilliams@hrmc.us

Carlos Migoya
Chief Executive Officer
1611 NW 12th Avenue, WW 117
Miami, FL 33136
(305) 585-6754

carlos.migoya@jhsmiami.org

Michael Hutchins
Administrator
14114 Alabama Street
Jay, FL 32505
(850) 675-8015
(850) 675-8070
Mike.Hutchins@bhcpns.org

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
Scott.Cihak@hcahealthcare.com

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
PHoward@lakebutlerhospital.com

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Boulevard
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
richard.fletcher@uhsinc.com

Anthony Degina
Chief Executive Officer
201 14th Street SW
Largo, FL 33770
(727) 588-5200
(727) 588-5906
Anthony.Degina@hcahealthcare.com

Greg Lowe
Chief Executive Officer
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
Greg.Lowe@hcahealthcare.com

James Nathan
CEO
2776 Cleveland Avenue
Fort Myers, FL 33901
(239) 343-6502
(239) 343-6991
Jim.Nathan@leememorial.org

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
donhenderson@cfhalliance.org

Jonathan Cherry
President/CEO
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7500
(352) 360-6595
jcherry@lsbc.net

Mark E. Robitaille
Chief Executive Officer
301 SE Hospital Avenue
Stuart, FL 34995

Mark.Robitaille@MartinHealth.org

Louis Galdieri
President
601 Main Street
Dunedin, FL 34698
(727) 734-6365
(727) 734-6887
Louis.Galdieri@baycare.org

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
Leigh.Massengill@hcahealthcare.com

Kristopher Hoce
Chief Operating Officer
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
kris.hoce@baycare.org

Michael Yungmann
President
6600 Madison Street
New Port Richey, FL 34652
(727) 843-4599
(727) 848-8762
Michael.Yungmann@baycare.org

Wayne Chutkan
Senior VP of Finance
4300 Alton Road
Miami Beach, FL 33140
(305) 674-2662
(305) 674-2007
wayne.chutkan@msmc.com

Allen S. Weiss, MD
Chief Executive Officer
350 7th Street North
Naples, FL 34102
(239) 624-4013
(239) 624-4001
Allen.Weiss@nchmd.org

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
Dia.Nichols@hcahealthcare.com

W. Mark Rader
Chief Executive Officer
2801 North State Road 7
Margate, FL 33063
(954) 974-0400
(954) 978-4183
William.Rader@hcahealthcare.com

Jesse G. Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
Mickey.Smith@hcahalthcare.com

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
Eric.Goldman@hcahealthcare.com

Barbara Simmons
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
barbara.simmons@hcahealthcare.com

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
Shayne.George@hcahealthcare.com

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
susan.davis@shhpens.org

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
susan.davis@shhpens.org

Susan Davis
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-6119
susan.davis@shhpens.org

Edward Jimenez
Chief Operating Officer
1600 SW Archer Road
Gainesville, FL 32610
(352) 733-1500
(352) 265-0231
jimedw@shands.ufl.edu

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

russ.armistead@jax.ufl.edu

Karen Kerr
Chief Operating Officer/President
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
Karen.Kerr@baycare.org

Lorraine Lutton
Chief Operating Officer
3001 W. Dr. M.L. King Jr. Blvd.
Tampa, FL 33607
(813) 870-4020
(813) 870-4639
lorraine.lutton@baycare.org

Robert Conroy, Jr.

Chief Executive Officer
6500 38th Avenue North
St. Petersburg, FL 33710
(727) 384-1414
(727) 341-4889
Robert.Conroy@hcahealthcare.com

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
Kim.Hodgkinson@jaxhealth.com

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
Kim.Hodgkinson@jaxhealth.com

Kim Hodgkinson
CFO
1670 St. Vincent's Way
Middleburg, FL 32068-8447
(904) 602-1151
(904) 602-2700
Kim.Hodgkinson@jaxhealth.com

G. Mark O'Bryant
President and Chief Executive Officer
1300 Miccosukee Road
Tallahassee, FL 32308
(850) 431-5380
(850) 431-5883
mark.obryant@tmh.org

James Burkhart
President & CEO
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
jburkhart@tgh.org

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

ALackey@CFHalliance.org

Joseph Melchiode
Chief Executive Officer
7201 North Unjiversity Drive
Tamarac, FL 33321
(954) 721-2200
(954) 724-6567
Joseph.Melchiode@hcahealthcare.com

David Zambrana
Chief Executive Officer
1400 NW 12th Avenue
Miami, FL 33136
(305) 689-4515
(305) 689-4673
dzambrana@med.miami.edu

Barbara J. Simmons
Chief Executive Officer
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
Barbara.Simmons@hcahealthcare.com

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
Lars.Houmann@flhosp.org

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
venise.caven@hcahealthcare.com kris.panetta@parallon.net

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
roberta.thompson@bhcpns.org roberta.thompson@bhcpns.org
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
david.pezewski@bhcpns.org david.pezewski@bhcpns.org

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
eileen.henderlite@bmcjax.com eileen.henderlite@bmcjax.com

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
vickie.norris@hma.com elizabeth.thomas@hma.com

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

beata.mach@hma.com beata.mach@hma.com

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

deborah.pancake@hcahealthcare.com kris.panetta@parallon.net

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
ana.almodovar@hcahealthcare.com kris.panetta@parallon.net

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
Ivellys.Gonzalez@hcahealthcare.com kris.panetta@parallon.net

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
donna.boroughs@doctorsmemorial.org brandi.stewart@doctorsmemorial.org

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
dhoward@doctorsmemorial.com dhoward@doctorsmemorial.com

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
milady.santana-burgos@hcahealthcare.com kris.panetta@parallon.net

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
katherine.weinmann@hcahealthcare.com kris.panetta@parallon.net

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
jackie.shugart@flaglerhospital.org stephanie.smith@flaglerhospital.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
tracy.goodwin@ahss.org tracy.goodwin@ahss.org

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
coy.ingram@ahss.org coy.ingram@ahss.org

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
tracy.goodwin@ahss.org tracy.goodwin@ahss.org

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
doug.duncan@halifax.org joni.rahn@halifax.org

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
hgiddens@hrmc.us ngreene@hrmc.us

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
roberta.thompson@bhcpns.org roberta.thompson@bhcpns.org
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
david.pezewski@bhcpns.org david.pezewski@bhcpns.org

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
anne.johnson@hcahealthcare.com kris.panetta@parallon.net

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
rosa.canseco@hcahealthcare.com kris.panetta@parallon.net

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
MYarley@lakebutlerhospital.com EAtwood@lakebutlerhospital.com

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
tammy.grant@mmhhs.com tim.perrin@mmhhs.com

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
beth.weekes@hcahealthcare.com kris.panetta@parallon.net

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
guadelupe.deloera@hcahealthcare.com kris.panetta@parallon.net

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
courtney.murray@leememorial.com

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
ebermudez@cfhalliance.org ebermudez@cfhalliance.org

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
sgregory@lsbc.net vmillner@lsbc.net

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
luis.cabrera@martinhealth.org carol.plato@martinhealth.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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

patsy.cooper@hcahealthcare.com kris.panetta@parallon.com

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
linda.lujan@msmc.com linda.lujan@msmc.com

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
patricia.thorn@nchmd.org sandy.wood@nchmd.org

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
cynthia.bacon@hcahealthcare.com kris.panetta@parallon.com

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
financial-counselor@nfch.org dcooper@nfch.org

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
robert.hurlock@hcahealthcare.com kris.panetta@parallon.com

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
linda.murphy@hcahealthcare.com kris.panetta@parallon.com

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
bridget.walters@orlandohealth.com bridget.walters@orlandohealth.com

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
maria.bolivar@hcahealthcare.com kris.panetta@parallon.com

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
fabiola.dickson@hcahealthcare.com kris.panetta@parallon.com

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
melinda.hernandez@hcahealthcare.com kris.panetta@parallon.com

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
kathleen.troutwine@hcahealthcare.com kris.panetta@parallon.com

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
mnelson@shhpens.org ivargas@accretivehealth.com

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
mnelson@shhpens.org ivargas@accretivehealth.com

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
mnelson@shhpens.org ivargas@accretivehealth.com

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
southb@shands.ufl.edu thoman@shands.ufl.edu

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
shakawn.jones@jax.ufl.edu shakawn.jones@jax.ufl.edu

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
veronica.vargas@hcahealthcare.com kris.panetta@parallon.com

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
vickie.norris@hma.com elizabeth.thomas@hma.com

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
jessica.villafanaopyd@baycare.org jessica.villafanaopyd@baycare.org

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
evelyn.noguez@hcahealthcare.com kris.panetta@parallon.com

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
msalaam@accretivehealth.com mrodenbeck@accretivehealth.com

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
msalaam@accretivehealth.com mrodenbeck@accretivehealth.com

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
jeff.sherman@tmh.org jeff.sherman@tmh.org

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
lesposito@tgh.org emartineau@tgh.org
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
kshepherd@tgh.org kshepherd@tgh.org

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
ebermudez@cfhalliance.org ebermudez@cfhalliance.org

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
jose.martinez@hcahealthcare.com kris.panetta@parallon.com

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
zachary.williams@hcahealthcare.com kris.panetta@parallon.com

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
Tammie.Rikansrud@flhosp.org Sharda.Parsaram@flhosp.org

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
Kirsten.Jacobson@ahca.myflorida.com Robert.Smith@ahca.myflorida.com
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
Karin.Jacobson@ahca.myflorida.com Felton.Bradley@ahca.myflorida.com

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

dianne.goldenberg@hcahealthcare.com

David Wildebrandt
Administrator
1000 W. Moreno Street
Pensacola, FL 32501
(850) 434-4011

david.wildebrandt@bhcpns.org

Joseph Mitrick
Hospital President
1350 13th Avenue South
Jacksonville Beach, FL 32250
(904) 627-2901
(904) 627-1008
joe.mitrick@bmcjax.com

Michael Mayo
Hospital President
800 Prudential Drive, Adult Tower 8th Floor
Jacksonville, FL 32207
(904) 202-2001
(904) 202-2285
michael.mayo@bmcjax.com

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
stephen.lee@bmcjax.com

Ron Robinson
Hospital President
14550 Old St. Augustine Road
Jacksonville, FL 32258
(904) 271-6002
(904) 271-6650
ron.robinson@bmcjax.com

Kenneth Wicker
Chief Executive Officer
17240 Cortez Boulevard
Brooksville, FL 34601
(352) 799-5111
(352) 754-3215
ken.wicker@hma.com

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
daniel.friedrich@hcahealthcare.com

Bland Eng
Chief Executive Officer
119 Oakfield Drive
Brandon, FL 33511
(813) 681-5551
(813) 571-5125
bland.eng@hcahealthcare.com

Wendy Brandon
Chief Executive Officer
1401 West Seminole Blvd
Sanford, FL 32771
(407) 321-4500
(407) 324-2155
wendy.brandon@hcahealthcare.com

JoAnn Baker
Administrator
2600 Hospital Drive
Bonifay, FL 32425
(850) 547-8003
(850) 547-8006
joann.baker@doctorsmemorial.org

Geri Forbes
CEO
333 North Byron Butler Parkway
Perry, FL 32347
(850) 584-0800
(850) 223-2308
ceo@doctorsmemorial.com

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
sharon.hayes@hcahealthcare.com

Dale F. Alward
Chief Executive Officer
700 Medical Boulevard
Englewood, FL 34223
(941) 475-6571
(941) 473-5015
dale1.alward@hcahealthcare.com

Joseph Gordy
CEO
400 Health Park Blvd.
St. Augustine, FL 32086
(904) 849-5155

joe.gordy@flaglerhospital.org

Lars Houmann
President & CEO
601 East Rollins Street
Orlando, FL 32803
(407) 303-2527
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
601 East Altamonte Drive
Altamonte Springs, FL 32701
(407) 303-4321
(407) 200-4965
Lars.Houmann@flhosp.org

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
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
400 Celebration Place
Celebration, FL 34747
(407) 303-4000
(407) 200-4965
Lars.Houmann@flhosp.org

Lars Houmann
President & CEO
7727 Lake Underhill Drive
Orlando, FL 32822
(407) 303-8110
(407) 200-4965
Lars.Houmann@flhosp.org

Warren Santander
Interim CEO
4200 Sun N' Lake Blvd
Sebring, FL 33872
(863) 402-3108
(863) 402-3110
warren.santander@ahss.org

Lars Houmann
President & CEO
200 Hilda Street
Kissimmee, FL 34741
(407) 846-4343
(407) 200-4965
Lars.Houmann@flhosp.org

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
bruce.bergherm@ahss.org

Denise Grimsley
Administrator
533 West Carlton Street
Wauchula, FL 33873
(863) 767-8342
(863) 773-0126
denise.grimsley@ahss.org

Eric Peburn
CFO
303 N. Clyde Morris Boulevard
Daytona Beach, FL 32114
(386) 254-4000
(386) 253-7593
eric.peburn@halifax.org

RD Williams
CEO
524 W Sagamore Ave
Clewiston, FL 33440
(863) 983-9121
(863) 983-1809
rwilliams@hrmc.us

Mike Hutchins
Administrator
14114 Alabama Street
Jay, FL 32565
(850) 675-8015

mike.hutchins@bhcpns.org

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
gina.melby@hcahealthcare.com

Scott A. Cihak
Chief Executive Officer
11750 Bird Road
Miami, FL 33175
(305) 223-3000
(305) 229-2444
scott.cihak@hcahealthcare.com

Pam Howard
CEO
P.O. Box 748
Lake Butler, FL 32054
(386) 496-2323
(386) 496-1611
PHoward@lakebutlerhospital.com

Richard Fletcher
Chief Executive Officer
8330 Lakewood Ranch Blvd.
Lakewood Ranch, FL 34202
(941) 782-2104
(941) 782-2119
richard.fletcher@uhsinc.com

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
anthony.degina@hcahealthcare.com

Steve Daugherty
Chief Executive Officer - Interim
1700 South 23rd Street
Fort Pierce, FL 34950
(772) 461-4000
(772) 460-1353
steve.daugherty@hcahealthcare.com

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
donhenderson@cfhalliance.org

Rick Hankey
Senior Vice President
P.O. Box 491000
Leesburg, FL 34749-1000
(352) 315-7815
(352) 360-6610
rhankey@lsbc.net

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

martin.robitaille@martinhealth.org

Louis Galderi
Chief Operating Officer
601 Main Street
Dunedin, FL 34698
(727) 734-6395
(727) 734-6887
louis.galderi@baycare.org

Kristopher Hoce
Chief Operating Officer
300 Pinellas Street
Clearwater, FL 33756
(727) 462-7100
(727) 461-8101
kris.hoce@baycare.org

Harrell Ziecheck
Chief Operating Officer
6600 Madison Street
New Port Richey, FL 34652
(727) 843-4599
(727) 848-8762
harrell.ziecheck@baycare.org

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
leigh.massengill@hcahealthcare.com

Wayne Chutkan
Senior VP of Finance
4300 Alton Road
Miami Beach, FL 33140
(305) 674-2662
(305) 674-2007
wayne.chutkan@msmc.com

Dr. Allen Weiss

CEO
PO Box 413001
Naples, FL 34101
(239) 624-4002
(239) 624-4001
allen.weiss@nchmd.org

Dia Nichols
Chief Executive Officer
6000 49th Street North
St. Petersburg, FL 33709
(727) 521-4411
(727) 521-5007
dia.nichols@hcahealthcare.com

Patrick Schlenker
CEO
PO Box 889
Chipley, FL 32428
(850) 415-8103
(850) 638-5764
pschlenker@nfch.org

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
william.rader@hcahealthcare.com

Jesse Smith
Chief Executive Officer
11375 Cortez Boulevard
Brooksville, FL 34613
(352) 596-6632
(352) 597-3024
mickey.smith@hcahealthcare.com

Thomas Yoesle
Chief Operating Officer, Revenue Management
3160 Southgate Commerce Blvd., Suite 40
Orlando, FL 32806
(407) 650-3768
(321) 843-6520
thomas.yoesle@orlandohealth.com

Eric Goldman
Chief Executive Officer
13001 Southern Boulevard
Loxahatchee, FL 33470
(561) 798-3300
(561) 791-8108
eric.goldman@hcahealthcare.com

Randy Gross
Chief Executive Officer
401 Northwest 42nd Avenue
Plantation, FL 33317
(954) 587-5010
(954) 587-3220
randy.gross@hcahealthcare.com

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
robert.lee@hcahealthcare.com

C. Shayne George
Chief Executive Officer
14000 Fivay Road
Hudson, FL 34667
(727) 819-2929
(727) 869-5491
shayne.george@hcahealthcare.com

Henry Stovall
President
5151 North 9th Avenue
Pensacola, FL 32504
(850) 416-7681
(850) 416-7618
henry.stovall@shhpens.org

Roger Hall
President
7800 U.S. Highway 98 West
Miramar Beach, FL 32550
(850) 278-3006
(850) 278-3010
rhall@shhpens.org

Roger Hall
President
7800 U.S. Highway 98 West
Miramar Beach, FL 32550
(850) 278-3006
(850) 278-3010
rhall@shhpens.org

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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

goldft@shands.ufl.edu

Russ Armistead
CEO
655 West 8th Street
Jacksonville, FL 32209
(904) 244-3002
(904) 244-4027
russ.armistead@jax.ufl.edu

Sharon Roush
Chief Executive Officer
4016 Sun City Center Boulevard
Sun City Center, FL 33573
(813) 634-3301
(813) 634-8712
sharon.roush@hcahealthcare.com

Karen Kerr
Chief Operating Officer - Interim
301 North Alexander Street
Plant City, FL 33566
(813) 757-1205
(813) 757-8204
Karen.Kerr@baycare.org

Kenneth Wicker
Chief Executive Officer
17240 Cortez Boulevard
Brooksville, FL 34601
(352) 799-5111

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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
(352) 754-3215
ken.wicker@hma.com

Lorraine Lutton
Chief Operating Officer
3001 W. Dr. M.L. King Jr. Blvd.
Tampa, FL 33607
(813) 870-4020
(813) 870-4639
lorraine.lutton@baycare.org

Robert Conroy, Jr.

Chief Executive Officer
6500 38th Avenue North
St. Petersburg, FL 33710
(727) 384-1414
(727) 341-4889
robert.conroy@hcahealthcare.com

Cathy Wambles
PFS Manager
PO Box 45167
Jacksonville, FL 32232
(904) 308-5919
(904) 308-2903
cwambles@jaxhealth.com

Cathy Wambles
PFS Manager
PO Box 45167
Jacksonville, FL 32232
(904) 308-5919
(904) 308-2903
cwambles@jaxhealth.com

G. Mark O'Bryant
President and Chief Executive Officer
1300 Miccosukee Road

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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
Tallahassee, FL 32308
(850) 431-5380
(850) 431-5883
mark.obryant@tmh.org

James Burkhart
President & Chief Executive Officer
1 Tampa General Circle
Tampa, FL 33606
(813) 844-4520
(813) 844-4144
jburkhart@tgh.org

Don Henderson
President and CEO
600 E. Dixie Avenue
Leesburg, FL 34748
(352) 323-5001
(352) 323-5009
donhenderson@cfhalliance.org

Joseph D. Melchiode
Chief Executive Officer
7201 North University Drive
Tamarac, FL 33321
(954) 721-2200
(954) 724-6567
joseph.melchiode@hcahealthcare.com

Lee B. Chaykin
Chief Executive Officer

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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
8201 West Broward Boulevard
Plantation, FL 33324
(954) 473-6600
(954) 452-2133
lee.chaykin@hcahealthcare.com

Lars Houmann
President & CEO
200 N. Lakemont Avenue
Winter Park, FL 32792
(407) 646-7000
(407) 200-4965
Lars.Houmann@flhosp.org

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