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Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811...

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Fresno PACE Provider List Provider from both Sante/PACE Provider from PACE ONLY Provider from SANTE Last_Name First_Name NPI License Number Expertise Provider Language 1 Degree Tax ID Address Designation Office Name Address_1 City State Zip_Code Phone_number_1 FAX Contact Acupuncture Castle Georgina 1548473341 10235 LAC 45-3152552 Billing, Mailing 46 W Jordan Ave Clovis CA 93611 (559)325-4775 Castle Georgina 1548473341 10235 LAC 45-3152552 Primary Georgina Castle, LAC 1175 W Shaw Ave Fresno CA 93711 (559)325-4775 (559)532-0209 Moore Timothy 1447335336 3894 LAC 56-3729016 Primary, Billing, Mailing Timothy Moore, L.AC. 5066 N. Fresno St. #104 Fresno CA 93710 (559)229-8202 (559)229-8642 Munoz-McWilliams Shirley 1346312691 7530 Spanish LAC 26-4168154 Primary Shirley McWilliams Acupuncture Inc. 7141 N Cedar #103 Fresno CA 93720 (559)975-5565 (559)474-8921 Munoz-McWilliams Shirley 1346312691 7530 Spanish LAC 26-4168154 Mailing, Billing PO Box 14055 Fresno CA 93650 (559)975-5565 Allergy/ Immunology Aminian A. M. 1508080193 A40672 MD 77-0326261 Billing, Primary, Mailing Allergy Institute, A Medical Corporation 7375 N. Fresno St. #101 Fresno CA 93720 (559)447-1700 (559)447-0121 Baz Malik 1114923307 A35393 Spanish MD 77-0208441 Primary, Billing, Mailing Baz Allergy, Asthma & Sinus Center Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526 Buddiga Praveen Hiyama Lauren 1215025275 A84500 Urgent Care MD 77-0208441 Billing, Mailing 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 Hiyama Lauren 1215025275 A84500 Urgent Care MD 77-0208441 Primary Baz Allergy, Asthma & Sinus Center, Inc. 1420 Shaw Ave. #105 Clovis CA 93611 (559)325-9990 (559)797-0004 Peralejo Belle 1104031327 A102716 MD 77-0208441 Billing, Mailing 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 Peralejo Belle 1104031327 A102716 MD 77-0208441 Primary Baz Allergy, Asthma and Sinus Center, Inc. 6643 N. Milburn Ave. #101 Fresno CA 93722 (559)275-1400 (559)274-1487 Pettigrew Howard 1891961835 A104136 MD, PHD 77-0208441 Primary Baz Allergy, Asthma & Sinus Center, Inc. 2021 E. Herndon Ave. #201 Clovis CA 93611 (559)472-3116 (559)324-8748 Roberto Lauro 1194878512 A49421 Pediatric Pulmonology Spanish MD 77-0208441 Mailing, Primary, Billing Baz Allergy, Asthma & Sinus Center Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526 Sabry Angela 1811297427 A117534 MD 77-0208441 Primary, Mailing, Billing Baz Allergy, Asthma & Sinus Center, Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526 Sidhu Rabinder 1013095991 A42338 Hindi MD 77-0517004 Primary, Billing, Mailing Allergy and Asthma Associates 7151 N. Cedar #103 Fresno CA 93720 (559)432-9292 (559)261-1526 Singh Sudeep 1225130008 A49147 Hindi MD 77-0500118 Primary, Mailing Singh Sinus and Breathing Center 7011 N. Howard #201 Fresno CA 93720 (559)431-9571 (559)431-4721 Singh Sudeep 1225130008 A49147 Hindi MD 77-0500118 Billing 8839 N. Cedar #53 Fresno CA 93720 (559)447-2227 Anesthesiology Community Regional Anesthesia Medical Group 7370 North Palm, Suite #101 Fresno CA 93711 (559)283-4960 Abdollahi-Fard Alireza 1205161932 A110374 Pain Management MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Abdollahi-Fard Alireza 1205161932 A110374 Pain Management MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Audd Lee 1497016653 141009 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Audd Lee 1497016653 141009 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Barga Renato 1467421578 A40782 Ilocano MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Barga Renato 1467421578 A40782 Ilocano MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Bhatt Ashwin 1750332631 A49357 Hindi MD 77-0500726 Mailing, Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Bhatt Ashwin 1750332631 A49357 Hindi MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Bierma Ronald 1629000369 A43625 MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Bierma Ronald 1629000369 A43625 MD 77-0500726 Mailing, Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Chan Sandy 1992026504 A103192 Cantonese MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Chan Sandy 1992026504 A103192 Cantonese MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Ding Lin 1538119623 A61803 MD 77-0500726 Billing, Mailing PO Box 45123 San Francis CA 94145 (559)228-5473 Ding Lin 1538119623 A61803 MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Drachenberg Ana 1851328108 A74874 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Drachenberg Ana 1851328108 A74874 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Gainor Robert 1871688754 G79476 MD 77-0500726 Billing P O Box 45123 San Francis CA 94145 (559)228-5400 Gainor Robert 1871688754 G79476 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Holloway Nathaniel 1699909507 G70859 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Holloway Nathaniel 1699909507 G70859 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Jaravata Danilo 1871552364 52971 Spanish MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Jaravata Danilo 1871552364 52971 Spanish MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Kagunye Silvester 1053639591 131153 Swahili MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Kagunye Silvester 1053639591 131153 Swahili MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Kim Robin 1942436324 A97165 Spanish MD 77-0500726 Mailing, Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Kim Robin 1942436324 A97165 Spanish MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Le Hoang 1912958893 G73035 Vietnamese MD 77-0500726 Billing, Mailing PO Box 45123 San Francis CA 94145 (559)228-5473 Le Hoang 1912958893 G73035 Vietnamese MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Lee Bartolome 1861447997 A83830 Tagalog MD 77-0500726 Billing, Mailing PO Box 45123 San Francis CA 94145 (559)228-5473 Lee Bartolome 1861447997 A83830 Tagalog MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Oji Oji 1750434783 A94340 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Oji Oji 1750434783 A94340 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Pham Hoa 1487604419 G80410 Vietnamese MD 77-0500726 Billing, Mailing PO Box 45123 San Francis CA 94145 (559)228-5473 Pham Hoa 1487604419 G80410 Vietnamese MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Phillips James 1851681399 A124786 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Phillips James 1851681399 A124786 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Raza Ahamed 1457325029 A89462 MD 77-0500726 Billing P O Box 45123 San Francis CA 94145 (559)228-5400 Raza Ahamed 1457325029 A89462 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Rohlen Brooks 1922295971 99038 Portuguese MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Rohlen Brooks 1922295971 99038 Portuguese MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Scherling Joshua 1801113543 A117151 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Scherling Joshua 1801113543 A117151 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Smith Brian 1265492821 G85417 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Smith Brian 1265492821 G85417 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Uyan Senen 1558312405 A41010 Tagalog MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Uyan Senen 1558312405 A41010 Tagalog MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Vander Werf Brian 1881030674 A135115 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Vander Werf Brian 1881030674 A135115 MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Wiest Daniel 1104139443 A132112 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Wiest Daniel 1104139443 A132112 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Yamoah Edwin 1073757738 A114280 MD 77-0500726 Billing PO Box 45123 San Francis CA 94145 (559)228-5473 Yamoah Edwin 1073757738 A114280 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Yanez-Segura Victor 1700838935 A43359 MD 20-4485281 Primary Madera Anesthesia Consultants, Inc. 1250 E. Almond Madera CA 93637 (209)675-5535xet5530 (209)675-9626 Yanez-Segura Victor 1700838935 A43359 MD 20-4485281 Billing, Mailing PO Box 7096 Stockton CA 95267 (209)956-7725 Yeagle Stephen 1104877083 G59499 German MD 77-0500726 Billing, Mailing PO Box 45123 San Francis CA 94145 (559)228-5473 Yeagle Stephen 1104877083 G59499 German MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750 Cardiovascular Disease Ambrose John 1598795429 G87536 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550 Ambrose John 1598795429 G87536 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682 Boran Kevin 1982673406 G56843 MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574 Borno Sam 1598758468 A44967 Arabic MD 27-0009464 Mailing, Billing, Primary Cardiac Institute of Fresno 30 River Park PL. W. #440 Fresno CA 93720 (559)256-5500 (559)256-5505 Daniele Teresa 1497791693 56123 Italian MD 46-3969536 Primary Cardiology Clinic/UFA 2210 E. Illinois Ave. #508 Fresno CA 93701 (559)320-0545 (559)320-0554 Daniele Teresa 1497791693 56123 Italian MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682 Deedwania Prakash 1467553586 A34886 Hindi MD 46-3969536 Primary Cardiology Clinic/UFA 2210 E. Illinois Ave. #508 Fresno CA 93701 (559)320-0545 (559)320-0554 Deedwania Prakash 1467553586 A34886 Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682
Transcript
Page 1: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Fresno PACE Provider List Provider from both Sante/PACE Provider from PACE ONLY Provider from SANTELast_Name First_Name NPI License Number Expertise Provider

Language 1Degree Tax ID Address

DesignationOffice Name Address_1 City State Zip_Code Phone_number_1 FAX Contact

AcupunctureCastle Georgina 1548473341 10235 LAC 45-3152552 Billing, Mailing 46 W Jordan Ave Clovis CA 93611 (559)325-4775Castle Georgina 1548473341 10235 LAC 45-3152552 Primary Georgina Castle, LAC 1175 W Shaw Ave Fresno CA 93711 (559)325-4775 (559)532-0209Moore Timothy 1447335336 3894 LAC 56-3729016 Primary, Billing, Mailing Timothy Moore, L.AC. 5066 N. Fresno St. #104 Fresno CA 93710 (559)229-8202 (559)229-8642Munoz-McWilliams Shirley 1346312691 7530 Spanish LAC 26-4168154 Primary Shirley McWilliams Acupuncture Inc. 7141 N Cedar #103 Fresno CA 93720 (559)975-5565 (559)474-8921Munoz-McWilliams Shirley 1346312691 7530 Spanish LAC 26-4168154 Mailing, Billing PO Box 14055 Fresno CA 93650 (559)975-5565Allergy/ ImmunologyAminian A. M. 1508080193 A40672 MD 77-0326261 Billing, Primary, Mailing Allergy Institute, A Medical Corporation 7375 N. Fresno St. #101 Fresno CA 93720 (559)447-1700 (559)447-0121Baz Malik 1114923307 A35393 Spanish MD 77-0208441 Primary, Billing, Mailing Baz Allergy, Asthma & Sinus Center Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526Buddiga PraveenHiyama Lauren 1215025275 A84500 Urgent Care MD 77-0208441 Billing, Mailing 7471 N. Fresno St. Fresno CA 93720 (559)436-4500Hiyama Lauren 1215025275 A84500 Urgent Care MD 77-0208441 Primary Baz Allergy, Asthma & Sinus Center, Inc. 1420 Shaw Ave. #105 Clovis CA 93611 (559)325-9990 (559)797-0004Peralejo Belle 1104031327 A102716 MD 77-0208441 Billing, Mailing 7471 N. Fresno St. Fresno CA 93720 (559)436-4500Peralejo Belle 1104031327 A102716 MD 77-0208441 Primary Baz Allergy, Asthma and Sinus Center, Inc. 6643 N. Milburn Ave. #101 Fresno CA 93722 (559)275-1400 (559)274-1487Pettigrew Howard 1891961835 A104136 MD, PHD 77-0208441 Primary Baz Allergy, Asthma & Sinus Center, Inc. 2021 E. Herndon Ave. #201 Clovis CA 93611 (559)472-3116 (559)324-8748Roberto Lauro 1194878512 A49421 Pediatric Pulmonology Spanish MD 77-0208441 Mailing, Primary, Billing Baz Allergy, Asthma & Sinus Center Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526Sabry Angela 1811297427 A117534 MD 77-0208441 Primary, Mailing, Billing Baz Allergy, Asthma & Sinus Center, Inc. 7471 N. Fresno St. Fresno CA 93720 (559)436-4500 (559)261-1526Sidhu Rabinder 1013095991 A42338 Hindi MD 77-0517004 Primary, Billing, Mailing Allergy and Asthma Associates 7151 N. Cedar #103 Fresno CA 93720 (559)432-9292 (559)261-1526Singh Sudeep 1225130008 A49147 Hindi MD 77-0500118 Primary, Mailing Singh Sinus and Breathing Center 7011 N. Howard #201 Fresno CA 93720 (559)431-9571 (559)431-4721Singh Sudeep 1225130008 A49147 Hindi MD 77-0500118 Billing 8839 N. Cedar #53 Fresno CA 93720 (559)447-2227AnesthesiologyCommunity Regional Anesthesia Medical Group 7370 North Palm, Suite #101 Fresno CA 93711 (559)283-4960Abdollahi-Fard Alireza 1205161932 A110374 Pain Management MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Abdollahi-Fard Alireza 1205161932 A110374 Pain Management MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Audd Lee 1497016653 141009 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Audd Lee 1497016653 141009 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Barga Renato 1467421578 A40782 Ilocano MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Barga Renato 1467421578 A40782 Ilocano MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Bhatt Ashwin 1750332631 A49357 Hindi MD 77-0500726 Mailing, Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Bhatt Ashwin 1750332631 A49357 Hindi MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Bierma Ronald 1629000369 A43625 MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Bierma Ronald 1629000369 A43625 MD 77-0500726 Mailing, Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Chan Sandy 1992026504 A103192 Cantonese MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Chan Sandy 1992026504 A103192 Cantonese MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Ding Lin 1538119623 A61803 MD 77-0500726 Billing, Mailing PO Box 45123 San FranciscoCA 94145 (559)228-5473Ding Lin 1538119623 A61803 MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Drachenberg Ana 1851328108 A74874 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Drachenberg Ana 1851328108 A74874 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Gainor Robert 1871688754 G79476 MD 77-0500726 Billing P O Box 45123 San FranciscoCA 94145 (559)228-5400Gainor Robert 1871688754 G79476 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Holloway Nathaniel 1699909507 G70859 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Holloway Nathaniel 1699909507 G70859 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Jaravata Danilo 1871552364 52971 Spanish MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Jaravata Danilo 1871552364 52971 Spanish MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Kagunye Silvester 1053639591 131153 Swahili MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Kagunye Silvester 1053639591 131153 Swahili MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Kim Robin 1942436324 A97165 Spanish MD 77-0500726 Mailing, Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Kim Robin 1942436324 A97165 Spanish MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Le Hoang 1912958893 G73035 Vietnamese MD 77-0500726 Billing, Mailing PO Box 45123 San FranciscoCA 94145 (559)228-5473Le Hoang 1912958893 G73035 Vietnamese MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Lee Bartolome 1861447997 A83830 Tagalog MD 77-0500726 Billing, Mailing PO Box 45123 San FranciscoCA 94145 (559)228-5473Lee Bartolome 1861447997 A83830 Tagalog MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Oji Oji 1750434783 A94340 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Oji Oji 1750434783 A94340 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Pham Hoa 1487604419 G80410 Vietnamese MD 77-0500726 Billing, Mailing PO Box 45123 San FranciscoCA 94145 (559)228-5473Pham Hoa 1487604419 G80410 Vietnamese MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Phillips James 1851681399 A124786 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Phillips James 1851681399 A124786 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Raza Ahamed 1457325029 A89462 MD 77-0500726 Billing P O Box 45123 San FranciscoCA 94145 (559)228-5400Raza Ahamed 1457325029 A89462 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Rohlen Brooks 1922295971 99038 Portuguese MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Rohlen Brooks 1922295971 99038 Portuguese MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Scherling Joshua 1801113543 A117151 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Scherling Joshua 1801113543 A117151 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Smith Brian 1265492821 G85417 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Smith Brian 1265492821 G85417 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Uyan Senen 1558312405 A41010 Tagalog MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Uyan Senen 1558312405 A41010 Tagalog MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Vander Werf Brian 1881030674 A135115 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Vander Werf Brian 1881030674 A135115 MD 77-0500726 Mailing, Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Wiest Daniel 1104139443 A132112 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Wiest Daniel 1104139443 A132112 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Yamoah Edwin 1073757738 A114280 MD 77-0500726 Billing PO Box 45123 San FranciscoCA 94145 (559)228-5473Yamoah Edwin 1073757738 A114280 MD 77-0500726 Primary, Mailing Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Yanez-Segura Victor 1700838935 A43359 MD 20-4485281 Primary Madera Anesthesia Consultants, Inc. 1250 E. Almond Madera CA 93637 (209)675-5535xet5530 (209)675-9626Yanez-Segura Victor 1700838935 A43359 MD 20-4485281 Billing, Mailing PO Box 7096 Stockton CA 95267 (209)956-7725Yeagle Stephen 1104877083 G59499 German MD 77-0500726 Billing, Mailing PO Box 45123 San FranciscoCA 94145 (559)228-5473Yeagle Stephen 1104877083 G59499 German MD 77-0500726 Primary Community Anesthesia Providers 7370 N. Palm Ave. #101 Fresno CA 93711 (559)451-1602 (559)435-6750Cardiovascular DiseaseAmbrose John 1598795429 G87536 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Ambrose John 1598795429 G87536 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Boran Kevin 1982673406 G56843 MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Borno Sam 1598758468 A44967 Arabic MD 27-0009464 Mailing, Billing, Primary Cardiac Institute of Fresno 30 River Park PL. W. #440 Fresno CA 93720 (559)256-5500 (559)256-5505Daniele Teresa 1497791693 56123 Italian MD 46-3969536 Primary Cardiology Clinic/UFA 2210 E. Illinois Ave. #508 Fresno CA 93701 (559)320-0545 (559)320-0554Daniele Teresa 1497791693 56123 Italian MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Deedwania Prakash 1467553586 A34886 Hindi MD 46-3969536 Primary Cardiology Clinic/UFA 2210 E. Illinois Ave. #508 Fresno CA 93701 (559)320-0545 (559)320-0554Deedwania Prakash 1467553586 A34886 Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682

Page 2: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Gen Michael 1487623906 A87239 Spanish MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Gregory Donald 1235108747 G43445 MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Hanks William 1609845189 G31359 Spanish MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Javed Usman 1770592578 A92184 Spanish MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574John Thampi 1043244122 A52031 Malayalam MD 20-0890936 Primary, Billing, Mailing 30 Riverpark PL. W. #330 Fresno CA 93720 (559)459-1965 (559)256-2452Joshi Bipin 1336162486 A44090 Hindi MD 77-0437259 Primary, Billing, Mailing California Heart Medical Association 7215 N. Fresno St. #103 Fresno CA 93720 (559)438-1111 (559)438-4002Kiel Richard 1073846747 A109756 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Kiel Richard 1073846747 A109756 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Krueger Michael 1396714937 20A6760 DO 77-0586736 Primary, Billing, Mailing Mid Valley Cardiology 7033 N. Fresno St. #301 Fresno CA 93720 (559)438-8181 (559)438-8179Mouanoutoua Mouatou 1396778189 A90873 Hmong MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Mouanoutoua Mouatou 1396778189 A90873 Hmong MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Palaniswamy Chandrasekar 1316170749 A141618 Hindi MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Palaniswamy Chandrasekar 1316170749 A141618 Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Rasmussen Henning 1487649943 G51673 Danish MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Rasmussen Henning 1487649943 G51673 Danish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Rathod Ankit 1073751962 A114382 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Rathod Ankit 1073751962 A114382 MD 46-3969536 Primary UFA 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Sandhu Lakhjit 1508872425 A45484 Hindi MD 77-0437259 Primary, Billing, Mailing California Heart Medical Association 7215 N. Fresno St. #103 Fresno CA 93720 (559)438-1111 (559)438-4002Singh Kanwal 1740203736 A46659 MD 20-3572300 Primary, Billing, Mailing Kanwal J. Singh, MD, FACC, INC. 1290 E Almond Madera CA 93637 (559)661-6212 (559)661-6216Sohn Charles 1033102900 G85198 Korean MD 27-0009464 Primary, Mailing, Billing Cardiac Institute of Fresno 30 River Park PL. W. #440 Fresno CA 93720 (559)256-5500 (559)256-5505Srikanth Sundararajan 1104934082 A79236 Hindi MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #240 Fresno CA 93701 (559)320-0545 (559)320-0550Srikanth Sundararajan 1104934082 A79236 Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Sundrani Rohit 1508835463 A78972 MD 94-2686822 Primary, Billing, Mailing Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Wessel Ralph 1801829569 G21904 MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-5721 (559)459-5097Wessel Ralph 1801829569 G21904 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Cardiovascular/Thoracic SurgeryChaudhry Pervaiz 1104804475 A79662 MD 77-0345840 Mailing, Primary, Billing Valley Cardiac Surgery 1903 E. Fir #101 Fresno CA 93720 (559)441-1777 (559)441-0726George Kristopher 1033173463 C140910 MD 27-0271872 Primary Cardiac Surgery Associates of Fresno Inc./CFMG 2335 E. Kashian Ln. #230 Fresno CA 93701 (559)499-0830 (559)499-0846George Kristopher 1033173463 C140910 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hanley Frank 1083632624 G42443 MD 77-0465765 Mailing, Primary 9300 Valley Children's PL. Madera CA 93638Hanley Frank 1083632624 G42443 MD 77-0465765 Billing 300 Pasteur Dr Stanford CA 94305 (650)724-2925Khwaja Shamsuddin 1679570527 A85907 Urdu MD 26-1921424 Primary, Billing, Mailing Central California Heart & Lung Surgery 7575 N. Cedar Ave. #101 Fresno CA 93720 (559)449-9990 (559)449-9991MacDonald Malcolm 1578584009 G85238 MD 77-0465765 Mailing, Primary 9300 Valley Children's PL. Madera CA 93638MacDonald Malcolm 1578584009 G85238 MD 77-0465765 Billing 300 Pasteur Dr Stanford CA 94305 (650)724-2925Minasyan Sarah 1669646451 A82064 Russian MD 27-0271872 Primary Cardiac Surgery Associates of Fresno Inc./CFMG 2335 E. Kashian Ln. #230 Fresno CA 93701 (559)499-0830 (559)499-0846Minasyan Sarah 1669646451 A82064 Russian MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Pamula Ramesh 1356382295 C55426 MD 47-3279882 Primary, Mailing 7085 N. Chestnut Ave. #103 Fresno CA 93720 (559)900-4395 (559)900-4396Pamula Ramesh 1356382295 C55426 MD 47-3279882 Billing 10691 N. Laura Valley Dr. Fresno CA 93730 (559)900-4395Stewart Robert 1659350668 G33488 MD 77-0345840 Mailing, Primary, Billing Valley Cardiac Surgery 1903 E. Fir #101 Fresno CA 93720 (559)441-1777 (559)441-0726ChiropracticArmas Matthew 1245301969 24272 DC 54-7770681 Primary, Billing, Mailing Coleman Chiropractic 6592 N First St Fresno CA 93710 (559)435-3331 (559)435-3222Baker Terry 1134150626 11175 DC 57-3045980 Primary, Billing 49220 Rd 426 Ste 2 Oakhurst CA 93644 (559)683-3770 (559)683-3770Balli Sergio 1568774180 29667 DC 27-2912975 Mailing, Primary, Billing Preferred Chiropractic Center 1305 N. Willow Ste. #160 Clovis CA 93619 (559)298-6325 (559)298-6322Birchall Isaac 1275622896 28631 DC 20-2199259 Billing, Primary, Mailing First Health Medical Center 7161 N. Howard St. Ste. #100 Fresno CA 93720 (559)227-2273 (559)227-3473Bowen Jason 1649363391 19721 DC 77-0298079 Primary, Billing, Mailing 5777 N Fresno St Ste #101 Fresno CA 93710 (559)438-4055 (559)438-4057Butterfield Keith 1639118334 15151 DC 77-0005965 Primary, Billing, Mailing Butterfield Chiropractic 1717 Mill St Selma CA 93662 (559)472-7314 (559)891-9800Clark John 1386731677 DC 45-2385716 Mailing, Primary, Billing Clark Chiropractic Office 7461 N First St Ste103 Fresno CA 93720 (559)226-3400 (559)226-3963Clymore Richard 1609809367 14341 DC 94-2832107 Primary, Billing, Mailing Harbin/Clymore Chiropractic 2416 W Shaw Ave Ste #107 Fresno CA 93711 (559)439-4439 (559)439-4448Coleman Jeffrey 1821171620 DC 54-7770681 Primary, Billing, Mailing Coleman Chiropractic 6592 N First St Fresno CA 93710 (559)435-3331 (559)435-3222Dahlin Stephen 1407952146 DC 77-0457159 Billing, Mailing P O Box 970 CoarsegoldCA 93614 (559)683-6292Dahlin Stephen 1407952146 DC 77-0457159 Primary 35463 Hwy 41 CoarsegoldCA 93614 (559)683-6292 (559) 683-4742Dawson John 1073625349 19749 DC 77-0227729 Mailing, Primary, Billing Dawson Chiropractic Center 6700 N First St #134 Fresno CA 93710 (559)432-5560 (559)432-5033DeCesare Brett 1811074594 17579 DC 26-4508075 Primary DeCesare Chiropractic 13416 S Oak Caruthers CA 93609 (559)864-9457 (559)864-0109DeCesare Brett 1811074594 17579 DC 26-4508075 Billing, Mailing PO Box 787 Caruthers CA 93609Delinger Jennifer 1144261116 25562 DC 20-3339510 Mailing, Primary, Billing Delinger Chiropractic 1445 Marion St Kingsburg CA 93631 (559)897-9300 (559) 897-9200Forrester George 1154383677 16378 DC 94-2461549 Billing, Primary, Mailing Forrester Family Chiropractic 875 W Ashlan #101 Clovis CA 93612 (559)292-6191 (559)292-6193Garabedian Richard 1790892958 23652 DC 569-92-3153 Primary, Billing, Mailing Garabedian Chiropractic 2133 High St Ste C Selma CA 93662 (559)896-3224 (559)896-3750Garabedian Troy 1972925774 DC32796 DC 47-5476063 Primary, Mailing, Billing 29369 Auberry Rd #101 Prather CA 93651 (559)855-8445 (559)855-8440Giel, Jr. Joseph 1790855013 21693 DC 77-0568428 Billing, Primary, Mailing 5339 N Fresno #107D Fresno CA 93710 (559)225-2881 (559)225-2952Grootendorst David 1225118177 15082 Spanish DC 77-0587402 Primary, Billing, Mailing Grootendorst Chiropractic Center 900 W Yosemite Ave Madera CA 93637 (559)674-8892 (559)674-1389Grootendorst John 1780765073 26630 Spanish DC 77-0587402 Primary, Billing, Mailing Grootendorst Chiropractic Center 900 W Yosemite Ave Madera CA 93637 (559)674-8892 (559)-674-1389Harbin Debra 1225044076 14387 DC 94-2832107 Primary, Billing, Mailing Harbin/Clymore Chiropractic 2416 W Shaw Ave Ste #107 Fresno CA 93711 (559)439-4439 (559)439-4448Hokokian John 1659456432 19837 DC 77-0336039 Primary, Billing, Mailing Hokokian Chiropractic Clinic 1543 W Shaw Ave Fresno CA 93711 (559)230-1102 (559)230-1105Kendrick-Marsoobian Pamela 1174988943 DC 20-2199259 Primary, Mailing, Billing First Health Medical Center 7161 N. Howard St. Ste. #100 Fresno CA 93720 (559)227-2273 (559)227-3473Kopper Timothy 1457469926 20263 Spanish DC 32-0418850 Billing, Mailing, Primary 1374 Smith St Kingsburg CA 93631 (559)897-5801 (559)897-9134Krikorian Samuel 1255399085 20268 DC 20-2199259 Primary, Billing, Mailing First Health Medical Center 7161 N. Howard St. Ste. #100 Fresno CA 93720 (559)227-2273 (559)227-3473Kuwamoto Russell 1104900380 14118 Spanish DC 77-0082163 Primary, Billing, Mailing Kuwamoto Chiropractic Clinic 2384 E Gettysburg Fresno CA 93726 (559)222-2333 (559)222-2547Lee John 1982759155 30219 Spanish DC 45-2395802 Mailing, Primary, Billing John Lee Chiropractic, Inc. 5680 N Fresno St Ste #110 Fresno CA 93710 (559)227-5301 (559) 227-3708Long Christopher 1114969094 29486 DC 61-8052615 Primary, Billing, Mailing Dynamic Integrative Health 1382 E Alluvial Ave Ste #106 Fresno CA 93720 (559)432-9700 (559)432-9701Markovich David 1154351898 22068 DC 55-5312874 Primary Backworks 670 E Bullard Ste #102 Fresno CA 93710 (559)440-1919 (559)440-1909Markovich David 1154351898 22068 DC Mailing, Billing PO Box 25267 Fresno CA 93729 (559)440-1919Martinez Theodore 1962424143 DC 93-0997408 Primary, Billing, Mailing Integrity Chiropractic 1782 E Bullard Ave Ste 102 Fresno CA 93710 (559)439-9001 (559) 439-9005McNaughton Stephen 1851381040 14146 Spanish DC 94-2821924 Primary, Billing, Mailing 1856 Whitson St Selma CA 93662 (559)896-0364 (559) 896-2301Meeks Kevin 1669535324 16628 DC 77-0076876 Primary, Mailing Hanford Chiropractic 425 N Redington Hanford CA 93230 (559)583-1801 (559)583-1100Meeks Kevin 1669535324 16628 DC 77-0076876 Billing PO Box 570 Hanford CA 93232 (559)583-1801Radtke Jason 1942563986 DC 60-4093979 Billing, Primary, Mailing 725 Pollasky Ave #111 Clovis CA 93612 (559)299-8300 (559)299-1835Robertson Dennis 1275688921 25025 Spanish DC 20-8310250 Primary, Mailing, Billing 5649 N Palm Ave Fresno CA 93704 (559)227-1777 (559)222-2262Rustigan Ryan 1659308997 29416 DC 20-2199259 Mailing, Primary, Billing First Health Medical Center 7161 N. Howard St. Ste. #100 Fresno CA 93720 (559)227-2273 (559)227-3473Ryan Travis 1417289869 31511 Spanish DC 62-0543813, 47-5407970Billing, Mailing, Primary Sierra Relief Chiropractic 2147 Herndon #104 Clovis CA 93611 (559)297-0030 (559)297-7888Schroeder Torrey 1952788333 DC 47-3916742 Primary, Mailing, Billing 7191 N Millbrook, #116 Fresno CA 93720 (559)432-2225 (559)432-2239Scott Matthew 1306167358 DC 80-0609346 Primary, Mailing, Billing Alliance Chiropractic 7065 N Chestnut #101 Fresno CA 93720 (559)478-5833 (559)439-7847Seibert Shane 1295016723 32064 DC 45-3084060 Primary, Mailing, Billing Dynamic Integrative Health 1382 E Alluvial #106 Fresno CA 93720 (559)432-9700 (559)432-9701Simons Mark 1285773770 22242 Spanish DC 57-2279840 Primary, Billing, Mailing Kerman Chiropractic Center 207 S Madera Ave Kerman CA 93630 (559)846-9406 (559)846-5580Smith Kenneth 1265476378 17540 DC 77-0126299 Billing, Primary, Mailing 508 Fifth St Clovis CA 93612 (559)299-2896 (559)325-0113Stafford Gregory 1669634937 DC 90-0394234 Primary, Billing, Mailing Stafford Chriopractics 1564 Shaw Ave Clovis CA 93611 (559)298-9511 (559)298-9571Starnes James 1952344103 DC 55-7278469 Billing, Mailing, Primary Oakhurst Family Chiropractic 49346 Rd 426 Ste #3 Oakhurst CA 93644 (559)642-2225 (559)658-7543Sullivan Charles Bret 1811086069 15406 Spanish DC 27-3022245 Mailing, Primary, Billing Bret Sullivan, DC 4678 N First St Fresno CA 93726 (559)438-8900 (559)227-7701Tsutsui Larry 1083703508 16565 DC 77-0177703 Mailing, Primary, Billing 2023 N Van Ness Blvd Fresno CA 93704 (559)222-1384 (559)222-2163Vinson Matthew 1710902259 29657 Spanish DC 20-2505491 Primary, Mailing, Billing Preferred Chiropractic Center 1305 N. Willow Ste. #160 Clovis CA 93619 (559)298-6325 (559)298-6322Zenimura Kirk 1669557971 16598 DC 77-0118129 Primary Zenimura Chiropractic 5430 N Palm Ste #106 Fresno CA 93704 (559)438-4141 (559)438-4150Zenimura Kirk 1669557971 16598 DC 77-0118129 Billing, Mailing 15520 Rockfield Blvd. Ste. #A200 Irvine CA 92618 (949)598-9999Colon & Rectal SurgeryCarveth William 1003992918 G51200 MD 77-0489353 Billing, Primary, Mailing Central Valley Colon & Rectal Surgical Associates, Inc. 6121 N. Thesta #202 Fresno CA 93710 (559)440-0283 (559)440-0192

Page 3: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Disbrow David 1730406901 A148973 MD 77-0489353 Billing, Primary, Mailing Central Valley Colon & Rectal Surgical Associates, Inc. 6121 N. Thesta #202 Fresno CA 93710 (559)440-0283 (559)440-0192Garry John 1669558573 G39995 Spanish MD 77-0489353 Mailing, Primary, Billing Central Valley Colon & Rectal Surgical Associates, Inc. 6121 N. Thesta #202 Fresno CA 93710 (559)440-0283 (559)440-0192Lee Wai 1053334748 G55211 Cantonese MD 71-0888428, 27-0271872Primary, Mailing Advanced Laparoscopic Surgery Associates 205 E. River Park Cir. #460 Fresno CA 93720 (559)261-4500 (559)261-4501Lee Wai 1053334748 G55211 Cantonese MD 71-0888428 Billing PO Box 28947 Fresno CA 93729-8921(559)228-4200Nguyen Phuong 1285782987 A137030 Vietnamese MD 77-0489353 Mailing, Primary, Billing Central Valley Colon & Rectal Surgical Associates, Inc. 6121 N. Thesta #202 Fresno CA 93710 (559)440-0283 (559)440-0192Critical Care MedicineMohammadi-Rad Seyed 1184851719 A139402 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Mohammadi-Rad Seyed 1184851719 A139402 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Savluk Robert 1225037013 G37174 MD 57-2842035 Mailing, Primary, Billing Pulmonary & Critical Care Medicine 1660 E. Herndon #101 Fresno CA 93720 (559)431-9753 (559)431-3478DentalOrdes DDSHmorvic DDSKullar Amrit 1982689998 54356 DDSKanzali James 1457329948 50935 DDSNabeel Joseph DDS 1515 West Shaw Avenue, Suite #101 Fresno CA 93711 (559)227-1700Eufracio Narajos Hilario DDS 4811 East Olive Avenue Fresno CA 93727 (559)255-5228DermatologyAbaza Sam 1831148501 A86393 MD 20-3325000 Primary Fresno Dermatology and Skin Cancer 6181 N. Thesta Ave. #104 Fresno CA 93710 (559)825-0300 (559)825-0301Abaza Sam 1831148501 A86393 MD 20-3325000 Billing PO Box 847030 Los AngelesCA 90084-7030(424)282-5804Boswell John 1295936961 A100542 Spanish MD 46-1131778 Primary, Billing, Mailing Boswell Dermatology 5701 N. West Ave. Fresno CA 93711 (559)439-3000 (559)439-3004Ceglieski Margot 2335 E. Kashian Ln. #410 Fresno CA 93701 (559)266-4100 (559)266-4199Dehesa Luis 1629412259 A142134 Spanish MD 46-3969536 Primary University Dermatology Associates/UFA 2335 E. Kashian Ln. #410 Fresno CA 93701 (559)266-4100 (559)266-4199Dehesa Luis 1629412259 A142134 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Gladstone Hayes 1619003282 A52367 MD 27-4988308 Billing, Mailing, Primary Edgar S. Macias, M.D., Inc. 7115 N. Chestnut Ave. #101 Fresno CA 93720 (559)431-2397 (559)472-3382Macias Edgar 1144482373 A112259 MD 27-4988308 Primary, Mailing, Billing Edgar S. Macias, M.D., Inc. 7115 N. Chestnut Ave. #101 Fresno CA 93720 (559)431-2397 (559)472-3382Mayo Sheila 1366532145 PA23273 PA-C,MMSc Primary, Mailing, Billing 2335 East Kashian Lane, Suite #410 Fresno CA 93701 (559)266-4100 (559)266-4199Paz Carlos 1275885709 A121126 Spanish MD 46-1924129 Primary, Billing, Mailing Fresno Dermatology Specialists, Inc. 7025 N. Chestnut #105 Fresno CA 93720 (559)233-3376 (559)233-6647Rao Babar 1447275904 Urdu MD 20-5289416 Primary, Billing, Mailing West Coast Skin & Cancer Med Ctr, Inc. 7055 N. Fresno St. #310 Fresno CA 93720 (559)446-0285 (559)446-1646Roshdieh Babak 1275589723 A76333 MD 95-3134847 Primary West Dermatology 6700 N. First St. #131 Fresno CA 93710 (559)432-3333 (559)432-3336Roshdieh Babak 1275589723 A76333 MD Billing PO Box 531670 HendersonNV 89053 (844)397-4234Shiell Ronald 1285687384 G70359 MD 95-3134847 Primary West Dermatology 6700 N. First St. #131 Fresno CA 93710 (559)432-3333 (559)432-3336Shiell Ronald 1285687384 G70359 MD 95-3134847 Billing PO Box 531670 HendersonNV 89053 (844)397-4234Simpson Gregory 1740488238 A112941 MD 46-3969536 Primary University Dermatology Associates/UFA 2335 E. Kashian Ln. #410 Fresno CA 93701 (559)266-4100 (559)266-4199Simpson Gregory 1740488238 A112941 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Storey Leslie 1043313133 A81742 Spanish MD 81-1848757 Mailing, Billing, Primary Valley Skin Institute 7777 N. Ingram Fresno CA 93711 (559)472-7546 (559)385-7733Taheri Daniel 1992774681 G80445 MD 20-3325000 Primary Fresno Dermatology and Skin Cancer 6181 N. Thesta Ave. #104 Fresno CA 93710 (559)825-0300 (559)825-0301Taheri Daniel 1992774681 G80445 MD 20-3325000 Billing PO Box 847030 Los AngelesCA 90084-7030(424)282-5804Tareen Naureen 1699952820 A64054 MD 20-5289416 Mailing, Billing, Primary West Coast Skin & Cancer Med Ctr, Inc. 7055 N. Fresno St. #310 Fresno CA 93720 (559)446-0285 (559)446-1646Developemental-Behavorial PediatricCopeland Linda 1801960406 G63521 MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-4300 (559)459-4569Copeland Linda 1801960406 G63521 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Emergency MedicineAcharya Janak 1376508721 A88161 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Acharya Janak 1376508721 A88161 Spanish MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Afarian Hagop 1710151840 A92959 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Afarian Hagop 1710151840 A92959 MD 46-3969536 Primary Emergency Medicine Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Anastopoulos Peter 1861792442 A119178 Greek MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Anastopoulos Peter 1861792442 A119178 Greek MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Andrews James 1629086269 G70523 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Andrews James 1629086269 G70523 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Armenian Patil 1073777686 A96704 Armenian MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Armenian Patil 1073777686 A96704 Armenian MD 33-1031395, 46-3969536Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Banh Kenny 1861697211 A92874 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Bivins Herbert 1972619518 G40063 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Bivins Herbert 1972619518 G40063 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Brueggemann Kurt 1730405077 A111785 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Brueggemann Kurt 1730405077 A111785 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Burg Michael 1497713150 G65791 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Burg Michael 1497713150 G65791 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Campagne Danielle 1184813487 A93155 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Campagne Danielle 1184813487 A93155 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Chinnock Brian 1861481947 A61117 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Chinnock Brian 1861481947 A61117 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Chooljian Carolyn 1982656807 G53673 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Chooljian Carolyn 1982656807 G53673 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Comes James 1669424412 G73201 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Comes James 1669424412 G73201 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Darracq Michael 1275553414 A92362 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Darracq Michael 1275553414 A92362 MD 46-39369536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227DeShields Scott 1467626408 A101755 MD 33-1037395 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441DeShields Scott 1467626408 A101755 MD 94-2613220 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Gastelum Nicholas 1528402948 A132726 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Gastelum Nicholas 1528402948 A132726 Spanish MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Heyne Steven 1881772770 Spanish MD 77-0372200 Primary, Mailing Hanford Community Hospital 450 N. Greenfield Hanford CA 93230 (559)537-0050Heyne Steven 1881772770 Spanish MD 77-0372200 Billing 16835 Algonquin St. #209 Huntington BeachCA 92649 (866)325-0281Ives Tallman Crystal 1063770824 A127520 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Ives Tallman Crystal 1063770824 A127520 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Kallsen Gene 1346275625 G35792 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Kallsen Gene 1346275625 G35792 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Li Xian 1467719476 A147552 French MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Li Xian 1467719476 A147552 French MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Loo Tricia 1215113832 A104949 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Loo Tricia 1215113832 A104949 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Lowder Harold 1720037419 G48264 MD 33-1037395, 46-3969536Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93715 (559)459-6000 (559)499-6441Lowder Harold 1720037419 G48264 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Macias Fernando 1972833853 A110221 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Macias Fernando 1972833853 A110221 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Mason Jessica 1508200619 143343 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Mason Jessica 1508200619 143343 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Maxwell Stuart 1255352001 A98661 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Maxwell Stuart 1255352001 A98661 MD 46-3969536 Primary Emergency Medicine Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441McCullough Sarah 1659393734 A70234 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93715 (559)459-6000 (559)499-6441McCullough Sarah 1659393734 A70234 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227

Page 4: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Orona John 1528110160 G62824 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Orona John 1528110160 G62824 Spanish MD 46-3969536 Primary Emergency Medicine Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Ramirez Gilbert 1962702662 A118983 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Ramirez Gilbert 1962702662 A118983 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Ramirez Rene 1356641062 A115170 MD 46-3969536 Primary Emergency Medicine Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Ramirez Rene 1356641062 A115170 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Riccoboni Steven 1154765196 A133402 Italian MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Riccoboni Steven 1154765196 A133402 Italian MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Richardson Gregory 1710326038 A141730 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Richardson Gregory 1710326038 A141730 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Ruegner Rawnica 1861657595 A97595 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Ruegner Rawnica 1861657595 A97595 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Savage Dan 1487915401 A141319 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Savage Dan 1487915401 A141319 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Sawtelle Vohra Stacy 1336283910 A104144 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Sawtelle Vohra Stacy 1336283910 A104144 MD 46-3969536 Primary Emergency Medicine Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Schmitt Eric 1629242888 A101478 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Schmitt Eric 1629242888 A101478 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Smith Ronald 1467498873 G25343 MD 77-0372200 Primary, Mailing Central California Emergency Services Med. Grp. 450 N. Greenfield Ave. Hanford CA 93230 (559)582-9000 (559)587-4191Smith Ronald 1467498873 G25343 MD 77-0372200 Billing PO Box 1417 Rancho CucamongaCA 91729 (888)559-0029Spano Susanne 1083888168 A97192 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Spano Susanne 1083888168 A97192 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Storkan Michelle 1003170358 A135572 French MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Storkan Michelle 1003170358 A135572 French MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Stroh Geoffrey 1073565990 G79651 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Stroh Geoffrey 1073565990 G79651 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Uller Jeffrey 1528006855 A66548 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Uller Jeffrey 1528006855 A66548 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Utecht Thomas 1538111448 G64272 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Utecht Thomas 1538111448 G64272 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Vohra Rais 1790740140 A86387 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Vohra Rais 1790740140 A86387 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Von Reinhart Anna 1528326477 A143611 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Von Reinhart Anna 1528326477 A143611 MD 46-3969536 Primary Emergency Department/UFA 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Weichenthal Lori 1922059575 A54701 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Weichenthal Lori 1922059575 A54701 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Woodmansee Susan 1275552580 A55503 Spanish MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Woodmansee Susan 1275552580 A55503 Spanish MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227Young Megann 1043535958 A106482 MD 46-3969536 Primary UFA - Emergency Department 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Young Megann 1043535958 A106482 MD 46-3969536 Billing PO Box 8036 Fountain ValleyCA 92728 (562)468-0227EndocrinologyKhanna Panchali 1477676286 A112116 MD 46-3969536 Primary University Diabetes & Endocrine Specialties 7085 N. Chestnut Ave. Ste. #101 Fresno CA 93720 (559)323-9236 (559)323-0294Khanna Panchali 1477676286 A112116 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Naing Soe 1467650341 A92540 Burmese MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Naing Soe 1467650341 A92540 Burmese MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Norwood Paul 1871503649 A38798 Spanish MD 77-0156596 Primary Paul Norwood, MD 550 E. Herndon Ave. #101 Fresno CA 93720 (209)261-0990 (209)261-0994Norwood Paul 1871503649 A38798 Spanish MD 77-0156596 Billing, Mailing PO Box 27396 Fresno CA 93729 (559)438-1245Punzalan Raymundo 1194721373 A50049 Spanish MD 46-3969536 Primary University Diabetes & Endocrine Specialties 7085 N. Chestnut Ave. Ste. #101 Fresno CA 93720 (559)323-9236 (559)323-0294Punzalan Raymundo 1194721373 A50049 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Sahasranam Prem 1720270820 A91333 Spanish MD 74-3226577 Mailing, Primary Central Valley Endocrinology, APC 1524 W. Lacey Blvd. #201 Hanford CA 93230 (559)587-1100 (559)587-9044Sahasranam Prem 1720270820 A91333 Spanish MD 74-3226577 Billing PO Box 1669 Hanford CA 93232 (559)587-1100Saini Nidhi 1386905974 20A15293 Hindi DO 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Saini Nidhi 1386905974 20A15293 Hindi DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Nang Soe 1467650341 A92540 Primary, Mailing, Billing 2336 East Kashian Lane, Suite #410 Fresno CA 93702 (559)266-4100 (559)266-4199Srikanth Sujatha 1124085287 A79529 Weight Management MD 46-3969536 Primary University Diabetes & Endocrine Specialties 7085 N. Chestnut Ave. Ste. #101 Fresno CA 93720 (559)323-9236 (559)323-0294Srikanth Sujatha 1124085287 A79529 Weight Management MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682GastroenterologyAbdulian John 1437114113 G65550 Armenian MD 27-0271872 Primary, Mailing Fresno Gastroenterology/Community Foundation Medical Group 7095 N. Chestnut Ave. #101 Fresno CA 93720 (559)323-8200 (559)323-9200Abdulian John 1437114113 G65550 Armenian MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Akhtar Naeem 1831291863 A45051 Urdu MD 77-0446449, 46-3969536Primary California Gastroenterology Associates 451 E. Almond Ave. #103 Madera CA 93637 (559)673-4000 (559)673-3661Akhtar Naeem 1831291863 A45051 Urdu MD 77-0446449 Mailing, Billing 451 E. Almond Ave. #103 Madera CA 93637 (559)673-4000Arora Ajit 1538253190 A45775 Hindi MD 27-0271872 Primary, Mailing Fresno Gastroenterology/Community Foundation Medical Group 7095 N. Chestnut Ave. #101 Fresno CA 93720 (559)323-8200 (559)323-9200Arora Ajit 1538253190 A45775 Hindi MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Au Alvin 1477639193 A45911 MD 26-3462339 Mailing, Billing, Primary 1360 Bailey St. Hanford CA 93230 (559)584-6499 (559)584-8124Chang Stanley 1013936566 G36222 MD 20-1539356, 46-3969536Primary, Billing, Mailing Spruce Multispecialty Group 1275 E. Spruce #101 Fresno CA 93720 (559)439-5757 (559)248-9585Choudhury Jayanta 1851312268 A98988 MD 27-0271872 Primary, Mailing Fresno Gastroenterology/Community Foundation Medical Group 7055 N. Maple #106 Fresno CA 93720 (559)297-2259 (559)297-2269Choudhury Jayanta 1851312268 A98988 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Davis Stephen 1801850102 G30022 MD 27-0271872 Primary Fresno Gastroenterology/Community Foundation Medical Group 7095 N. Chestnut #101 Fresno CA 93720 (559)323-8200 (559)323-9200Davis Stephen 1801850102 G30022 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Dhillon Ujagger 1518054808 A36464 Hindi MD 94-2841290, 46-3969536Primary, Billing, Mailing California Digestive Disease Center 7405 N. Fresno St. Fresno CA 93720 (559)438-8400 (559)438-0477Farooqi Mufti Saadat 1275610503 A69294 MD 20-3376650 Billing, Primary, Mailing Gastroenterology & Hepatology 1332 W. Herndon Ave. #100 Fresno CA 93711 (559)435-1979 (559)434-9988Farr Charles 1205821592 G45250 MD 055-38-3422 Primary, Billing, Mailing 7202 N. Millbrook #100 Fresno CA 93720 (559)435-1750 (559)449-2108Ginn Patrick 1790799864 G50537 MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Ginn Patrick 1790799864 G50537 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gulati Abhishek 1629380308 A146063 MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Gulati Abhishek 1629380308 A146063 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hanchett Paul 1396833075 G30605 Spanish MD 27-0271872 Mailing, Primary Fresno Gastroenterology/Community Foundation Medical Group 7095 N. Chestnut Ave. #101 Fresno CA 93720 (559)323-8200 (559)323-9200Hanchett Paul 1396833075 G30605 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Jajodia Prahalad 1114092186 A56084 Hindi MD 73-1651691 Mailing, Primary, Billing Digestive & Liver Disease Medical Center 7085 N. Maple Ave. Fresno CA 93720 (559)431-8888 (559)447-8400Khurshid Ambreen 1265490551 C52016 Punjabi MD 26-2222547 Primary, Mailing, Billing California Gastroenterology Associates 451 E. Almond Ave. #103 Madera CA 93637 (559)673-4000 (559)673-3661Kim Soo 1205924800 G86091 MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Kim Soo 1205924800 G86091 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Kodama Kevin 1750395828 G78832 MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Kodama Kevin 1750395828 G78832 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lewis Donald 1033295282 G39078 Spanish MD 71-0888428, 27-0271872Mailing, Primary Advanced Laparoscopic Surgery Associates 205 E. River Park Circle #460 Fresno CA 93720 (559)261-4500 (559)261-4501Lewis Donald 1033295282 G39078 Spanish MD 71-0888428 Billing PO Box 28947 Fresno CA 93729-8921(559)228-4200Mitroo Pradnya 1538371901 A99901 Hindi MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Mitroo Pradnya 1538371901 A99901 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Mittal Ram 1306893516 A48570 Hindi MD 65-1163154, 46-3969536Billing, Primary, Mailing 7215 N. Fresno St. #101 Fresno CA 93720 (559)449-0309 (559)449-0609Mittal Vivek 1396888277 A125783 MD 7045 North Maple Avenue, Suite #101 Fresno CA 93720 (559)493-19Myers Jonathan 1831173293 A14894 DO 27-0271872 Primary Fresno Gastroenterology/Community Foundation Medical Group 7095 N. Chestnut Ave. #101 Fresno CA 93720 (559)323-8200 (559)323-9200Myers Jonathan 1831173293 A14894 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Reznik Boris 1710087846 A91193 MD 62-6170190 Primary, Billing, Mailing Boris Reznik, M.D. 470 N. Greenfield Ave. #37 Hanford CA 93230 (559)589-9460 (559)589-9248

Page 5: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Sekhon Sandeep 1205058856 A109110 MD 27-0271872 Primary Digestive Disease Consultants/Community Foundation Medical Group 1187 E. Herndon #101 Fresno CA 93720 (559)440-0450 (559)440-0461Sekhon Sandeep 1205058856 A109110 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Shah Kandarp 1801815352 C52145 Spanish MD 61-1545816, 46-3969536Mailing, Billing PO Box 4044 Clovis CA 93613-4044Shah Kandarp 1801815352 C52145 Spanish MD 46-3969536, 61-1545816Primary Kandarp Krishnalal Shah, MD 6335 N. Fresno St. #102 Fresno CA 93710 (559)412-5955 (559)412-8276Sheikh Muhammad 1538194048 A66317 MD 27-0271872 Primary, Mailing Fresno Gastroenterology/Community Foundation Medical Group 7055 N. Maple #106 Fresno CA 93720 (559)297-2259 (559)297-2269Sheikh Muhammad 1538194048 A66317 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Singh Mandeep 1669638391 A106158 Hindi MD 27-0271872 Mailing, Primary Fresno Gastroenterology/Community Foundation Medical Group 7055 N. Maple #106 Fresno CA 93720 (559)297-2259 (559)297-2269Singh Mandeep 1669638391 A106158 Hindi MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Utarnachitt Ryan 1659545796 A100613 MD 68-0357690 Primary, Mailing Adventist Health Physicians Network 1419 N. Acacia Ave. #101 Reedley CA 93654 (559)391-3160 (559)391-3162Utarnachitt Ryan 1659545796 A100613 MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (559)537-0297Win Min 1316079619 A92873 MD 94-2841290, 46-3969536Mailing, Primary, Billing California Digestive Disease Center 7405 N. Fresno St. Fresno CA 93720 (559)438-8400 (559)438-0477Wu Ching-Fong 1912018177 Mandarin DO 77-0547423 Primary 440 Greenfield Ste. I Hanford CA 93230 (559)587-0128 (559)587-0280Wu Ching-Fong 1912018177 Mandarin DO 573-51-3020 Billing, Mailing PO Box 6490 Visalia CA 93290 (559)587-0128General SurgeryAdelaja Ibironke 1417118159 A102787 MD 27-0271872, 46-3969536Primary University Specialty Surgery Associates/Community Foundation Medical Group 2335 E. Kashian Ln. Ste. #220 CA 93701 (559)256-5140 (559)485-4505Adelaja Ibironke 1417118159 A102787 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Ambe Chenwi 1942325832 A146144 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ambe Chenwi 1942325832 A146144 MD 27-0271872 Primary, Mailing Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Anwar Muhammad 1477632651 C42620 Urdu MD 77-0516602 Mailing, Billing, Primary Central Valley Surgical Associates 1210 E. Almond Ave. Ste. B Madera CA 93637 (559)675-5598 (559)675-2705Bilello John 1912017856 G84890 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-3571Bilello John 1912017856 G84890 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Boone Keith 1265495139 G68568 Vascular Surgery Spanish MD 71-0888428 Billing PO Box 28947 Fresno CA 93729-8921(559)228-4200Boone Keith 1265495139 G68568 Vascular Surgery Spanish MD 71-0888428, 27-0271872Mailing, Primary Advanced Laparoscopic Surgery Associates 205 E. River Park Cir. #460 Fresno CA 93720 (559)261-4500 (559)261-4501Chahal Sukhjit 1619080058 A36802 Vascular Surgery Spanish MD 94-2880072 Primary, Billing, Mailing 7011 N. Howard #102 Fresno CA 93720 (209)436-4396 (209)436-4399Concepcion Rendoll 1669498655 A39752 Spanish MD 20-4400442 Mailing, Primary, Billing 1885 E. Alluvial #101 Fresno CA 93720 (559)298-9032 (559)298-9061Cunningham Mark 1174621593 G75261 Vascular Surgery MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Cunningham Mark 1174621593 G75261 Vascular Surgery MD 27-0271872 Primary, Mailing Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Davis James 1194835512 G55680 MD 46-3969536 Billing PO Box 5672 Fresno CA 93755 (559)453-5200Davis James 1194835512 G55680 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-3571Dhillon Kalwant 1578731428 A30582 Spanish MD 94-2393373 Primary, Billing, Mailing Kalwant S. Dhillon, MD 4425 W. Ashlan Ave. #106 Fresno CA 93722 (559)438-0292 (559)438-0294Dominic William 1942310891 G60346 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-3870 (559)459-7043Dominic William 1942310891 G60346 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Eghbalieh Babak 1770774770 A89592 Spanish MD 46-3969536 Primary Multi-Specialty Center/UFA 7415 N. Cedar #102 Fresno CA 93720 (559)435-6600 (559)435-6622Eghbalieh Babak 1770774770 A89592 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Fathi Amir 1396908398 A136988 Persian MD 46-3969536, 27-0271872Primary University Specialty Surgery Associates/Community Foundation Medical Group 2335 E. Kashian Ln. Ste. #220 CA 93701 (559)256-5140 (559)485-4505Fathi Amir 1396908398 A136988 Persian MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Fong Leo 1215047659 G79576 Vascular Surgery Spanish MD 46-3969536 Primary Valley Vascular Surgery Associates/UFA 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005Fong Leo 1215047659 G79576 Vascular Surgery Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Gardikas Vassi 1881792208 G65732 Greek MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gardikas Vassi 1881792208 G65732 Greek MD 27-0271872 Primary, Mailing Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Gonzalez Mario 1376557991 A41462 Spanish MD 90-0675113 Primary, Billing, Mailing Elmore Vein and Laser Treatment Center 7131 N. 11th St. #101 Fresno CA 93720 (559)435-0717 (559)435-9105Gumina Deborah 1679671002 G74344 Vascular Surgery MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gumina Deborah 1679671002 G74344 Vascular Surgery MD 27-0271872 Primary, Mailing Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Higa Kelvin 1356304224 G53771 Vascular Surgery MD 71-0888428 Billing PO Box 28947 Fresno CA 93729-8921(559)228-4200Higa Kelvin 1356304224 G53771 Vascular Surgery MD 71-0888428, 27-0271872Mailing, Primary Advanced Laparoscopic Surgery Associates 205 E. River Park Circle #460 Fresno CA 93720 (559)261-4500 (559)261-4501Holmes Jonathan 1750698635 A122213 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Holmes Jonathan 1750698635 A122213 MD 27-0271872 Mailing, Primary Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Juarez Carlos 1285664243 G73601 Spanish MD 27-1910274 Primary California Bariatrics, Inc. 1381 E. Herndon #104 Fresno CA 93720 (559)432-3434 (559)432-3585Juarez Carlos 1285664243 G73601 Spanish MD 27-1910274 Mailing, Billing 1099 E. Champlain Ste. A PMB 249 Fresno CA 93720 (559)432-3434Kaups Krista 1518077460 G80370 Estonian MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-3571Kaups Krista 1518077460 G80370 Estonian MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Kesavaramanujam Satish 1609969005 A96658 MD 68-0357690, 45-3220509Mailing, Primary Adventist Health Physicians Network 125 Mall Dr. #303 Hanford CA 93230 (559)537-0310 (559)537-0312Kesavaramanujam Satish 1609969005 A96658 MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Khan Mohammad 1063520062 C137433 Hindi MD 68-0357690 Mailing, Primary Adventist Health Physicians Network 1142 Rose Ave. Ste. B Selma CA 93662 (559)856-6180 (559)856-6182Khan Mohammad 1063520062 C137433 Hindi MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Kinter Christopher 1922118884 G73863 Vascular Surgery MD 46-3969536 Primary Multi-Specialty Center/UFA 7415 N. Cedar #102 Fresno CA 93720 (559)435-6600 (559)435-6622Kinter Christopher 1922118884 G73863 Vascular Surgery MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Krauthammer Juergen 1518163997 A31682 Surgery Assist Spanish MD 94-2774592 Primary, Billing, Mailing 6145 N. Thesta Ave. Fresno CA 93710 (559)446-1065 (559)436-8193Kwok Amy 1205951704 A96221 MD 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Kwok Amy 1205951704 A96221 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Lee Siew-Ming 1568559342 A54322 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lee Siew-Ming 1568559342 A54322 MD 27-0271872 Primary, Mailing Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Long Andrea 1851529564 A143241 Trauma Surgery MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-4090 (559)459-3750Long Andrea 1851529564 A143241 Trauma Surgery MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ma Pearl 1073815767 118162 MD 71-0888428, 27-0271872Mailing, Primary Advanced Laparoscopic Surgery Associates 205 E. River Park Circle #460 Fresno CA 93720 (559)261-4500 (559)261-4501Ma Pearl 1073815767 118162 MD 71-0888428 Billing PO Box 28947 Fresno CA 93729-8921(559)228-4200Martin Russell 1770741217 A108122 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Martin Russell 1770741217 A108122 MD 27-0271872 Primary Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Maruyama Michael 1649354408 G32834 Vascular Surgery Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Maruyama Michael 1649354408 G32834 Vascular Surgery Spanish MD 27-0271872 Mailing, Primary Valley Surgical Specialists/Community Foundation Medical Group 782 Medical Center Drive East #101 Clovis CA 93611 (559)256-4111 (559)256-4113Maser Christina 1073571774 A96884 MD 46-3969536 Primary Multi-Specialty Center/UFA 7415 N. Cedar #102 Fresno CA 93720 (559)435-6600 (559)435-6622Maser Christina 1073571774 A96884 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682O'Banion Leigh Ann 1194023259 Vascular Surgery MD 46-3969536 Primary Valley Vascular Surgery Associates/UFA 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005O'Banion Leigh Ann 1194023259 Vascular Surgery MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Pandya Tejal 1497011316 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Pandya Tejal 1497011316 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Parks Nancy 1770757734 A93743 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Parks Nancy 1770757734 A93743 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Prentice Anne 1902877236 A60257 Vascular Surgery Spanish MD 46-3969536 Primary Valley Vascular Surgery Associates/UFA 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005Prentice Anne 1902877236 A60257 Vascular Surgery Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Romanyshyn Jonathan 1942450069 A120296 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-3571Romanyshyn Jonathan 1942450069 A120296 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Scherer Thomas 1679539365 20A11656 DO 45-3220509, 68-0357690Mailing, Primary Adventist Health Physicians Network 125 Mall Dr. #303 Hanford CA 93230 (559)537-0310 (559)537-0312Scherer Thomas 1679539365 20A11656 DO 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Stewart Edythe 1497775720 A65931 MD 56-2293236 Primary, Mailing, Billing Sequoia Surgical Specialists 1157 W. Lacey Blvd. Hanford CA 93230 (559)584-2695 (559)584-2697Swartz Daniel 1831134899 A76339 Weight Management French MD 27-0271872, 71-0888428Primary, Mailing Advanced Laparoscopic Surgery Associates 205 E. River Park Circle #460 Fresno CA 93720 (559)261-4500 (559)261-4501Swartz Daniel 1831134899 A76339 Weight Management French MD 71-0888428 Billing PO Box 28947 Fresno CA 93729 (559)228-4200GeneticsCurry Cynthia 1043328149 G22943 MD 94-2480127 Primary Cynthia Curry, MD 155 N. Fresno St. Fresno CA 93701 (559)459-2269 (559)459-7179Curry Cynthia 1043328149 G22943 MD 94-2480127 Mailing, Billing PO Box 7096 Stockton CA 95267 (877)866-9877Joseph Maries 1891804076 A93682 MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-4300 (559)459-4569Joseph Maries 1891804076 A93682 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Shen Joseph 1477633816 A101846 MD, PHD 27-0271872 Primary University Pediatric Specialists, Inc./Community Foundation Medical Group 7060 N. Recreation #101 Fresno CA 93720 (559)325-5656 (559)325-5568

Page 6: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Shen Joseph 1477633816 A101846 MD, PHD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gynecologic OncologyO'Hanlan Katherine 1467486407 G70108 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200O'Hanlan Katherine 1467486407 G70108 MD 27-0271872 Primary Urogynecology Specialty Center/Community Foundation Medical Group 2210 E. Illinois Ave. Fresno CA 93701 (559)443-2694 (559)443-2696Rich William 1548286511 G28911 MD 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Rich William 1548286511 G28911 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682GynecologyFobbs Denard 1184769879 C38922 MD 94-2812521 Mailing, Billing PO Box 26990 Fresno CA 93729-6990(559)225-7600Fobbs Denard 1184769879 C38922 MD 94-2812521 Primary Fobbs Lifepoint Women's Institute 7455 N Fresno St Ste 202 Fresno CA 93720 (559)225-7600 (559)435-2472Sueldo Carlos 1760408736 A31662 Spanish MD 27-0271872 Primary, Mailing Women's Specialty & Fertility Center/Community Foundation Medical Group 729 N. Medical Center Dr. W. #205 Clovis CA 93611 (559)299-7700 (559)297-9679Sueldo Carlos 1760408736 A31662 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hand SurgeryHoekzema Nathan 1205815164 C132314 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hoekzema Nathan 1205815164 C132314 MD 27-0271872, 46-3969536Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Majors Alexander 1598879694 A79976 Orthopedic Surgery MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-1639 (559)256-5309Hematology/OncologyAbdulhaq Haifaa 1508024647 A111931 MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (312)431-0123 (559)256-9681Abdulhaq Haifaa 1508024647 A111931 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Alam Muhammad 1417906835 C144556 Urdu MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Alam Muhammad 1417906835 C144556 Urdu MD 27-0271872 Primary Michael Moffet, MD, Inc./Community Foundation Medical Group 729 N. Medical Ctr. Dr. W. #221 Clovis CA 93611 (559)299-6600 (559)326-2531Bukari Mohammed 1487802385 A150043 Hausa(W.African)MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)256-9680 (559)256-9681Bukari Mohammed 1487802385 A150043 Hausa(W.African)MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Chatrath Bhupinder 1023082088 C50244 MD 81-0555508 Primary Sequoia Regional Cancer Center 857 Garner Ave. Hanford CA 93230 (559)584-6000 (559)584-6123Chatrath Bhupinder 1023082088 C50244 MD 81-0555508 Mailing, Billing 4945 W. Cypress Ste. C Visalia CA 93277 (559)624-3100Chaudhary Uzair 1629186580 A62549 MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)256-9680 (559)256-9681Chaudhary Uzair 1629186580 A62549 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Havard Robert 1225002694 G54783 MD 81-0555508 Primary Sequoia Regional Cancer Center 857 Garner Ave. Hanford CA 93230 (559)584-6000 (559)584-6123Havard Robert 1225002694 G54783 MD 81-0555508 Billing, Mailing 4945 W. Cypress Ste. C Visalia CA 93277 (559)624-3100Hsu Shu-Dean 1912971300 A33845 MD 81-0555508 Primary Sequoia Regional Cancer Center 857 Garner Ave. Hanford CA 93230 (559)584-6000 (559)584-6123Hsu Shu-Dean 1912971300 A33845 MD 81-0555508 Billing, Mailing 4945 W. Cypress Ste. C Visalia CA 93277 (559)624-3100Li Li 1528355120 A145066 Chinese MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)256-9680 (559)256-9681Li Li 1528355120 A145066 Chinese MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Moffett Michael 1407803083 G80577 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Moffett Michael 1407803083 G80577 MD 27-0271872 Primary Michael Moffet, MD, Inc./Community Foundation Medical Group 729 N. Medical Ctr. Dr. W. #221 Clovis CA 93611 (559)299-6600 (559)326-2531Perkins Christopher 1396820189 A41513 Spanish MD 27-0271872 Primary, Mailing Oncology Associates of Fresno Medical Group/Community Foundation Medical Group6121 N. Thesta #204 Fresno CA 93710 (559)438-7390 (559)438-7166Perkins Christopher 1396820189 A41513 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Shaikh Anwer 1609879170 A80989 Spanish MD 46-3214628 Mailing, Primary, Billing Anwer A. Shaikh, Inc. 347 E. Barstow Ave. #108 Fresno CA 93710 (559)431-0995 (559)431-0998Sharma Sanjai 1659458867 A75974 Hindi MD 81-0555508 Primary Sequoia Regional Cancer Center 857 Garner Ave. Hanford CA 93230 (559)584-6000 (559)584-6123Sharma Sanjai 1659458867 A75974 Hindi MD 81-0555508 Mailing, Billing 4945 W. Cypress Ste. C Visalia CA 93277 (559)624-3100Stebel Andrea 1447258389 A41693 Spanish MD 27-0271872 Primary, Mailing Oncology Associates of Fresno Medical Group/Community Foundation Medical Group6121 N. Thesta #204 Fresno CA 93710 (559)438-7390 (559)438-7166Stebel Andrea 1447258389 A41693 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Stoehr Constance 1851579635 A107582 MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)256-9680 (559)256-9681Stoehr Constance 1851579635 A107582 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Tabassum Vajeeha 1699951582 A145442 Urdu MD 27-0271872 Primary University Oncology Associates/Community Foundation Medical Group 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)256-9680 (559)256-9681Tabassum Vajeeha 1699951582 A145442 Urdu MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200HospitalsCommunity Regional Medical Center 2823 Fresno Street Fresno CA 93721 (559)459-6000Clovis Community 2755 Herndon Avenue Fresno CA 93611 (559)324-4000St. Agnes medical Center 1303 East Herndon Avenue Fresno CA 93720 (559)450-3000Fresno Heart and Surgical Hospital 15 East Audubon Drive Fresno CA 93720 (559)433-8000HospitalistAdhlakha Aadhar 1487091575 A146430 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Adhlakha Aadhar 1487091575 A146430 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ahir Nimeshkumar 1396069944 A144975 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Ahir Nimeshkumar 1396069944 A144975 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Al-Aedan Naif 1760708341 A126155 Arabic MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Al-Aedan Naif 1760708341 A126155 Arabic MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Attraplsi Shada 1659707826 A146466 Arabic MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Attraplsi Shada 1659707826 A146466 Arabic MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Au Yeung Kam Lun 1669449823 C142071 Cantonese MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Au Yeung Kam Lun 1669449823 C142071 Cantonese MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Aung Naw 1336499763 A123605 Burmese MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Aung Naw 1336499763 A123605 Burmese MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Bansal Manu 1467874800 A134672 Punjabi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Bansal Manu 1467874800 A134672 Punjabi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Basraon Rajvir 1245422559 A122530 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Basraon Rajvir 1245422559 A122530 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Batth Amtinder 1386914067 A118675 MD 77-0566052 Billing PO Box 28901 Fresno CA 93729Batth Amtinder 1386914067 A118675 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Batth Amtinder 1386914067 A118675 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Bella Archie 1487098497 A134155 Tagalog MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Bella Archie 1487098497 A134155 Tagalog MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Bhinder Mandeep 1942326517 A98472 Hindi MD 27-0271872 Mailing, Billing P O Box 28949 Fresno CA 93729 (559)228-4200Bhinder Mandeep 1942326517 A98472 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Bhogireddy Varija 1750644944 A137452 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Bhogireddy Varija 1750644944 A137452 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Bista Prakriti 1336577527 A139923 Nepali MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Bista Prakriti 1336577527 A139923 Nepali MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Carey-Ledford Latanya 1568413755 C53324 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Carey-Ledford Latanya 1568413755 C53324 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Collins David 1801060926 20A8957 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Collins David 1801060926 20A8957 DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Cunanan Francis 1457309262 A81356 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Cunanan Francis 1457309262 A81356 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299D'Souza Ria 1679943880 A142018 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200D'Souza Ria 1679943880 A142018 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Das Ankur Kumar 1225430937 A148194 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Das Ankur Kumar 1225430937 A148194 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Desai Anand 1417211749 A135071 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Desai Anand 1417211749 A135071 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Dimitrova Albena 1861490674 A86862 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729-8901(559)228-4200Dimitrova Albena 1861490674 A86862 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Dolle Nahlla 1427128354 A50630 Arabic MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200

Page 7: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Dolle Nahlla 1427128354 A50630 Arabic MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Elhassan Mohammed 1437425550 A125562 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Elhassan Mohammed 1437425550 A125562 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ellis Bradley 1831164607 A107115 Spanish MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Ellis Bradley 1831164607 A107115 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Escobar-Naranjo Andres 1043420912 A102420 Spanish MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Escobar-Naranjo Andres 1043420912 A102420 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Fagbule Olasunkanmi 1699950063 A100735 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Fagbule Olasunkanmi 1699950063 A100735 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Fletcher Chantal 1831207976 A80448 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Fletcher Chantal 1831207976 A80448 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Francis Shamitha 1265686273 A127966 MD 27-0271872 Mailing, Billing P O Box 28949 Fresno CA 93729 (559)228-4200Francis Shamitha 1265686273 A127966 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gabriel San 1922025857 A95909 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Gabriel San 1922025857 A95909 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gambhir Vandana 1316226327 A148930 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gambhir Vandana 1316226327 A148930 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ganta Jyotsna 1528402260 A140167 Telugu MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ganta Jyotsna 1528402260 A140167 Telugu MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gill Firdose 1407081342 20A10782 Urdu DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gill Firdose 1407081342 20A10782 Urdu DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gowda Akshatha 1639333164 A135632 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gowda Akshatha 1639333164 A135632 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Grewal Sundeep 1114245248 20A13377 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Grewal Sundeep 1114245248 20A13377 DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gudwani Sangeeta 1396701884 A122970 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gudwani Sangeeta 1396701884 A122970 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Gupta Monika 1417194234 A105120 Punjabi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729-8901(559)228-4200Gupta Monika 1417194234 A105120 Punjabi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gupta Rohan 1811304462 A145462 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gupta Rohan 1811304462 A145462 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Gurtch Shota 1821284449 A101612 Russian MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gurtch Shota 1821284449 A101612 Russian MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Hernandez Christina 1386824043 A101109 Filipino MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Hernandez Christina 1386824043 A101109 Filipino MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Hootman Kyra 1437108131 20A10293 DO 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Hootman Kyra 1437108131 20A10293 DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Hublikar Siddharth 1912133646 A129113 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Hublikar Siddharth 1912133646 A129113 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Hung Charles 1518974161 C53252 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hung Charles 1518974161 C53252 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Husnain Shaikh 1801237011 A140904 Urdu MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Husnain Shaikh 1801237011 A140904 Urdu MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ibrahim Wagih 1518152867 A99134 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Ibrahim Wagih 1518152867 A99134 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ihm Jahyeok 1467893933 A145037 Korean MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Ihm Jahyeok 1467893933 A145037 Korean MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Jaini Sridivya 1093096919 A130261 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Jaini Sridivya 1093096919 A130261 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Jimenez Angelica 1013012566 A93472 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Jimenez Angelica 1013012566 A93472 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Jimenez Gloria 1023218419 A99553 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Jimenez Gloria 1023218419 A99553 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Jin Manlin 1366644957 A97844 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Jin Manlin 1366644957 A97844 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Kaur Navjot 1174824015 A123216 Punjabi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Kaur Navjot 1174824015 A123216 Punjabi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ko Ryan 1609207281 A128029 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ko Ryan 1609207281 A128029 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Lee Joohee 1366685067 A106466 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Lee Joohee 1366685067 A106466 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Lim Linath 1669428728 A63592 Spanish MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Lim Linath 1669428728 A63592 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Louis-Jacques Patrick 1992707442 A77500 French MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Louis-Jacques Patrick 1992707442 A77500 French MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lwin Kyaw 1043518665 A116283 Burmese MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Lwin Kyaw 1043518665 A116283 Burmese MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Lwin Tin 1588850879 A116284 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Lwin Tin 1588850879 A116284 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ma Shing-Lu 1154625044 A110398 Mandarin MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ma Shing-Lu 1154625044 A110398 Mandarin MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Mahajan Rohit 1144534744 A144240 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Mahajan Rohit 1144534744 A144240 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Manesh Supreet 1568661296 A102170 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Manesh Supreet 1568661296 A102170 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Martinez-Cuellar Jorge 1750568523 A105687 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Martinez-Cuellar Jorge 1750568523 A105687 MD 27-0271872 Primary, Mailing Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Mian Raza 1518373869 A149611 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Mian Raza 1518373869 A149611 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Munjal Atul 1023240579 A121630 MD 27-0271872 Billing, Mailing P O Box 28949 Fresno CA 93729 (559)228-4200Munjal Atul 1023240579 A121630 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Naragalu Boregowda Umesha 1881977619 A131265 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Naragalu Boregowda Umesha 1881977619 A131265 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Narra Swapna 1538391271 A112773 MD 20-0517238, 77-0566052, 27-0271872Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Narra Swapna 1538391271 A112773 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Nwadei Fabian 1457348310 128694 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Nwadei Fabian 1457348310 128694 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Osijo Gail 1225337967 A127809 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Osijo Gail 1225337967 A127809 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Parmar Sarojben 1053608133 A125473 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Parmar Sarojben 1053608133 A125473 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Partovi Kiandokht 1689763427 C55287 Farsi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Partovi Kiandokht 1689763427 C55287 Farsi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299

Page 8: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Perera Isira 1497068100 A125288 Sinhalese MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Perera Isira 1497068100 A125288 Sinhalese MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Pillai Manju 1275843575 A121909 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Pillai Manju 1275843575 A121909 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Plancey Robert 1053378000 G45522 MD 27-0271872 Billing, Mailing P O Box 28949 Fresno CA 93729 (559)228-4200Plancey Robert 1053378000 G45522 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Rahman Ambar 1851601488 A119537 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Rahman Ambar 1851601488 A119537 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Rattan Bharat 1518150226 A131571 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)499-6441Rattan Bharat 1518150226 A131571 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Raut Hrishikesh 1861792335 A125446 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Raut Hrishikesh 1861792335 A125446 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Reddy Sunayana 1790074383 A127231 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Reddy Sunayana 1790074383 A127231 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Richardson Laura 1871865816 20A12435 DO 27-0271872 Billing, Mailing P O Box 28949 Fresno CA 93729 (559)228-4200Richardson Laura 1871865816 20A12435 DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Rizvi Bisharah 1447693882 A142914 Urdu MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Rizvi Bisharah 1447693882 A142914 Urdu MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Russom Jill 1639140791 A71632 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Russom Jill 1639140791 A71632 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Salazar-Kagunye Raquel 1174896880 129754 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Salazar-Kagunye Raquel 1174896880 129754 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Satish-Balaji Kalavagunta 1902093511 A107157 Telugu MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Satish-Balaji Kalavagunta 1902093511 A107157 Telugu MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Shabbir Shahid 1891189072 A146864 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Shabbir Shahid 1891189072 A146864 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Sharma Vidushi 1790091064 A124066 Hindi MD 27-0271872 Billing, Mailing P O Box 28949 Fresno CA 93729 (559)228-4200Sharma Vidushi 1790091064 A124066 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Shilpa Mysore 1750398897 A109570 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Shilpa Mysore 1750398897 A109570 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Shwe Sein 1477868412 A117739 MD 27-0271872 Mailing, Billing PO Box 28901 Fresno CA 93729Shwe Sein 1477868412 A117739 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Silver Kenneth 1073628079 G59984 Spanish MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Silver Kenneth 1073628079 G59984 Spanish MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Singh Amandeep 1669729414 A135869 Hindi MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Singh Amandeep 1669729414 A135869 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Singh Manjit 1487933263 128925 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Singh Manjit 1487933263 128925 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Steinbrueck Eric 1134485022 20A13789 DO 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Steinbrueck Eric 1134485022 20A13789 DO 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Stoltz Steven 1356459259 A60363 Spanish MD 46-3969536 Primary University Faculty Associates, inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-1550 (559)459-1017Stoltz Steven 1356459259 A60363 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Subramaniam Rajarathinam 1053628198 A123370 Tamil MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Subramaniam Rajarathinam 1053628198 A123370 Tamil MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Suman Jagpal 1336411685 A128300 Punjabi MD 27-0271872 Billing, Mailing P O Box 28949 Fresno CA 93729 (559)228-4200Suman Jagpal 1336411685 A128300 Punjabi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Syed Wahid 1902162225 A140134 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Syed Wahid 1902162225 A140134 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Tadi Ravikanth 1275823635 A147160 Telugu MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Tadi Ravikanth 1275823635 A147160 Telugu MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Tandon Abhishek 1841300050 A103629 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Tandon Abhishek 1841300050 A103629 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Theethira Thimmaiah 1225284359 A135528 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Theethira Thimmaiah 1225284359 A135528 MD 27-0271872 Primary, Mailing Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Ting Jarriet Anne 1265792360 A117859 Tagalog MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ting Jarriet Anne 1265792360 A117859 Tagalog MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Tiwary Kaushik 1144584434 A139071 Hindi MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Tiwary Kaushik 1144584434 A139071 Hindi MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Tringali Steven 1144557414 20A11009 Spanish DO 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)459-6000 (559)459-5097Tringali Steven 1144557414 20A11009 Spanish DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Tsao Derek 1427499268 A149523 Mandarin MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Tsao Derek 1427499268 A149523 Mandarin MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Valera Redel Dionisio 1184880528 C145763 Filipino MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Valera Redel Dionisio 1184880528 C145763 Filipino MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Walker Ramona 1215969506 C131004 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Walker Ramona 1215969506 C131004 MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Wang Hongtao 1609173517 A125458 Mandarin MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Wang Hongtao 1609173517 A125458 Mandarin MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Win Sandar 1639304975 A107902 Burmese MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Win Sandar 1639304975 A107902 Burmese MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Infectious DiseaseArakere Pushpalatha 1154380343 A88072 HIV / Aids MD 45-5519937 Primary, Mailing, Billing 7035 N. Maple #101 Fresno CA 93720 (559)323-4987 (559)323-1833Kasper Erica 1912160896 A103374 HIV / Aids Spanish MD 46-3969536 Primary Ambulatory Care Center/UFA 290 N. Wayte Ln. Fresno CA 93701 (559)459-5721 (559)459-4922Kasper Erica 1912160896 A103374 HIV / Aids Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Libke Robert 1497780985 G13591 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Libke Robert 1497780985 G13591 MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Lane Fresno CA 93701 (559)459-5755 (559)449-4453Mu Anandit 1841465192 20A10969 HIV / Aids Spanish DO 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Mu Anandit 1841465192 20A10969 HIV / Aids Spanish DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Nassar Naiel 1699743617 A49334 HIV / Aids MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Nassar Naiel 1699743617 A49334 HIV / Aids MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Raju Mina 1588600068 HIV / Aids DO 81-1246527 Primary Mina Raju, DO 1025 N. Douty Hanford CA 93230 (559)583-2100 (559)741-9938Raju Mina 1588600068 HIV / Aids DO 81-1246527 Mailing, Billing PO Box 2744 Visalia CA 93279Reddy Manthani 1073523916 A49497 HIV / Aids Hindi MD 77-0476968 Primary, Billing, Mailing Reddy Medical Group 7202 N. Milllbrook Ave. #105 Fresno CA 93720 (559)450-7600 (559)450-7605Roshan Bakht 1639201502 A120800 HIV / Aids Urdu MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Roshan Bakht 1639201502 A120800 HIV / Aids Urdu MD 27-0271872 Primary Community Hospitalist Medical Group/Community Foundation Medical Group 7370 N. Palm Ave. Ste. #101 Fresno CA 93711 (559)228-4222 (559)228-4299Simon Paul MDSopia Tran MDStockamp Nathan 1164695557 A112689 HIV / Aids MD 46-3969536 Primary Ambulatory Care Center/UFA 290 N. Wayte Ln. Fresno CA 93701 (559)459-5721 (559)459-4922Stockamp Nathan 1164695557 A112689 HIV / Aids MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Internal MedicineAbejie Belayneh 1831210756 A100095 MD,MPH 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099Atmajian Timothy 1003816141 G778170 MD 3233 North Chestnut Avenue, #102 Fresno CA 93726 (559)456-1167 (559)456-1183Dizon Dominic 1659384295 A62295 MD, MBA 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099

Page 9: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Kelton Alan 1508851056 A76211 MD 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099Khandelwal Stulee MD 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099Orme Nicholas 1689674632 G63574 MD 6183 North Fresno Street, Suite #101 Fresno CA 93710 (559)432-5003Poliyedath Anupama 1548317126 C55333 MD 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099Sigala Teresa 1487663233 G78051 MD 2335 East Kashian Lane, Suite #280 Fresno CA 93701 (559)320-1090 (559)3201099Interventional RadiologyEradat Jilbert 1083927115 A107977 MD 77-0383758 Mailing, Billing, Primary The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Mental HealthAlvarez-Hernandez Blanca 1245441757 52422 Spanish MFT 77-0287103 Primary 5100 N 6th, #104 Fresno CA 93710 (559)224-4999 (559)224-4990Alvarez-Hernandez Blanca 1245441757 52422 Spanish MFT 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Ashmore Diane 1558307009 23823 LMFT 77-0287103 Primary 264 Clovis Ave #210 Clovis CA 93612 (559)324-6658 (559)324-6565Ashmore Diane 1558307009 23823 LMFT 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Baca Morgan Alexia 1245327626 PSY14911 PHD 525-15-8023 Mailing, Primary, Billing 106 Pollasky #C Clovis CA 93612 (559)472-8375 (888)466-8290Backlund James 1295847515 11805 LCSW 77-0287103 Primary, Billing, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118De Soto Barbara 1841419744 14271 Spanish LCSW 77-0287103 Primary, Billing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118DelaTorre Carol 1508112368 LCSW 77-0287103 Primary 659 W Shaw Ste D Fresno CA 93704 (559)647-1546 (559)439-9660DelaTorre Carol 1508112368 LCSW 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Donaldson Michelle 1508124066 52931 LMFT 77-0287103 Billing, Mailing, Primary Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Horsman Lacey 1720398704 46897 LMFT 77-0287103 Primary 1500 W. Shaw#400 Fresno CA 93711 (559)824-8403 (559)272-5287Horsman Lacey 1720398704 46897 LMFT 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111McOmber Mark 1104941830 26149 Tagalog LCSW 77-0287103 Billing, Mailing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111McOmber Mark 1104941830 26149 Tagalog LCSW 77-0287103 Primary 624 Woodworth Ave Clovis CA 93612 (559)297-6060 (559)297-6061Osuna Randy 1609992627 20702 PHD 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Osuna Randy 1609992627 20702 PHD 77-0287103 Primary 5446 N. Palm #101 Fresno CA 93704 (559)441-3538 (559)222-1952Rabin Michelle 1407284359 21295 Spanish LCSW 77-0287103 Mailing, Primary, Billing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Smith H. 1063524395 17591 Spanish LMFT 77-0287103 Mailing, Primary, Billing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Sommers David 1972645091 6263 LCSW 77-0287103 Primary, Billing, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Thomas Terri 1811140486 46016 LMFT 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Thomas Terri 1811140486 46016 LMFT 77-0287103 Primary 624 Woodworth Ave Clovis CA 93612 (559)297-6060 (559)297-6061Zilfugharyan Narine 1861664740 65201 LCSW 77-0287103 Billing, Primary, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118NephrologyAdapa Sreedhar 1881997872 A123534 MD 77-0383758 Primary, Mailing, Billing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Atwal Sukhvir 1669685251 A96047 MD 77-0383758 Primary, Mailing, Billing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Barsoum Yasser 1467618363 A91481 Spanish MD 45-3217505 Primary 2711 Cinema Way #111 Selma CA 93662 (559)891-2750 (559)891-2755Barsoum Yasser 1467618363 A91481 Spanish MD 45-3217505 Billing, Mailing PO Box 630 Visalia CA 93279 (559)697-6290Cao Yangming 1558339630 A81989 Cantonese MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Chandra Kalyani 1922388537 A130431 Hindi MD 77-0383758 Mailing, Billing, Primary The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Chen Wei-Tzuoh 1184732398 A34640 MD 77-0383758 Primary The Nephrology Group, Inc. 900 N. Douty Ste. B Hanford CA 93230 (559)585-6630 (559)584-6569Chen Wei-Tzuoh 1184732398 A34640 MD 77-0383758 Billing, Mailing 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600Claudio-Rodriguez Carlos 1841524196 A143576 Spanish MD 77-0383758 Mailing, Billing, Primary The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Dhindsa Harpreet 1801864020 A64349 Punjabi MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Dhingra Hemant 1487672192 A100412 Hindi MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Do Thong 1437369303 A100983 MD 27-3878230 Billing, Primary, Mailing 550 W. Grangeville Blvd. Hanford CA 93230 (559)585-8364 (877)697-8463Duflot Joseph 1467420679 A44916 MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Garbutt Glenn 1063513737 G13844 Spanish MD 94-2227342 Primary, Billing, Mailing 1381 E. Herndon Ave. #102 Fresno CA 93720 (559)448-8481 (559)448-0996Gurm Harmeet 1972831790 A123671 MD 77-0383758 Mailing, Primary, Billing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Hwang Mei-Tsuey 1184771974 A99715 Mandarin MD 77-0383758 Mailing, Billing, Primary The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Levy Steven 1487623427 G29011 Hmong MD 77-0383758 Primary, Mailing, Billing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Martinez Gregory 1982863098 A103241 MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Masood Sheikh 1669422812 C52769 Punjabi MD 26-0459270 Primary, Billing, Mailing Sheikh M. Masood, MD 508 E. Almond Ave. Madera CA 93637 (559)661-1965 (559)661-1952Ram Pankaj 1679539837 A30106 Hindi MD 20-5257913 Billing, Mailing, Primary California Nephrology Consultants 1313 E. Herndon Ave. #106 Fresno CA 93720 (559)320-0701 (559)320-0707Schuerman-Gen Amy 1043328545 A88462 Spanish MD 20-5257913 Primary, Mailing, Billing California Nephrology Consultants 1313 E. Herndon #106 Fresno CA 93720 (559)320-0701 (559)320-0707Siddiqui Mohammed 1184916983 A114991 Urdu MD 26-0459270 Mailing, Billing, Primary Kidney Specialist, Inc. 508 E Almond Madera CA 93637 (559)661-1965 (559)661-1952Singh Jasjit 1366744021 A116114 MD 77-0383758 Billing, Mailing, Primary The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Su Wei-Shing 1033187133 G34109 Spanish MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Suri Anuradha 1285602490 C43129 Hmong MD 77-0383758 Primary, Billing, Mailing The Nephrology Group, Inc. 568 E. Herndon Ave. #201 Fresno CA 93720 (559)228-6600 (559)226-3709Thomas Mohsen 1225092877 Arabic MD 154-82-0996 Mailing, Billing 128 N. Akers Ste. A Visalia CA 93291 (559)625-6031Thomas Mohsen 1225092877 Arabic MD 154-82-0996 Primary 1105 N. Douty Hanford CA 93230 (559)582-0347 (559)582-7360Yang Tom 1548346695 A88613 Spanish MD 26-3689376 Mailing, Billing PO Box 6758 Visalia CA 93290 (559)627-6363Yang Tom 1548346695 A88613 Spanish MD 26-3689376 Primary Tom Yang, MD, Inc. 1105 N. Douty St. Ste. A Hanford CA 93230 (559)584-1664 (559)623-9951Yee Khin 1720377070 A119019 Spanish MD 46-5629659 Mailing, Billing 438 E. Shaw #136 Fresno CA 93710 (559)744-3558Yee Khin 1720377070 A119019 Spanish MD 46-5629659 Primary Ace Nephrology, Inc. 6700 N. First St., Ste. #119 Fresno CA 93710 (559)540-7171 (559)540-7175Neurocritical CareGlassner Stuart 1912105677 20A14656 DO 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Glassner Stuart 1912105677 20A14656 DO 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532NeurologyAfshinnik Arash 1154598183 A126403 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Afshinnik Arash 1154598183 A126403 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Akhtar Shahrzad 1700047263 A107908 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)320-0530 (559)320-0539Akhtar Shahrzad 1700047263 A107908 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Alving Loren 1861423501 G75668 MD 75-2989686 Mailing, Primary UCSF, Fresno Alzheimer & Memory Center 6137 N. Thesta St. #101B Fresno CA 93710 (559)227-4810 (559)227-4167Alving Loren 1861423501 G75668 MD 75-2989686 Billing PO Box 742611 Los AngelesCA 90074Bhatia Perminder 1013002328 A61797 Punjabi MD 77-0586745 Mailing, Primary Neuro-Pain Medical Center, Inc. 736 E. Bullard #101 Fresno CA 93710 (559)437-9700 (559)437-9799Bhatia Perminder 1013002328 A61797 Punjabi MD 77-0586745 Billing PO Box 25907 Fresno CA 93729-5907(559)437-9700Birnbaum Alan 1912937186 G32784 MD 20-1539356 Billing, Primary, Mailing Spruce Multi Specialty Group 1275 E. Spruce #101 Fresno CA 93720 (559)439-5757 (559)243-1303Cantrell Frank 1528068814 A23314 Spanish MD 94-2426670 Mailing, Billing, Primary 6057 N. First St. #101 Fresno CA 93710 (559)435-0600 (559)435-2124Helm Melvin 1124076211 A64438 Spanish MD 77-0574175 Primary, Billing, Mailing Melvin R. Helm, Inc. 1865 E. Alluvial Ave. #102 Fresno CA 93720 (559)435-6492 (559)435-1280Hutchison Harrol 1831155654 G36024 Pediatric Neurology Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Hutchison Harrol 1831155654 G36024 Pediatric Neurology Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Jones H. James 1073642773 20A6500 DO 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Jones H. James 1073642773 20A6500 DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Khan Amir 1588864805 A126949 Urdu MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Khan Amir 1588864805 A126949 Urdu MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Likosky William 1730176207 G23813 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)320-0530 (559)320-0539Likosky William 1730176207 G23813 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Medeiros Michael 1417120866 A117400 MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Medeiros Michael 1417120866 A117400 MD 68-0357690, 45-3220509Mailing, Primary Adventist Health Physicians Network 2256 Dockery Ave. Ste. B Selma CA 93662 (559)856-6170 (559)856-6172Mehdi Abbas 1356348387 A66769 Spanish MD 77-0557731 Primary, Billing, Mailing California Neurological Center 7585 N. Cedar Ave. #102 Fresno CA 93720 (559)243-1232 (559)243-9954Menezes Krishe 1568639573 C150040 Portuguese MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Menezes Krishe 1568639573 C150040 Portuguese MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Miller Kurt 1508894379 G58514 MD 73-1625885 Billing, Mailing, Primary 1660 E. Herndon #150 Fresno CA 93720 (559)431-8500 (559)431-8520Narwani Gunjan 1699062547 A143407 Sleep Medicine MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Narwani Gunjan 1699062547 A143407 Sleep Medicine MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682

Page 10: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Nguyen Loan 1578582029 20A6198 Vietnamese DO 26-3456680 Primary Loan P. Nguyen, DO 1817 Shaw Ave. #102 Clovis CA 93611 (559)325-9060 (559)325-9055Nguyen Loan 1578582029 20A6198 Vietnamese DO Billing, Mailing PO Box 1981 Clovis CA 93613-1981(559)355-2503Royter Vladimir 1972734119 A109062 MD 81-1006412 Primary, Billing, Mailing Vladimir Royter MD, APMC 125 Mall Dr. #209B Hanford CA 93230 (559)584-9000 (559)589-9015Sarwar Nighat 1003809989 A71634 Spanish MD 26-0245982 Primary, Billing, Mailing Nighat Sarwar, MD. Inc. 1381 E. Herndon Ave. #101 Fresno CA 93720 (559)431-4007 (559)431-3357Saxton Ernestina 1295751402 G52068 Spanish MD, PHD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Saxton Ernestina 1295751402 G52068 Spanish MD, PHD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Singh Loveneet 1952560377 A103947 Spanish MD 27-0271872 Primary Community Neurology and Pulmonary Medical Group/Community Foundation Medical Group7407 N. Cedar Ste. #101 Fresno CA 93720 (559)449-9500 (559)449-9501Singh Loveneet 1952560377 A103947 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Stecker Mark 1740238856 G144358 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)320-0530 (559)320-0539Stecker Mark 1740238856 G144358 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Suri Madhav 1669456539 A51804 Pediatric Neurology Hindi MD 77-0517015 Primary, Mailing Madhav Suri, MD, Inc. 7151 N. Cedar Ave. #102 Fresno CA 93720 (559)322-7766 (559)322-7120Suri Madhav 1669456539 A51804 Pediatric Neurology Hindi MD 77-0517015 Billing PO Box 25548 Fresno CA 93729-5548Walton Vickie 1366447658 G58237 MD 27-1712579 Primary, Billing, Mailing Vickie Walton, MD, Inc. 1313 E. Herndon Ste. #205 Fresno CA 93720 (559)435-0311 (559)435-1708Zhao Cong 1629248661 A136412 Mandarin MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)320-0530 (559)320-0539Zhao Cong 1629248661 A136412 Mandarin MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Zuzuarregui Jose-Rafael 1558660746 A135789 Sleep Medicine Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Zuzuarregui Jose-Rafael 1558660746 A135789 Sleep Medicine Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682NeuropsychologyBauer Christopher 1821103524 PSY24234 PHD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #301 Fresno CA 93701 (559)264-9100 (559)264-9199Bauer Christopher 1821103524 PSY24234 PHD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Munsell Kathleen 1215112990 PSY21798 PHD 26-2842649 Primary, Billing, Mailing 1617 W. Shaw Ave. Ste. E Fresno CA 93711 (559)475-0210 (559)475-0779Schuyler Bradley 1588688519 8600 PHD 77-0336740 Primary, Billing, Mailing 1130 E Shaw Ave #105 Fresno CA 93710 (559)227-1977 (559)227-2698NeurosurgeryAryan Henry 1992867329 A76676 MD 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-1030 (559)261-1906Brant Adam 1811998248 A60203 MD 94-2407634, 27-0271872Primary Neurosurgical Associates Medical Group/Community Foundation Medical Group 7130 N. Sharon Ave. #100 Fresno CA 93720 (559)449-1100 (559)449-1170Brant Adam 1811998248 A60203 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Choulakian Armen 1861694242 A108492 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Choulakian Armen 1861694242 A108492 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Deis Nathan 1063884757 A139370 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Deis Nathan 1063884757 A139370 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Johnson Ian 1407936115 A114456 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Johnson Ian 1407936115 A114456 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Kuo Yu-Hung 1902085657 C129803 MD, PHD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Kuo Yu-Hung 1902085657 C129803 MD, PHD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Levine Nicholas 1023229325 C143668 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Levine Nicholas 1023229325 C143668 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Levy Mark 1548243389 G85330 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Levy Mark 1548243389 G85330 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Najafi Ali 1124129473 A74093 Pain Management Persian MD 94-2407634, 27-0271872Primary Neurosurgical Associates Medical Group/Community Foundation Medical Group 7130 N. Sharon Ave. #100 Fresno CA 93720 (559)449-1100 (559)449-1170Najafi Ali 1124129473 A74093 Pain Management Persian MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Taggard Derek 1548242589 80229 MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Taggard Derek 1548242589 80229 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Nuclear MedicineHsu Te-Chung 1467531251 A62972 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Hsu Te-Chung 1467531251 A62972 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Watters Thomas 1508816596 G50566 MD 94-3353451 Primary Fresno Heart Hospital 15 E. Audubon Dr. Fresno CA 93720 (559)433-8000 (559)433-8348Watters Thomas 1508816596 G50566 MD 94-3353451 Billing, Mailing 101 S. San Mateo Dr. #303 San Mateo CA 94401 (877)722-6384OB/GYNAgrawal Anubhav 1790179661 A142749 Pelvic Medicine/Reconstructive SurgHindi MD 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Agrawal Anubhav 1790179661 A142749 Pelvic Medicine/Reconstructive SurgHindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Basel Sayed 1851732622 A120406 MD 77-0404406 Mailing, Billing, Primary Kings Comprehensive Women's Health Care 460 Greenfield Ave. #1 Hanford CA 93230 (559)584-0141 (559)584-5711Bosch Kelleen 1811105414 20A9211 DO 27-0271872 Mailing, Primary Central Valley Women's Health Associates/Community Foundation Medical Group 1374 E. Alluvial Fresno CA 93720 (559)981-2600 (559)981-2610Bosch Kelleen 1811105414 20A9211 DO 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Brown Willie 1043300874 A40710 Spanish MD 94-1740281 Mailing, Billing, Primary W.L. Brown Medical Corporation 6225 N. Fresno St. #104 Fresno CA 93710 (559)265-4444 (559)265-4454Cano Miguel 1760485445 G75797 Spanish MD 13-4224995 Mailing, Billing PO Box 151 Reedley CA 93654 (559)493-5307Cano Miguel 1760485445 G75797 Spanish MD 13-4224995 Primary Sierra Kings Women's Health Center, Inc. 925 G St. Reedley CA 93654 (559)558-9715 (661)237-6889Dhami Kanwer 1326134115 A64661 Punjabi MD 27-0271872 Mailing, Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois #505 Fresno CA 93701 (559)266-8989 (559)266-8994Dhami Kanwer 1326134115 A64661 Punjabi MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Dominguez Aaron 1639360613 A91370 Spanish MD 45-3220509, 47-4607902Primary, Mailing Adventist Health Community Care 550 W. Cypress Ave. Reedley CA 93654 (559)637-2455 (559)637-2459Dominguez Aaron 1639360613 A91370 Spanish MD 45-3220509 Billing PO Box 810 Hanford CA 93232 (559)731-2476Downer Christopher 1205003233 A103785 MD 46-3969536 Primary Womens Health Center/UFA 290 N. Wayte Ln. Fresno CA 93701 (559)459-5755 (559)459-4453Downer Christopher 1205003233 A103785 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ellsworth Richard 1093730277 20A4614 DO 77-0404406 Primary, Billing, Mailing 460 N. Greenfield #1 Hanford CA 93230 (559)584-0141 (559)584-5711Emeney Pamela 1033260559 A103067 MD 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Emeney Pamela 1033260559 A103067 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Enloe, Jr. Thomas 1093747396 G36115 Spanish MD 77-0404406 Primary, Mailing 1122 N. Harris #104 Hanford CA 93230 (559)582-1041 (559)584-5711Enloe, Jr. Thomas 1093747396 G36115 Spanish MD 77-0404406 Billing 460 N. Greenfield #1 Hanford CA 93230 (559)584-0141Harris Roderick 1780646018 G36995 Spanish MD 94-2801694 Primary, Mailing, Billing 7081 N. Marks #104-331 Fresno CA 93711 (559)431-1300 (559)431-2445Ikedilo Adanna 1659554509 A116330 Igbo MD 27-0271872 Primary, Mailing Central Valley Women's Health Associates/Community Foundation Medical Group 1374 E. Alluvial Fresno CA 93720 (559)981-2600 (559)981-2610Ikedilo Adanna 1659554509 A116330 Igbo MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Illingworth Michael 1932251089 G68327 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Illingworth Michael 1932251089 G68327 Spanish MD 27-0271872 Primary, Mailing Central Valley OB/GYN Medical Group/Community Foundation Medical Group 722 Medical Center Dr. E. #105 Clovis CA 93611 (559)299-6300 (559)299-2137Kopacz Sharon 1952552333 A105590 Spanish MD 27-0271872, 77-0473635Primary Fresno Women's Medical Group, Inc. 726 Medical Center Dr. E #221 Clovis CA 93611 (559)322-2900 (559)322-2901Kopacz Sharon 1952552333 A105590 Spanish MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Kremer Mallory 1114215845 A137565 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Kremer Mallory 1114215845 A137565 Spanish MD 94-2613220 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Kroeker Kristin 1205908969 A63997 MD 27-0271872 Primary, Mailing Central Valley Women's Health Associates (Peters & Kroeker)/Community Foundation Medical Group7050 N. Recreation St. #101 Fresno CA 93720 (559)325-3515 (559)325-3527Kroeker Kristin 1205908969 A63997 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lee Fenglaly 1730239682 A90450 Hmong MD 77-0413651 Primary Omni Women's Health Medical Group 2210 E. Illinois Ave. #201 Fresno CA 93701 (559)266-2496 (559)266-8560Lee Fenglaly 1730239682 A90450 Hmong MD 77-0413651 Mailing, Billing 3812 N. First St. Fresno CA 93726 (559)495-3120Lichtenstein Ron 1447243191 G77034 Hebrew MD 77-0413651 Primary Omni Women's Health Medical Group, Inc. 2210 E. Illinois Ave. #406 Fresno CA 93701 (559)486-8888 (559)486-8887Lichtenstein Ron 1447243191 G77034 Hebrew MD 77-0413651 Mailing, Billing 3812 N. First St. Fresno CA 93726 (559)495-3120Mallard-Warren Gail 1487665535 G42804 MD 77-0049015 Primary, Billing, Mailing Gail Mallard-Warren, M.D., Inc 6107 N. First St. #103 Fresno CA 93710 (559)432-4963 (559)432-5699Mason Stewart 1871519835 A72105 MD 26-1713203, 27-0271872Primary, Mailing Central Valley Women's Health Associates/Community Foundation Medical Group 1374 E. Alluvial Fresno CA 93720 (559)981-2600 (559)981-2610Mason Stewart 1871519835 A72105 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Mayer Jonathan 1043389513 A88082 MD 47-2092691 Mailing, Primary Affiliated Physician Practice 505 E. Almond #109 Madera CA 93637 (559)675-8990 (559)675-8994Mayer Jonathan 1043389513 A88082 MD 47-2092691 Billing 87 E Olive #101 Fresno CA 93728 (559)499-1233Moran Gilbert 1891873709 G64451 Spanish MD 27-1977962 Primary, Mailing, Billing Gilbert Moran, MD, FACOG, Inc. 681 Medical Center Dr. #101 Clovis CA 93611 (559)299-9000 (559)299-8581Nassar Theodore 1609962000 A31164 Spanish MD 77-0585914 Mailing, Primary 363 E. Almond Ave. #101 Madera CA 93637 (559)674-0917 (559)674-3104Nassar Theodore 1609962000 A31164 Spanish MD 94-2503904 Billing PO Box 299 Madera CA 93639 (559)664-4000Nelson David 1013923952 G28470 Spanish MD 77-0235591 Primary, Mailing, Billing Women's Health & Pregnancy Care Medical Center 440 Greenfield Ave. Ste. D Hanford CA 93230 (559)582-1045 (559)582-2174Nicole Julie 1912149691 A123758 French MD 27-0271872 Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois Ave. #505 Fresno CA 93701 (559)266-8989 (559)266-8994Nicole Julie 1912149691 A123758 French MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200

Page 11: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Novack Mallory 1427324185 20A13191 DO 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Novack Mallory 1427324185 20A13191 DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682O'Shaughnessy Michael 1548294093 G68291 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-5755 (559)459-4453O'Shaughnessy Michael 1548294093 G68291 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ostoya Paul 1649318338 A52252 Polish MD 77-0465405 Primary, Billing, Mailing Paul W. Ostoya, M.D., Inc. 1095 E. Warner #101 Fresno CA 93710 (559)435-3567 (559)435-4035Peters Alfred 1396817052 G19127 MD 27-0271872 Primary, Mailing Central Valley Women's Health Associates (Peters & Kroeker)/Community Foundation Medical Group7050 N. Recreation St. #101 Fresno CA 93720 (559)325-3515 (559)325-3527Peters Alfred 1396817052 G19127 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Reddington Lura 1447253158 G76987 MD 27-0271872 Primary Lura Reddington, MD/Central Valley Women's Health Associates-CFMG 6730 N. West Ave. #115 Fresno CA 93711 (559)261-9320 (559)261-9324Reddington Lura 1447253158 G76987 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Sandhu Tejinder 1386730125 A33330 MD 27-0271872, 94-2747822Mailing, Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois #505 Fresno CA 93701 (559)266-8989 (559)266-8994Sandhu Tejinder 1386730125 A33330 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Singleton Chrystal 1407886948 A65522 Spanish MD 77-0535065 Primary, Billing, Mailing Chrystal J.L. Singleton, MD 3410 McCall Ave. #115 Selma CA 93662 (559)891-7390 (559)891-7393Steinke Roydon 1003931304 G42498 French MD 94-2766800 Mailing, Primary, Billing Roydon Steinke, MD, Inc. 6327 N. Fresno St. #101 Fresno CA 93710 (559)435-5265 (559)435-7195Swanson John 1255433025 C34145 MD 94-2599241 Mailing, Billing, Primary John Swanson, MD 9483 North Fort Washington Road #101 Fresno CA 93730 (559)439-1835 (559)439-3936Synn Howard 1902831274 G57415 Spanish MD 27-0271872 Primary, Mailing Women's Specialty & Fertility Center/Community Foundation Medical Group 729 N. Medical Center Dr. W. #205 Clovis CA 93611 (559)299-7700 (559)297-9679Synn Howard 1902831274 G57415 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Thomas Jeffrey 1831115807 A67160 Spanish MD 27-0271872 Mailing, Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois #505 Fresno CA 93701 (559)266-8989 (559)266-8994Thomas Jeffrey 1831115807 A67160 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ugwu-Oju Charles 1366534901 A50187 MD 77-0300568 Primary, Billing, Mailing 840 E. Almond Madera CA 93637 (559)674-7643 (559)674-4915Ung Feei Feei 1013235605 A112193 Mandarin MD 77-0413651 Primary Omni Women's Health Medical Group 1530 W. Shaw Clovis CA 93611 (559)323-9133 (559)323-8070Ung Feei Feei 1013235605 A112193 Mandarin MD 77-0413651 Billing, Mailing 3812 N. First St. Fresno CA 93726 (559)495-3120Vishwanath Vasanth 1891809968 G77810 Hindi MD 84-1717053 Mailing, Primary, Billing Vasanth Vishwanath, MD, Fresno Womens Care 7075 N. Maple #102 Fresno CA 93720 (559)299-8800 (559)299-9944White Paul 1326254624 A99179 Spanish MD 45-3220509 Primary Adventist Health Community Care- Reedley 372 W. Cypress Ave. Reedley CA 93654 (559)638-8155 (559)391-3312White Paul 1326254624 A99179 Spanish MD 45-3220509 Mailing, Billing PO Box 810 Hanford CA 93232 (559)731-2476Wilson Robert 1649354465 A34072 Spanish MD 77-0431148 Primary, Billing, Mailing Robert Wilson, MD, Inc. 6327 N. Fresno St. #101 Fresno CA 93710 (559)435-5252OphthalmologyBeard Bradley 1821077165 A44058 Spanish MD 77-0566388 Billing, Primary, Mailing Kings Eye Center Medical Group, Inc. 1395 W. Lacey Blvd. Hanford CA 93230 (559)585-3937 (559)582-3645Bertolucci George 1447267505 G60951 MD 94-2179577 Billing, Mailing, Primary Eye Medical Center of Fresno, Inc. 1360 E Herndon Ave #301 Fresno CA 93720 (559)486-5000 (559)439-7854Cavallaro Brian 1396836250 G86098 Spanish MD 94-1717441 Billing, Primary, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Hinton Samuel 1952492621 A86470 MD 94-1717441 Billing, Mailing, Primary Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Kan Leo 1447338926 20A9163 Spanish DO 77-0566388 Primary, Billing, Mailing Kings Eye Center Medical Group, Inc. 1395 W. Lacey Blvd. Hanford CA 93230 (559)585-3937 (559)582-3645Moors Richard 1164513081 G20379 Spanish MD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Nerenberg Alan 1255422051 G37901 MD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Poindexter Theresa 1548249881 G40686 MD 77-0566388 Primary, Billing, Mailing Kings Eye Center Medical Group, Inc. 1395 W. Lacey Blvd. Hanford CA 93230 (559)585-3937 (559)582-3645Prescott Daniel 1588860829 A119629 Spanish MD 77-0440644, 77-0440645Mailing, Primary, Billing Fogg, Maxwell, Lanier & Remington Eye Care 1360 E Herndon Ave. Ste. #401 Fresno CA 93720 (559)449-5010 (559)449-5014Thinda Sumeer 1568784098 A125632 Punjabi MD 94-2179577 Billing, Primary, Mailing Eye Medical Center of Fresno, Inc. 1360 E Herndon Ave #301 Fresno CA 93720 (559)486-5000 (559)439-7854Waldrop Frank 1275624090 A81690 MD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Walker Bairn 1861443889 A98407 MD 94-1717441 Billing, Mailing, Primary Eye-Q-Vision Care 7075 N. Sharon Fresno CA 93720 (559)486-2000 (559)256-8484OptometryBarron John 1386738367 13018 OD 94-1717441 Primary, Mailing, Billing Eye-Q-Vision Care 7075 N Sharon Fresno CA 93720 (559)486-2000 (559)256-8575Baudonnet Anthony 1396837290 10876 OD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Borba Karisa 1932292901 12549 Spanish OD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Cochran Kathleen 1548325475 9895 OD 94-1717441 Mailing, Primary, Billing Eye-Q-Vision Care 7075 N Sharon Fresno CA 93720 (559)486-2000 (559)256-8575Keck Ronald 1902812811 OD 77-0566388 Billing, Primary, Mailing Kings Eye Center Medical Group, Inc. 1395 W. Lacey Blvd. Hanford CA 93230 (559)585-3937 (559)582-3645Lopez Daniel 1861584765 6601 Spanish OD 94-1717441 Primary, Billing, Mailing Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Mendoza Michael 1255531331 13328 OD 94-1717441 Mailing, Billing, Primary Eye-Q-Vision Care 7075 N Sharon Fresno CA 93720 (559)486-2000 (559) 256-8575Nguyen Chi 1740372382 11292 OD 94-1717441 Billing, Mailing, Primary Eye Q/Vision Care 7075 N. Sharon Ave. Fresno CA 93720 (559)486-2000 (559)256-8484Omon Stacy 1821013707 12521 OD 77-0566388 Primary Kings Eye Center Medical Group, Inc. 321 C St Lemoore CA 93245 (559)924-2666 (559)924-0266Vuong Thien Kim 1669745782 OD 94-1717441 Mailing, Primary, Billing Eye-Q-Vision Care 7075 N Sharon Fresno CA 93720 (559)486-2000 (559) 256-8575Oral/Maxillofacial SurgeryAlexander Gerald 1144257619 23910 DDS 94-6215713 Primary, Billing, Mailing Fresno Oral Maxillofacial & Dental Implant Center 7025 N Maple Ste 108 Fresno CA 93720 (559)226-2722 (559)226-6989Barnhart Shannon 1932302486 61785 DDS 94-6215713 Primary, Billing, Mailing Fresno Oral & Maxillofacial Surgery Group 7025 N Maple Ave Ste 108 Fresno CA 93720 (559)226-2722 (559)226-6989Chien Allen 1518145598 1505 Mandarin DDS 94-6215713 Mailing, Primary, Billing Fresno Oral Maxillofacial & Dental Implant Center 7025 N Maple Ste 108 Fresno CA 93720 (559)226-2722 (559) 226-6989Julian Robert 1427119791 A63994 DDS, MD 77-0502535 Primary, Mailing, Billing Oral and Maxillofacial Surgery 290 N Wayte Ln Fresno CA 93701 (559)459-6114 (559) 459-5744Kheradpir Ardavan 1053417261 52875 DMD 94-6215713 Mailing, Billing, Primary Fresno Oral Maxillofacial & Dental Implant Center 7025 N Maple Ste 108 Fresno CA 93720 (559)226-2722 (559)226-6989Kuo Mark 1407901424 44203 Spanish DMD 77-0438019 Primary, Billing, Mailing 1164 Rose Ave Selma CA 93662-3250(559)896-3145 (559)896-7042Woo Brian 1558579144 1484 DDS, MD 26-4787813 Primary, Billing, Mailing Oral and Maxillofacial Surgery Dept. 290 N Wayte Ln Fresno CA 93701 (559)459-6114 (559) 459-5744Orthopedic SurgeryAllyn Donald 1558302893 G21696 Spanish MD 77-0390396 Primary, Billing, Mailing Certified Medical Group, Inc. 125 Mall Dr. #301 Hanford CA 93230 (559)584-3000 (559)583-8456Ayoub Mark 1689961310 150352 Arabic MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ayoub Mark 1689961310 150352 Arabic MD 27-0271872 Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Baysal Deniz 1992772610 A100582 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Baysal Deniz 1992772610 A100582 MD 46-3969536, 27-0271872Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Brambila Maximino 1952559353 A110773 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Brambila Maximino 1952559353 A110773 Spanish MD 46-3969536, 27-0271872Primary University Faculty Associates, Inc./Community Foundation Medical Group 7235 N. First St. Ste. #103 Fresno CA 93720 (559)320-0531 (559)320-0539Castonguay Ronald 1154467074 A55167 MD 77-0528099 Billing PO Box 25042 Fresno CA 93729-5042(559)438-1245Castonguay Ronald 1154467074 A55167 MD 77-0528099 Primary, Mailing Ronald R. Castonguay, MD, Inc. 7255 N. Cedar Ave. #103 Fresno CA 93720 (559)431-5353 (559)431-5361Davis Jason 1053600940 A116229 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Davis Jason 1053600940 A116229 Spanish MD 46-3969536, 27-0271872Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Dunklin Jerome 1063403442 G58378 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)261-0234 (559)436-1043Ghaffar Samia 1093004988 Urdu MD 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3571Ghaffar Samia 1093004988 Urdu MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Hanson Eric 1013990811 G53645 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)435-9020 (559)432-3782Johnson Toby 1144203258 A87693 MD 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-1514 (559)256-5309Knedel Matthew 1548588239 MD 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)290-7051 (559)440-1318Kollmorgen Robert 1760621759 20A11856 DO 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Kollmorgen Robert 1760621759 20A11856 DO 27-0271872 Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Lee Julia 1437444759 A151273 Spanish MD 77-0548187 Mailing, Billing, Primary Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)290-7052 (559)256-5309Lester Don 1467568550 G44984 Spanish MD 77-0033323 Primary, Billing, Mailing 6085 N. First St. #101 Fresno CA 93710 (559)431-2332 (559)431-3784Lindvall Eric 1124025325 20A7718 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lindvall Eric 1124025325 20A7718 DO 46-3969536, 27-0271872Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Mai Kenny 1962426064 A96023 MD 38-3769910 Billing PO Box 1329 Hanford CA 93232-1329(559)582-9621Mai Kenny 1962426064 A96023 MD 38-3769910 Primary, Mailing Hanford Orthopedics, Inc. 870 W. 7th St. Hanford CA 93230 (559)582-9621 (559)582-9622Manimtim Danilo 1477663854 A36441 Filipino MD 94-2915703 Primary, Billing, Mailing 6101 N. Fresno St. #101 Fresno CA 93710 (209)435-4168 (209)435-6733Martirosian Armen 1114087046 A103597 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Martirosian Armen 1114087046 A103597 MD 46-3959536, 27-0271872Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Mochizuki Robert 1023028883 G32450 MD 20-4139971 Billing, Mailing PO Box 26480 Fresno CA 93729Mochizuki Robert 1023028883 G32450 MD 20-4139971 Primary Arthroscopy Surgery Associates 7215 N. Fresno St. #102 Fresno CA 93720 (559)432-3374 (559)432-3378Naeni Fariborz 1427168806 A44740 Persian MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Naeni Fariborz 1427168806 A44740 Persian MD 46-3969536, 27-0271872Primary University Faculty Associates, Inc./Community Foundation Medical Group 255 N. Herwaldt Dr. Fresno CA 93701 (559)457-4004 (559)459-3750Rebel Cyril 1952479180 A62819 French MD 77-0461802 Primary, Billing, Mailing 550 E. Almond Ste. A Madera CA 93637 (559)661-0476 (559)673-4565Refaat Motasem 1780976902 A122720 Arabic MD 27-0271872 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Refaat Motasem 1780976902 A122720 Arabic MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200

Page 12: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Schulz Michele 1891778775 G81551 MD 77-0548187 Billing, Mailing, Primary Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5154 (559)432-8364Shantharam Sanagaram 1558454546 A52010 MD 77-0532800 Mailing, Primary, Billing Center for Bone and Joint Surgery 7065 N. Maple #102 Fresno CA 93720 (559)431-5888 (553)431-0888Simonian Peter 1679571624 G83773 Pediatric Sports Medicine MD 77-0586576 Mailing, Billing PO Box 28921 Fresno CA 93729 (559)439-7633Simonian Peter 1679571624 G83773 Pediatric Sports Medicine MD 77-0586576 Primary Simonian Sport Medicine Clinic 729 N. Medical Center Dr. W. #101 Clovis CA 93611 (559)439-7633 (559)439-7631Simons Matthew 1689816266 A135495 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5395 (559)432-8364Spychalski Jeffrey 1760480479 G70781 MD 68-0357690 Primary Adventist Health Physicians Network 1142 Rose Ave. Ste. B Selma CA 93662 (559)856-6180 (559)856-6182Spychalski Jeffrey 1760480479 G70781 MD 68-0357690 Mailing, Billing PO Box 2087 Hanford CA 93232 (855)731-2476Tanner Cary 1942284096 G52071 MD 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-1086 (559)256-5309Taylor David 1487637104 G23608 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)436-1500 (559)436-1043Telles Connor 1053595280 A115099 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5393 (559)256-1699Thaxter Steven 1760465496 G69020 MD 77-0548187 Primary, Billing, Mailing 1630 E. Herndon Ave. Fresno CA 93720 (559)446-0777 (559)446-1288Tidwell John 1184885519 A137400 MD 46-3969536 Primary University Faculty Associates, Inc. 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Tidwell John 1184885519 A137400 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Varshney Anuj 1518177104 A117539 MD 68-0357690, 45-3220509Primary, Mailing Adventist Health Physician Network 125 Mall Dr. #303 Hanford CA 93230 (559)537-0310 (559)537-0312Varshney Anuj 1518177104 A117539 MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Verioti Christopher 1215257092 20A13329 DO 68-0357690 Primary, Mailing Adventist Health Physicians Network 125 Mall Dr. #211A Hanford CA 93230 (559)537-0400 (559)537-0402Verioti Christopher 1215257092 20A13329 DO 68-0357690 Billing PO Box 2087 Hanford CA 93232 (855)731-2476Volk William 1235384637 A131279 MD 38-3769910 Primary Hanford Orthopedics, Inc. 870 W. 7th St. Hanford CA 93230 (559)582-9621 (559)582-9622Volk William 1235384637 A131279 MD 38-3769910 Mailing, Billing PO Box 1329 Hanford CA 93232-1329(559)582-9621Watson Timothy 1649253295 G54436 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)449-1622 (559)261-1906Wiens Jeryl 1760465686 G50505 Physical Medicine/Rehab MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)261-0100 (559)261-1906OtolaryngologyDavies Jennifer 1184828238 A100204 Spanish MD 94-2375985 Mailing, Primary, Billing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Evans Allen 1285694422 G73994 MD 94-2375985 Primary, Billing, Mailing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Hsu George 1881801157 20A11211 DO 94-2375985 Primary, Billing, Mailing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Lanier Brent 1447219720 G50104 Pediatric Otolaryngology MD 94-2375985 Primary, Billing, Mailing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Moore Jerry 1396705547 A20618 MD 94-2375985 Mailing, Primary, Billing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Schlund Daniel 1164440822 G60662 Spanish MD 91-1601641 Primary, Billing, Mailing Hanford Ear, Nose & Throat Associates 125 Mall Dr. #307 Hanford CA 93230 (559)582-8791 (559)582-8792Shin Mike 1992791495 A97516 Tagalog MD 27-0258394 Primary, Mailing, Billing Mike Shin, MD 860 W. 7th St. Hanford CA 93230 (559)585-7252 (559)585-7253Teitelbaum Benjamin 1457364333 G88530 MD 94-2375985 Mailing, Primary, Billing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Tonkinson Brien 1376691683 C54644 MD 94-2375985 Primary, Mailing, Billing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Wong Ronald 1184649220 G34227 Spanish MD 94-2917317 Primary, Billing, Mailing 355 Campus Dr. Ste. B Hanford CA 93230 (209)584-6684 (209)584-6686Pain ManagementAmireh Rasheed 1023040748 A71934 MD 77-0555464 Mailing, Primary Rasheed A. Amireh, M.D., Inc. 1642 E. Herndon #106 Fresno CA 93720 (559)447-1432 (559)432-2847Amireh Rasheed 1023040748 A71934 MD 77-0555464 Billing PO Box 3087 Pinedale CA 93650 (559)447-1432Goswami Amitabh 1447451539 20A9044 DO 26-0689621 Primary, Mailing, Billing California Pain Consultants 7255 N. Cedar Ave. #101 Fresno CA 93720 (559)478-4757 (559)323-4143Ky Paul 1043374028 20A10743 Physical Medicine/RehabSpanish DO 27-0163308 Mailing, Billing, Primary Advanced Pain Solutions 6169 N. Thesta St. Fresno CA 93710 (559)435-1757 (559)435-1768O'Laughlin Thomas 1306886916 G71958 Physical Medicine/Rehab MD 77-0348542 Mailing, Billing, Primary Thomas J. O'Laughlin MD Inc 255 W. Bullard Ave. #112 Clovis CA 93612 (559)498-0268 (559)498-0269Salazar Robert 1437366622 G42244 Spanish MD 77-0392396 Primary, Mailing Robert G. Salazar, MD, Inc. 7152 N. Sharon #102 Fresno CA 93720 (559)432-6807 (559)432-6937Salazar Robert 1437366622 G42244 Spanish MD 77-0392396 Billing PO Box 3506 Pinedale CA 93650 (559)446-2227Von Kaenel William 1336201011 G69164 MD 77-0543690 Primary, Mailing Spine Intervention Medical Group 6121 N. Thesta St. #106 Fresno CA 93710 (559)435-9745 559-0000Von Kaenel William 1336201011 G69164 MD 77-0543690 Billing PO Box 321086 Los Gatos CA 95032 (408)370-9080Palliative MedicineDoe Marian 1861640997 A105109 MD 47-3187428 Mailing, Billing, Primary Doe Medical, Inc. 30 E. Riverpark PL W. Ste. #320 Fresno CA 93720 (559)412-8910 (559)492-1111Liyanage Dineshi 1740367903 A76771 Sinhalese MD 607-27-9458 Primary 2755 Herndon Ave Clovis CA 93611 (559)324-4904 (559)324-9455Liyanage Dineshi 1740367903 A76771 Sinhalese MD 607-27-9458 Billing Po Box 25042 Fresno CA 93729 (559)324-4904MacMillan Patrick 1457492910 C137278 MD 46-3969536 Primary Ambulatory Care Center/UFA 290 N Wayte Ln Fresno CA 93701 (559)459-5700 (559)459-5097MacMillan Patrick 1457492910 C137278 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Rodriguez-Carranza Lidia 1225221641 A94807 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Rodriguez-Carranza Lidia 1225221641 A94807 MD 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St Fresno CA 93721 (559)459-6000 (559)499-6501PathologyAvalos Stephen 1962444836 G56424 MD 77-0113417 Mailing, Primary Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Avalos Stephen 1962444836 G56424 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Barrett David 1013035096 A115290 MD 77-0113417 Mailing, Primary Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Barrett David 1013035096 A115290 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Chen Baorong 1093756231 A80660 Cantonese MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Chen Baorong 1093756231 A80660 Cantonese MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Chen Calvin 1982858395 20A12258 Mandarin DO 77-0113417 Mailing, Primary Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Chen Calvin 1982858395 20A12258 Mandarin DO 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Crawford J. Michael 1033171848 G54555 MD 77-0424787 Primary Hanford Community Hospital 450 N. Greenfield Hanford CA 93230Crawford J. Michael 1033171848 G54555 MD 77-0424787 Mailing, Billing Dept. # WS208 PO Box 509015 San Diego CA 92150 (903)453-2500Futoran Robert 1184661027 G70323 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Futoran Robert 1184661027 G70323 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Harding Clarke 1467493437 G54892 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Harding Clarke 1467493437 G54892 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Honda Gordon 1699712430 A48027 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Honda Gordon 1699712430 A48027 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Jennings-Dover Charay 1114282076 A109084 MD, PHD 77-0113417 Mailing, Primary Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Jennings-Dover Charay 1114282076 A109084 MD, PHD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Knezevich Stevan 1134333511 A108355 MD, PHD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Knezevich Stevan 1134333511 A108355 MD, PHD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Phillips Daniel 1144344003 A111207 MD 77-0113417 Mailing, Primary Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Phillips Daniel 1144344003 A111207 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Pitts William 1639110471 G51515 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Pitts William 1639110471 G51515 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Pollard John 1407897192 A92587 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Pollard John 1407897192 A92587 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Reiber Nicholas 1346202694 G43587 MD 77-0424787 Primary Hanford Community Hospital 450 N. Greenfield Hanford CA 93230Reiber Nicholas 1346202694 G43587 MD 77-0424787 Billing, Mailing Dept. # WS208 PO Box 509015 San Diego CA 92150 (903)453-2500Slater David 1609817873 G63203 MD 77-0113417 Primary, Mailing Pathology Associates 305 Park Creek Dr. Clovis CA 93611 (559)326-2800 (559)326-2801Slater David 1609817873 G63203 MD 77-0113417 Billing Dept. #WS206 PO Box 509015 San Diego CA 92150 (903)453-2500Pelvic Medicine/Reconstructive SurgSteinberg Benjamin 1124280581 20A11769 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Steinberg Benjamin 1124280581 20A11769 DO 27-0271872 Primary Urogynecology Specialty Center/Community Foundation Medical Group 7060 N. Recreation Ave. #104 Fresno CA 93720 (559)321-2930 (559)321-2940Physical Medicine/RehabAtallah Najdat 1558347187 C51461 MD 27-0271872 Primary 2823 Fresno St. Fresno CA 93721 (559)459-6296 (559)459-2162Atallah Najdat 1558347187 C51461 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Cha Tha 1073547824 A84894 Hmong MD 27-1772021 Billing, Mailing, Primary H-Care, Inc. 125 E. Barstow #118 Fresno CA 93710 (559)486-5290 (559)486-5630Comrie Frederick 1376780387 A126856 MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)478-5243Comrie Frederick 1376780387 A126856 MD 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Edwards John 1649299199 G38967 MD 94-2749155 Primary, Billing, Mailing Edward and Kirby, Inc. 5680 N. Fresno St. #107 Fresno CA 93710 (559)435-1800 (559)432-6435Grossman Jonathan 1225242332 A98906 Spanish MD 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532

Page 13: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Grossman Jonathan 1225242332 A98906 Spanish MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hadilaksono Matthew 1205225174 15470 DO 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)478-5243Hadilaksono Matthew 1205225174 15470 DO 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Kasturi Gopi 1497963896 A107851 MD 77-0548187 Primary, Billing, Mailing SPOC 1630 E. Herndon #303 Fresno CA 93720 (559)256-5953 (559)261-1906Kirby John 1093734543 G15922 MD 94-2580152 Primary, Billing, Mailing Edward and Kirby, Inc. 5680 N. Fresno St. #107 Fresno CA 93710 (559)435-1800 (559)432-6435Lagattuta Francis 1992799704 G84334 MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)478-5243Lagattuta Francis 1992799704 G84334 MD 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Le Roy Edward 1508992660 C53624 Spanish MD 27-1332245 Billing, Mailing, Primary 6594 N. First St. #103 Fresno CA 93710 (559)840-0517 (559)840-1159Ma Fajie 1891079455 A129917 MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)478-5243Ma Fajie 1891079455 A129917 MD 86-1074782 Billing, Mailing 218 North I St. Lompoc CA 93436 (805)736-7886Montero Winston 1851550404 A122675 MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)369-7014Montero Winston 1851550404 A122675 MD 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Olegario-Nebel Marissa 1639476112 C150160 Tagalog MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)478-5243Olegario-Nebel Marissa 1639476112 C150160 Tagalog MD 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Singh Harwinder 1346211620 A72576 Punjabi MD 20-2185740 Primary, Mailing, Billing 7125 N. Chestnut Ave. #106 Fresno CA 93720 (559)325-3070 (559)325-3073Sison Mark 1275777583 A149604 MD 77-0548187 Primary, Billing, Mailing SPOC 1630 E. Herndon #303 Fresno CA 93720 (559)290-7049 (559)261-1906Smith Jerry 1780667667 C51861 MD 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-0439 (559)261-1906Wang Jane 1518285717 A45559 MD 86-1074782 Primary Lags Spine & Sportscare Medical Center Inc. 349 Bullard #105 Fresno CA 93710 (559)272-1295 (559)369-7014Wang Jane 1518285717 A45559 MD 86-1074782 Mailing, Billing 218 North I St. Lompoc CA 93436 (805)736-7886Plastic SurgeryAskren Carl 1134188097 G60139 MD 94-2375985 Mailing, Billing, Primary Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468Lemker Erich 1568622355 A95116 MD 46-3969536 Primary Renaissance Surgery Center/UFA 2365 E. Fir Ave. Fresno CA 93720 (559)797-9100 (559)797-9103Lemker Erich 1568622355 A95116 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Sian Kenty 1407882004 A75906 Tagalog MD 81-3131241 Mailing, Primary, Billing Kenty U. Sian, MD, Inc. 1855 E. Alluvial Ste. #101 Fresno CA 93720 (559)797-0501 (559)797-0504Stefanacci Hedieh 1770693178 G81489 French MD 46-1249986 Primary, Billing, Mailing Stefanacci Medical Group 2365 E. Fir Ave. Fresno CA 93720 (559)797-9000 (559)797-9005Yamaguchi Kent 1124042924 G24836 MD 46-3969536 Primary 2365 E. Fir Ave. Fresno CA 93720 (559)797-9000 (559)797-9005Yamaguchi Kent 1124042924 G24836 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Zuniga Stephen 1669431409 G63144 MD 94-2375985 Primary, Billing, Mailing Central California Ear, Nose & Throat 1351 E. Spruce Fresno CA 93720 (559)432-3303 (559)432-1468PodiatryAaronson Craig 1407896517 E3420 DPM 77-0166532 Primary, Billing, Mailing 6235 N. Fresno St. #101 Fresno CA 93710 (559)229-3668 (559)244-5866Cazzell Shawn 1629392568 E4881 Wound Management DPM 81-2483283 Primary, Mailing Shawn M. Cazzell DPM INC 6215 N. Fresno St. #108 Fresno CA 93710 (559)256-9600 (559)489-0498Cazzell Shawn 1629392568 E4881 Wound Management DPM 81-2483283 Billing 8839 N. Cedar Ave. #363 Fresno CA 93720 (559)256-9600Clyde Allen 1962538462 E1976 Spanish DPM 94-6424550 Mailing, Billing, Primary Allen O. Clyde, DPM 688 Medical Center Dr. E. #106 Clovis CA 93611 (559)297-8604 (559)297-0625Kroeker Roy 1790829992 E1401 German DPM 94-2670297 Primary, Billing, Mailing Roy O. Kroeker, DPM, INC. 6061 N. First St. #103 Fresno CA 93710 (559)436-8262 (559)436-0444Kruger Frederick 1417954447 E2782 DPM 81-3125504 Primary, Mailing, Billing Frederick J. Kruger, DPM, Inc. 530 E. Herndon Avenue Suite 104 Fresno CA 93720-2990(559)447-9040 (559)447-9042Oji Emmy 1114281557 E5223 Igbo DPM 27-0271872 Primary Valley Foot and Ankle Specialty Providers/Community Foundation Medical Group 7407 N. Cedar Ave. #101 Fresno CA 93720 (559)449-9500 (559)449-9501Oji Emmy 1114281557 E5223 Igbo DPM 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200PsychiatryAdapa Indira 1588776918 A86927 Spanish MD 77-0287103 Primary, Mailing, Billing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Brar Nirmal 1710982608 A73984 Punjabi MD 77-0287103 Primary 1130 E Shaw Ave #105 Fresno CA 93710 (559)227-1977 (559)227-2698Brar Nirmal 1710982608 A73984 Punjabi MD 77-0287103 Mailing, Billing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111De Soto Mateo 1316059751 A40927 Spanish MD 77-0287103 Billing, Primary, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Pick James 1205019395 A55683 German MD 77-0287103 Primary, Billing, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Sievert Dwight 1841388022 G47593 MD 77-0287103 Primary 7131 N 11th St #104 Fresno CA 93720 (559)435-0800 (559)435-7720Sievert Dwight 1841388022 G47593 MD 77-0287103 Billing, Mailing 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111Steinbach Kenneth 1821100173 A43021 Spanish MD 77-0287103 Billing, Primary, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Ting Mark 1588925861 A131596 Mandarin MD 77-0287103 Billing, Primary, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Vydro Aleksandr 1124130430 A54990 Russian MD 77-0287103 Primary, Billing, Mailing Bio-Behavioral Medical Clinic 1060 W. Sierra Ave. #104 Fresno CA 93711 (559)437-1111 (559)437-1118Pulmonary DiseaseAlmasri Eyad 1992840490 A111780 Critical Care Medicine MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Almasri Eyad 1992840490 A111780 Critical Care Medicine MD 46-3969536 Primary University Faculty Associates, Inc. 6733 N. Willow Ave. #107 Fresno CA 93710-5953(559)435-4700 (559)435-9944Balasubramanian Vijay 1548289093 A94876 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Balasubramanian Vijay 1548289093 A94876 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Bezwada Vishnu 1730178922 C134770 Critical Care Medicine Spanish MD 94-0535360, 47-3501139Primary, Mailing Adventist Health Lung Care Center/Central Valley Critical Care 115 Mall Dr. Hanford CA 93230 (559)582-9000 (559)537-0052Bezwada Vishnu 1730178922 C134770 Critical Care Medicine Spanish MD 94-0535360 Billing PO Box 1304 Hanford CA 93232 (559)537-0440Bilello Kathryn 1366461816 G84862 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Bilello Kathryn 1366461816 G84862 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Daniel Vijai 1043473986 C55861 Critical Care Medicine Tamil MD 47-1682171 Billing, Mailing, Primary Pulmonary & Critical Care Medicine 1660 E. Herndon #101 Fresno CA 93720 (559)431-9753 (559)431-3478Evans Timothy 1992724447 C50746 MD, PHD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Evans Timothy 1992724447 C50746 MD, PHD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Fayed Mohamed 1942437819 A128863 Critical Care Medicine MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Fayed Mohamed 1942437819 A128863 Critical Care Medicine MD 46-3969536 Primary University Faculty Associates, Inc. 6733 N. Willow Ave. #107 Fresno CA 93710-5953(559)435-4700 (559)435-9944Gill Kuldeep 1184623969 A82057 Hindi MD 61-5386264 Billing, Mailing, Primary Pulmonary & Critical Care Medicine 1660 E. Herndon #101 Fresno CA 93720 (559)431-9753 (559)431-3478Hegde Pravachan 1801050331 A135467 Critical Care Medicine Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Hegde Pravachan 1801050331 A135467 Critical Care Medicine Hindi MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Jain Vipul 1295927911 A88214 Critical Care Medicine MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Jain Vipul 1295927911 A88214 Critical Care Medicine MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Kandaswamy Chitradevi 1225146293 A92981 Critical Care Medicine MD 45-2156242 Mailing, Primary, Billing Community Pulmonary Assoc. Inc. 7035 N. Maple Ave. #102B Fresno CA 93720 (559)326-7569 (559)326-7498Lee David 1528015906 A125875 Critical Care Medicine Malay MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Lee David 1528015906 A125875 Critical Care Medicine Malay MD 46-3969536 Primary University Faculty Associates, Inc. 6733 N. Willow Ave. #107 Fresno CA 93710-5953(559)435-4700 (559)435-9944Peterson Michael 1437178985 G86406 MD 75-2989686 Primary University Central Medical Specialty Center 2828 Fresno St. #203 Fresno CA 93721 (559)320-1090 (559)320-1099Peterson Michael 1437178985 G86406 MD 75-2989686 Billing PO Box 742611 Los AngelesCA 90074Pyreddy Lovrdu 1952334583 A94932 Critical Care Medicine MD 591-77-5287 Primary, Mailing, Billing Pulmonary & Critical Care Medicine 1660 E. Herndon #101 Fresno CA 93720 (559)431-9753 (559)431-3478Rana Naeem 1871528638 A52541 Critical Care Medicine Urdu MD 47-3501139, 94-0535360Primary, Mailing Adventist Health Lung Care Center/Central Valley Critical Care 115 Mall Dr. Hanford CA 93230 (559)582-9000 (559)537-0052Rana Naeem 1871528638 A52541 Critical Care Medicine Urdu MD 94-0535360 Billing PO Box 1304 Hanford CA 93232 (559)537-0440Rashid Saqib 1922009752 A96384 Critical Care Medicine MD 27-0799378, 94-0535360Primary, Mailing Hanford Medical Associates, Inc. 125 Mall Dr. #305 Hanford CA 93230 (559)537-0440 (559)537-0442Rashid Saqib 1922009752 A96384 Critical Care Medicine MD 27-0799378 Billing PO Box 417 Hanford CA 93232 (559)537-0440Rashidian Ali 1740590298 A114143 MD 45-3089947 Billing, Mailing, Primary Arya Medical Group Corp. 1660 E. Herndon #101 Fresno CA 93720 (559)431-9753 (559)431-3478Upadhyay Daya 1710029798 A81185 Hindi MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Upadhyay Daya 1710029798 A81185 Hindi MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Van Gundy Karl 1073532529 A42584 Critical Care Medicine MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Van Gundy Karl 1073532529 A42584 Critical Care Medicine MD 46-3969536 Primary University Faculty Associates, Inc. 6733 N. Willow Ave. #107 Fresno CA 93710-5953(559)435-4700 (559)435-9944Vempilly Jose 1356360804 A93681 MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #260 Fresno CA 93701 (559)256-5130 (559)485-4504Vempilly Jose 1356360804 A93681 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Radiation OncologyKane Brent 1093718785 G75272 MD 27-0271872, 77-0436168Primary Oncology Care Providers/Community Foundation Medical Group 7257 N. Fresno St. Fresno CA 93720 (559)447-4050 (559)451-3637Kane Brent 1093718785 G75272 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Silveira William 1447494398 115447 MD 77-0436168, 27-0271872Primary Oncology Care Providers/Community Foundation Medical Group 7257 N. Fresno St. Fresno CA 93720 (559)447-4050 (559)451-3637Silveira William 1447494398 115447 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Tan Raymond 1104809946 A73252 MD 77-0436168 Billing PO Box 28911 Fresno CA 93729Tan Raymond 1104809946 A73252 MD 27-0271872, 77-0436168Primary Oncology Care Providers/Community Foundation Medical Group 7257 N. Fresno St. Fresno CA 93720 (559)447-4050 (559)451-3637Tan Raymond 1104809946 A73252 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200

Page 14: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

RadiologyBarrows Susan 1295803302 G59482 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Barrows Susan 1295803302 G59482 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 1867 E. Fir Ave. #101 Fresno CA 93720 (559)325-5800 (559)325-5835Batth Nitasha Klar 1275709883 A146379 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Batth Nitasha Klar 1275709883 A146379 MD 20-3710108 Billing Dept. WS205 PO Box 509015 San Diego CA 92150 (559)325-5800Bhandary Pramode 1366529026 G87429 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Bhandary Pramode 1366529026 G87429 MD 77-0078751 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Canavan Lydia 1851342539 G58166 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Canavan Lydia 1851342539 G58166 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Carson William 1053378794 A107073 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Carson William 1053378794 A107073 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Champaign Judy 1043304074 G57762 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 1867 E. Fir Ave. #101 Fresno CA 93720 (559)325-5800 (559)325-5835Champaign Judy 1043304074 G57762 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Chang Frank 1568556413 G52716 MD 20-3710108 Mailing, Primary California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Chang Frank 1568556413 G52716 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Draeger Marc 1508077355 A115013 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Draeger Marc 1508077355 A115013 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Fontaine Arthur 1225020845 G58286 MD 26-1415805 Primary Arthur B. Fontaine MD, Inc. 1250 E. Almond Madera CA 93637 (559)675-5555 (209)577-1509Fontaine Arthur 1225020845 G58286 MD 26-1415805 Mailing, Billing 4536 Broadway Ave. #906 Salida CA 95368 (209)577-9900Foster Elisa 1801905773 20A9979 DO 20-3710108 Mailing, Primary California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Foster Elisa 1801905773 20A9979 DO 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Ginier Bruce 1356347298 A45708 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Ginier Bruce 1356347298 A45708 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Hildebrandt Hans 1194721035 G76378 MD 77-0292042 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Hildebrandt Hans 1194721035 G76378 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Hildebrandt Kurt 1770554271 A64070 MD 77-0078751 Mailing, Primary Community Medical Imaging (CMI) 1867 E. Fir Ave. #104 Fresno CA 93720 (559)325-5800 (559)325-5838Hildebrandt Kurt 1770554271 A64070 MD 77-0078751 Billing PO Box 27737 Fresno CA 93729 (559)325-5800Lo Galbo Fred 1821164864 G65032 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Lo Galbo Fred 1821164864 G65032 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Meyer Monique 1417186081 A125434 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Meyer Monique 1417186081 A125434 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Murray Sean 1629044805 G78213 MD 26-3948892 Primary Coalinga Regional Medical Center 1191 S. Phelps Coalinga CA 93210 (559)935-6400Murray Sean 1629044805 G78213 MD 26-3948892 Billing, Mailing 4536 Broadway Ave. #906 Salida CA 95356 (209)577-9900x#1Nguyen Chanh 1992901250 A91152 MD 20-3710108 Mailing, Primary California Imaging Institute Medical Group, Inc./Advance Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Nguyen Chanh 1992901250 A91152 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Ramirez Ivan 1053456806 A102748 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Ramirez Ivan 1053456806 A102748 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Raymond Eric 1265598585 A81666 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Raymond Eric 1265598585 A81666 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Resendes Mariela 1811913833 G58114 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Resendes Mariela 1811913833 G58114 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Rindahl Martin 1174529135 G69216 MD 20-3710108 Mailing, Primary California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Rindahl Martin 1174529135 G69216 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Roberts Jason 1508845579 A95372 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Roberts Jason 1508845579 A95372 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Saavedra Jeffrey 1558459891 G80305 Spanish MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Saavedra Jeffrey 1558459891 G80305 Spanish MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Speece Paul 1932171733 A102465 MD 77-0292042 Mailing, Primary California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Speece Paul 1932171733 A102465 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Tamura Frank 1932275906 G57212 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Tamura Frank 1932275906 G57212 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Tarau Gabriela 1396894986 A103329 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Tarau Gabriela 1396894986 A103329 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Thant Ronald 1306016464 A103630 Burmese MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advance Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93720 (559)447-4000 (559)447-4043Thant Ronald 1306016464 A103630 Burmese MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Tran Phillip 1316951577 A55091 MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Tran Phillip 1316951577 A55091 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Vanderschelden Philippe 1558327106 C52596 French MD 20-3710108 Primary, Mailing California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Vanderschelden Philippe 1558327106 C52596 French MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000Venugopal Chandrasekar 1972679959 G73401 MD 20-3710108 Mailing, Primary California Imaging Institute Medical Group, Inc./Advanced Medical Imaging (CII/AMI) 6297 N. Fresno St. Fresno CA 93710 (559)447-4000 (559)447-4043Venugopal Chandrasekar 1972679959 G73401 MD 20-3710108 Billing Department #WS205 PO Box 509015 San Diego CA 92150 (559)447-4000RheumatologyBertken Richard 1609895150 G30979 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 290 N. Wayte Ln. Fresno CA 93701 (559)459-5721 (559)459-4922Bertken Richard 1609895150 G30979 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Gill Himmat 1891728838 A97685 Hindi MD 26-1674115 Primary, Mailing, Billing Himmat S. Gill, M.D., Inc. 7135 N. Chestnut Ave. #104 Fresno CA 93720 (559)447-8632 (559)447-8872Khalid Yasmeen 1548291156 A62895 Spanish MD 45-2744644 Primary, Mailing, Billing 1260 E. Almond Ave. Madera CA 93637 (559)674-0075 (559)674-9676Leyba Mauro 1730125105 A41228 MD 77-0152867 Billing, Mailing, Primary 7085 N. Chestnut Ave. #109 Fresno CA 93720 (559)299-2600 (559)299-2854Majmudar Shefali 1982876751 DO 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Majmudar Shefali 1982876751 DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Mittal Manisha 1154627776 A126113 Hindi MD 82-0847822 Mailing, Billing, Primary Mittal Gastroenterology & Rheumatology 7045 N. Maple Ave. Ste. #101 Fresno CA 93720 (559)900-4013 (559)900-4172Naramala Srikanth 1437412129 A145595 Telugu MD 68-0357690 Primary, Mailing Adventist Health Physicians Network 470 Greenfield Ave. #305 Hanford CA 93230 (559)537-0425 (559)537-0427Naramala Srikanth 1437412129 A145595 Telugu MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (559)537-0297Virk-Dulai Amneet 1992911309 A117190 Spanish MD 46-3133161 Billing PO Box 28915 Fresno CA 93729 (559)253-2800Virk-Dulai Amneet 1992911309 A117190 Spanish MD 46-3133161 Mailing, Primary California Rheumatology and Wellness, Inc. 7082 N. Maple Ave. #101 Fresno CA 93720 (559)449-0331 (559)449-0246Wu Ying 1225329303 A126483 Cantonese MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Wu Ying 1225329303 A126483 Cantonese MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Yuvienco Candice 1720269418 A122233 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 2335 E. Kashian Ln. #280 Fresno CA 93701 (559)320-1090 (559)320-0331Yuvienco Candice 1720269418 A122233 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Sleep MedicineKeenan Lynn 1528176500 G71333 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Keenan Lynn 1528176500 G71333 Spanish MD 46-3969536 Primary University Faculty Associates, Inc. 6733 N. Willow Ave. #107 Fresno CA 93710-5953(559)435-4700 (559)435-9944Rugama Arnold 1487656021 A63350 Spanish MD 42-5279784 Primary Arnold Rugama, MD, Inc. 1660 E. Herndon #103 Fresno CA 93720 (559)840-2262 (559)840-2855Rugama Arnold 1487656021 A63350 Spanish MD 42-5279784 Mailing, Billing PO Box 28915 Fresno CA 93729 (559)840-2262Sports MedicineGousse Robert 1952667792 A149982 Spanish MD 77-0548187 Mailing, Billing, Primary SPOC 1630 E. Herndon #303 Fresno CA 93720 (559)290-7050 (559)256-5305Surgery AssistCurry Robert 1033205539 G24344 MD 26-1713203, 27-0271872Mailing, Primary Central Valley Women's Health Associates/Community Foundation Medical Group 1374 E. Alluvial Fresno CA 93720 (559)981-2600 (559)981-2610Curry Robert 1033205539 G24344 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Gavin Charles 1184790735 G32896 MD 55-1802560 Billing, Primary, Mailing 478 E. Prescott Fresno CA 93720 (559)250-8179 (559)434-3571Kielmeyer Keith 1326132903 C35402 MD 47-5480765 Primary 5321 N. Fresno St. #105C Fresno CA 93710 (559)970-3411 (559)970-3411Kielmeyer Keith 1326132903 C35402 MD 47-5480765 Mailing, Billing PO Box 27364 Fresno CA 93729 (559)970-3411Kim Seung Nam 1134112154 A32168 Korean MD 94-2711505 Mailing, Primary, Billing Seung Nam Kim, MD 475 W. Fallbrook Ave. Clovis CA 93611 (559)900-4951Polglase Van 1609809839 C33735 MD 550-44-8811 Billing PO Box 27409 Fresno CA 93729-7409(559)439-7888

Page 15: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Polglase Van 1609809839 C33735 MD 550-44-8811 Mailing, Primary 1159 W. Sample Fresno CA 93710 (559)439-7888Roth James 1366557928 20A4011 Wound Management DO 36-4567126 Primary 550 E. Herndon Ave. Fresno CA 93720-2907(559)438-1245Roth James 1366557928 20A4011 Wound Management DO 36-4567126 Billing, Mailing PO Box 25042 Fresno CA 93729-5042(559)438-1245Schilling Lee 1457377426 C30382 MD 217-28-4339 Primary, Billing, Mailing Lee Schilling, MD 1671 W. Morris Fresno CA 93711 (559)439-4048Witmer Bruce 1548286255 G47289 Spanish MD 77-0037799, 33-1037098Mailing, Billing, Primary San Joaquin Valley Imaging, Inc. 6121 N. Thesta Ste. #110 Fresno CA 93710 (559)432-5633 (559)431-4226Surgery Assist (AHP)Asatrian Naira 1912153131 19993 Armenian PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Asatrian Naira 1912153131 19993 Armenian PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Bates Faye 1851669782 646182 Certified Nurse MidwifeHmong CNM 46-3969536 Primary University Faculty Associates, Inc. 2210 E. Illinois Ave. #408 Fresno CA 93701 (559)443-2694 (559)443-2696Bates Faye 1851669782 646182 Certified Nurse MidwifeHmong CNM 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Bentley Daniel 1629177647 PA52397 PA 27-0271872 Primary Cardiac Surgery Associates of Fresno Inc./CFMG 2335 E. Kashian Ln. #230 Fresno CA 93701 (559)499-0830 (559)499-0846Bentley Daniel 1629177647 PA52397 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Bevan Jordan 1124577408 PA53854 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Bevan Jordan 1124577408 PA53854 PA 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Bonilla Daniel 1396871893 503329 Spanish RNFA 77-0511340 Billing 302 W Fallbrook Ave #105 Fresno CA 93711 (559)674-9076Bonilla Daniel 1396871893 503329 Spanish RNFA 77-0511340 Primary, Mailing Daniel Bonilla, RNFA 26 Pointe W Madera CA 93637 (559)871-5790 (559)432-5255Braner Todd 1932182193 17090 PA 77-0548187 Billing, Mailing, Primary Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Brown Jeffrey 1083978928 PA22336 PA 94-2613220 Mailing, Billing PO Box 5254 Fresno CA 93755-5254(559)459-5712Brown Jeffrey 1083978928 PA22336 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Carlock Julie 1174910020 612074 RNFA 71-0888428, 27-0271872Primary, Mailing Advanced Laparoscopic Surgery Associates 205 E. River Park Circle #460 Fresno CA 93720 (559)261-4500 (559)261-4501Carlock Julie 1174910020 612074 RNFA 71-0888428 Billing PO Box 28947 Fresno CA 93729 (559)228-4200Cayco Celeste 1134221906 PA14362 Spanish PA 94-2407634, 27-0271872Primary Neurosurgical Associates Medical Group/Community Foundation Medical Group 7130 N. Sharon Ave. #100 Fresno CA 93720 (559)449-1100 (559)449-1170Cayco Celeste 1134221906 PA14362 Spanish PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Clawges Amy 1982007837 PA52667 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Clawges Amy 1982007837 PA52667 PA 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Cornwell Lindsey 1609267079 52308 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Cornwell Lindsey 1609267079 52308 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Cox Brittany 1992027965 PA20818 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Cox Brittany 1992027965 PA20818 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Crosby Jonathan 1356778302 PA23296 Spanish PA 77-0586576 Mailing, Primary Simonian Sport Medicine Clinic 729 N. Medical Center Dr. W. #101 Clovis CA 93611 (559)439-7633 (559)439-7631Crosby Jonathan 1356778302 PA23296 Spanish PA 77-0586576 Billing PO Box 28921 Fresno CA 93729D'Oyley Anthony 1093151508 PA52933 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532D'Oyley Anthony 1093151508 PA52933 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Delenikos Sarah 1043643224 23141 PA 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376DeMary Veronica 1871905984 PA51812 PA 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-4090 (559)459-3750DeMary Veronica 1871905984 PA51812 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Doctolero Rex 1740382787 PA18009 PA 94-2407634, 27-0271872Primary Neurosurgical Associates Medical Group/Community Foundation Medical Group 7130 N. Sharon Ave. #100 Fresno CA 93720 (559)449-1100 (559)449-1170Doctolero Rex 1740382787 PA18009 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Dougherty Simon 1780660761 PA17805 PA 77-0548187 Billing, Primary, Mailing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Eastman Courtney 1073873741 PA22221 PA 77-0548187 Mailing, Billing, Primary Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Edginton Melissa 1093136269 95000180 NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Edginton Melissa 1093136269 95000180 NP 27-0271872 Primary Urogynecology Specialty Center/Community Foundation Medical Group 7060 N. Recreation Ave. #104 Fresno CA 93720 (559)321-2930 (559)321-2940Elliot Jason 1225157852 PA19008 PA 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-3770Elliot Jason 1225157852 PA19008 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Ellis Christopher 1578664744 PA18256 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Fagundes Annie 1891178182 95002607 RNFA 77-0586576 Primary Simonian Sport Medicine Clinic 729 N. Medical Center Dr. W. #101 Clovis CA 93611 (559)439-7633 (559)439-7631Fagundes Annie 1891178182 95002607 RNFA 77-0586576 Mailing, Billing PO Box 28921 Fresno CA 93729 (559)228-5400Farkas Lorraine 1164401154 969 Certified Nurse Midwife CNM 27-0271872 Mailing, Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois Ave. #505 Fresno CA 93701 (559)266-8989 (559)266-8994Farkas Lorraine 1164401154 969 Certified Nurse Midwife CNM 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Fuentes Funez Magdiel 1467972612 54487 Spanish PA 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Fuentes Funez Magdiel 1467972612 54487 Spanish PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Garcia Joann 1265415046 541792 NP 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Garcia Peter 1205832763 529858 Spanish NP 77-0361443 Primary, Billing, Mailing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Goss Steven 1629054309 PA10682 Spanish PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Gunnell Steven 1578004164 54356 PA 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Hanks Kathryn 1558739052 95003515 NP 94-2686822 Mailing, Billing, Primary Cardiovascular Consultant Heart Center 1207 E. Herndon Ave. Fresno CA 93720 (559)432-4303 (559)432-4574Hapke Elizabeth 1770766842 PA22250 PA 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Hapke Elizabeth 1770766842 PA22250 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Healy Nathan 1902043458 PA20155 Spanish PA 77-0548187 Mailing, Primary, Billing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5737 (559)261-1906Hillman Christopher 1104014562 PA19208 Spanish PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Hillman Christopher 1104014562 PA19208 Spanish PA 27-0271872 Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Hitter Kathryne 1750892501 95007067 NP 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Hitter Kathryne 1750892501 95007067 NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Holt Jennifer 1801054879 PA54689 PA 77-0586576 Mailing, Billing PO Box 28921 Fresno CA 93729 (559)439-7633Holt Jennifer 1801054879 PA54689 PA 77-0586576 Primary Simonian Sport Medicine Clinic 729 N. Medical Center Dr. W. #101 Clovis CA 93611 (559)439-7633 (559)439-7631Hurd Charles 1629529540 PA53933 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Hurd Charles 1629529540 PA53933 PA 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Jackson Alice 1295754109 12469 NP 71-0888428, 27-0271872Mailing, Primary Advanced Laparoscopic Surgery Associates 205 E River Park Cir Ste 460 Fresno CA 93720 (559)261-4500 (559)261-4501Johnson Kirk 1700086949 PA19261 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Ortho. & Spine Center Med 1630 E Herndon Fresno CA 93720 (559)256-5200 (559) 256-5376Johnson Marne 1972058584 731771 NP 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Johnson Marne 1972058584 731771 NP 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Jones William 1508842725 53332 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Jones William 1508842725 53332 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Juarez Kyomi 1508971623 505856 NP 27-1910274 Primary California Bariatrics, Inc. 1381 E. Herndon #104 Fresno CA 93720 (559)432-3434 (559)432-3585Juarez Kyomi 1508971623 505856 NP 27-1910274 Billing, Mailing 1099 E. Champlain Ste. A PMB 249 Fresno CA 93720 (559)432-3434Kapoor Monika 1144451329 PA20667 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Kapoor Monika 1144451329 PA20667 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Kunz David 1518477348 54988 PA 46-3969536 Primary University Faculty Associates, Inc. 2823 Fresno St. Fresno CA 93721 (559)499-6493 (559)459-5097Kunz David 1518477348 54988 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Lauc Leda Lurleen 1497274385 95007384 Tagalog NP 26-1921424 Mailing, Billing, Primary Central California Heart & Lung Surgery 7575 N. Cedar Ave. #101 Fresno CA 93720 (559)449-9990 (559)449-9991Lopez Jehnette 1669915666 746692 NP 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Lopez Jehnette 1669915666 746692 NP 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Luong Tran 1821532292 54061 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Luong Tran 1821532292 54061 PA 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Manriquez Maribel 1487003414 53350 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Manriquez Maribel 1487003414 53350 PA 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Marinakis Dionysios 1174712624 PA20585 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5737 (559)261-1906May Elizabeth 1598155202 PA52306 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200May Elizabeth 1598155202 PA52306 PA 27-0271872 Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539May Joshua 1033655238 54099 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200May Joshua 1033655238 54099 PA 46-3969536, 27-0271872Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Meisner Daniel 1992941934 PA20129 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Meisner Daniel 1992941934 PA20129 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200

Page 16: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Mellor Greg 1487637468 PA16213 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopeadic Center 1630 E Herndon Ave Fresno CA 93720 (559)256-5200 (559)256-5376Miller Nathan 1073829487 PA21116 PA 77-0586576 Billing PO Box 28921 Fresno CA 93729Miller Nathan 1073829487 PA21116 PA 77-0586576 Primary, Mailing Simonian Sport Medicine Clinic 729 N. Medical Center Dr. W. #101 Clovis CA 93611 (559)439-7633 (559)439-7631Miranda Crystal 1851627178 PA53244 PA 27-0271872 Primary Cardiac Surgery Associates of Fresno Inc./CFMG 2335 E. Kashian Ln. #230 Fresno CA 93701 (559)499-0830 (559)499-0846Miranda Crystal 1851627178 PA53244 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Mizyed Simon 1952301087 PA19237 Spanish PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Mizyed Simon 1952301087 PA19237 Spanish PA 27-0271872 Primary University Orthopaedic Associates/Community Foundation Medical Group 729 N. Medical Center Dr. W. #111 Clovis CA 93611 (559)320-0531 (559)320-0539Munoz Robin 1013444165 776768 NP 27-0271872 Primary University Specialty Surgery Associates/Community Foundation Medical Group 2335 E. Kashian Ln. Ste. #220 CA 93701 (559)256-5140 (559)485-4505Munoz Robin 1013444165 776768 NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Palecek David 1104337393 544002 NP 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Palecek David 1104337393 544002 NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Payseno Samantha 1679954747 PA52554 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedic Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-1698 (559)256-1699Rahal Hardip 1730162611 PA17627 PA 77-0548187 Primary, Billing, Mailing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5737 (559)261-1906Rajyaguru Prutha 1306396700 PA53876 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Rajyaguru Prutha 1306396700 PA53876 PA 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ruskell Lauren 1932576584 95002969 Spanish NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Ruskell Lauren 1932576584 95002969 Spanish NP 27-0271872 Primary Central Valley Women's Health Associates/Community Foundation Medical Group 1374 E. Alluvial Fresno CA 93720 (559)981-2600 (559)981-2610Schleicher Laura 1225307614 1985 Certified Nurse Midwife CNM 27-0271872 Primary Central Valley OB/GYN Medical Group/Community Foundation Medical Group 2210 E. Illinois Ave. #505 Fresno CA 93701 (559)266-8989 (559)266-8994Schleicher Laura 1225307614 1985 Certified Nurse Midwife CNM 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Stewart Alicia 1871850883 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Stewart Alicia 1871850883 PA 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Thomas Cheryl 1528146198 489845 Certified Nurse Midwife CNM 77-0235591 Primary, Billing, Mailing Women's Health & Pregnancy Care Medical Center 440 Greenfield Ave. Ste. D Hanford CA 93230 (559)582-1045 (559)582-2174Tyler-Richards Renita 1437689346 PA54576 PA 46-3969536 Primary 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3750Tyler-Richards Renita 1437689346 PA54576 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Waireri Andrew 1376089219 837467 NP 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Waireri Andrew 1376089219 837467 NP 27-0271872 Primary University Neurosciences Institute/Community Foundation Medical Group 45 River Park PL. W. #104 Fresno CA 93720 (559)320-0530 (559)320-0532Weller Lindsay 1942746144 54128 PA 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Weller Lindsay 1942746144 54128 PA 46-3969536, 27-0271872Primary University Faculty Associates, Inc./Community Foundation Medical Group 255 N. Herwaldt Dr. Fresno CA 93701 (559)457-4004 (559)459-3750Wickwire Andrew 1982115275 55075 PA 46-3969536 Primary University Faculty Associates, Inc. 255 N. Herwaldt Dr. Fresno CA 93701 (559)459-7300 (559)459-3571Wickwire Andrew 1982115275 55075 PA 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Wilkes Anne 1225063969 257910 Certified Nurse Midwife CNM 94-1740281 Primary, Mailing, Billing W.L. Brown Medical Corporation 6225 N. Fresno St. #104 Fresno CA 93710 (559)265-4444 (559)265-4454Wilson Jennifer 1053714089 PA52022 PA 77-0548187 Primary, Mailing, Billing Sierra Pacific Orthopedics Center 1630 E. Herndon Ave. Fresno CA 93720 (559)256-5737 (559)261-1906Surgical Critical CareBallow Shana 1275821936 20A10299 DO 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-3770Ballow Shana 1275821936 20A10299 DO 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Sue Lawrence 1538279765 G80892 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-3770Sue Lawrence 1538279765 G80892 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Wolfe Mary 1346429537 A96987 MD 46-3969536 Primary Community Regional Medical Center 2823 Fresno St. Fresno CA 93721 (559)459-4090 (559)459-3750Wolfe Mary 1346429537 A96987 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Urgent CareAbraham Ariya 1013199041 A50162 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Abraham Ariya 1013199041 A50162 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Alch Michael 1295775062 G21010 Spanish MD 27-0271872 Primary Community Medical Providers/Community Foundation Medical Group 1570 E. Herndon Ave. Fresno CA 93720 (559)437-7338 (559)437-7153Alch Michael 1295775062 G21010 Spanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Brough Gloria 1942234935 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Brough Gloria 1942234935 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Green Erick 1821371022 130378 MD 46-2315013 Primary Premium Urgent Care 2021 Herndon Ave. #101 Clovis CA 93611 (559)797-4315 (559)797-4320Green Erick 1821371022 130378 MD 46-2315013 Mailing, Billing 7471 N. Fresno St. Fresno CA 93720 (559)436-4500Hansen Robert 1831232099 G53037 Spanish MD 77-0372730 Mailing, Primary, Billing Willow Urgent Care and Diagnostic Center 6721 N. Willow #101 Fresno CA 93710 (559)324-0911 (559)297-6708Kircher John 1225116114 G72653 MD 77-0403684, 27-0271872Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6200 (559)324-6280Kircher John 1225116114 G72653 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Kundu Sudeshna 1275565707 A105649 MD 77-0403684, 27-0271872Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6200 (559)324-6280Kundu Sudeshna 1275565707 A105649 MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Lauterio Richard 1417011933 G39383 Pediatric Emergency MedicineSpanish MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6277 (559)324-6280Lauterio Richard 1417011933 G39383 Pediatric Emergency MedicineSpanish MD 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Le Duong 1497191738 A133090 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Le Duong 1497191738 A133090 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Levin Roy 1770528002 A24866 MD 94-3371075 Primary, Mailing Clovis Urgent Care Medical Center 1555 Shaw Ave. #101 Clovis CA 93611 (559)324-7001 (559)324-1164Levin Roy 1770528002 A24866 MD 94-3371075 Billing PO Box 10727 Burbank CA 91510 (559)324-7001Little Daniel 1619031051 G72337 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Little Daniel 1619031051 G72337 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Manalo Rachel 1033520937 20A14412 DO 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Manalo Rachel 1033520937 20A14412 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Naqvi Syed 1679532725 C52487 Urdu MD 20-2199259 Mailing, Billing, Primary First Health Medical Center 7161 N. Howard St. Ste. #100 Fresno CA 93720 (559)227-2273 (559)227-3473Okereke Odira 1982768412 A88906 MD 27-0271872 Primary, Mailing Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6200 (559)324-6280Okereke Odira 1982768412 A88906 MD 27-0271872 Billing PO Box 28949 Fresno CA 93729 (559)228-4200Patton Jack 1437192739 G15827 MD 30-0121538 Primary, Mailing Everyday Health Care 199 W. Shields Fresno CA 93705 (559)225-4706 (559)225-4710Patton Jack 1437192739 G15827 MD 30-0121538 Billing PO Box 16219 Belfast ME 04915 (559)225-4706Pierce Laura 1154709616 20A15573 DO 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Pierce Laura 1154709616 20A15573 DO 27-0271872 Mailing, Billing PO Box 28949 Fresno CA 93729 (559)228-4200Rezai Sana 1588963839 A131410 MD 27-0271872 Primary Community Medical Providers/Community Foundation Medical Group 1570 E. Herndon Ave. Fresno CA 93720 (559)437-7338 (559)437-7153Rezai Sana 1588963839 A131410 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Saleh Moussa 1467795112 A142870 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6201 (559)324-6280Saleh Moussa 1467795112 A142870 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Schleif Dustin 1386961175 A121819 MD 45-3220509 Mailing, Primary Adventist Health Community Care-Dinuba Plaza 444 W El Monte Way Dinuba CA 93618 (559)591-2148 (559)591-2149Schleif Dustin 1386961175 A121819 MD 45-3220509 Billing PO Box 810 Hanford CA 93232 (559)731-2476Tran Daniel 1063518355 A44772 MD 27-0271872 Primary Peachwood Medical Group, Inc. (CMP)/Community Foundation Medical Group 275 W. Herndon Ave. Clovis CA 93612 (559)324-6200 (559)324-6280Tran Daniel 1063518355 A44772 MD 27-0271872 Billing, Mailing PO Box 28949 Fresno CA 93729 (559)228-4200Wilson Brent 1184647091 A84254 General Practice MD 30-0121538 Primary, Mailing Everyday Health Care 199 W. Shields Ave. Fresno CA 93705 (559)225-4706 (559)225-4710Wilson Brent 1184647091 A84254 General Practice MD 30-0121538 Billing PO Box 16219 Belfast ME 04915 (559)225-4706UrologyAshok Seetharaman 1669408415 C54457 MD 45-3952181 Primary, Mailing, Billing Urology Clinic of Hanford 880 W. 7th St. #103 Hanford CA 93230 (559)410-8446 (559)410-8468Behniwal Kuldip 1356346365 A39586 Punjabi MD 77-0361443 Mailing, Primary, Billing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Csiszar Jeffrey 1902807829 G70471 MD 68-0357690 Primary, Mailing Adventist Health Physician Network 804 W. 7th St. Hanford CA 93230 (559)587-0330 (559)587-0332Csiszar Jeffrey 1902807829 G70471 MD 68-0357690 Billing PO Box 2087 Hanford CA 93232 (559)537-0297DiPietro Jamie 1740477850 20A11764 DO 77-0361443 Primary, Mailing, Billing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Grewall Jatinder 1821292152 A99543 MD 77-0361443 Mailing, Primary, Billing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Griffith Lyle 1528268372 Spanish MD 93-1083369 Mailing, Billing, Primary Griffith Urology Clinic PC 1004 N Douty Hanford CA 93230 (559)582-4245 (559)582-4298Julian John 1467457093 G75874 Spanish MD 77-0361443 Mailing, Primary, Billing Urology Associates of Central California 7014 N. Whitney Fresno CA 93720 (559)321-2898 (559)432-2252Julian Sydney 1760487375 C33145 MD 77-0361443 Primary, Billing, Mailing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Leung Yuk-Yuen 1083612949 A92169 Cantonese MD 77-0361443 Primary, Billing, Mailing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Schiff William 1629073226 G50243 Spanish MD 77-0361443 Primary, Billing, Mailing Urology Associates of Central California (UACC) 7014 N. Whitney Ave. Fresno CA 93720 (559)321-2800 (559)321-2787Vascular Surgery

Page 17: Fresno PACE Provider List P rovidef mb th San / AC EO NLY T...Mofidi Roshanak 1912255282 A148811 Farsi MD 77-0500726 Billing POBox45123 SanFranciscCoA 94145 (559)228-5473 Mofidi Roshanak

Eckroth-Bernard Kamell 1558522094 A102660 MD 46-3969536 Primary Valley Vascular Surgery Associates/University Faculty Associates, Inc. 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005Eckroth-Bernard Kamell 1558522094 A102660 MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Hadcock William 1154353795 A41224 Spanish MD 46-3969536 Mailing, Primary, Billing Valley Vascular Surgery Associates/UFA 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005Stern Randall 1962512319 G33214 Spanish MD 46-3969536 Primary Valley Vascular Surgery Associates/UFA 1247 E. Alluvial #101 Fresno CA 93720 (559)431-6226 (559)440-9005Stern Randall 1962512319 G33214 Spanish MD 46-3969536 Billing PO Box 5418 Fresno CA 93755 (559)443-2682Weight ManagementMahal Amber 1134370901 A90980 MD 26-4093106 Primary, Billing, Mailing Weight Management 7710 N. Fresno St. #102 Fresno CA 93720 (559)437-9100 (559)437-9111Mahal Kanwar 1154455806 A88928 Hindi MD 26-4093106 Primary, Mailing, Billing Weight Management 7710 N. Fresno St. #102 Fresno CA 93720 (559)437-9100 (559)437-9111


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