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Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Adams
Not Provided 601 Rosary Dr Corning, IA /
Adams
50841 Kopp Bethel Corning Adams Closed -
Unreachable
Adams
Rosary Clinic Hagen Traci Corning Adams Closed -
Enrolled
Appanoose
Not Provided 19876 Saint
Joseph Drive
Centerville, IA /
Appanoose
52544 Parrish Cassie Centerville Appanoose Closed -
Unreachable
Audubon
Not Provided 515 Pacific Ave
Ste 2
Audubon, IA / Cunningham James Kimballton Audubon Closed -
Declined
Benton
Atkins Family Medicine Clinic 52206 VOGLER Stephani
e
Hiawatha Linn Closed -
Enrolled
Benton
Unity Point Shellsburg 52332 Hoffmann Julie Vinton Benton Closed -
Already
Participating
Benton
UNITY POINT SCHELLSBURG HOFFMANN JULIE Vinton Benton Closed -
Enrolled
Benton
Unity Point Shellsburg Hoffmann Julie Shellsburg Benton Closed -
Unreachable
Black Hawk
Covenant Clinic Division 50613 Moore Paula Waterloo Black Hawk Closed -
Unreachable
Black Hawk
COVENANT Clinic 50702 Visokey DR
Davod
Evansdale Black Hawk Closed -
Current
Appointment
Black Hawk
Covenant Midwives and Women's
Health
50702 Goodrich Amber Waterloo Black Hawk Closed -
Unreachable
Black Hawk
Peoples Clinic 50703 Ijaz Kiran Waterloo Black Hawk Closed -
Declined
Black Hawk
Peoples Community Health Clinic 50703 Lame Sarah Waterloo Black Hawk Closed - Intake
Only
Black Hawk
Covenant Clinic Pulmonology Visokey David Evansdale Black Hawk Closed - Intake
Only
Black Hawk
FAM MED WATERLOO UNITYPOINT
CLINIC
Closed -
Unreachable
Black Hawk
FAM MED WATERLOO UNITYPOINT
CLINIC
Waterloo Black Hawk Closed -
Enrolled
Black Hawk
Iowa Dept of Human Services 5100 Prairie
Parkway
Cedar Falls, IA
/
Huwe Cindy Waterloo Black Hawk Closed -
Unreachable
Black Hawk
Not Provided 905 Franklin Waterloo, IA / Berry Carrie Waterloo Black Hawk Closed -
Unreachable
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 1 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Black Hawk
Peoples Clinic Berry Carrie Waterloo Black Hawk Closed -
Unreachable
Black Hawk
Peoples Community Health Clinic Kane Sarah Waterloo Black Hawk Closed -
Already
Participating
Black Hawk
Peoples Community Health Clinic N/A Berry Carrie Denver Bremer Closed - Intake
Only
Black Hawk
PEOPLES COMMUNITY HEALTH
CLINIC
Waterloo Black Hawk Closed -
Enrolled
Black Hawk
Peoples Community Health Clinic Emily Waterloo Black Hawk Closed -
Enrolled
Black Hawk
PEOPLES COMMUNITY HEALTH
CLINIC
Closed -
Already
Participating
Black Hawk
Peoples Community Health Clinic Gutz Emily Waterloo Black Hawk Closed -
Already
Participating
Black Hawk
PEOPLES COMMUNITY HEALTH
CLINIC
Waterloo Black Hawk Closed -
Unreachable
Black Hawk
PEOPLES COMMUNITY HEALTH
CLINIC
Evansdale Black Hawk Closed -
Unreachable
Black Hawk
Peoples Community Health Clinic Independence Buchanan Closed - Intake
Only
Black Hawk
Sartori Hsp Iqbal Jamaica Guthrie Closed -
Unreachable
Boone
Not Provided 120 South Story
Street
Boone, IA /
Boone
50036 Kalenak Alexande
r
Boone Boone Closed -
Enrolled
Boone
Cherokee Menta Health Institute Madrid Boone Closed -
Declined
Bremer
Waverly Health Center-Womens Clinic 50677 Rathe Ann Clarksville Butler Closed -
Unreachable
Bremer
Waverly Health Center- Women's Clinic Rathe Ann Nashua Chickasaw Closed -
Enrolled
Buchanan
Not Provided Sinram Erin Independence Buchanan Closed -
Unreachable
Buena Vista
Not Provided 2015 West 5th
Street
Storm Lake, IA
/ Buena Vista
50588 Huisenga Jason Storm Lake Buena Vista Closed -
Enrolled
Butler
Unity Point Clinic Allison 50602 Foxer Montica Parkersburg Butler Closed -
Unreachable
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 2 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Calhoun
Not Provided 1351 W Main LakeCity, IA / Duncan Pomeroy Calhoun Closed -
Unreachable
Carroll
DMU Family Medicine 3200 Grand Ave Des Moines, IA
/ Carroll
51401 Garner Sheila Closed -
Duplicate
Cass
AMC 1501 E 10th St Atlantic, IA /
Cass
50022 Brend Sarah Anita Cass Closed -
Unreachable
Cass
ATLANTIC MED CTR Cumberland Cass Closed -
Unreachable
Cass
Atlantic Medical Center Atlantic Cass Closed - Intake
Only
Cass
Atlantic Medical Center Robinson Mary Griswold Cass Closed -
Enrolled
Cass
Atlantic Medical Center Robinson Mary Wiota Cass Closed - Intake
Only
Cerro Gordo
Mercy Family Medicine Residency 1000 Fourth
Street S.W.
Mason City, IA
/ Cerro Gordo
50401 Roy Rency Mason City Cerro Gordo Closed -
Enrolled
Cerro Gordo
Not Provided 1010 4th St ste
340
Mason City, IA
/ Cerro Gordo
50401 Kuhn Hayley Mason City Cerro Gordo Closed -
Enrolled
Cerro Gordo
Not Provided 331 13th St SE Mason City, IA
/ Cerro Gordo
50401 Parekm Preyans
ho
Mason City Cerro Gordo Closed -
Enrolled
Cerro Gordo
Mercy Family Clinic Clear Lake Clear Lake Cerro Gordo Closed - Intake
Only
Cherokee
Cherokee Mental Health Institute 51012 Baughman N/A Cherokee Cherokee Closed -
Unreachable
Cherokee
Cherokee Regional Clinic 300 Sioux valley Cherokee, IA /
Cherokee
51012 Vandelune Christop
her
Aurelia Closed -
Unreachable
Cherokee
Cherokee Regional Clinic 300 Sioux Valley
Dr
Cherokee, IA /
Cherokee
51012 Tentinger Abby Cherokee Closed -
Declined
Cherokee
Cherokee Regional Clinics 300 Sioux Valley
Dr.
Cherokee, IA /
Cherokee
51012 Mogensen-
Kruger
ARNP
Rebecca Quimby Closed -
Unreachable
Cherokee
Cherokee Regional clinid 300 sioux Valley
Dr
Cherokee, IA /
Cherokee
51012 Mogensen-
Kruger
Rebecca Cherokee Closed -
Unreachable
Cherokee
Cherokee Family Practice Cherokee Cherokee Closed -
Declined
Cherokee
CHerokee Family Practice Cherokee Cherokee Closed -
Enrolled
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 3 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Cherokee
Cherokee Regional Clinics Rice Timothy Marcus Cherokee Closed -
Unreachable
Cherokee
Cherokee Regional Clinics Rice Timothy Marcus Cherokee Closed -
Enrolled
Clarke
CLARKS COUNTY HOSPITAL Osceola Clarke Closed -
Unreachable
Clinton
Community Health Care 925 S 4th St Clinton, IA /
Clinton
52732 Johnson Brooke Clinton Clinton Closed -
Unreachable
Clinton
COMMUNITY HEALTH CARE 925 SOUTH 4TH
ST
CLINTON, IA /
Clinton
52732 Clinton Clinton Closed -
Enrolled
Clinton
Community Health Care 925 South 4th
Street
Clinton, IA /
Clinton
52732 Fuller Ashley Clinton Clinton Closed -
Unreachable
Clinton
COMMUNITY HEALTH CARE INC 925 SOUTH 4TH
ST
CLINTON, IA /
Clinton
52732 JOHNSON BROOK
E
CHARLOTTE Clinton Closed -
Enrolled
Clinton
Community Health Care, Inc. 925 South 4th
Street
Clinton, IA /
Clinton
52732 Johnson Brook Clinton Clinton Closed -
Enrolled
Clinton
Medical Associates 52732 Kauffman Theresa Clinton Clinton Closed -
Enrolled
Clinton
Not Provided 4800 Utica Ridge
Rd ste 2235
Bettendorf, IA /
Clinton
52732 Mehta Falquni Davenport Scott Closed - Intake
Only
Clinton
Steven Breaux MD PC 52732 Breaux Steven Clinton Clinton Closed -
Unreachable
Clinton
Not Provided 1021 11th st Dewitt, IA /
Clinton
52742 Fowler Steven Eldridge Scott Closed -
Enrolled
Clinton
Mercy Medical Center Clinton Hoff Stephine Clinton Clinton Closed -
Declined
Clinton
Mercy Medical Center Clinton Clinton Clinton Closed -
Enrolled
Dallas
Mercy Clinics 50220 Sohu Steven Yale Guthrie Closed -
Unreachable
Dallas
Not Provided 30 E Hickman Rd Waukee, IA /
Dallas
50263 Engel-
Brower
Hanna West Des
Moines
Polk Closed -
Unreachable
Dallas
Not Provided 25 W Hickman
Rd Ste 100
Waukee, IA /
Dallas
50263 Bowshier Laura Adel Dallas Closed -
Unreachable
Dallas
Mercy Family Care Perry Noble Jason Grinnell Poweshiek Closed -
Unreachable
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 4 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Delaware
REGIONAL FAMILY HEALTH 52057 gerst dr tim Manchester Delaware Closed -
Declined
Delaware
Regional Family Health 52057 CUMMINGS CLINTO
N
Quasqueton Buchanan Closed -
Declined
Delaware
Regional Family Health Cummings Clinton Quasqueton Buchanan Closed -
Already
Participating
Delaware
Regional Family Health Cummings Clinton Dubuque Dubuque Closed -
Unreachable
Des Moines
CHC/SEIA 52655 HAUENSTEI
N
NAARAH Burlington Des Moines Closed -
Enrolled
Des Moines
CHCI Seia 52655 Ihrig Timothy West
Burlington
Des Moines Closed -
Duplicate
Des Moines
Community Health Center Southeast IA 52655 Zwanziger Rebecca Burlington Des Moines Closed -
Unreachable
Des Moines
Community health center southeast
Iowa
52655 Lawer Georgia Burlington Des Moines Closed - Intake
Only
Des Moines
Not Provided 1706 W Agency
Rd
W Burlington,
IA / Des
Moines
52655 Elliott Charissa Burlington Des Moines Closed -
Declined
Des Moines
CHC/SFIA Burlington Des Moines Closed -
Enrolled
Des Moines
Great River Pulmonary Velno Denz Valerie Burlington Des Moines Closed -
Unreachable
Dubuque
Not Provided 8293 Hendricks
ln
Peosta, IA /
Dubuque
52068 Benda Jr Thomas Peosta Dubuque Closed -
Enrolled
Dubuque
REGIONAL FAMILY HEALTH CUMMINGS CLINTO
N
Dubuque Dubuque Closed -
Unreachable
Greene
McFarland Clinic 50129 Gordon Ruth Grand
Junction
Greene Closed -
Enrolled
Greene
McFarland Clinic Gerdes James Jefferson Greene Closed - Intake
Only
Grundy
Not Provided 1506 G Avenue Grundy Center,
IA / Grundy
50638 LaTendresse Charles Grundy Center Grundy Closed -
Enrolled
Hamilton
Not Provided 903 Willson
Avenue
Woodhouse Don Duncombe Webster Closed -
Enrolled
Hardin
Unity Point Southglen FP 7481
Highway65.69
Des Moines, IA
/ Hardin
50230 Jenkins Jennifer Pleasant Hill Polk Closed -
Enrolled
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 5 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Harrison
ACH Community Memorial Hospital -
Missouri Valley
631 North 8th
Street
Missouri
Valley, IA /
Harrison
51555 Grady Carrie Missouri Valley Harrison Closed -
Unreachable
Henry
Family Medicine Mt Pleasant 52641 Wagner Julie Winfield Henry Closed -
Unreachable
Henry
Family Medicine Of Mt Pleasant Lockridge Jefferson Closed -
Declined
Henry
IRL FAMILY MEDICINE Winfield Henry Closed -
Already
Participating
Howard
Cresco Medical Center Haas Mary Cresco Howard Closed - Intake
Only
Howard
Cresco Medical Clinic Kammerer Jon Cresco Howard Closed -
Unreachable
Ida
Not Provided 101 2nd Street Ida Grove, IA /
Ida
51445 Blankenship Angela Denison Crawford Closed - Intake
Only
Iowa
OBGYN Assoc. PC Bussrwitz Elizabeth South Amana Iowa Closed -
Unreachable
Jackson
Medical Associates 52060 THOMPSON DR K Baldwin Jackson Closed -
Unreachable
Jackson
Medical Associates fo Muloveketa 52060 Peterson Eric Maquoketa Jackson Closed -
Declined
Jackson
Medical Associates of Maquoketa 52060 Petersen Eric Maquoketa Jackson Closed -
Enrolled
Jasper
Newton Clinic 50208 Unknown Unknow
n
Newton Jasper Closed -
Unreachable
Jasper
Newton Clinic 50208 Yardley Lyndi Newton Jasper Closed -
Unreachable
Jasper
Not Provided 300 n 4th Ave E
ste 200
Newton, IA / 50508 Holloway Jodi Newton Jasper Closed -
Unreachable
Jasper
Not Provided 300 N 4th Ave E Newton, IA / Ruggle paul Closed -
Enrolled
Johnson
IRL East Family Medicine 52241 Kics Valerie Iowa City Johnson Closed -
Enrolled
Johnson
Not Provided 105 East 9th
Street
Coralville, IA /
Johnson
52241 Tandon Anamika North Liberty Johnson Closed -
Unreachable
Johnson
Not Provided 920 E 2nd Ave Coralville, IA /
Johnson
52241 Banu Hussain Iowa City Johnson Closed -
Enrolled
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 6 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Johnson
UIHC Internal Medicine IRL 52241 Dirksen Rachael Burlington Des Moines Closed -
Enrolled
Johnson
Not Provided 200 Hawkins
Drive
Iowa City, IA /
Johnson
52242 Newtson Andrea Davenport Scott Closed -
Unreachable
Johnson
Not Provided 200 Hwkins Dr
11911 JPP
Iowa City, IA /
Johnson
52242 Hsiao Shelly Coralville Johnson Closed -
Unreachable
Johnson
Not Provided 200 Hawkins
Drive
Iowa City, IA /
Johnson
52242 Shriver Erin Spragueville Jackson Closed -
Enrolled
Johnson
UIHC Family Med 200 Hawkins Dr 52242 Flint Diana Coralville Johnson Closed -
Already
Participating
Jones
Eastern Iowa Health Center Snitker Sara Anamosa Jones Closed -
Enrolled
Jones
Jones Regional Anamosa Clinic Schepanski Alissa Anamosa Jones Closed -
Enrolled
Keokuk
Not Provided 1314 South
Stuart Street,
Suite B
Sigourney, IA /
Keokuk
52591 Obradovich Lucia Hayesville Keokuk Closed -
Enrolled
Kossuth
KRHC 50511 Venteicher Rachel Algona Kossuth Closed -
Unreachable
Lee
IA Dept of Public Health. 5409 Ave O Ft Madison, IA
/ Lee
52627 Newton Chase Keokuk Lee Closed - Intake
Only
Lee
Not Provided 5409 Avenue O Fort Madison,
IA / Lee
52627 Newton Chase Keokuk Lee Closed -
Unreachable
Lee
Not Provided Newton Chase Donnellson Lee Closed -
Ineligible
Linn
Not Provided 310 Highway 1
Southeast
Mount Vernon,
IA / Linn
52314 Pentico Todd Lisbon Linn Closed -
Unreachable
Linn
Mercy Cardiology Clinic 788 8th Ave SE Cedar Rapids,
IA / Linn
52401 dhaliwal amande
ep
Cedar Rapids Closed -
Unreachable
Linn
Not Provided 600 7th St SE
Ste 101
Cedar Rapids,
IA / Linn
52401 Meeker Monica Fairfax Linn Closed -
Unreachable
Linn
AM Mercy Pulmonary Medicine Center 1201 3rd Ave SE Cedar Rapids,
IA / Linn
52403 Efimov Alexandr
e
CEDAR
RAPIDS
Linn Closed -
Unreachable
Linn
AM Mercy Pulmonary Medicine Center 1201 3rd Ave SE Cedar Rapids,
IA / Linn
52403 Efimov Alexandr
e
Cedar Rapids Linn Closed -
Unreachable
Linn
Eastern IA Health Center 52403 Schabilin Rose Cedar Rapids Linn Closed -
Enrolled
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 7 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Linn
Eastern IA Health Center 52403 Snitker Sara Cedar Rapids Linn Closed -
Enrolled
Linn
Eastern Iowa Health Center 52403 Bhalala Neel Marion Linn Closed -
Unreachable
Linn
Eastern Iowa Health Center 52403 Snitker Sara Marion Linn Closed -
Current
Appointment
Linn
EIHC 52403 Jindal Prachi Cedar Rapids Linn Closed -
Enrolled
Linn
EIHC 52403 Wilson Amy Hiawatha Linn Closed -
Duplicate
Linn
Northwest Medical 1444 2 Ave SE Cedar Rapids,
IA / Linn
52403 Ramsey Merrilee Cedar Rapids Linn Closed -
Enrolled
Linn
Not Provided 850 4th Ave SE Cedar Rapids,
IA / Linn
52403 Younger Clete Cedar Rapids Linn Closed - Intake
Only
Linn
EASTERN Inna Health Center 52404 BRYNE DAVID Marion Linn Closed -
Unreachable
Linn
Northwest Medical 1444 Second Ave
SE
Cedar Rapids,
IA / Linn
52406 Cedar Rapids Linn Closed -
Enrolled
Linn
Eastern Iowa Health Center Maturu Dr Cedar Rapids Linn Closed -
Unreachable
Linn
Eastern Iowa Health Center N/A Donovan Dr
Jennifer
Cedar Rapids Linn Closed -
Enrolled
Linn
Eastern Iowa Health Center Young-
cooper
Jacqueli
ne
Cedar Rapids Linn Closed -
Unreachable
Linn
Eastern Iowa Health Center Matura Ramya Marion Linn Closed -
Unreachable
Linn
Eastern Iowa Health Centere Cedar Rapids Linn Closed - Intake
Only
Linn
EIHC Bhalala Neel Cedar Rapids Linn Closed -
Unreachable
Linn
EIHC Hiawatha Linn Closed -
Enrolled
Linn
EIHC Cedar Rapids Linn Closed -
Unreachable
Linn
Not Provided Cree Barbara Newhall Benton Closed -
Declined
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 8 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Linn
Not Provided 830 4th Avenue
Southeast, Suite
1
Younger Clete Walker Linn Closed -
Enrolled
Linn
Not Provided 2375 Edgewood
Road SW
Cedar Rapids,
IA /
Kahler Melissa Cedar Rapids Linn Closed - Intake
Only
Linn
OBGYN Bemus Scott Springville Linn Closed -
Unreachable
Linn
The Ghosh Center Harpers Ferry Allamakee Closed -
Enrolled
Linn
The Ghosh Center Closed -
Enrolled
Mahaska
Not Provided 112 S Main St New Sharon,
IA / Mahaska
50207 Smith Lisa Barnes City Mahaska Closed -
Enrolled
Marion
Pleasantville Clinic 104 Washington
St
Pleasantville,
IA / Marion
50225 Booth Brandi Pleasantville Closed -
Enrolled
Marshall
McFarland Clinic PC 50158 Ruopp Megan Marshalltown Marshall Closed -
Unreachable
Marshall
Primary Health 50158 Swinton Tim Eldora Hardin Closed -
Unreachable
Marshall
Primary Health Care 50158 Swinton Tim Marshalltown Marshall Closed -
Unreachable
Marshall
Primary Health Care 50158 Swinton Tim Saint Anthony Marshall Closed -
Unreachable
Marshall
Primary Health Care 50158 Harter Marilyn Marshalltown Marshall Closed -
Unreachable
Marshall
Primary Health Care 50158 Harter Marilyn Marshalltown Marshall Closed -
Enrolled
Marshall
Not Provided 503 3rd ave sw State Center,
IA / Marshall
50247 George Amanda State Center Marshall Closed -
Unreachable
Marshall
CIH Marshalltown Marshalltown Marshall Closed -
Unreachable
Marshall
Primary Health Care Gilman Marshall Closed -
Unreachable
Marshall
Primary Health Care Marshalltown Marshall Closed -
Enrolled
Marshall
Primary Health Care Haverhill Marshall Closed -
Enrolled
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 9 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Marshall
primary Health Care Dale Allan Marshalltown Marshall Closed - Intake
Only
Marshall
Primary Health Care Clinic Dale Allen Saint Marys Warren Closed -
Enrolled
Marshall
PRIMARY HEALTHCARE CLENDENIN
G
DEBOR
AH
Marshalltown Marshall Closed -
Unreachable
Mills
CHI Health Clinic 1203 S Locust St Glenwood, IA /
Mills
51534 Kent Robert Emerson Closed -
Unreachable
Mills
Not Provided 1701 Broadway Council Bluff,
IA / Mills
51571 Silver City Mills Closed -
Enrolled
Monona
BURGESS MAPLETON CLINIC 51034 Walker Chad Ricketts Crawford Closed -
Unreachable
Monona
Burgess Mapleton Clinic 51034 Walker Chad Ricketts Crawford Closed -
Unreachable
Monona
Burgess Family Clinic Schenne Jennifer Ute Monona Closed -
Unreachable
Montgomery
Villisca Family Health Center 50864 Martinez Effie Clarinda Page Closed -
Unreachable
Montgomery
Villisca Family Health Center 50864 Martinez Effie Villisca Montgomery Closed -
Unreachable
Muscatine
UICMS Muscatine 52761 Nelson Christina Muscatine Muscatine Closed -
Ineligible
Muscatine
Unity Point Clinic 52761 Cox Lindsay Muscatine Muscatine Closed -
Already
Participating
Muscatine
UNITY POINT CLINIC 52761 PAULSRUD DR
STEVEN
Mediapolis Des Moines Closed -
Enrolled
Muscatine
Unity Point Clinic Family Medicine North Port, IA /
Muscatine
52761 Muscatine Muscatine Closed -
Enrolled
Muscatine
Unity Point Family Medicine at Mulberry 52761 Pohl Ben Muscatine Muscatine Closed - Intake
Only
Nebraska
Nebraska Medicine 68198 Darrah Lauren Council Bluffs Pottawattam
ie
Closed -
Already
Participating
Nebraska
ACH BERGAN MERCY MED CTR Closed -
Unreachable
Page
Clarinda Medical Associates 51362 Furst Talisha CLARINDA Page Closed -
Already
Participating 4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 10 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Page
Shenandoah Physicians Clinic 51601 Olberding Kauindra Shenandoah Page Closed - Intake
Only
Page
Shenandoah Physicians Clinic 51601 Holmes Connie Shenandoah Page Closed -
Unreachable
Page
SMC Womens Center 300 Pershing Ave Shenandoah,
IA / Page
51601 Prusa Flores Jessica Shenandoah Page Closed -
Unreachable
Page
Clarinda Medical Associates 51632 Furst Talisha Braddyville Page Closed - Intake
Only
Page
Clarinda Medical Associates 51632 Furst Talish Braddyville Page Closed -
Unreachable
Page
Clarinda Medical Associates CMA 51632 Bjorn Michele Clarinda Page Closed -
Current
Appointment
Page
Clannda Regional Health Care Bedford Taylor Closed -
Enrolled
Page
Clarinda Medical Associates Freemen Steven Clarinda Page Closed -
Unreachable
Page
CRHC Clarinda Page Closed - Intake
Only
Page
Shenandoah Medical Center Holmes Connie Shenandoah Page Closed -
Enrolled
Palo Alto
Palo Alto County Health System 3201 1st Street Emmetsburg,
IA / Palo Alto
50536 Prabhakaran Madhan Emmetsburg Closed -
Enrolled
Palo Alto
Palo Alto County Health System 3201 1st Street Emmetsburg,
IA / Palo Alto
50536 Frields Amy Emmetsburg Closed -
Declined
Plymouth
Other 714 Lincoln St Le Mars, IA / Holcomb Sheila Le Mars Plymouth Closed -
Enrolled
Pocahontas
Unity Point Clinic 307 W Hwy 10 Laurens, IA /
Pocahontas
50554 Maurer Kylie Closed -
Unreachable
Polk
Not Provided 8900 NW 86th
ste 100
Johnston, IA /
Polk
50131 Vander Joel Boone Boone Closed - Intake
Only
Polk
Not Provided 320 Watson
Powekk Jr Way
Des Moines, IA
/ Polk
50309 Tiemens Christin Des Moines Polk Closed - Intake
Only
Polk
Not Provided 320 Watson
Powell Jr Way
Des Moines, IA
/ Polk
50309 Steinmann Lori Indianola Warren Closed -
Unreachable
Polk
Mercy Beverdale Clinic 1750 48th St Ste
1
TXS Mornes,
IA / Polk
50310 Callahan Robert Norwalk Warren Closed -
Unreachable
4/14/2017 1:24:12 PM
/QLR Reporting/Production Reports
Page 11 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Polk
DMU Family Medicine 3200 Grand Ave Des Moines, IA
/ Polk
50312 Garner Sheila Closed -
Duplicate
Polk
Broadlawns Geriatric Clinic 50314 Bender Robert Johnston Polk Closed -
Unreachable
Polk
Broadlawns Medical Center 50314 Lair Bradley Des Moines Polk Closed -
Enrolled
Polk
Not Provided 1801 Hickman
Road
Des Moines, IA
/ Polk
50314 Matson Christop
her
Des Moines Polk Closed -
Unreachable
Polk
Not Provided 1801 Hickman
Rd
Des Moines, IA
/ Polk
50314 Mathes DES MOINES Polk Closed - Intake
Only
Polk
Primary Health at Mercy 250 Laurel St Des Moines, IA
/ Polk
50314 Gill Vikram Des Moines Polk Closed -
Enrolled
Polk
Mercy South Medical Clinic Triage 6601 SW 9th St Des Moines, IA
/ Polk
50315 Nordstom Lindy Closed -
Unreachable
Polk
Not Provided 6601 SW 8th St Des Moines, IA
/ Polk
50315 Zachary Dennis New Virginia Warren Closed -
Unreachable
Polk
Not Provided 6601 SW 9th St Des Moines, IA
/ Polk
50315 Nordstrom Lindy Des Moines Polk Closed -
Unreachable
Polk
Not Provided 5101 SE 14th ST Des Moines, IA
/ Polk
50320 Young Sheryl Des Moines Polk Closed -
Unreachable
Polk
Not Provided 5900 East
Univeristy, Suite
100
Pleasant Hill,
IA / Polk
50327 Abler Jennifer Des Moines Polk Closed - Intake
Only
Polk
Des Moine University Clinic Crane Amy Des Moines Polk Closed -
Duplicate
Polk
DES MOINES UNIVERSITY CLINIC Des Moines Polk Closed -
Declined
Polk
Not Provided 3509 E 29th St Des Moines, IA
/
Newton
Rosenaw
Mandy Des Moines Polk Closed -
Enrolled
Polk
Not Provided 7481 Hwy 65169 Des Moines, IA
/
Lamberty Amy Des Moines Polk Closed -
Enrolled
Polk
Not Provided Hanson Doug Earlham Madison Closed - Intake
Only
Polk
Parks Area Family Clinic Hatchcroft Michelle Des Moines Polk Closed -
Unreachable
Pottawattamie
All Care Health Center 51501 Aabinda Afeera Council Bluffs Pottawattam
ie
Closed -
Unreachable
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Page 12 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Pottawattamie
CHI West Broadway Clinic 51501 Vacek Joyce Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital 51501 Willadsen Kent Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital 51501 Jones Christian Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Not Provided 1701 W
Broadway
Council Bluffs,
IA /
Pottawattamie
51501 Rabadi-
Marar
Diana Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Not Provided 1701 W Bdy Council Bluff,
IA /
Pottawattamie
51501 Rabadi-
Marar
Diana Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Not Provided 1701 W
Broadway
Council Bluff,
IA /
Pottawattamie
51501 Bodalucco Laura Council Bluffs Pottawattam
ie
Closed -
Ineligible
Pottawattamie
Not Provided 1701 W
Broadway
Council Bluff,
IA /
Pottawattamie
51501 Badalucco Laura Carter Lake Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Chi Health Alegent Crghtn Clinic 1751 Madison
Ave
Council Bluffs,
IA /
Pottawattamie
51503 Whalen James Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Heartland Oncology and Hematology 51503 Hassain Sakeer Elk Horn Shelby Closed -
Declined
Pottawattamie
Iowa Dept of Human Services 1001 Risenson
Blvd
Council Bluffs,
IA /
Pottawattamie
51503 Willadsen Kent Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
METHODIST JEANNIE EDMUNSON
HOSP
51503 MCCOO
L
Council Bluffs Pottawattam
ie
Closed -
Declined
Pottawattamie
METHODIST JEANNIE-EDMUNDSON
HOSPITAL
51503 ESMADI DR Clarinda Page Closed - Intake
Only
Pottawattamie
Methodist Jennie Edmundson 51503 Huang Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Methodist Jennie Edmundson Hospital 51503 Armbruster Robert Council Bluffs Pottawattam
ie
Closed -
Declined
Pottawattamie
Methodist Jennie Edmundson Hospital 51503 Haan Jenni Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital 51503 Coker Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital 933 East Pierce
St
Council Bluffs,
IA /
Pottawattamie
51503 Alvarez Jorge Council Bluffs Closed -
Unreachable
Pottawattamie
METHODIST PHYSICIAN CLINIC 51503 NADIA Council Bluffs Pottawattam
ie
Closed - Invalid
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Page 13 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Pottawattamie
METHODIST PHYSICIANS CLINIC 51503 Rawamitsu Takashi Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
CHI West Broadway Clinc Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Heartland Oncology & Hematology Husain Sakeer Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Heartland Oncology and Hematology Hussain Sakeer Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Methodist Jennie Silver City Mills Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmondson
Hospital/Lung
Jones Christian Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundison Hospital Suedkamp Avoca Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Vogel Angela Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
METHODIST JENNIE EDMUNDSON
HOSP
Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hosp Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital N/A Whalen Dr
James
Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
Methodist Jennie Edmundson Hospital Council Bluffs Pottawattam
ie
Closed -
Unreachable
Pottawattamie
METHODIST JENNIE EDMUNSON
HOSP
Closed -
Ineligible
Pottawattamie
Not Provided 3135 W
Broadway
Council Bluff,
IA /
Sheppard K Neil Council Bluffs Pottawattam
ie
Closed -
Enrolled
Pottawattamie
Not Provided 1701 West
Broadway
Council Bluffs,
IA /
Marar Isam Council Bluffs Pottawattam
ie
Closed -
Declined
Scott
GHG Bettendorf Health Prep 52722 Daniel Myra Tipton Cedar Closed -
Declined
Scott
Not Provided 4480 Utica
Bridge Rd ste
2236
Bettendorf, IA /
Scott
52722 Menta Falqurs Davenport Scott Closed - Intake
Only
Scott
Not Provided 4311 E 5rd St Davenport, IA /
Scott
52748 Eldridge Scott Closed -
Enrolled
4/14/2017 1:24:12 PM
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Page 14 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Scott
COMMUNITY HEALTH 52801 CHARA DR Davenport Scott Closed -
Current
Appointment
Scott
Community Health Care 52801 Misiag Davenport Scott Closed -
Unreachable
Scott
Community Health Care 52801 Javron Sarah Eldridge Scott Closed -
Unreachable
Scott
Community Health Care 52801 Jauron Sarah Davenport Scott Closed -
Unreachable
Scott
Community Health Care 52801 Jauron Sarah Davenport Scott Closed -
Current
Appointment
Scott
Community Health Care 52801 Besch Jackie Davenport Scott Closed -
Unreachable
Scott
Community Health Care 500 W River Dr Davenport, IA /
Scott
52801 Schmidt Carrie Davenport Scott Closed -
Unreachable
Scott
Community Health Care 52801 Besch Jacklyn Davenport Scott Closed -
Unreachable
Scott
Community Health Care 52801 Barkley Stephani
e
Walcott Scott Closed -
Already
Participating
Scott
Community Health Care 52801 Chana Dr Davenport Scott Closed -
Enrolled
Scott
Community Health Care 52801 Metuge Anne Davenport Scott Closed -
Duplicate
Scott
Community Health Care River Drive
Clinic
500 W River Dr Davenport, IA /
Scott
52801 Chana Davenport Scott Closed -
Unreachable
Scott
Community Health Care, Inc. 52801 Sheldon Tami Davenport Scott Closed -
Enrolled
Scott
Community Healthcare 52801 Metuge Anne Davenport Scott Closed -
Unreachable
Scott
Community Healthcare 52801 Metuge Anne Davenport Scott Closed -
Unreachable
Scott
Community Healthcare 52801 Metuge Anne Davenport Scott Closed -
Duplicate
Scott
Not Provided 1820 West 3rd
Street
Davenport, IA /
Scott
52802 Cone Regan Davenport Scott Closed -
Unreachable
Scott
Family Medicne 1805 Brady St Davenport, IA /
Scott
52803 Alston Jessica Davenport Scott Closed -
Unreachable
4/14/2017 1:24:12 PM
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Page 15 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Scott
Not Provided 1345 West
Central Park
Avenue
Davenport, IA /
Scott
52804 Woodhouse Cristina Donahue Scott Closed -
Enrolled
Scott
Not Provided 1345 W Central
Park
Davenport, IA /
Scott
52804 Davis Brittany Davenport Scott Closed -
Unreachable
Scott
Not Provided 1345 West
Central Park
Avenue
Davenport, IA /
Scott
52804 Brokloff Nicole Davenport Scott Closed -
Unreachable
Scott
Not Provided 1351 W
CENTRAL PARK
AVE
DAVENPORT,
/ Scott
52804 Hunemuller Heather Tipton Cedar Closed -
Enrolled
Scott
Vera French Community Mental Health
Center
1441 W Central
Park Ave
Davenport, IA /
Scott
52804 Nelson Genevie
ve
Le Claire Scott Closed -
Unreachable
Scott
Vera French Community Mental Health
Center
1441 W Central
Park Ave
Davenport, IA /
Scott
52804 Nelson Geneviv
e
Le Claire Scott Closed -
Unreachable
Scott
Unity Point Family Medicine 52807 Blechle Kevin Blue Grass Scott Closed -
Unreachable
Scott
UNITY POINT FAMILY MEDICINE 52807 Blechle Kevin DAVENPORT Scott Closed -
Unreachable
Scott
Community Health Care Davenport Scott Closed -
Current
Appointment
Scott
Community Health Care Johnson Brooke Clinton Clinton Closed -
Enrolled
Scott
Community Health Care Clinton Clinton Closed -
Ineligible
Scott
Community Health Care Metuge Anne Davenport Scott Closed -
Unreachable
Scott
COMMUNITY HEALTH CARE BARKLEY STEPHA
NIE
Davenport Scott Closed -
Unreachable
Scott
Community Health Care Jauron Sarah Davenport Scott Closed -
Current
Appointment
Scott
Community Health Care Metuge Anne Davenport Scott Closed -
Unreachable
Scott
Community Health Care Davenport Scott Closed -
Unreachable
Scott
Community Health Center Bisch Jacklyn Davenport Scott Closed -
Already
Participating
Scott
GHG PULMONARY ASSOCIATES WONG HUMPH
REY
Maquoketa Jackson Closed -
Ineligible
4/14/2017 1:24:12 PM
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Page 16 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Scott
Unity Point Family Medicine Blechie Dr Kevin Davenport Scott Closed -
Unreachable
Sioux
Sioux Center Health 51250 Koelewyn Jason Sioux Center Sioux Closed -
Enrolled
Story
McFarland Clinic (FMW) 3600 W Lincoln
Way
Ames, IA /
Story
50014 Bohner Scott Ames Closed -
Unreachable
Taylor
Not Provided 408 Dodge Kempf Michelle Bedford Taylor Closed -
Enrolled
Union
Unity Point Family 50801 Gapp April Closed -
Already
Participating
Unknown
Heart of Iowa 25404 Achenbach Andrea Cedar Rapids Linn Closed -
Unreachable
Unknown
La Clinica De La Esperanza 50512 Gunn Kelly Latimer Franklin Closed -
Unreachable
Unknown
CHI HEALTH 51501 Amubuster Janice Council Bluffs Pottawattam
ie
Closed -
Ineligible
Unknown
CHI Health Clinic 68107 Council Bluffs Pottawattam
ie
Closed -
Current
Appointment
Unknown
Alere Closed -
Enrolled
Unknown
AMERIGROUP CRESTON Union Closed -
Unreachable
Unknown
AVERA MED GROUP Sioux City Woodbury Closed -
Unreachable
Unknown
Care for Yourself Waterloo Black Hawk Closed - Intake
Only
Unknown
CHC ISEIA Closed -
Duplicate
Unknown
CHI HEALTH Closed -
Already
Participating
Unknown
CHI Health Clinic Council Bluffs Pottawattam
ie
Closed -
Unreachable
Unknown
CHI Health Clinic Roca Mel Council Bluffs Pottawattam
ie
Closed -
Duplicate
Unknown
Community Health Centers Burlington Des Moines Closed -
Unreachable
4/14/2017 1:24:12 PM
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Page 17 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Unknown
Covenent Clinic Oelwein Fayette Closed -
Enrolled
Unknown
Covenent Clinic West Union Fayette Closed -
Declined
Unknown
Dr Dunbar Dunbar Dr Sioux City Woodbury Closed -
Unreachable
Unknown
DSM Family Med DSM Family Med Carroll Carroll Closed -
Enrolled
Unknown
EIHZ Marion Linn Closed -
Enrolled
Unknown
Medical Associates Clinton Clinton Closed -
Duplicate
Unknown
medical Clinic PC Durada Michael Sidney Fremont Closed -
Already
Participating
Unknown
MERCY CLINIC Grand
Junction
Greene Closed -
Unreachable
Unknown
MERCY FAM CLINIC Buffalo Center Winnebago Closed - Intake
Only
Unknown
Mercy Family Care Sonn Steven Perry Dallas Closed -
Unreachable
Unknown
Mercy Family Care Sohn Steven Perry Dallas Closed -
Enrolled
Unknown
N/A Ihria Dr
Timothy
Closed -
Unreachable
Unknown
Not Avail Des Moines Polk Closed -
Declined
Unknown
Not Provided Kosters Kay Akron Plymouth Closed -
Unreachable
Unknown
Not Provided Iowa City Johnson Closed -
Unreachable
Unknown
Not Provided Solon Johnson Closed -
Enrolled
Unknown
Not Provided Graettinger Palo Alto Closed -
Enrolled
Unknown
Not Provided Clinton Clinton Closed -
Unreachable
4/14/2017 1:24:12 PM
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Page 18 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Unknown
Not Provided Burlington Des Moines Closed -
Unreachable
Unknown
Not Provided Des Moines Polk Closed -
Enrolled
Unknown
Not Provided SPENCER Clay Closed -
Unreachable
Unknown
Not Provided Des Moines Polk Closed - Intake
Only
Unknown
Not Provided Marion Linn Closed -
Enrolled
Unknown
Not Provided Des Moines Polk Closed -
Unreachable
Unknown
Not Provided Pleasantville Marion Closed -
Enrolled
Unknown
Not Provided Des Moines Polk Closed -
Unreachable
Unknown
Not Provided Closed -
Unreachable
Unknown
Not Provided Burlington Des Moines Closed -
Declined
Unknown
Not Provided Ottumwa Wapello Closed -
Enrolled
Unknown
Not Provided Dubuque Closed -
Enrolled
Unknown
Not Provided Marion Linn Closed -
Unreachable
Unknown
Not Provided Cedar Rapids Linn Closed -
Duplicate
Unknown
Not Provided Des Moines Polk Closed -
Enrolled
Unknown
Not Provided Red Oak Montgomery Closed -
Enrolled
Unknown
Not Provided Iowa City Johnson Closed -
Enrolled
Unknown
Not Provided Nashua Chickasaw Closed -
Unreachable
4/14/2017 1:24:12 PM
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Page 19 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Unknown
Not Provided Des Moines Polk Closed - Intake
Only
Unknown
Not Provided Council Bluffs Pottawattam
ie
Closed - Intake
Only
Unknown
Not Provided Perry Dallas Closed - Intake
Only
Unknown
Not Provided Fort Dodge Webster Closed -
Unreachable
Unknown
Not Provided Des Moines Polk Closed -
Unreachable
Unknown
Not Provided Davenport Scott Closed -
Enrolled
Unknown
Not Provided Iowa City Johnson Closed -
Enrolled
Unknown
Not Provided Indianola Warren Closed -
Enrolled
Unknown
Not Provided Marion Linn Closed -
Enrolled
Unknown
River Hills Community Health Center Moravia Appanoose Closed -
Unreachable
Unknown
UI Health Ventures Mahony Michael Muscatine Muscatine Closed -
Declined
Unknown
Unity Point Clinic Nichols Muscatine Closed -
Unreachable
Unknown
Unity Point Clinic Hiawatha Linn Closed - Intake
Only
Unknown
UNITY POINT FAM MED Closed -
Unreachable
Unknown
Unity Point Family Medicine Bode Humboldt Closed -
Enrolled
Unknown
Unknown Burlington Des Moines Closed -
Unreachable
Unknown
WBC Council Bluffs Pottawattam
ie
Closed -
Unreachable
Van Buren
VBCH Bonaparte Clinic Nank Kelsey Farmington Van Buren Closed -
Unreachable
4/14/2017 1:24:12 PM
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Page 20 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Wapello
MERCY CLINICS 1005 E.
PENNSYLVANIA
Ottumwa, IA /
Wapello
52501 HENDERSO
N
FLORIT
A
Ottumwa Closed -
Unreachable
Wapello
Pella Regional Ottumwa Clinic 920 N Quincy Ottumwa, IA /
Wapello
52501 Kanis S. John Fairfield Jefferson Closed -
Enrolled
Wapello
Ottumwa OBGYN ALANS DR
LINDSE
Y
Closed -
Unreachable
Washington
Not Provided 3056 River
Crossing Court
Riverside, IA /
Washington
52327 Bedell David Iowa City Johnson Closed -
Unreachable
Washington
Rivercrossing 52327 Stillwell Ashley Riverside Washington Closed -
Unreachable
Washington
Rivercrossing Nichols Muscatine Closed -
Enrolled
Washington
RIVERCROSSING Washington Washington Closed -
Enrolled
Wayne
SCIMC 417 SE Street Corydon, IA /
Wayne
50060 Hoch Douglas Centerville Closed -
Enrolled
Webster
CHC 126 N 10th Ft Dodge, IA /
Webster
50501 Chase Lisa Fort Dodge Webster Closed -
Enrolled
Webster
Not Provided 126 North 10th
Street
Fort Dodge, IA
/ Webster
50501 Zigrang Jennifer Fort Dodge Webster Closed -
Enrolled
Webster
Not Provided 126 N 10th St Fort Dodge, IA
/ Webster
50501 Zigrang Jennifer Fort Dodge Webster Closed -
Unreachable
Webster
Webster County Health Dept 50501 Laurens Pocahontas Closed -
Enrolled
Webster
COVENIENT CARE FALY MEDICINE
AND WALK IN CLINIC
51501 Schmidt Wyatt Council Bluffs Pottawattam
ie
Closed -
Enrolled
Winnebago
Mercy Family Clinic Lake Mills Keller Pamela Lake Mills Winnebago Closed -
Unreachable
Wisconsin
WHEATON FRANCISCAN
HEALTHCARE
Jamaica Guthrie Closed - Invalid
Woodbury
Mercy Medical Center - Sioux City 51102 Unknown Unknow
n
Sioux City Woodbury Closed -
Already
Participating
Woodbury
Mercy Medical Center-Sioux City 51102 Sioux City Woodbury Closed - Intake
Only
Woodbury
Not Provided 1021 Nebraska
St
Sioux City, IA /
Woodbury
51102 Greene Dylan Akron Plymouth Closed - Intake
Only
4/14/2017 1:24:12 PM
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Page 21 of 22 gb edits Iowa March 2017 Referral Detail
Clinic County Clinic Name Clinic Address Clinic City,
State / County
Clinic
Zip
Code
Referred By
Last Name
Referred
By First
Name
Participant City Participant
County
Status
Woodbury
Family Health Care 51104 Peterson Paul Sioux City Woodbury Closed -
Unreachable
Woodbury
FAMILY HEALTH CARE 51104 PETERSON PAUL Sioux City Woodbury Closed - Intake
Only
Woodbury
Family Health Care 51104 Shook Steven Sioux City Woodbury Closed -
Enrolled
Woodbury
Unity Point Pulmonology 51104 S Venketra
man
Sioux City Woodbury Closed -
Enrolled
Woodbury
Unity Point Pulmonology 51104 Sahasranam
an
Venketra
man
Sioux City Woodbury Closed -
Already
Participating
Woodbury
Siouxland Community Health Center of
NE
FaHmo David Sioux City Woodbury Closed -
Enrolled
Woodbury
Unity Point Sunnybrook Neils Ashley Sioux City Woodbury Closed -
Declined
Wright
Not Provided 403 1st St SE Belmond, IA /
Wright
50421 Williams Joy Fort Dodge Webster Closed -
Unreachable
Referral Details
Report
4/14/2017 1:24:12 PM
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Page 22 of 22 gb edits Iowa March 2017 Referral Detail
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