2021 CONTRACTED PAYERS - OR

(1)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

Ambulatory Surgery Center COM_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

Facility / Ambulatory Surgery Center / Ancillary _{MA_(EPSC_PHH_PMMC)_FAC_ASC}COM_(PHSOR)_ANC_FAC

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Home Health; OR-Providence Benedictine Nursing Center; OR-Providence Child Center; OR-East Pavilion Surgery

Center

Professional COM_(PHSOR)_PROF

OR-Providence Seaside Hospital; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Medical Group South; OR-Providence Connections

NOTE: PMG-S Contracted thru PrimeCare IPA for COM and MA PPO

ALLCARE HEALTH PLAN Facility / Ambulatory Surgery Center / Professional MCAID_(PHH_PH_PMMC_PMGS)_ASC_FAC_PROF

OR-Providence Medford Medical Center; OR-Providence Medical Group South; OR-Providence Home Health; OR-Providence Hospice

NOTE: PMG-S contracted thru PrimeCare IPA for MCAID and MA ASANTE HEALTH SYSTEM Facility COM_(PMMC)_FAC OR-Providence Medford Medical Center _{NOTE: PMG-S contracted thru PrimeCare IPA for MA}

ATRIO HEALTH PLANS Facility MA_(PMMC)_FAC OR-Providence Medford Medical Center _{NOTE: PMG}

Ambulatory Surgery Center MCAID_MA_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Ambulatory Surgery Center / Facility / Professional / Ancillary MCAID_MA_(PHSOR)_ANC_ASC_FAC_PROF

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Home Health; OR-Providence Benedictine Nursing Center; OR-Providence Child Center; OR-Oregon Outpatient Surgery Center, LLC; OR-East Pavilion Surgery Center; OR-Surgery Center at Tanasbourne

NOTE: PMG-S contracted thru PrimeCare IPA for MCAID and MA thru Jackson Care Connect CCO

CIGNA HEALTH AND LIFE INSURANCE COMPANY Ambulatory Surgery Center COM_(SCTSBN)_ASC OR-Surgery Center at Tanasbourne

COM_(EPSC)_ASC OR-East Pavilion Surgery Center

COM_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

COM_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Facility / Ancillary COM_(PHSOR)_ANC_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; WA-Providence Home Services; _{OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Home Health; OR-Providence Hospice; OR-Providence Specialty Pharmacy Services}

Professional COM-PPO_(PHSOR)_PROF

OR-Providence Portland Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture; OR-Providence Willamette Falls Clinic; OR-Providence Connections

NOTE: PMG-S contracted thru PrimeCare IPA for COM COMMUNITY HEALTH PLAN OF WA Facility MCAID_(PHRMC)_FAC OR-Providence Hood River Memorial Hospital

Ancillary GOV_(PHH)_ANC OR-Providence Home Health

Professional GOV_(PMGS)_PROF OR-Providence Medical Group South

Last updated 05/14/2021

Pg 1

DEPT OF VA

2021 CONTRACTED PAYERS - OR

AETNA HEALTHCARE

Not Contracted for SRC plans

CARE OREGON

Includes JCC-CCO and CPCCO MCAID plans, MA Advantage Plus, MA plan-Dual Eligibles

CIGNA HEALTHCARE

Ambulatory Surgery Center

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any payer

(2)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

COM_(SCTSBN)_ASC OR-Surgery Center at Tanasbourne

Facility / Ancillary / Professional COM_(PHSOR)_ANC_FAC_PROF

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; Providence Willamette Falls Medical Center; Providence Hood River Memorial Hospital; Providence Medical Group North; Clackamas Rad.Oncology Center -CROC joint venture; Providence Express Care-OR;

OR-Providence Credena Health Speciality Pharmacy; OR-OR-Providence Home Health; OR-OR-Providence Hospice; OR-OR-Providence Benedictine Nursing Center; OR-OR-Providence Child Center; OR-OR-Providence Connections NOTE: PMG-S contracted thru PrimeCare IPA for COM

COM-PPO_(PHRMH)_FAC OR-Providence Hood River Memorial Hospital

COM-PPO_(PMMC)_FAC_PROF

OR-Providence Medford Medical Center NOTE: PMG-S contracted thru PrimeCare IPA for Com and WC COM-PPO_(PNMC)_FAC OR-Providence Newberg Medical Center

COM-PPO_(PWFMC)_FAC OR-Providence Willamette Falls Medical Center

COM_MA_(EPSC)_ASC OR-East Pavilion Surgery Center

COM_MA_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Facility / Professional COM_MA_(PMMC_PMGS)_FAC_PROF OR-Providence Medford Medical Center; OR-Providence Medical Group South

HEALTH NET-TRICARE Facility / Ancillary / Professional TRICARE_(PHSOR)_ANC_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Credena Health Speciality Pharmacy; OR-Providence Home Health} HEALTH SHARE OF OREGON

BH Contract for Mult Co., Clackamus Co, and Tuality Facility / Ancillary / Professional MCAID_(PMGN_PPMC_PSVMC_PWFMC)_ANC_FAC__PROF OR-Providence Portland Medical Center; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Medical Group North

HOSPICE CARE OF THE NORTHWEST Ancillary MA_(PPMC_PSVMC)_FAC OR-Providence Portland Medical Center; OR-Providence Saint Vincent Medical Center

HUMANA Facility / Ancillary COM_(PHSOR)_FAC_ANC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Hood River Memorial Hospital; OR-Providence Home Health; OR-Providence Hospice; OR-Providence Specialty Pharmacy Services; OR-Providence Benedictine Nursing Center; OR-Providence Child Center}

INTERCOMMUNITY HEALTH PLANS Facility / Professional MCAID_(PHSOR)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Medical Group North

Facility/Ancillary COM_MA_MCAID_(PHSOR)_FAC OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital, OR-Providence _{Benedictine Nursing Center}

Professional COM_MA_MCAID_(PMGN)_PROF OR-Providence Medical Group North

Pg 2

FIRST CHOICE

FIRST HEALTH GROUP CORPORATION Facility

HEALTH NET

KAISER FOUNDATION

Not contracted for Added Choice/FCHN plans

2021 CONTRACTED PAYERS - OR

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any payer

(3)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

Facility COM_MA_(PMH_PPMC_PSVMC_PWFMC)_FAC_(BH) OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center

Professional COM_MA_(PMGN)_PROF_(BH) OR-Providence Medical Group North

Facility / Ancillary / Professional COM-PPO_(PHRMH)_FAC OR-Providence Hood River Memorial Hospital

Facility / Professional COM-PPO_(PWFC_PWFMC)_FAC_PROF_(BH) OR-Providence Willamette Falls Medical Center; OR-Providence Willamette Falls Clinic

MARQUIS ADVANTAGE Facility / Ancillary / Professional MA_(PHSOR)_ANC_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood _{River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Home Health}

MID-ROGUE COMMUNITY HEALTH PLAN Facility / Professional MA_(PMMC_PMGS)_FAC_PROF OR-Providence Medford Medical Center; OR-Providence Medical Group South

MA_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

MA_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Ancillary MA_(PBNC)_ANC OR-Providence Benedictine Nursing Center

COM_MA_(PHSOR)_ANC_FAC_PROF

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Medical Group South; OR-Clackamas Rad.Oncology Center -CROC joint venture;

OR-Providence Credena Health Speciality Pharmacy; OR-Providence Express Care-Virtual; OR-Providence Home Health; OR-Providence Benedictine Nursing Center; OR-Providence Child Center; OR-Providence Connections; OR-Express Care LLC

NOTE: PMG-S contracted thru PrimeCare IPA for COM HMO & PPO and MA PPO

MA_(PHSOR)_ANC_FAC_PROF

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; Providence Willamette Falls Medical Center; Providence Medical Group North; Providence Medical Group South; Clackamas Rad.Oncology Center -CROC joint venture; Providence Express Care-OR;

OR-Providence Credena Health Speciality Pharmacy; OR-OR-Providence Express Care-Virtual; OR-OR-Providence Home Health

MOLINA Facility / Professional MA_MCAID_(PHRMH_PMGN_PMGSW)_FAC_PROF OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North Limited; WA-PMG SW WA; WA-PMG SW WA Rochester Family Medicine

MT HOOD HOSPICE Facility P2P_(PMH_PNMC_PPMC_PSVMC_PWFMC)_FAC_(H

OSPICE) OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center MULTIPLAN-Private Health Care Systems (PHCS)-must have

the PHCS logo

Not contracted with other Multiplan networks

Ambulatory Surgery Center / Facility / Professional / Ancillary COM_(PHSOR)_ANC_ASC_FAC_PROF

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture; OR-Providence Willamette Falls

Clinic; OR-Providence Home Health; OR-Providence Hospice; OR-Providence Benedictine Nursing Center

NAPHCARE Facility / Professional GOV_(PMH_PPMC_PSVMC_PWFMC)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center

OPTUM HEALTH CARE SOLUTIONS Facility / Professional P2P_(PPMC_PSVMC)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Saint Vincent Medical Center

OREGON HEALTH SYSTEMS Facility WC_(PHSOR)_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North}

Ambulatory Surgery Center COM_MA_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Facility / Ambulatory Surgery Center / Ancillary / Professional COM_MA_(PHSOR)_ANC_ASC_FAC_PROF

OR-Providence Medford Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Home Health; OR-Providence Specialty Pharmacy Services; OR-Providence Benedictine Nursing Center; OR-Oregon Outpatient Surgery Center, LLC; OR-East Pavilion Surgery Center; OR-Surgery Center at Tanasbourne

NOTE: PMG-S Contracted Thru PrimeCare IPA for COM PPO and MA

Facility / Professional MCAID_(PHRMH_PPMC_PSVMC)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Saint Vincent Medical Center; OR-Providence Hood River Memorial Hospital, OR-Providence Home Health, OR-Providence Benedictine Nursing Center

Professional MCAID_MA_(PGSSM)_PROF OR-Providence Gorge Spine and Sports Medicine

Pg 3

MANAGED HEALTHCARE NORTHWEST

MODA HEALTH PLAN -Connexx Network Beacon Network Beacon-(PPMC only)

Not contracted with Affinity, Summit, and Synergy networks

Added Summit MA Healthplan Jan. 1st, 2021 Not contracted with Legacy or Salem Medicare

Facility / Ancillary / Professional MANAGED HEALTH NETWORK

2021 CONTRACTED PAYERS - OR

PACIFIC SOURCE HEALTH

Added BH-COM only for PPMC, PSVMC, PMH & PWFMC Jan. 1, 2021

Termed all other commercial contracts for PPMC, PSVMC, PMH, PSVMC, PSH, & PNMC effective April 1, 2020

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any payer

(4)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

PREMERA

SW WA only Ancillary COM_(PHH)_ANC OR-Providence Home Health

PROVIDENCE ELDERPLACE Facility / Ancillary / Professional MA_(PHSOR)_ANC_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture

MCAID_MA_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

Ambulatory Surgery Center / Facility / Professional / Ancillary

COM-EPO_(PHSOR)_ANC_ASC_FAC_PROF_(PROV4PROV )

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Medical Group North Limited; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Gorge Spine and Sports Medicine;

Providence Medical Group South; Clackamas Rad.Oncology Center -CROC joint venture; Providence Willamette Falls Clinic; Providence Express Care-OR; Providence Credena Health Speciality Pharmacy; OR-Providence Express Care-Virtual; OR-OR-Providence Medical Group - North Immediate Care Clinics only; OR-OR-Providence Home Health; OR-OR-Providence St. Vincent Heart Clinics Cardiology Mill Plain; Providence Neurological Specialties Esther Short; Providence Neurological Specialties Mill Plain; Providence Occupational Health Mill Plain; Providence Rehabilitation Services Camas; Providence Hospice;

OR-Providence Specialty Pharmacy Services; OR-OR-Providence Benedictine Nursing Center; OR-OR-Providence Child Center; OR-OR-Providence Connections; OR-Oregon Outpatient Surgery Center, LLC

COM_MCAID_MA_(PHH)_ANC OR-Providence Home Health

COM_(PCHSP)_ANC OR-Providence Credena Health Speciality Pharmacy

Facility / Ambulatory Surgery Center COM_(PHSOR)_ASC_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Child Center}

Facility / Ancillary / Professional MA_MCAID_(PHSOR) FAC_PROF OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood _{River Memorial Hospital; OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture; OR-Providence Child Center}

COM_(CROC_PMGN)_PROF OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture

COM_MCAID_MA_(PMGN)_PROF OR-Providence Medical Group North

NOTE: PMG-S contracted thru PrimeCare IPA for COM

PROVIDENCE HOSPICE AND PALLIATIVE CARE Facility P2P_(PHSOR)_FAC OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood _{River Memorial Hospital}

Ambulatory Surgery Center WC_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

Ancillary WC_(PHH)_ANC OR-Providence Home Health

Facility WC_(PHSOR)_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls _{Medical Center; OR-Providence Hood River Memorial Hospital}

Professional WC_(PMGN_PMGS)_PROF OR-Providence Medical Group North; OR-Providence Medical Group South

Pg 4

PROVIDENCE MCO

2021 CONTRACTED PAYERS - OR

PROVIDENCE HEALTH PLAN (PHP)

Added COM & MA BH services Jan. 1st, 2021 (previously under Optum)

Ancillary

Professional

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any

payer related processes, including but not limited to verifications for eligibility, benefits, and medical authorizations. The recipient is accountable for the appropriate use and dissemination of this

(5)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

COM-EPO_(SCMS)_ASC OR-Surgery Center at Mt. Scott

COM_NNWK_(SCTSBN)_ASC OR-Surgery Center at Tanasbourne

COM-PPO_(CROC)_ANC OR-Clackamas Rad.Oncology Center -CROC joint venture

COM_NNWK_(PHH_PH)_ANC OR-Providence Home Health; OR-Providence Hospice

Facility COM_NNWK_(PHSOR)_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Hood River Memorial Hospital}

Professional COM_NNWK_(PHSOR)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Seaside Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Medical Group South; OR-Providence Connections

Provider Network of America Facility COM_(PMMC)_FAC OR-Providence Medford Medical Center

Ambulatory Surgery Center COM_(SCMS)_ASC OR-Surgery Center at Mt. Scott

Ambulatory Surgery Center /Professional COM_MA-PPO_(PHSOR)_ASC_PROF WA-PMG SE WA; OR-Providence Medical Group North; OR-Providence Express Care-OR; OR-Oregon Outpatient Surgery Center, LLC; OR-East Pavilion Surgery Center; OR-Surgery Center at Tanasbourne

Facility MA-HMO_(PMH_PPMC_PSVMC_PWFC)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center

Facility / Ancillary COM_MA-PPO_(PHSOR)_ANC_FAC

OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; Providence Willamette Falls Medical Center; Providence Hood River Memorial Hospital; Providence Home Health; Providence Specialty Pharmacy Services; Providence Benedictine Nursing Center;

OR-Providence Child Center

NOTE: PMG-S contracted thru PrimeCare IPA for COM & MA-PPO

Professional COM-PPO_(KRMC)_ASC WK-Kadlec Regional Medical Center

SAMARITAN HEALTH PLANS Facility / Professional MA_(PHSOR)_FAC_PROF OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Medical Group North

MA_(PHSOR)_FAC_PROF OR-Providence Portland Medical Center

MCAID_(PPMC)_FAC OR-Providence Portland Medical Center

MCAID_(PSVMC)_FAC OR-Providence Saint Vincent Medical Center

MCAID_(PSH)_FAC OR-Providence Seaside Hospital

MCAID_(PCC)_FAC OR-Providence Child Center

Professional MCAID_(PMGN)_PROF OR-Providence Medical Group North

TRILLIUM COMMUNITY HEALTH PLAN Facility MA_(PMMC)_FAC OR-Providence Medford Medical Center

TRIWEST VACP3 (REGENCE) Ambulatory Surgery Center GOV_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

Pg 5

2021 CONTRACTED PAYERS - OR

PROVIDENCE PREFERRED

Ancillary

REGENCE BLUECROSS BLUESHIELD OF OREGON MA-PPO contracted only for PHRMH, PMMC, PWFMC, & PWF clinics only

STATE OF OREGON (DMAP)

Facility

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any

payer related processes, including but not limited to verifications for eligibility, benefits, and medical authorizations. The recipient is accountable for the appropriate use and dissemination of this

(6)

Payer

Contract Type

Agreement Description

(FINANCIAL

CLASS-PRODUCT_PAYMENT

STRUCTURE_PROGRAM_(

MINISTRY)_TYPE)

Locations

Ancillary COM_(PBNC_PHH)_ANC OR-Providence Home Health; OR-Providence Benedictine Nursing Center

Facility COM_MA_(PHSOR)_FAC_(BH) OR-Providence Portland Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital

Professional COM_MA_(PHSOR)_PROF_(BH) OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Medical Group South

COM_MA_(SCMS)_ASC OR-Surgery Center at Mt. Scott

COM_(SCT)_ASC OR-Surgery Center at Tanasbourne

Ambulatory Surgery Center / Ancillary COM_(OOSC)_ASC OR-Oregon Outpatient Surgery Center, LLC

Facility / Ancillary COM_MA-HMO_MA-PPO_(PHSOR)_ANC_FAC OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Home Health; OR-Providence Benedictine Nursing Center

COM_(PHSOR)_FAC_PROF_ACO OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Providence Medical Group South}

MA_(PHSOR)_FAC_PROF_ACO OR-Providence Portland Medical Center; OR-Providence Medford Medical Center; OR-Providence Newberg Medical Center; OR-Providence Seaside Hospital; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical _{Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North}

Professional COM_MA_(PHSOR)_FAC

OR-Providence Portland Medical Center; OR-Providence Newberg Medical Center; OR-Providence Milwaukie Hospital; OR-Providence Saint Vincent Medical Center; OR-Providence Willamette Falls Medical Center; OR-Providence Hood River Memorial Hospital; OR-Providence Medical Group North; OR-Clackamas Rad.Oncology Center -CROC joint venture; OR-Providence Express Care-OR; OR-Providence Connections; OR-Express Care LLC

NOTE: PMG-S contracted thru PrimeCare IPA for COM-PPO

Pg 6

2021 CONTRACTED PAYERS - OR

UNITED BEHAVIORAL HEALTH

UNITED HEALTHCARE

Contracted for COM-Signature Value HMO & PPO (PSH, PHRMH & PMMC not contracted for COM-HMO) Contracted for Navigate COM-HMO for all facilites Contracted for MA-AARP HMO for all but PSH, PHRMH & PMMC

Contracted for MA-AARP PPO for PWFMC only

Facility / Professional

DISCLAIMER: You (“the recipient”) acknowledge and agree the data contained in this file is to be used as a reference tool only. The recipient understands this information is NOT A SUBSTITUTE for any

(7)

LEGENDS:

S T AT E D E S I G N A T I O N

P A Y E R T Y P E

ABBREVIATION

STATE

ABBREVIATION

PAYER TYPE

AK

Alaska

AASGARD

AASGARD SUMMIT MANAGEMENT

CA

California

ASHC

ACCESS SENIOR HEALTHCARE

ID

Idaho

ACCOLADE

ACCOLADE HOSPICE

MT

Montana

ACCOUNTABLE

NM

New Mexico

AETNA

AETNA HEALTHCARE

OR

Oregon

AHF

AFFILIATED HEALTH FUNDS

TX

Texas

AFFORDABLE

AFFORDABLE HEALTH CARE

WA

Washington

AIRNZ

AIR NEW ZEALAND

AIR TAHITI NUI

C O N T R A C T T Y P E

ALAMEDA

ALAMEDA SURGERY CENTER

ABBREVIATION

CONTRACT TYPE

ANTHC

ALASKA NATIVE TRIBAL HEALTH CONSORTIUM

ASC

Ambulatory Surgery Center

AKUSA

ALASKA USA INSURANCE BROKERS

ANC

Ancillary

ALLCARE

ALLCARE HEALTH PLAN

FAC

Facility

ALLEGIANCE

Plan2Plan

Plan to Plan

AMERICAS

AMERICASHEALTH PLAN

PROF

Professional

AMERIGROUP

ANABAPTIST

ANABAPTIST MEDICAL MINISTRY

F I N A N C I A L C L A S S

CARNIVAL

CARNIVAL CRUISE LINE

ABBREVIATION

FINANCIAL CLASS

CARRUM

CARRUM HEALTH

COM

Commercial

CPAL

CATHAY PACIFIC AIRWAYS

BNDL

Bundle

CCN

CCN (COMMUNITY CARE NETWORK)

EXCH

Exchange

CSMCF

CEDAR-SINAI MEDICAL CARE FOUNDATION

GOV

Government

CSMC

CEDAR-SINAI MEDICAL CENTER

GRANT

Grant

CVIPA

CENTINELA VALLEY IPA

HOSPICE

Hospice

CHP

CENTRAL HEALTH PLAN OF CALIFORNIA

MCAID

Medicaid

CIG-HSP

CIG-HEALTHSPRING

MA

Medicare Advantage

CBH

CIGNA BEHAVIORAL HEALTH

OPO

Organ Procurement Organization

CIGNA

CIGNA HEALTHCARE

PROV4PROV

Providence for Providence

CIGNA

CIGNA LIFESOURCE

P2P

Provider to Provider

CCHP

CITIZENS CHOICE

SELF-INS

Self-Insured

CBRBNK

CITY OF BURBANK

TRICARE

Tricare

CLEVER CARE

TRIWEST

Triwest

CMAC

WC

Worker's Compensation

CMN

CMN GLOBAL

CPPD

COLLEGE PLACE POLICE DEPARTMENT

P R O D U C T T Y P E

CHN

COMMUNITY HEALTH NETWORK

ABBREVIATION

PRODUCT TYPE

CHPW

COMMUNITY HEALTH PLAN OF WASHINGTON

EPN

Exclusive Provider Network

CONIFER

CONIFER VALUE BASED CARE

EPO

Exclusive Provider Organization

_CCC

_{COORDINATED CARE}

HMO

Health Maintenance Organization

_CCS

_{CORRECT CARE SOLUTIONS}

POS

Point-of-Service

_CORVEL

PPO

Preferred Provider Organization

_COH

_{COUNTY OF HUMBOLDT}

CTYLAMH

COUNTY OF LA MENTAL HEALTH

(8)

E X T R A D E S C R I P T I O N

P A Y E R T Y P E (continued)

ABBREVIATION

EXTRA DESCRIPTION

ABBREVIATION

PAYER TYPE

ACO

Accountable Care Organization

COVENTRY

COVENTRY HEALTH

BH

Behavioral Health

DOC

DEPARTMENT OF CORRECTIONS

HBP

Hospital-Based Provider

NSH

DEPARTMENT OF STATE HOSPITALS-NAPA

NNWK

Narrow Network

_VA

_{DEPT OF VA}

NWKPYR

Network Payors

_DHCHSP

_{DIRECT HEALTH CARE HOSPICE}

OPG

Outpatient Grouper

_{EASY CHOICE}

_{EASY CHOICE HEALTH PLAN}

P4P

Pay for Performance

EL PROYECTO

EL PROYECTO DEL BARRIO

QUAL

Quality

EMRS

EMPLOYER'S MEDICAL REVIEW SERVICES

SS

Shared Savings

EVGRNSCPS

EVERGREEN STATE COLLEGE POLICE SERVICES

SNF

Skilled Nursing Facility

EVRGNHLTH

EVERGREENHEALTH

TRANSPLANT

Transplant

EXCEPTIONAL

EXCEPTIONAL CARE MEDICAL GROUP - SERENDIB HEALTHWAYS

COVID

COVID-19

FACEY

FACEY MEDICAL FOUNDATION

LTR

(Extra Description) Letter

_FHA

_{FAMILY HEALTH ADMINISTRATORS}

CAP

Capitation

_FCHN

_{FIRST CHOICE}

GLRK

Global Risk

FHGRP

FIRST HEALTH GROUP CORPORATION

SR

Shared Risk

_FHCOV

_{FIRST HEALTH-COVENTRY}

FIRSTCARE

NOTE: MINISTRY LEGEND BEGINS ON PAGE 12

GHN

GALAXY

GENTIVA

GENTIVA HOSPICE

GLOBAL CARE

GLOBAL CARE MEDICAL GROUP

GLOBAL ONE

GLOBAL ONE VENTURES

GOLD COAST

GOLD COAST HEALTH PLAN

GREATWEST

HHSC

HEALTH & HUMAN SERVICES COMMISSION

HCI LA

HEALTH CARE LA IPA

HMC

HEALTH MANAGEMENT CONCEPTS

HEALTH NET

HNFS

HEALTH NET-TRICARE

HPO

HEALTH PAYORS ORGANIZATION

HEALTH SHARE

HEALTH SHARE OF OREGON

HSI

HEALTH SYSTEMS INTERNATIONAL

HCP

HEALTHCARE PARTNERS MG

HSPC

HEALTHSMART

HPN

HERITAGE PROVIDER NETWORK

HOMEPORT

HOMEPORT INSURANCE COMPANY

HZN HSP

HORIZON HOSPICE

HCNW

HOSPICE CARE OF THE NORTHWEST

HSPLUBBOCK

HOSPICE OF LUBBOCK

HSPSPOKANE

HOSPICE OF SPOKANE

HUMANA

HMHS

HUMANA MILITARY-TRICARE

IPN

IDAHO PHYSICIANS NETWORK

UCLA IMPACT

IMPACT PROGRAM (UCLA IMPACT-DEPARTMENT OF UROLOGY)

IMPERIAL

IMPERIAL_GREAT STATES

IEHP

INLAND EMPIRE HEALTH PLAN (IEHP)

IMS

INSURANCE MAGEMENT SERVICES

(9)

P A Y E R T Y P E (continued)

ABBREVIATION

PAYER TYPE

ISL

INSURANCE SERVICES OF LUBBOCK

INTEGRACARE

INTEGRACARE HOSPICE

IHP

INTEGRATED HEALTH PLAN

INTERCOMMUNITY

INTERCOMMUNITY HEALTH PLANS

INTERIM HOSPICE

INTERLINK

ICHS PACE

INTERNATIONAL COMMUNITY HEALTH SERVICES PACE PROGRAM

INTL SOS

INTERNATIONAL SOS ASSISTANCE

INTERPLAN

INTERVALLEY

INTERVALLEY HEALTH PLAN

INTERWEST

INTERWEST HEALTH

IHIC

ISLAND HOME INSURANCE COMPANY

JAL

JAPAN AIRLINES INTERNATIONAL

KAISER

KAISER FOUNDATION

KINDRED

KINDRED HEALTHCARE

KLM

KLM ROYAL DUTCH AIRLINES

KODIAK FD

KODIAC FIRE DEPARTMENT

LA CARE

LA CARE HEALTH PLAN

LACEY PD

LACEY POLICE DEPARTMENT

LAKESIDE

LAKESIDE MEDICAL GROUP

LIFEGIFT

LRMHMRC

LUBBOCK MHMR

LSA

LUBBOCK SURGICAL ASSOCIATES

MAGELLAN

MAJORIS

MAJORIS HEALTH SYSTEMS OREGON

MHNW

MANAGED HEALTHCARE NORTHWEST

MPCHP

MARION POLK COMMUNITY HEALTH PLAN

MARQUIS

MARQUIS ADVANTAGE

MARRIOTT

MARRIOTT INTERNATIONAL

MCS

MCS-MEDICAL SERVICES COMPANY

MDI-GHS

MDI GOVERNMENT HEALTHCARE SERVICES

MHS

METHODIST HEALTHCARE SYSTEM

MHN

MANAGED HEALTH NETWORK

MID ROGUE

MID-ROGUE COMMUNITY HEALTH PLAN

MCEBP

MISSOULA COUNTY EMPLOYEE BENEFITS PLAN

MODA

MODA HEALTH PLAN

MOLINA

MONARACH

MONARCH HEALTHCARE

MAHCP

MONTANA ASSOCIATION OF HEALTH CARE PURCHASERS

MNA

MONTANA NONPROFIT ASSOCIATION GROUP BENEFITS TRUST

MTDPH

MONTANA STATE DEPARTMENT OF PUBLIC HEALTH

MTCOOP

MOUNTAIN HEALTH CO-OP (UNIVERSITY OF UTAH HEALTH PLANS)

MTHOOD HSP

MT HOOD HOSPICE

MTCCH

MTC MEDICAL CORRECTIOL HLTH SVCS

MULTIPLAN

MYNEXUS

(10)

P A Y E R T Y P E (continued)

ABBREVIATION

PAYER TYPE

NAPHCARE

NHI

NATIONAL HEALTH INSURANCE COMPANY

NMHC

NEW MEXICO HEALTH CONNECTIONS

NMMC

NEW MEXICO MUTUAL AND CASUALTY

NWS

NORTHWESTONE

OCCUNET

OLYMPIA PD

OLYMPIA POLICE DEPARTMENT

OPTUM HEALTH

OPTUM HEALTH CARE SOLUTIONS

OPTUM

OPTUM ORTHOPEDIC/NEUROSURGERY SPECIALTY NETWORK

OHA

OREGON HEALTH AUTHORITY

OHS

OREGON HEALTH SYSTEMS

OSCAR

PACMED

PACIFIC MEDICAL CENTER

PACIFICSOURCE

PACIFIC SOURCE COMMUNITY SOLUTIONS

PACIFICSOURCE

PACIFIC SOURCE HEALTH

PACIFICARE

PMC

PACMED CLINICS

PARTNERSHIP

PARTNERSHIP HEALTHPLAN

PCN

PHYSICIANS CARE NETWORK

PSW

PHYSICIANS OF SOUTHWEST WASHINGTON

PPN

PIONEER PROVIDER NETWORK (PPN)

PLOTKIN

PLOTKIN CONSULTING

PPONEXT

PRHN

PREFERRED HEALTH NETWORK

PREFERRED

PREFERRED IPA

PREMERA

PPN

PREMIER PHYSICIAN NETWORK

PRESBYTERIAN

PRESBYTERIAN HEALTHPLAN

PCPCA

PRIMARY CARE PHYSICIANS OF CALIFORNIA

PHCS

PRIVATE HEALTHCARE SYSTEMS (PHCS)

PHP

PROSPECT HEALTH PLAN

PROSPECT

PROSPECT MEDICAL GROUP

PEP

PROVIDENCE ELDERPLACE

PHN

PROVIDENCE HEALTH NETWORK

PHP

PROVIDENCE HEALTH PLAN (PHP)

PHCMC

PROVIDENCE HOLY CROSS MEDICAL CENTER

PHPC

PROVIDENCE HOSPICE AND PALLIATIVE CARE

PHPMCO

PROVIDENCE MCO

PPOR

PROVIDENCE PREFERRED

PNOA

PROVIDER NETWORK OF AMERICA

PHSKC

PUBLIC HEALTH - SEATTLE & KING COUNTY

REGAL

REGAL MEDICAL GROUP

RBSI

REGENCE BLUE SHIELD OF IDAHO

BSSEA

REGENCE BLUE SHIELD OF SEATTLE

BCBSO

REGENCE BLUECROSS BLUESHIELD OF OREGON

BSWA

REGENCE BLUESHIELD

(11)

P A Y E R T Y P E (continued)

ABBREVIATION

PAYER TYPE

REGENTS

REGENTS OF THE UNIVERSITY OF CA

ROYAL CARIBBEAN

ROYAL CARIBBEAN CRUISES

SAMARITAN

SAMARITAN HEALTH PLANS

SFVSC

SAN FERNANDO VALLEY SURGERY CENTER

SANSUM

SANSUM CLINIC

SCAN

SWHP

SCOTT & WHITE HEALTH PLAN

SA

SINGAPORE AIRLINES

SKIRBALL

SKIRBALL HOSPICE

SPIPA

SOUTH PUGET INTERTRIBAL PLANNING AGENCY

SOR

STATE OF OREGON (DMAP)

SWADC

STATE OF WASHINGTON DEPARTMENT OF CORRECTIONS

SCSO

STEVENS COUNTY SHERIFF'S OFFICE

SUPERIOR

TTC

TEXAS TRUE CHOICE

TXCOM

TEXAS WORK COMMISSION

IHN

THE INDUSTRY HEALTH NETWORK

TCCORR

THURSTON COUNTY CORRECTIONS

TCCTDY

THURSTON COUNTY CUSTODY

TMH

TORRANCE MEMORIAL MEDICAL CENTER

TRILLIUM

TRILLIUM COMMUNITY HEALTH PLAN

TRIWEST ASURIS

TRIWEST VAPC3 (ASURIS)

TRIWEST REGENCE

TRIWEST VAPC3 (REGENCE)

TTUHSC

TTUHSC CORRECTIONAL HLTH SVCS

TWPD

TUMWATER PD

TURKISH AIR

TURKISH AIRLINES

UBH

UNITED BEHAVIORAL HEALTH

UHC

UNITED HEALTHCARE

UPI

UNITED PHYSICIANS INTERNATIONAL

UNIAMN

UNIVERSAL AMERICAN

USBHP

US BEHAVIORAL HEALTH PLAN

USA

USA MANAGED CARE

VA

VETERANS AFFAIRS

TRIWEST

VA TRIWEST

VPH

VALLEY PRESBYTERIAN HOSPITAL

VO

VALUEOPTIONS

VISTACARE

VISTACARE HOSPICE

VITAS

VITAS HEALTHCARE

WWPD

WALLA WALLA PD

WWSD

WALLA WALLA SHERIFF'S DEPARTMENT

WSDC

WASHINGTON STATE DEPARTMENT OF CORRECTIONS

WHA

WESTERN HEALTH ADVANTAGE(WHA)

WESTERN SKY

WVCH

WILLAMETTE VALLEY HEALTH

YWCA LUBBOCK

YWCA OF LUBBOCK

(12)

M I N I S T R Y

ENTITY ABBREVIATION

ABBREVIATION

MINISTRY

CHS

CCH

TX-Covenant Children's Hospital

CHS

CDI

TX-Covenant Diagnostic Imaging

LRMC

CHHB

NM-Covenant Health Hobbs Hospital

CHS

TX-Covenant Health System

CHS

CHCP

TX-Covenant Healthcare Center Plainview

CHS

CHPSC

TX-Covenant High Plains Surgery Center - Quaker Ave/22nd

CHS

HIT

TX-Covenant Home Infusion

CHS

CHL

TX-Covenant Hospital Levelland

CHS

CHP

TX-Covenant Hospital Plainview

CHS

CMC

TX-Covenant Medical Center

CHS

CMG

TX-Covenant Medical Group

CHS

CPMC

TX-Covenant Plainview Medical Clinic

CHS

CSH

TX-Covenant Specialty Hospital

CHS

FML

TX-Family Medicine of Levelland

GHS

GC

TX-Grace Clinic of Lubbock

GHS

GMC

TX-Grace Medical Center

CHS

HOL

TX-Hospice of Lubbock

LRMC

NM-Lea Regional Medical Center

CHS

LC

TX-Levelland Clinic

CHS

LCN

TX-Levelland Clinic North

CHS

TP

TX-Trustpoint Rehab Hospital

ECAK

AK-Express Care AK LLC

ECCA

CA-Express Care CA

ECMT

MT-Express Care WA PC

ECOR

OR-Express Care OR LLC

ECWA

WA-Express Care WA PC

PHSAK

PATC

AK-Providence Adolescent Treatment Center

PHSAK

PAMC

AK-Providence Alaska Medical Center

PHSAK

PBMG

AK-Providence Behavioral Medicine Group

PHSAK

PB

AK-Providence Breakthrough

PHSAK

PCRC

AK-Providence Crisis Recovery Center

PHSAK

ECAK

AK-Providence Express Care AK

PHSAK

PEC

AK-Providence Extended Care

PHSAK

PFMC

AK-Providence Family Medicine Clinic

PHSAK

PH

AK-Providence Hospice

PHSAK

PIC

AK-Providence Imaging Center

PHSAK

PIHS

AK-Providence In Home Services

PHSAK

PKICC

AK-Providence Kodiak Island Counseling Center

PHSAK

PKIMC

AK-Providence Kodiak Island Medical Center

PHSAK

PKIMHC

AK-Providence Kodiak Island Mental Health Center

PHSAK

PMGAK

AK-Providence Medical Group Alaska

PHSAK

PRTC

AK-Providence Residential Treatment Center

PHSAK

PSMC

AK-Providence Seward Medical Center

PHSAK

PTCC

AK-Providence Transitional Care Center

PHSAK

PVCC

AK-Providence Valdez Counseling Center

PHSAK

PVMC

AK-Providence Valdez Medical Center

(13)

M I N I S T R Y (continued)

ENTITY ABBREVIATION

ABBREVIATION

MINISTRY

PHSAK

PSE

AK-St. Elias Specialty Hospital

PHSCA

PHCMC

CA-Providence Holy Cross Medical Center

PHSCA

PHCB

CA-Providence Home Health (Burbank)

PHSCA

PLCMHH

CA-Providence Home Health (LCT)

PHSCA

PLCMSP

CA-Providence LCM -San Pedro

PHSCA

PLCMT

CA-Providence Little Company of Mary Medical Center -Torrance

PHSCA

PLCMOIT

CA-Providence Little Company of Mary Outpatient Imaging Torrance

PHSCA

PSJHC

CA-Providence Saint John's Health Center

PHSCA

SJPP

CA-Providence Saint John's Physician Partners

PHSCA

PSJ

CA-Providence Saint Joseph Medical Center

PHSCA

PTZ

CA-Providence Tarzana Medical Center

PHSCA

PSECC

CA-Saint Elizabeth

PHSCA

PTCH

CA-Trinity Hospice

PHSWA

PMGEIL

WA-IL PMG E WA Independent Lab

PHSWA

NWHLSA

WA-NW Heart & Lungs Surgical Associates

PHSWA

PMGE

WA-PMG E WA

PHSWA

PMGE

WA-PMG E WA Coville Clinic

PHSWA

PMGE

WA-PMG E WA Kettle Falls Clinic

PHSWA

PMGE

WA-PMG E WA Orthopedics

PHSWA

PMGNW

WA-PMG NW WA

PHSWA

PMGNW

WA-PMG NW WA Everett Physiatry

PHSWA

PMGNW

WA-PMG NW WA Medical Hospitalists

PHSWA

PMGNW

WA-PMG NW WA System Telehealth

PHSWA

PMGPHC

WA-PMG PHC

PHSMT

PMGMT

MT-Providence Medical Group MT

PHSMT

PMGP

MT-Providence Medical Group Polson

PHSMT

PMGS

MT-Providence Medical Group Salmon

PHSMT

PMGW

MT-Providence Medical Group WMT

PHSMT

PSJMC

MT-Providence Saint Joseph Medical Center

PHSMT

SPH

MT-Providence Saint Patrick Hospital

PHSOR

CROC

OR-Clackamas Rad.Oncology Center -CROC joint venture

PHSOR

CSC

OR-Cornell SurgiCenter, LLC

PHSOR

EPSC

OR-East Pavilion Surgery Center

PHSOR

OOSC

OR-Oregon Outpatient Surgery Center, LLC

PHSOR

PBNC

OR-Providence Benedictine Nursing Center

PHSOR

PCC

OR-Providence Child Center

PHSOR

PC

OR-Providence Connections

PHSOR

PCHSP

OR-Providence Credena Health Speciality Pharmacy

PHSOR

ECOR

OR-Providence Express Care-OR

PHSOR

ECVRL

OR-Providence Express Care-Virtual

PHSOR

PGSSM

OR-Providence Gorge Spine and Sports Medicine

PHSOR

PHH

OR-Providence Home Health

PHSOR

PHRMH

OR-Providence Hood River Memorial Hospital

PHSOR

PH

OR-Providence Hospice

PHSOR

PMMC

OR-Providence Medford Medical Center

PHSOR

PMGN

OR-Providence Medical Group - North Immediate Care Clinics only

(14)

M I N I S T R Y (continued)

ENTITY ABBREVIATION

ABBREVIATION

MINISTRY

PHSOR

PMGN

OR-Providence Medical Group North

PHSOR

PMGN

OR-Providence Medical Group North Limited

PHSOR

PMGS

OR-Providence Medical Group South

PHSOR

PMH

OR-Providence Milwaukie Hospital

PHSOR

PNS

OR-Providence Neurological Specialties Esther Short

PHSOR

PNS

OR-Providence Neurological Specialties Mill Plain

PHSOR

PNMC

OR-Providence Newberg Medical Center

PHSOR

POH

OR-Providence Occupational Health Mill Plain

PHSOR

PPMC

OR-Providence Portland Medical Center

PHSOR

PRS

OR-Providence Rehabilitation Services Camas

PHSOR

PSVMC

OR-Providence Saint Vincent Medical Center

PHSOR

PSH

OR-Providence Seaside Hospital

PHSOR

PSPS

OR-Providence Specialty Pharmacy Services

PHSOR

PSVHC

OR-Providence St. Vincent Heart Clinics Cardiology Mill Plain

PHSOR

PWFC

OR-Providence Willamette Falls Clinic

PHSOR

PWFMC

OR-Providence Willamette Falls Medical Center

PHSOR

SCMS

OR-Surgery Center at Mt. Scott

PHSOR

SCTSBN

OR-Surgery Center at Tanasbourne

PHSWA

PMGPHC

WA-PMG PHC SYSTEM TELEHEALTH

PHSWA

PMGSE

WA-PMG SE WA

PHSWA

PMGSE

WA-PMG SE WA Physiatry

PHSWA

PMGSW

WA-PMG SW WA

PHSWA

PMGSW

WA-PMG SW WA Rochester Family Medicine

PHSWA

PMGSW

WA-PMG SW WA System Telehealth

PHSWA

PEBH

WA-PRMCE BH Outpatient

PHSWA

PECC

WA-PRMCE Children's Center

PHSWA

PEHC

WA-PRMCE Everett Healthcare Clinic

PHSWA

PEICAA

WA-PRMCE Intervention Center for Assault and Abuse

PHSWA

ECLH

WA-Prov Express Care Lincoln Heights (PMG PHC)

PHSWA

ECVRL

WA-Prov Express Care Virtual NW WA (PMG NW WA)

PHSWA

ECVRL

WA-Prov Express Care Virtual SW WA (PMG SW WA)

PHSWA

PCCHD

WA-Prov.Ctr for Congenital Heart Disease

PHSWA

PAS

WA-Providence Anesthesia Services

PHSWA

PCS

WA-Providence Cardiology Associates

PHSWA

PCH

WA-Providence Centralia Hospital

PHSWA

PRMCE

WA-Providence Everett Regional Medical Center (PRMCE)

PHSWA

ECWW

WA-Providence Express Care Walla Walla (PMG SE WA)

PHSWA

PHFH

WA-Providence Holy Family Hospital

PHSWA

PHS

WA-Providence Home Services

PHSWA

PHHCSC

WA-Providence Hospice and Home Care of Snohomish County

PHSWA

PHOS

WA-Providence Hospice of Seattle

PHSWA

PIPS

WA-Providence Infusion and Pharmacy Services

PHSWA

PIPSE

WA-Providence Infusion and Pharmacy Services-East

PHSWA

PM

WA-Providence Marianwood

PHSWA

PMJCC

WA-Providence Mother Joseph Care Center

PHSWA

PMCH

WA-Providence Mount Carmel Hospital

(15)

M I N I S T R Y (continued)

ENTITY ABBREVIATION

ABBREVIATION

MINISTRY

PHSWA

PMSV

WA-Providence Mount St. Vincent

PHSWA

PPHARM

WA-Providence Pharmacy

PHSWA

PPT

WA-Providence Physical Therapy

PHSWA

PRCA

WA-Providence Radiation Care Aberdeen

PHSWA

PSHMC

WA-Providence Sacred Heart Medical Center and Children's Hospital

PHSWA

PSHC

WA-Providence SoundHomeCare and Hospice (Olympia)

PHSWA

PSHI

WA-Providence Spokane Heart Institute

PHSWA

PSJCC

WA-Providence St. Joseph Care Center

PHSWA

PSJH

WA-Providence St. Joseph's Hospital (Chewelah)

PHSWA

PSMHH

WA-Providence St. Mary Home Health

PHSWA

PSMMC

WA-Providence St. Mary Medical Center

PHSWA

PSMSNF

WA-Providence St. Mary Skilled Nursing Facility

PHSWA

PSPCDC

WA-Providence St. Peter Chemical Dependency Center

PHSWA

PSPH

WA-Providence St. Peter Hospital

PHSWA

PSPHDI

WA-Providence St. Peter Hospital Diagnostic Imaging (Lacey)

PHSWA

PSPCS

WA-Providence Surgery & Procedure Center (Spokane ASC)

PHSWA

PVNA

WA-Providence VNA Home Health

PHSWA

PCWEV

WA-WEV Providence Center

ACC

CA-Access Medical Group

AFF

CA-Affiliates Medical Group

CSC

CA-ASC Coast Surgery Center

SFVSC

CA-ASC San Fernando Valley Surgery Center

SSC

CA-ASC Summit Surgery Center

VSC

CA-ASC Ventana Surgical Center, LLC

AXM

CA-Axminster Medical Group

FEC

CA-Facey Endoscopy Center

FMF

CA-Facey Medical Foundation

PMI

CA-PMI Providence Medical Institute

PMI

PMIRB

CA-PMI Radiology Burbank

KRMC

KAEC

WK-Kadlec Ambulatory Endoscopy Center

KRMC

WK-Kadlec Regional Medical Center

KRMC

KSASC

WK-Kadlec Spaulding ASC

KRMC

TCRSC

WK-Tri-City Regional Surgery Center

INHS

WL-St Luke's Rehab (INHS)

PACMED

WP-Pacific Medical Center (Pacmed)

PACMED

PACMEDASC

WP-PacMed ASC

PACMED

PACMED Dr. Gee

WP-PacMed- Dr. Gee

PACMED

PACMED Dr. Knutson

WP-PacMed- Dr. Knutson

SHS

SPETCT

WS-PET/CT Imaging at Swedish Cancer

SHS

SB

WS-Sam Bobek

SHS

SE

WS-Swedish Edmonds

SHS

SFMCH

WS-Swedish Family Medicine Cherry Hill

SHS

SFHDI

WS-Swedish First Hill Diagnostic Imaging

SHS

SHVC

WS-Swedish Heart & Vascular Clinic/Swedish Advanced

SHS

SIC

WS-Swedish Imaging Clinics

SHS

SMC

WS-Swedish Medical Center

(16)

M I N I S T R Y (continued)

ENTITY ABBREVIATION

ABBREVIATION

MINISTRY

SHS

SMCB

WS-Swedish Medical Center Ballard

SHS

SCH

WS-Swedish Medical Center Cherry Hill

SHS

SE

WS-Swedish Medical Center Edmonds

SHS

SFH

WS-Swedish Medical Center First Hill

SHS

SI

WS-Swedish Medical Center Issaquah

SHS

SMI

WS-Swedish Medical Center Mill Creek

SHS

SR

WS-Swedish Medical Center Redmond

SHS

SMG

WS-Swedish Medical Group

SHS

SMJM

WS-Swedish Minor & James Medical

SHS

SPDV

WS-Swedish Physician Division

SHS

SP

WS-Swedish Physicians (SMG)

SHS

SPD

WS-Swedish Physicians Downtown

SHS

SPC

WS-Swedish Primary Care

SHS

SPH

WS-Swedish Psychiatric Hospitalists

SHS

SRASC

WS-Swedish Redmond ASC

SHS

SSCA

WS-Swedish Single Case Agreements

SHS

SST

WS-Swedish Sleep Therapy

SHS

SSC

WS-Swedish Specialty Clinics

SJH

CSSC

CA-California Specialty Surgery Center

SJH

FSC

CA-Fullerton Surgical Center

SJH

HPLMA

CA-Hospice of Petaluma

SJH

HHI

CA-Humboldt Home Infusion

SJH

MRLH

CA-Memorial Hospice

SJH

MHLH

CA-Mission Hospital Regional Medical Center-Laguna Beach

SJH

MHMV

CA-Mission Hospital Regional Medical Center-Mission Viejo

SJH

MSC

CA-Mission Surgery Center

SJH

NCH

CA-North County Hospice

SJH

PAV

CA-Pavillion Surgery Center

SJH

PVH

CA-Petaluma Valley Hospital

SJH

QVMC

CA-Queen of the Valley Medical Center

SJH

RMH

CA-Redwood Memorial Hospital

SJH

SRMH

CA-Santa Rosa Memorial Hospital

SJH

SJHMN

CA-St Joseph Health Medical Network

SJH

SJHRHC

CA-St Joseph Health Rural Health Clinic

SJH

SJHHHC

CA-St Joseph Health System Home Care Services

SJH

SJHHH

CA-St Joseph Health System Home Health Agency

SJH

SJHH

CA-St Joseph Heritage Healthcare

SJH

SJHCN

CA-St Joseph Home Care Network

SJH

SJE

CA-St Joseph Hospital - Eureka

SJH

SJO

CA-St Joseph Hospital - Orange

SJH

SJMC

CA-St Jude Medical Center

SJH

SMMC

CA-St Mary Medical Center

SJH

NSHC

CA-North Star Healthcare

SJH

SCHH

CA-Sea Crest Home Health Services

SJH

SMHDHH

CA-St Mary High Desert Home Health Services

SJH

ASI

CA-Advanced Surgery Institute

SJH

CC

CA-Collabria Care

SJH

LCH

CA-Living Care Hospice