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1 Table of ContentsMetroPlus Provider Directory160 Water Street, New York, NY 11 FQHCs (Federally Qualified Health Centers).. 13Co-located Substance Abuse/HIV Primary Care Providers (for Essential Plan 3/4 Members).. 19 Maternal/Pediatric HIV Specialized Care Centers (for Essential Plan 3/4 Members).. 21 HIV Primary Care Medicaid Programs (Article 28 Facilities) (for Essential Plan 3/4 Members).. 23 Health Home / Psychosocial Support 27 Retail Health Care Virtual 35 Primary Care 37 HIV Primary Care 91 Participating 93 Participating Dentists (for Members age 19+ with Dental Coverage).. 173 Behavioral Health 193 Behavioral Health 249 287 Certified Home Health 288 Consumer Directed Personal Care Services (for Essential Plan 3/4 Members).. 290 Dialysis 291 Durable Medical Equipment (DME).

2 295 Facility Based Occupational 307 Facility Based Physical 308 Facility Based Speech 309 Family 310 Hospice 312 Orthotics and 317 Personal Care Services (for Essential Plan 3/4 Members).. 321 Personal Emergency Response System (for Essential Plan 3/4 Members).. 323 Radiology Nursing 329 Transportation (for Essential Plan 3/4 Members).. 334 Vision Care Services (for Members age 19+ with Vision Coverage).. 338 Chain 343 Retail 345 Mail Order 365 Long Term Care 367 Home Infusion 369 Provider 3715 MBR Important Information Welcome to MetroPlus Essential Plan. We are pleased that you chose MetroPlus for your health plan. Please read the information below. It will help you choose a Primary Care Provider for you and your family if you have not done so already. It will also give you other important information.

3 Your Primary Care Provider When you join MetroPlus, you choose a MetroPlus participating physician or nurse practitioner to be your Primary Care Provider (PCP). We have many PCPs in our network. Your PCP will take care of your health care needs and refer you to other health care providers if you need them. How to Choose Your Primary Care Provider If you already have a PCP who is a MetroPlus provider, you can continue to see that provider. If you don t have a PCP who currently participates with our Essential plans, you can select a new provider from this Provider Directory, or you can recommend your current provider by calling MetroPlus. We will contact them to see if they would like to join our network You can find a PCP who speaks your language, is associated with a particular hospital or facility, has an office in or near a particular zip code that is convenient to you and that is wheelchair accessible.

4 There are times when a PCP may close their panel. This is noted in the directory. On certain occasions these PCPs open their panels. If you wish to verify that the PCP s panel is still closed please contact our Member Service Department at 1-855-809- 4073 (TTY: 711). You can also use the MetroPlus web site, , to find a PCP. On the website, go to the Find a Doctor tab and then select Find a Primary Care Provider. You can search for a PCP who meets your needs speaks your language, is associated with a particular hospital/facility, has an office in or near a particular zip code that is convenient to you and that is wheelchair accessible. Once you choose a PCP, call MetroPlus Member Services at 1-855-809-4073 (TTY: 711), Monday Friday, 8 am 8 pm, or Saturday, 9 am 5 pm, and make sure the provider is taking new patients.

5 This will ensure that you can have the PCP you want. 6 How to Use This Directory This directory only includes providers in Queens. If you would like a provider/pharmacy directory from another participating county, please visit our website at or call 1-855-809-4073 (TTY: 711). PCPs are listed in alphabetical order by borough, by specialty (Adult Health Care, Family Practice, Internal Medicine), by zip code. To help you choose a PCP, each provider listing offers the following information: Sample Listing: Explanation: INTERNAL MEDICINE Specialty Smith, John Provider Name 123456-AB12 Provider ID Number ^ Indicates the Provider is Board Certified / Male provider/Female provider accepting current patients only Evening hours available spanish /French Languages other than English spoken by the Provider and Clinical Staff Geriatrics Practice Limitations or Additions Family Health Center Clinic Name (If Any) 82-64 164th St Jamaica, NY 11432 Provider Address (718)123-4567 Office Phone Number Office is wheelchair accessible Queens Hospital Hospital where Provider is affiliated and admits patients Specialists, including Obstetricians (OB) and Gynecologists (GYN), are listed in alphabetical order by specialty, by zip code.

6 If a Provider practices more than one specialty (for example, Internal Medicine and Dermatology) they will be listed under each specialty. Dentists are listed by borough, by specialty, by zip code. (For children under age 19 or Members age 19+ with Dental Coverage) Behavioral Health providers, including Alcohol and Substance Abuse Counseling, are listed by borough, by specialty, by zip code. Behavioral Health Organizations are listed by zip code within each borough. Following Behavioral Health, other providers, such as Laboratory and Vision Care Services (for members with Vision Coverage), are listed alphabetically by provider type. 7 MBR Hospitals and Federally Qualified Health Centers are listed by borough in the front of the Directory. An alphabetical listing of all MetroPlus Participating Providers is included at the back of the Directory.

7 If you cannot find your provider in this Directory, please call Member Services to see if we have recently added him/her in our network. Getting Your Prescriptions MetroPlus members can fill their prescriptions and get certain medical supplies from any pharmacy in the MetroPlus network. To find a convenient MetroPlus participating pharmacy, go to (select Find a Doctor tab and then Find a Pharmacy ) or call MetroPlus Member Services at 1-855-809-4073 (TTY: 711), Monday Friday, 8 am 8 pm, or Saturday, 9 am 5pm. For Maintenance Drugs we have a mail order option which provides 90 days of medication delivered to your door. Important Telephone Numbers & Web Site MetroPlus Member Services: Call if you need help making an appointment or if you have a question or concern. MetroPlus Member Services: 1-855-809-4073 (TTY: 711) Monday through Friday 8 am 8 pm, or Saturday, 9 am 5 pm MetroPlus After Hours Service Line: 1-855-809-4073 (TTY: 711), if you need help during the night or on weekends MetroPlus Utilization Review: For review of a MetroPlus decision that treatment is not medically necessary.

8 There are some treatments and services that you need to get approval for before you receive them or in order to be able to continue receiving them. This is called prior authorization. To get approval for these treatments or services you need to call: MetroPlus Member Services: 1-855-809-4073 (TTY: 711) Monday through Friday 8:30 am 5 pm Fax: 212-908-8521 A Member Services Representative will answer any questions you have about the process and will transfer your call to the Utilization Review (UR) Department, if needed. Utilization review is what we do to decide whether treatment is medically necessary and will be approved or paid for by MetroPlus Health Plan. Doctors and nurses make the decisions. They do this by checking your treatment plan against medically acceptable standards. Our UR staff is available 8:30 to 5:00 Monday through Friday.

9 We have a 24-Hour Health Care Hotline 1-855-809-4073 if you need assistance with a medical problem. UR staff will respond to your message on the next business day. 8 You or your doctor may also submit a service authorization request in writing by sending it to: MetroPlus Health Plan 160 Water Street, 3rd Floor New York, NY 10038 Attention: Prior Authorization Emergency Services: In case of emergency, call 911 and follow instructions or go to the nearest Emergency Room. MetroPlus web site: You can also visit us at our web site Dental Services: If you are a MetroPlus member with dental coverage (including children under age 19 or Members age 19+ with a Dental Coverage rider) and you need help or have questions about dental services, call Healthplex at 1-888-468-2189 Monday through Friday 8 am - 6 pm.

10 Questions about your Provider's license: Call the New York State Office of Professional Medical Conduct at 1-800-663-6114 Monday through Friday 8 am 5 pm. NYS Department of Health Complaint Hot Line: If you have a complaint about MetroPlus, you can call 1-800-206-8125 Monday through Friday between 8:30 am 4:45 pm. Making Appointments Appointments to See Your PCP After choosing your PCP, call and make an appointment for a check-up right away. This will give your PCP the opportunity to learn about you and your health care needs. To make an appointment with your PCP, call the number listed in the Provider Directory or on your MetroPlus Member ID Card. If you need help making an appointment to see your PCP, call MetroPlus Member Services at 1-855-809-4073 (TTY: 711).