Blue Blue Shield of IL 3200 Robbins Road Springfield, IL 62704 (12/11) Jennifer (800) 582-6418 Ext. 2130 Fax (217) 698-0718 Blue Cross Blue Shield of MN P.O. Box 64560 St. Paul, MN (4/06) Greg Walsh (651) 662-6278 Fax (651) 662-1099 Blue Cross Blue Shield of ND 4510 13th Avenue Fargo, ND 58121 (5/10) Kristi Schlosser Carlson (701) 277-2539 Fax (701) 282-1554 Britton Center 360 Sherman Street, Suite 400 St. Paul, MN 55102-2425 (9/15) www.brittoncenter.com Abigail M. Thomas (651) 340-3854 Burke Chiropractic Center 7250 France Avenue South, Suite 111 Edina, MN 55435 Adam Burke (952) 835-0006 Fax (952) 835-9355 Danielle Burke (952) 224-4423 Fax (952) 835-9355 Carpenters & Joiners Health & Welfare Fund 3001 Metro Drive, Suite 500 Bloomington, MN 55425 (9/17) Bryan Morben (612) 435-6352 Fax (612) 435-6379 Anderson, Helgen, Davis & Nissen, P.A. Kim Tuckner (612) 435-6358 Fax (612) 435-6379 Cass Lake Indian Hospital (4/07) See U.S. Department of Health and Human Services Center for Diagnostic Imaging (CDI) 5775 Wayzata Blvd. Suite 500A St. Louis Park, MN 55416 (3/18) Kris Wittwer/Jessica Syverson (attorneys) (651) 493-2934 Fax (651) 493-2987
Fairview Health Services Work Comp Interventions 400 Stinson Boulevard NE Minneapolis, MN (1/2019) Includes all Fairview facilities [hospitals, clinics, home care, etc., also includes Institute for Athletic Medicine, University of MN Surgical Consultants, (Fairview) Diagnostic Labs] (excluding Mesaba/Hibbing/Range area) Melissa Dietrich (612) 672-7679 Fax (612) 365-0396 (Attn: Interventions) ***Prefer notice to be e-mailed instead of by fax, if possible. If applicable, on sheet list sites you are serving. Sarah Bishop (612) 672-5010 Fax (612) 365-0396 (Attn: Interventions) Family Health Medical Clinics 2000 Avenue Northfield, MN (5/13) Laura Peterson (507) 646-1176 Fax (507) 646-1486 Family Practice Medical Center 502 Second Street S.W. P.O. Box 957 Willmar, MN 56201 Anne Moudry (320) 231-8627 Fax (320) 231-8609 Gary McDowell (320) 231-8642 Class Recoveries, Inc. (for Preferred One Administrative Services 7900 International Suite 300 Bloomington, MN 55425 (10/14) Bill Brady (952) 883-3250 First Plan of MN 525 S. Lake Ave. 222 Duluth, MN (4/06) Greg P. O. Box 64560 St. Paul, MN 55164 (651) 662-6278 Fax (651) 662-1099 First Unum Life Insurance Company 1 Fountain Square Chattanooga, TN 12/17 Jennifer (423) 294-5673 Fax (423) 294-2424 Firstlight Health System 301 Highway 65 Mora, MN 55051 Kelly Caswell (320) 225-3337 Fax (320) 225-3345 Lisa Wren (320) 225-3534 Fax (320) 225-3345
Mayo Clinic Health System – Southwest Minnesota Region d/b/a Mayo Clinic Health System – Mankato, d/b/a Mayo Clinic Health System – New Prague, d/b/a Mayo Clinic Health System – Springfield, d/b/a Mayo Clinic Health System – Waseca See Mayo Clinic Mayo Clinic Health System – Fairmont See Mayo Clinic Mayo Clinic Health System – Lake City See Mayo Clinic Mayo Clinic Health System – St. James See Mayo Clinic McGuire Family Chiropractic, P.A. 215 3rd Street P.O. Box 226 Gaylord, MN Dr. Cassie McGuire (507) 237-2777 Fax (507) 237-3777 Melissa Cochrane (507) 237-2777 Fax (507) 237-3777 Medica Health Plans/Optum (4/14) See Optum Medical Advanced Pain Specialists (MAPS) 2104 Northdale Boulevard NW, Suite 220 Coon Rapids, MN 55433 (4/18) Juli Lemke (763) 537-6000, Ext. 7196 Fax (763) 767-7172 Meds-1 Ambulance Service, Inc. 1328 N.W. 5th Street Grand Rapids, MN 55744 Timothy J. George (218) 326-0020 Fax (218) 326-1402 Sherri L. Beddoe (218) 326-0020 Fax (218) 326-1402 Methodist Hospital Third Party-Workers’ Compensation 6500 Excelsior Blvd. St. Park, MN 55426 (11/09) Kris Wittwer/Jessica Syverson (attorneys) 1700 Highway 36 W, Suite 640 Roseville, MN 55113 (651) 493-2934 Fax (651) 493-2987 Midwest Radiology (6/07) See St. Paul Radiology
MN Department of Employment and Economic Development 332 Minnesota St. Suite E200 St. Paul, MN 55101-1351 Tax ID# 41-1681137 (1/15) Rachel Cornell (atty) (651) 259-7633 Fax (651) 205-4007 MN Department of Services Benefit Recovery Section/Tort Recovery Unit P.O. Box 64994 St. Paul, MN 55164-0994 (12/17) Kalli Bennett (651) 431-3137 Fax (651) 431-7431 MN Department of and Industry Vocational Rehabilitation Unit 443 Lafayette Rd. N. St. Paul, MN 55155 (3/06) Cheryl Eliason (651) 284-5414 Fax (651) 284-5734 Gerald Meyer, Director (651) 284-5007 Fax (320) 255-3951 MN Surgery Center 4131 West Loomis Road, Suite 300 Greenfield, WI 53221 (7/15) Je’Nean Lessard (414) 324-4625 Fax (414) 324-3720 MN Teamsters Health & Welfare Fund C/o Wilson McShane Co. 3001 Metro Drive Suite 500 Bloomington, MN 55425 (3/06) Mike Theirl (952) 854-0795 Fax (952) 854-1632 Thomas McCormick (atty) 222 9th Street Suite 1600 Minneapolis, MN 55402 (612) 337-9550 Fax (612) 337-9049 Minnesota Occupational Health 710 Commerce Drive, Suite 200 Woodbury, MN 55125 (4/16) Cynthia Office (651) 968-5022 Cell (651) 795-1111 Fax (651) 968-5900 Jim Cleary (651) 968-5007 Fax (651) 968-5900
Minnetonka Imaging MRI, P.A. Nicollet Avenue South Burnsville, MN 55337 4/6/15 Dr. Carlos A. Rivera, D.C. (952) 303-6648 Fax (952) 426-1826 Jose A. Rivera (612) 803-0589 Mobile Imaging (3/06) See Consulting Radiology MSPRC-NGHP (Medicare) P.O. Box 138832 Oklahoma City, OK 73113 Toll free: 866-677-7220 Fax: (405) 869-3309 (08/12) Neurosurgical Associates, Ltd. Piper Building, Suite 305 800 E. 28th St. Minneapolis, MN (9/15) Carrean Wallraff (612) 879-7157 Fax (612) 879-7189 Kathy Kleinboehl (612) 879-7156 Fax (612) 879-7189 New River Medical Center 1013 Hart Boulevard Monticello, MN 55362 www.newrivermedical.com (08/12) Lynn Wicezorek (attorney) (763) 271-1365 Fax (763) 271-2299 Heather Hooper (Business Office) (763) 271-2306 Fax (763) 271-2344 North Memorial Health Care Intervention Notice-Business Office 3300 Oakdale Avenue North Robbinsdale, MN (11/09) North Memorial Health Care (763) 520-5400 Kris Wittwer/Jessica Syverson (attorneys) 1700 Highway 36 W, Suite 640 Roseville, MN 55113 (651) 493-2934 Fax (651) 493-2987 Northfield Hospital & Clinics 2000 Avenue Northfield, MN 55057 (5/13) Peterson (507) 646-1176 Fax (507) 646-1486 NovaCare Rehabilitation 555 Railroad Suite C Elk MN 55330 (6/15) Patten Cell (763) 350-2058 Office (763)-441-8111 Fax (717) 635-3915
Park Nicollet Health Services Third Party-Workers’ Compensation 3800 Park Nicollet Blvd. St. Park, MN 55426 (11/09) Kris Wittwer/Jessica Syverson (attorneys) 1700 Highway 36 W, Suite 640 Roseville, MN 55113 (651) 493-2934 Fax (651) 493-2987 Parker Chiropractic, P.A. 1320 S. Frontage Rd. Suite 102 Hastings, MN 55033 (3/06) Dr. Bill Parker (651) 480-2200 Fax (651) 480-1551 Physical Therapy Consultants, Inc. 139 Main Street Bethel, MN 55005 3/16 Nicole Pietila (763) 269-8065 Fax (763) 269-8053 Beth Churchsmith (763) 269-8065 Fax (763) 269-8053 Plumbers and Steamfitters Local 6 Health and Welfare Fund (1/08) See Rosene, Haugrud & Staab, Chtd. Polinski Rehabilitation Center (3/06) See St. Mary’s Duluth Clinic Health System Preferred One Administrative Services/First Class Recoveries, Inc. (3/09) See First Class Recoveries, Inc. Primary Behavioral Health Clinics, Inc. 3433 Broadway St. NE Suite 160 Minneapolis, MN (9/15) John Patrick Cronin, Ph.D., MPH, LP (612) 378-2363 (612) 791-1119 Fax (612) 378-2215 Fax (612) 378-2215 Carol Sax Office (612) 378-2363 Cell (612) 743-3447 Fax (612) 378-2215 Prime Meridian, Inc. 2627 E Franklin, Suite 201 Minneapolis, MN 55406 (9/15) Madsen, LAC (612) 870-1500 Fax (612) 870-1551 Mary Miller (612) 870-1500 Fax (612) 870-1551 Prime West Health 3905 Dakota Street Alexandria, MN 56308 (10/15) Shelly Steidl (320) 335-5271 Fax (320) 335-5323
Professional Associates of Rehabilitation, Inc. (PAR, Inc.) P.O. Box 270100 St. Paul, MN (2/12) Lisa Fischer (651) 330-5151 Fax (651) 330-5426 Deb Rush (651) 330-5151 Fax (651) 330-5426 Public Health Service (4/07) See U.S. Department of Health and Human Services Red Lake Indian Hospital (4/07) See U.S. Department of Health and Human Services Regions Hospital 640 Jackson St. Mail Stop 12403A St. Paul, MN (6/15) Work Comp Billing Manager (651) 254-4791 Fax (651) 254-5649 Kris Wittwer/Jessica Syverson (attorneys) 1700 Highway 36 W, 640 Roseville, MN 55113 (651) 493-2934 Fax (651) 493-2987 Rehabauthority, LLC 1560 South Carol Street Meridian, ID 9/17 Amy Roe (888) 467-9117 Fax (208) 287-9426 Reimann Counseling Clinic 7365 Kirkwood Court, Suite 360 Maple Grove, MN 55369 12/18 Jenny Reimann (763) 424-9591 Fax (763) 496-0635 Patty Walczak (763) 424-9591 Fax (763) 496-0635 Ridgeview Sibley Medical Center 601 West Chandler Street Arlington, MN 55307 7/18 Jane Scharpe (507) 964-8420 Fax (507) 964-5898 jane.scharpe@ridgeviewmedical.org Darla Anderson (507) 964-8424 Fax (507) 964-5898 darla.anderson@ridgeviewmedical.org Rivera Chiropractic Center, L.L.C. 13767 Nicollet Avenue South Burnsville, MN 55337 4/6/15 Dr. Carlos A. Rivera, D.C. (952) 303-6648 Fax (952) 426-1826 Jose A. Rivera (612) 803-0589 Roofers No. 96 Health and Welfare Fund (1/08) See Rosene, Haugrud & Staab, Chtd.
Sanford Health Legal Department P.O. Box 2010 Fargo, ND 58122-0786 (8/10) Penny Hoppe, Business Services (701) 234-1232 Fax (701) 234-1005 St. Orthopedics 1901 Connecticut Avenue South Sartell, MN 56377 5/18 Patricia (320) 257-7838 Fax (320) 259-8044 Shelley Gerads (320) 202-5519 Fax (320) 259-8044 St. Croix County Department of Health & Human Services Office of Corporation Counsel St. Croix County Government Center 1101 Carmichael Road Hudson, WI 54016 (8/06) Donald Gillen Assistant Corporation Counsel (715) 381-4313 Fax (715) 381-4301 Nancy Muller Fraud/FEV Coordinator (715) 246-8304 Fax (715)246-8220 St. Regional Medical Center 235 East State Street St. Croix Falls, MN 54024 (10/18) Katie Knutson (715) 483-0487 Fax (715) 483-0505 Nicole Stone (715) 483-0425 Fax (715) 483-0505 St. Croix Orthopedics 5803 Neal Avenue Oak Park Heights, MN (12/16) to 7/1/15: St. Croix Orthopedics Twin Cities Orthopedics Eggen Business Office Manager (651) 439-8807 Fax (651) 439-0232 St. Luke’s Hospital and Regional Trauma Center 915 East 1st Street Duluth, MN 55805 (218) 733-5737 (2/15) Bernadette Katich (218) 249-6871 Fax (218) 249-6880 Kelly M. Johnson (218) 249-6878 Fax (218) 249-6879
Trustmark Insurance Co. c/o Erickson, Bell, Beckman & Quinn 1700 West Highway 36, Suite 110 Roseville, MN 55113 (10/15) Caroline Bell Beckman (atty) (651) 223-4999 Fax (651)223-4987 Kari (atty) (651) 223-4999 Fax (651) 223-4987 Twin Cities Iron Workers Health and Welfare Fund c/o Wilson-McShane Co. 3001 Metro Drive Suite 500 Bloomington, MN 55425 (3/06) Rick Lemke (952) 854-0795 Fax (952) 854-1632 Thomas McCormick (atty) 222 South 9th Street Suite 1600 Minneapolis, MN (612) 337-9550 Fax (612) 337-9049 Twin Cities Orthopedics 4200 Dahlberg Drive, Suite 300 Golden Valley, MN 55422 (11/17) Christine Helmbrecht Supervisor, Patient Financial Services (952) 345-7755 or (952) 512-5600 x21180 Fax (952) 512-5651 Twin Cities Spine Center (Allina Health d/b/a) 913 E 26th Street, Suite 600 Minneapolis, MN 55404 (8/15) Kris Wittwer/Jessica Syverson (attorneys) 1700 Highway 36 W, 640 Roseville, MN 55113 (651) 493-2934 Fax (651) 493-2987 Pipe Trades Services MN Welfare Fund f/k/a Twin City Pipe Trades Health & Welfare Fund Attention: Gail Gross 4461 White Bear Parkway, Suite 1 White Bear Lake, MN 55101 (1/2019) Stacey L. Drentlaw, Attorney Leonard, O’Brien, Spencer, Gale & Sayre, Ltd. (612) 332-1030 Fax 612-332-2740 UCare MN/Optum (4/14) See Optum
Security Insurance Company (f/k/a Fortis Benefits Insurance Company) (3/06) Dana L. Boyle (atty) 411 E. Wisconsin St. Suite 1800 Milwaukee, WI 53202 (414) 273-3910 Fax (414) 273-1986 website: lindner-marsack.com United Food & Commercial Workers Local 789 Health & Welfare Fund 3001 Drive Suite 500 Bloomington, MN 55425 (3/06) McGrann Shea Law Firm (Amy Court) 800 Nicollet Mall Suite 2600 Minneapolis, MN (612) 338-2525 Fax (612) 339-2386 Mary Pat Baily (952) 854-0795 Fax (952) 851-3521 UFCW National Health and Welfare Fund 66 Grand Avenue Englewood, NJ 07631-3545 (6/15) Maurce Hodos, Fund Administrator (201) 569-8801 Fax (201) 569-1085 www.ufcwnationalfund.org United Healthcare/Optum (4/14) See U.S. Department of Health and Human Services Office of General Counsel 233 N. Michigan Ave., Ste. 700 Chicago, IL 60601 (4/07) C. Douglas Ferguson Assistant Regional Counsel Office of the General Counsel (312) 886-3605 Fax (312) 886-1718 Barbara Altman, Assistant Regional Counsel Office of the General Counsel (312) 353-1640 Fax (312) 886-1718 U.S. Department of Veterans Affairs Office of Regional Counsel (438/02) 2506 West 22nd Street, Building 16 P.O. Box 5046 Sioux Falls, SD 57117 (7/14) Sara Dannen Office of Regional Counsel (605) 336-3230 x6015 Fax (605) 333-6884 Unum Life Insurance Company of America 1 Fountain Square Chattanooga, TN 37402 12/17 Jennifer Majic (423) 294-5673 Fax (423) 294-2424 V.A. Medical Center See U.S. Dept. of Veteran’s Affairs