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PROVIDER NOTIFICATION
Important Information and Provider Notices
September 25, 2017
Pain Management network change
Plans Affected:   Mercy Care Plan, Mercy Care Plan Long Term Care and Mercy Care Advantage
  
A recent change was made to our network that affects pain management referrals that we would like to inform you about. Mercy Care has several pain management providers you may refer to in order to meet your patient's pain management needs. Pain management providers in Mercy Care's network are listed below:

Mercy Care Plan/ Mercy Care Advantage
List of Participating Pain Management Providers
 
PAIN SPECIALISTS
GROUPNAME ADDRESS CITY STATE ZIP PHONE
CENTER FOR NEUROSCIENCES 2450 E RIVER RD TUCSON AZ 85718 5203202140     
PIMA PAIN CENTER 6226 E PIMA ST STE 3 TUCSON AZ 85712 5203996000     
RANDALL PRUST MD PC 4745 E CAMP LOWELL DR TUCSON AZ 85712 4806569225     
RANDALL PRUST MD PC 4747 E CAMP LOWELL DR TUCSON AZ 85712 5207315540     
SOUTHWEST SPORTS AND SPINE LLC 5800 N LA CHOLLA BLVD STE 150 TUCSON AZ 85741 5203950512     
THE PAIN CENTER OF ARIZONA PC 1704 W ANKIAM RD STE 108 TUCSON AZ 85745 6235168252     
THE PAIN INSTITUTE OF SOUTHERN ARIZONA PC 4582 N 1ST AVE STE 170 TUCSON AZ 85718 5203186035     
THE PAIN INSTITUTE OF SOUTHERN ARIZONA PC 4881 E GRANT RD STE 101 TUCSON AZ 85712 5203186035     
TMC MEDICAL NETWORK 5300 ERICKSON DR STE 116 TUCSON AZ 85712 5202998200     
TUCSON INTERVENTIONAL PAIN MANAGEMENT PC 5300 ERICKSON DR STE 116 TUCSON AZ 85712 5202998200     
TUCSON PAIN INSTITUTE PC 6252 E GRANT RD STE 150 TUCSON AZ 85712 5208867246     
PHYSICAL MEDICINE / REHABILITATION
GROUP NAME ADDRESS CITY STATE ZIP PHONE
AGILITY SPINE AND SPORTS PHYSICAL THERAPY 1777 ST MARY RD TUCSON AZ 85745 5208849819     
AGILITY SPINE AND SPORTS PHYSICAL THERAPY 8987 E TANQUE VERDE STE 104 TUCSON AZ 85749 5208849819     
ATI PHYSICAL THERAPY 10355 N LA CANADA DR STE 125 TUCSON AZ 85737 5208228640     
ATI PHYSICAL THERAPY 5977 E GRANT RD STE 101 TUCSON AZ 85712 5208228640     
AUSTIN ALLEN GENTRY DC PT 899 N WLMONT RD STE A3 TUCSON AZ 85711 5207450545     
BODY CENTRAL PHYSICAL THERAPY 3124 N SWAN RD TUCSON AZ 85712 5203254002     
DESERT PALMS PHYSICAL THERAPY 12142 N RANCHO VISTOSO BLVD STE B-150 ORO VALLEY AZ 85755 5203382728     
IDEAL REHABILITATION PLLC 5977 E GRANT RD STE 101 TUCSON AZ 85712 5208228640     
MOUNTAIN OSTEOPATHIC PLLC 8070 N ORACLE RD STE 100 TUCSON AZ 85704 5202627554     
NOONAN PHYSICAL THERAPY ASSOCIATES 5956 E PIMA ST STE 140 TUCSON AZ 85712 5208854636     
PHYSIATRY ASSOCIATES LTD 2102 N COUNTRY CLUB RD STE B TUCSON AZ 85716 5207958371     
PROACTIVE PHYSICAL THERAPY LLC 3100 N CAMPBELL TUCSON AZ 85719 5209171060     
PROACTIVE PHYSICAL THERAPY LLC 3945 E PARADISE FALLS DR STE 109 TUCSON AZ 85712 5203210204     
PROACTIVE PHYSICAL THERAPY LLC 6246 E PIMA ST STE 160 TUCSON AZ 85712 5207210319     
PROACTIVE PHYSICAL THERAPY LLC 7530 N ORACLE RD STE 100 TUCSON AZ 85704 5203212476     
R R PHYSICAL THERAPY 4099 E 22ND ST STE 103 TUCSON AZ 85711 5203252001     
SIMONS PHYSICAL THERAPY 8703 E GOLF LINKS RD TUCSON AZ 85730 5205141114     
SUSAN R BULEN MD 1921 W HOSPITAL DR TUCSON AZ 85704 5202969399     
THE PAIN INSTITUTE OF SOUTHERN ARIZONA PC 4881 E GRANT RD STE 101 TUCSON AZ 85712 5203186035     
TUCSON ORTHOPAEDIC INSTITUTE 2424 N WYATT DR TUCSON AZ 85712 5207845660     
TUCSON PHYSICAL THERAPY 7315 N ORACLE RD STE 101 TUCSON AZ 85704 5202195553     
TUCSON PHYSICAL THERAPY 7315 N ORACLE RD STE 101 TUCSON AZ 85704 5202935551     
VIBRANTCARE OUTPATIENT REHABILITATION WEST INC 6246 E PIMA ST STE 160 TUCSON AZ 85712 5207210319     
WALLACE PHYSICAL THERAPY 5501 N ORACLE RD STE 101 TUCSON AZ 85704 5202971550     
WALLACE PHYSICAL THERAPY 5501 N ORACLE RD, STE 101 TUCSON AZ 85704 5204089547     
PSYCHOLOGIST
GROUP NAME ADDRESS  CITY STATE ZIP PHONE
ALEPH CENTER PLLC 6150 E GRANT RD TUCSON AZ 85712 5208855558     
ALEPH CENTER PLLC 6408 E TANQUE VERDE RD TUCSON AZ 85715 5208855558     
ASSURANCE HEALTH AND WELLNESS CENTER 3939 S PARK STE 150 TUCSON AZ 85714 5203334320     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE TUCSON AZ 85724 5206262544     
BANNER UNIVERSITY MEDICAL GROUP 2225 E AJO WAY TUCSON AZ 85713 5208743500     
BANNER UNIVERSITY MEDICAL GROUP 2800 E AJO WAY TUCSON AZ 85713 5208744068     
CENTER FOR NEUROSCIENCES 2600 N WYATT DR TUCSON AZ 85712 5203243217     
CENTER FOR NEUROSCIENCES 2650 N WYATT DR TUCSON AZ 85712 5203529955     
CENTER FOR NEUROSCIENCES 7461 E TANQUE VERDE RD TUCSON AZ 85715 5203206230     
CENTER FOR NEUROSCIENCES 7461 E TANQUE VERDE RD TUCSON AZ 85718 5203529955     
DAVID HERMOSILO ROMO PHD 5363 E PIMA ST STE 100 TUCSON AZ 85712 5206906443     
EL RIO SANTA CRUZ NEIGHBORHOOD HEALTH CENTER 6950 E GOLF LINKS RD TUCSON AZ 85730 5206703909     
FALCON, PATRICIA A 7618 N LA CHOLLA BLVD TUCSON AZ 85741 5203034209     
LA FRONTERA CENTER INC 4891 E GRANT RD TUCSON AZ 85712 5202963296     
SOUTHERN ARIZONA NEUROPSYCHOLOGY ASSOCIATES LLC 1921 W HOSPITAL DR TUCSON AZ 85704 5205445237     
SOUTHERN ARIZONA NEUROPSYCHOLOGY ASSOCIATES LLC 1921 W HOSPITAL DR TUCSON AZ 85704 5207223777     
TUCSON CONCUSSION CENTER LLC 5199 E FARNESS DR STE 101 TUCSON AZ 85712 5206209200     
ANESTHESIOLOGIST
GROUP NAME ADDRESS CITY STATE ZIP PHONE
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 2059346600     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 5205721773     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 5206262761     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 5206267195     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 5206267747     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL TUCSON AZ 85724 6469575620     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE TUCSON AZ 85724 4097721221     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE TUCSON AZ 85724 5203234464     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE TUCSON AZ 85724 5207953500     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE TUCSON AZ 85724 8585659666     
BANNER UNIVERSITY MEDICAL GROUP 1501 N CAMPBELL AVE BOX 245114 TUCSON AZ 85724 5206267221     
BANNER UNIVERSITY MEDICAL GROUP 2800 E AJO WAY TUCSON AZ 85713 5206948888     
BANNER UNIVERSITY MEDICAL GROUP 2800 E AJO WAY TUCSON AZ 85713 5208744700     
BANNER UNIVERSITY MEDICAL GROUP 5301 E GRANT RD TUCSON AZ 85712 5203242030     
BANNER UNIVERSITY MEDICAL GROUP 575 E RIVER RD TUCSON AZ 85704 5207953500     
BANNER UNIVERSITY MEDICAL GROUP 750 N ALVERNON WAY TUCSON AZ 85711 5208743500     
OLD PUEBLO ANESTHESIA PC 5700 E PIMA STE E TUCSON AZ 85712 5203242030     
OLD PUEBLO ANESTHESIA PC 5301 E GRANT RD TUCSON AZ 85712 5204456002     
OLD PUEBLO ANESTHESIA PC 2810 N SWAN RD STE 100 TUCSON AZ 85712 5203242030     
SANTA RITA ANESTHESIA SV 5301 E GRANT RD TUCSON AZ 85712 5205772246     

New pain management cases for your patients should be referred to one of the above participating providers in Mercy Care's network.  Any follow-up care provided by a non-participating provider will be allowed as long as the following criteria are met: 
  • An authorization is received by Mercy Care Plan from the non-participating provider; and
  • The surgical procedure was done prior to the non-participating provider's termination with Mercy Care Plan. 
According to our Provider Manual under the section, Contract Additions or Terminations , in order to meet contractual obligations and state and federal regulations, providers must
report any terminations or additions to their contract at least 90 days prior to the change. Providers are required to continue providing services to members throughout the termination period.

Under the Continuity of Care section it indicates that providers terminating their contracts
without cause are required to continue to treat MCP members until the treatment course has
been completed or care is transitioned. Authorization may be necessary for these services.
Members who lose eligibility and continue to have medical needs must be referred to a facility or provider that can provide the needed care at no or low cost. MCP is not responsible for payment of services rendered to members who are not eligible.

As always, don't hesitate to contact your Provider Relations Representative with any
questions or comments. You can find this notice and all other provider notices posted on our website.
  
Thanks for all you do!

QB 3120




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