Clinic Number Clinic Address Zip Phone s Care Primary Care 2016 … · 2017. 1. 4. · ID County...

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ID County City ST Primary Care Clinic Number Clinic Address Zip Phone Type (PCC=Primary Care; PD= Pediatrics Care System 2016 Cost Level Final 2017 Cost Level (* denotes clinic moved to 2 for access) HP Adams Hettinger ND 3000 Hettinger Clinic 1000 E Hwy 12 58639 701-567-4561 PCC INW 2 2 BC Aitkin Aitkin MN R122050 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2121 PCC RRC 2* 2* HP Aitkin Aitkin MN 2689 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2157 PCC RRC 2* 2* P1 Aitkin Aitkin MN NA281 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2157 PCC RRC 2* 2* BC Aitkin McGregor MN N302203 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4 HP Aitkin McGregor MN 3213 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4 P1 Aitkin McGregor MN NA370 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4 BC Aitkin McGregor MN R122533 Riverwood McGregor Clinic 2 E. Center Ave. 55760 218-768-4011 PCC RRC 2* 2* HP Aitkin McGregor MN 2690 Riverwood McGregor Clinic 2 E Center Ave 55760 218-768-4011 PCC RRC 2* 2* P1 Aitkin McGregor MN NA280 Riverwood McGregor Clinic 2 E. Center Ave. 55760 218-768-4011 PCC RRC 2* 2* BC Allamakee Lansing IA G091951 Gundersen Lutheran Lansing Clinic 50 N 4th St 52151 319-538-4874 PCC GUN 4 4 HP Allamakee Lansing IA 2660 Gundersen Lutheran Lansing Clinic 50 N 4th St 52151 319-538-4874 PCC GUN 4 4 BC Allamakee Postville IA G091658 Gundersen Palmer Lutheran Hospital & Clinics - Postville 111 S Reynolds 52162 563-864-7512 PCC GUN 4 4 HP Allamakee Postville IA 2682 Gundersen Palmer Lutheran Hospital & Clinics - Postville 111 S Reynolds St 52162 563-864-7512 PCC GUN 4 4 HP Allamakee Waukon IA 2590 Mayo Clinic Health System Franciscan Healthcare - Waukon 105 E Main St 52172 563-568-3449 PCC MAY 4 4 P1 Allamakee Waukon IA FS110 Mayo Clinic Health System Franciscan Healthcare - Waukon 105 E. Main St. 52172 563-568-3449 PCC MAY 4 4 BC Allamakee Waukon IA G092288 Gundersen Lutheran Waukon Clinic 120 2nd Ave SE 52172 563-568-3000 PCC GUN 4 4 HP Allamakee Waukon IA 2704 Gundersen Lutheran Waukon Clinic 120 2nd Ave SE 52172 563-560-3000 PCC GUN 4 4 BC Anoka Andover MN F262094 Fairview Clinics - Andover 13819 Hanson Blvd. NW 55304 763-392-4001 PCC FAI 2 2 HP Anoka Andover MN 2268 Fairview Clinics - Andover 13819 Hanson Blvd. NW 55304 763-392-4001 PCC FAI 2 3 P1 Anoka Andover MN FP204 Fairview Clinics - Andover 13819 Hanson Blvd. NW 55304 763-392-4001 PCC FAI 2 2 HP Anoka Andover MN 2254 HealthPartners RiverWay Clinics - Andover 15245 Bluebird St NW 55304 952-967-7075 PCC HPR 1 1 HP Anoka Anoka MN 402 HealthPartners RiverWay Clinics - Anoka 601 Jacob Ln 55303 763-587-4400 PCC HPR 1 1 BC Anoka Blaine MN A262521 Allina Health Blaine Clinic 10705 Town Square Drive NE, #100 55449 763-236-5400 PCC ALL 3 2 HP Anoka Blaine MN 3182 Allina Health Blaine Clinic 10705 Town Square Dr. NE Ste 100 55449 763-236-5400 PCC ALL 3 4 2017 MN Advantage Network October 10, 2016 Page 1

Transcript of Clinic Number Clinic Address Zip Phone s Care Primary Care 2016 … · 2017. 1. 4. · ID County...

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    HP Adams Hettinger ND 3000 Hettinger Clinic 1000 E Hwy 12 58639 701-567-4561 PCC INW 2 2

    BC Aitkin Aitkin MN R122050 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2121 PCC RRC 2* 2*

    HP Aitkin Aitkin MN 2689 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2157 PCC RRC 2* 2*

    P1 Aitkin Aitkin MN NA281 Riverwood Aitkin Clinic 200 Bunker Hill Dr. 56431 218-927-2157 PCC RRC 2* 2*

    BC Aitkin McGregor MN N302203 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4

    HP Aitkin McGregor MN 3213 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4

    P1 Aitkin McGregor MN NA370 Ne La Shing (East Lake Clinic) 36666 St. Hwy. 65 55760 218-768-3311 PCC INE 3 4

    BC Aitkin McGregor MN R122533 Riverwood McGregor Clinic 2 E. Center Ave. 55760 218-768-4011 PCC RRC 2* 2*

    HP Aitkin McGregor MN 2690 Riverwood McGregor Clinic 2 E Center Ave 55760 218-768-4011 PCC RRC 2* 2*

    P1 Aitkin McGregor MN NA280 Riverwood McGregor Clinic 2 E. Center Ave. 55760 218-768-4011 PCC RRC 2* 2*

    BC Allamakee Lansing IA G091951 Gundersen Lutheran Lansing Clinic 50 N 4th St 52151 319-538-4874 PCC GUN 4 4

    HP Allamakee Lansing IA 2660 Gundersen Lutheran Lansing Clinic 50 N 4th St 52151 319-538-4874 PCC GUN 4 4

    BC Allamakee Postville IA G091658

    Gundersen Palmer Lutheran Hospital &

    Clinics - Postville 111 S Reynolds 52162 563-864-7512 PCC GUN 4 4

    HP Allamakee Postville IA 2682

    Gundersen Palmer Lutheran Hospital &

    Clinics - Postville 111 S Reynolds St 52162 563-864-7512 PCC GUN 4 4

    HP Allamakee Waukon IA 2590

    Mayo Clinic Health System Franciscan

    Healthcare - Waukon 105 E Main St 52172 563-568-3449 PCC MAY 4 4

    P1 Allamakee Waukon IA FS110

    Mayo Clinic Health System Franciscan

    Healthcare - Waukon 105 E. Main St. 52172 563-568-3449 PCC MAY 4 4

    BC Allamakee Waukon IA G092288 Gundersen Lutheran Waukon Clinic 120 2nd Ave SE 52172 563-568-3000 PCC GUN 4 4

    HP Allamakee Waukon IA 2704 Gundersen Lutheran Waukon Clinic 120 2nd Ave SE 52172 563-560-3000 PCC GUN 4 4

    BC Anoka Andover MN F262094 Fairview Clinics - Andover

    13819 Hanson Blvd.

    NW 55304 763-392-4001 PCC FAI 2 2

    HP Anoka Andover MN 2268 Fairview Clinics - Andover

    13819 Hanson Blvd.

    NW 55304 763-392-4001 PCC FAI 2 3

    P1 Anoka Andover MN FP204 Fairview Clinics - Andover

    13819 Hanson Blvd.

    NW 55304 763-392-4001 PCC FAI 2 2

    HP Anoka Andover MN 2254 HealthPartners RiverWay Clinics - Andover 15245 Bluebird St NW 55304 952-967-7075 PCC HPR 1 1

    HP Anoka Anoka MN 402 HealthPartners RiverWay Clinics - Anoka 601 Jacob Ln 55303 763-587-4400 PCC HPR 1 1

    BC Anoka Blaine MN A262521 Allina Health Blaine Clinic

    10705 Town Square

    Drive NE, #100 55449 763-236-5400 PCC ALL 3 2

    HP Anoka Blaine MN 3182 Allina Health Blaine Clinic

    10705 Town Square Dr.

    NE Ste 100 55449 763-236-5400 PCC ALL 3 4

    2017 MN Advantage Network October 10, 2016 Page 1

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    P1 Anoka Blaine MN AM160 Allina Health Blaine Clinic

    10705 Town Square Dr.

    NE, #100 55449 763-236-5400 PCC ALL 2 4

    BC Anoka Blaine MN M131034

    Multicare Associates - Blaine Medical

    Center 11855 Ulysses St. NE 55449 763-785-4200 PCC MUL 2 4

    HP Anoka Blaine MN 2354

    Multicare Associates - Blaine Medical

    Center 11855 Ulysses St NE 55434 763-785-4200 PCC MUL 2 4

    P1 Anoka Blaine MN NA520

    Multicare Associates - Blaine Medical

    Center 11855 Ulysses St. N.E. 55434 763-785-4200 PCC MUL 2 4

    BC Anoka Blaine MN F262478 Fairview Clinics - Blaine

    10961 Club W. Parkway

    NE 55449 763-528-2987 PCC FAI 2 2

    HP Anoka Blaine MN 2771 Fairview Clinics - Blaine 10961 Club W Pkwy NE 55449 763-528-2987 PCC FAI 2 3

    P1 Anoka Blaine MN FP205 Fairview Clinics - Blaine

    10961 Club West Pkwy.

    NE 55449 763-528-2987 PCC FAI 2 2

    BC Anoka Blaine MN S671074 North Memorial Clinic - Blaine

    1420 - 109th Avenue

    NE, #100 55449 763-581-5550 PCC NOR 2 2

    HP Anoka Blaine MN 980 North Memorial Clinic - Blaine

    1420 - 109th Avenue

    NE, #100 55449 763-581-5550 PCC NOR 2 2

    P1 Anoka Blaine MN NM107 North Memorial Clinic - Blaine

    1420 -109th Avenue

    NE, #100 55449 763-581-5500 PCC NOR 2 2

    BC Anoka

    Columbia

    Heights MN F261561 Fairview Clinics - Columbia Heights 4000 Central Ave. NE 55421 763-782-8183 PCC FAI 2 2

    HP Anoka

    Columbia

    Heights MN 748 Fairview Clinics - Columbia Heights 4000 Central Ave NE 55421 763-782-8183 PCC FAI 2 3

    P1 Anoka

    Columbia

    Heights MN FP207 Fairview Clinics - Columbia Heights 4000 Central Ave. NE 55421 763-782-8183 PCC FAI 2 2

    BC Anoka

    Columbia

    Heights MN T122541 Total Health Clinic Corp 5178 Central Ave. NE 55421 763-586-6045 PCC IMT 2 3

    HP Anoka

    Columbia

    Heights MN 2790 Total Health Clinic Corp 5178 Central Ave NE 55421 763-586-6045 PCC IMT 2 3

    P1 Anoka

    Columbia

    Heights MN NA476 Total Health Clinic Corp 5178 Central Ave. NE 55421 763-586-6045 PCC IMT 2 3

    BC Anoka Coon Rapids MN A261023 Allina Health Coon Rapids Clinic

    9055 Springbrook Dr.

    NW 55433 763-236-1090 PCC ALL 3 2

    HP Anoka Coon Rapids MN 427 Allina Health Coon Rapids Clinic

    9055 Springbrook Dr.

    NW 55433 763-236-1090 PCC ALL 3 4

    2017 MN Advantage Network October 10, 2016 Page 2

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    P1 Anoka Coon Rapids MN AM106 Allina Health Coon Rapids Clinic 9055 Springbrook Dr. 55433 763-780-9155 PCC ALL 2 4

    HP Anoka Coon Rapids MN 426 HealthPartners Coon Rapids Clinic

    11475 Robinson Dr.

    NW 55433 952-967-6990 PCC HPR 1 1

    BC Anoka Coon Rapids MN N412457 North Metro Pediatrics - Coon Rapids

    10081 Dogwood St.

    NW, #100 55448 763-783-3722 PD PED 2 2

    HP Anoka Coon Rapids MN 3329 North Metro Pediatrics - Coon Rapids

    10081 Dogwood St NW

    Ste 100 55448 763-783-3722 PD PED 2 2

    P1 Anoka Coon Rapids MN NA566 North Metro Pediatrics - Coon Rapids

    10081 Dogwood St.

    NW, #100 55448 763-783-3722 PD PED 2 2

    BC Anoka Fridley MN A261798 Allina Health Fridley Clinic

    500 Osborne Road NE,

    Suite 255 55432 763-786-6011 PCC ALL 3 2

    HP Anoka Fridley MN 3143 Allina Health Fridley Clinic

    500 Osborne Rd NE Ste

    255 55432 763-236-2500 PCC ALL 3 4

    P1 Anoka Fridley MN AM176 Allina Health Fridley Clinic 500 Osborne Rd., #255 55432 763-786-6011 PCC ALL 2 4

    BC Anoka Fridley MN F261562 Fairview Clinics - Fridley

    6341 University Ave.

    NE 55432 763-586-5844 PCC FAI 2 2

    HP Anoka Fridley MN 749 Fairview Clinics - Fridley 6341 University Ave NE 55432 763-586-5844 PCC FAI 2 3

    P1 Anoka Fridley MN FP208 Fairview Clinics - Fridley

    6341 University Ave.

    NE 55432 763-586-5844 PCC FAI 2 2

    BC Anoka Fridley MN F381033

    Fridley Children & Teenagers Medical

    Center

    500 NE Osborne Rd.,

    #310 55432 763-236-2700 PD PED 2 2

    HP Anoka Fridley MN 613

    Fridley Children & Teenagers Medical

    Center

    500 NE Osborne Rd Ste

    215 55432 763-236-2700 PD PED 2 2

    P1 Anoka Fridley MN CP105

    Fridley Children & Teenagers Medical

    Center

    500 N.E. Osborne Rd.,

    #215 55432 763-236-2700 PD CHI 2 2

    BC Anoka Fridley MN M131034

    Multicare Associates - Fridley Medical

    Center 480 Osborne Road 55432 763-785-4500 PCC MUL 2 4

    HP Anoka Fridley MN 2356

    Multicare Associates - Fridley Medical

    Center 480 Osborne Rd 55432 763-785-4500 PCC MUL 2 4

    P1 Anoka Fridley MN NA521

    Multicare Associates - Fridley Medical

    Center 480 Osborne Rd. 55432 763-785-4500 PCC MUL 2 4

    BC Anoka Lino Lakes MN F262764 Fairview Clinics - Lino Lakes 7455 Village Dr. 55014 651-717-3400 PCC FAI 2 2

    HP Anoka Lino Lakes MN 2223 Fairview Clinics - Lino Lakes 7455 Village Dr. 55014 651-717-3400 PCC FAI 2 3

    2017 MN Advantage Network October 10, 2016 Page 3

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    P1 Anoka Lino Lakes MN FP175 Fairview Clinics - Lino Lakes 7455 Village Dr. 55014 651-717-3400 PCC FAI 2 2

    HP Anoka Lino Lakes MN 722

    HealthPartners North Suburban Family

    Physicians - Lino Lakes 576 Apollo Dr. 55014 952-967-6620 PCC HPR 1 1

    BC Anoka Ramsey MN A262184 Allina Health Ramsey Clinic 7231 Sunwood Dr. NW 55303 763-236-0000 PCC ALL 3 2

    HP Anoka Ramsey MN 509 Allina Health Ramsey Clinic 7231 Sunwood Dr. NW 55303 763-236-0000 PCC ALL 3 4

    P1 Anoka Ramsey MN AM109 Allina Health Ramsey Clinic 7231 Sunwood Dr. NW 55303 763-236-0000 PCC ALL 2 4

    HP Ashland Ashland WI 145 Chequamegon Clinic 415 Ellis Ave 54806 715-685-6600 PCC SLK 2 2

    P1 Ashland Ashland WI SL107 Chequamegon Clinic 415 Ellis Ave. 54806 715-685-6600 PCC SLK 2 3

    HP Ashland Ashland WI 2368 Essentia Health - Ashland Clinic

    1615 Maple Lane, Suite

    #1 54806 715-685-7500 PCC SMD 2 2

    P1 Ashland Ashland WI DC101 Essentia Health - Ashland Clinic

    1615 Maple Lane, Suite

    #1 54806 715-685-7500 PCC SMD 4 4

    HP Ashland Ashland WI 2874 Main Street Clinic 1001 W Main 54806 715-682-5601 PCC NST 2 2

    P1 Ashland Ashland WI NS119 MainStreet Clinic 1001 W. Main St. 54806 715-682-5601 PCC NST 2 2

    P1 Aurora Stickney SD NA645 Prairie Health Clinic - Stickney 301 Main Street 57375 605-732-4508 PCC ISW 3 3

    HP Aurora White SD 3421 White Lake Medical Clinic Avera 306 S Johnston St 57383 605-337-1529 PCC AVH 2 2

    P1 Aurora White Lake SD AH231 White Lake Medical Clinic Avera 306 S. Johnston St. 57383 605-337-1529 PCC AVH 2 2

    HP Barnes Valley City ND 565 Essentia Health - Valley City Clinic 132 4th Ave NE 58072 701-846-8067 PCC DCH 1 1

    P1 Barnes Valley City ND DC151 Essentia Health - Valley City Clinic 132 4th Ave. NE 58072 701-845-8060 PCC DCH 1 1

    HP Barnes Valley City ND 892 Sanford Health - Valley City Clinic 520 Chautauqua Blvd 58072 701-845-6000 PCC MER 2 2

    P1 Barnes Valley City ND SV202 Sanford Health - Valley City Clinic 520 Chautauqua 58072 701-845-6000 PCC MER 2 2

    HP Barron Barron WI 2595

    Mayo Clinic Health System Northland -

    Barron Clinic 1222 E Woodland Ave 54812 715-537-3166 PCC MAY 4 4

    HP Barron Cameron WI 2597

    Mayo Clinic Health System Northland -

    Cameron Clinic 2049 15th Ave 54822 715-458-4380 PCC MAY 4 4

    HP Barron Chetek WI 2598

    Mayo Clinic Health System Northland -

    Chetek Clinic 220 Douglas St 54728 715-924-4811 PCC MAY 4 4

    HP Barron Chetek WI 2826 Marshfield Clinic Chetek Center 806 2nd St 54728 715-924-2000 PCC IWI 2 2

    HP Barron Cumberland WI 2792 Cumberland Healthcare - Cumberland 1110 7th Ave 54829 715-822-7500 PCC IWI 2 2

    P1 Barron Cumberland WI NA580 Cumberland Healthcare - Cumberland 1110 7th Ave. 54829 715-822-7500 PCC IWI 2 2

    HP Barron Cumberland WI 3072 Marshfield Clinic - Cumberland Center 1200 State Rd 48 54829 715-822-6900 PCC IWI 2 2

    2017 MN Advantage Network October 10, 2016 Page 4

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    HP Barron Rice Lake WI 3035

    Mayo Clinic Health System - Rice Lake

    Clinic 331 S Main St Ste H 54868 715-537-6747 PCC MAY 4 4

    HP Barron Rice Lake WI 3076 Marshfield Clinic - Rice Lake Center 1700 W Stout St 54868 715-236-8100 PCC IWI 2 2

    HP Barron Rice Lake WI 2828 Marshfield Clinic Lakewoods Family Center 1215 W Knapp 54868 715-234-1564 PCC IWI 2 2

    HP Barron Turtle Lake WI 2779 Turtle Lake Medical Clinic 550 Martin Ave 54889 715-986-4101 PCC IWI 2 2

    P1 Barron Turtle Lake WI NA464 Turtle Lake Medical Clinic 550 Martin Ave. 54889 715-986-4101 PCC IWI 2 2

    HP Barron Turtle Lake WI 3402

    Cumberland Healthcare - Turtle Lake

    Center 632 US Hwy 8 54889 715-986-2022 PCC IWI 2 2

    HP Bayfield Washburn WI 3222 Kreuser Clinic 320 Superior Ave 54891 715-373-0128 PCC IWI 2 2

    HP Bayfield Bayfield WI 3088 Red Cliff Community Health Center 36745 Aiken Rd 54814 715-779-3707 PCC IWI 2 2

    HP Bayfield Iron River WI 3082 The Lakes Community Health Center 7665 US Hwy 2 54847 715-372-5000 PCC NST 2 2

    P1 Bayfield Iron River WI NS122 Northlakes Community Clinic 7665 US Hwy. 2 54847 715-372-5001 PCC NST 2 2

    P1 Beadle Huron SD NA633 Huron Clinic Foundation 111 Fourth Street SE 57350 605-352-8691 PCC ISW 3 3

    BC Becker Detroit Lakes MN F132070 Sanford Health Detroit Lakes Clinic 1245 S. Washington 56501 218-846-2000 PCC MER 2 2

    HP Becker Detroit Lakes MN 590 Sanford Health Detroit Lakes Clinic 1245 S. Washington 56501 218-846-2000 PCC MER 2 2

    P1 Becker Detroit Lakes MN SV177 Sanford Health Detroit Lakes Clinic 1245 S. Washington 56501 218-846-2000 PCC MER 2 2

    BC Becker Detroit Lakes MN S752509

    Essentia Health St. Mary's - Detroit Lakes

    Clinic 1027 Washington Ave. 56502 218-847-5611 PCC DCH 1 1

    HP Becker Detroit Lakes MN 352

    Essentia Health St. Mary's - Detroit Lakes

    Clinic 1027 Washington Ave 56501 218-847-5611 PCC DCH 1 1

    P1 Becker Detroit Lakes MN DC160

    Essentia Health St. Mary's - Detroit Lakes

    Clinic 1027 Washington Ave. 56501 218-844-2300 PCC DCH 1 1

    BC Becker Frazee MN S752509 Essentia Health St. Mary's - Frazee Clinic 300 Main Ave. East 56544 218-334-7255 PCC DCH 1 1

    HP Becker Frazee MN 355 Essentia Health St. Mary's - Frazee Clinic 300 Main Ave E 56544 218-334-7255 PCC DCH 1 1

    P1 Becker Frazee MN DC161 Essentia Health St. Mary's - Frazee Clinic 300 Main Ave. E. 56544 218-334-7255 PCC DCH 1 1

    BC Becker Lake Park MN S752509

    Essentia Health St. Mary's - Lake Park

    Clinic 1005 1st St. 56554 218-238-5901 PCC DCH 1 1

    HP Becker Lake Park MN 357

    Essentia Health St. Mary's - Lake Park

    Clinic 1005 1st St 56554 218-238-5901 PCC DCH 1 1

    P1 Becker Lake Park MN DC162

    Essentia Health St. Mary's - Lake Park

    Clinic 1005 1st St. 56554 218-238-5901 PCC DCH 1 1

    HP Becker Ogema MN 3257 White Earth Health Center 40520 Cty Hwy 34 56569 218-983-4300 PCC INW 2 2

    2017 MN Advantage Network October 10, 2016 Page 5

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    HP Becker Ponsford MN 3258 Pine Point Clinic 47520 252nd St 56575 218-573-3162 PCC INW 2 2

    BC Beltrami Bemidji MN F132676 Sanford Bemidji Main Clinic 1300 Anne St. NW 56601 218-333-5000 PCC MER 2 2

    HP Beltrami Bemidji MN 885 Sanford Bemidji Main Clinic 1300 Anne St NW 56601 218-333-5000 PCC MER 2 2

    P1 Beltrami Bemidji MN SV169 Sanford Bemidji Main Clinic 1300 Anne St. NW 56601 218-333-5000 PCC MER 2 2

    BC Beltrami Bemidji MN F132678 Sanford Bemidji 1611 Anne St Clinic 1611 Anne St. N.W. 56601 218-333-2020 PCC MER 2 2

    HP Beltrami Bemidji MN 3410 Sanford Bemidji 1611 Anne St Clinic 1611 Anne St NW 56601 218-333-2020 PCC MER 2 2

    P1 Beltrami Bemidji MN SV209 Sanford Bemidji 1611 Anne St Clinic 1611 Anne St. N.W. 56601 218-333-2020 PCC MER 2 2

    BC Beltrami Bemidji MN F132677 Sanford Bemidji 1705 Anne Street Clinic 1705 Anne St. NW 56601 218-333-5000 PCC MER 2 2

    HP Beltrami Bemidji MN 2579 Sanford Bemidji 1705 Anne Street Clinic 1705 Anne St NW 56601 218-333-5000 PCC MER 2 2

    P1 Beltrami Bemidji MN SV170 Sanford Bemidji 1705 Anne Street Clinic 1705 Anne St. NW 56601 218-333-5000 PCC MER 2 2

    BC Beltrami Blackduck MN F132679 Sanford Clinic - Blackduck 81 1st St NW 56630 218-835-4222 PCC MER 2 2

    HP Beltrami Blackduck MN 2386 Sanford Clinic - Blackduck 81 1st St NW 56630 218-835-4222 PCC MER 2 2

    P1 Beltrami Blackduck MN SV171 Sanford Clinic - Blackduck 81 1st St NW 56630 218-835-4222 PCC MER 2 2

    BC Beltrami Kelliher MN F132610 Sanford Health Kelliher Clinic 243 Clark Ave. North 56650 218-647-8832 PCC MER 2 2

    HP Beltrami Kelliher MN 3347 Sanford Health Kelliher Clinic 234 Clark Ave 56650 218-647-8832 PCC MER 2 2

    P1 Beltrami Kelliher MN SV245 Sanford Health Kelliher Clinic 243 Clark Ave. 56650 218-647-8832 PCC MER 2 2

    P1 Benson Maddock ND NA544 Heart of America Johnson Clinic - Maddock 301 Roosevelt Ave. 58348 701-438-2555 PCC INW 2 2

    BC Benton Foley MN F362352 Foley Medical Center Ltd 471 Hwy. 23 56329 320-968-7234 PCC ICM 3 2

    HP Benton Foley MN 742 Foley Medical Center Ltd 471 Hwy 23 56329 320-968-7234 PCC ICM 3 2

    P1 Benton Foley MN NA130 Foley Medical Center Ltd 471 Hwy. 23 56329 320-968-7234 PCC ICM 3 2

    BC Big Stone Clinton MN N221762 Northside Medical Center (part time clinic) 324 Main St. 56225 320-839-6157 PCC ICM 2* 2

    BC Big Stone Graceville MN G121756 Essentia Health - Graceville Clinic 115 W. 2nd St. 56240 320-748-7223 PCC DCH 1 1

    HP Big Stone Graceville MN 316 Essentia Health - Graceville Clinic 115 W 2nd St 56240 320-748-7243 PCC DCH 1 1

    P1 Big Stone Graceville MN DC143 Essentia Health - Graceville Clinic 115 W. 2nd St. 56240 320-748-7243 PCC DCH 1 1

    BC Big Stone Ortonville MN N221762

    Northside Medical Center - Ortonville Area

    Health Services 450 Eastvold Ave. 56278 320-839-6157 PCC ICM 2* 2

    HP Big Stone Ortonville MN 315

    Northside Medical Center - Ortonville Area

    Health Services 450 Eastvold Ave 56278 320-839-6157 PCC ICM 2* 2

    P1 Big Stone Ortonville MN MR103

    Northside Medical Center - Ortonville Area

    Health Services 450 Eastvold Ave. 56278 320-839-6157 PCC ICM 2* 2

    BC Blue Earth Lake Crystal MN M242025 Mayo Clinic Health System - Lake Crystal 200 E. Prince St. 56055 507-726-6966 PCC ISJ 2 2

    2017 MN Advantage Network October 10, 2016 Page 6

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    HP Blue Earth Lake Crystal MN 992 Mayo Clinic Health System - Lake Crystal 200 E Prince St 56055 507-726-6966 PCC ISJ 4 4

    P1 Blue Earth Lake Crystal MN MH142 Mayo Clinic Health System - Lake Crystal 200 E. Prince St. 56055 507-726-6966 PCC ISJ 1 1

    BC Blue Earth Lake Crystal MN M181588 Lake Crystal Family Practice Clinic 221 S. Murphy St. 56055 507-726-2136 PCC MAN 2 2

    HP Blue Earth Lake Crystal MN 2623 Lake Crystal Family Practice Clinic 221 S Murphy St 56055 507-726-2136 PCC MAN 2 2

    P1 Blue Earth Lake Crystal MN NA297 Lake Crystal Family Practice Clinic 221 S. Murphy 56002 507-726-2136 PCC MAN 2 2

    BC Blue Earth Mankato MN I082423 Mayo Clinic Health System - Mankato 1015 Marsh St. 56001 507-625-4031 PCC ISJ 2 2

    HP Blue Earth Mankato MN 3335 Mayo Clinic Health System - Mankato 1015 Marsh St 56001 507-625-4031 PCC ISJ 4 4

    P1 Blue Earth Mankato MN MH146 Mayo Clinic Health System Mankato 1015 Marsh St. 56001 507-625-4031 PCC ISJ 1 1

    BC Blue Earth Mankato MN I082423

    Mayo Clinic Health System Mankato -

    Eastridge

    101 Martin Luther King

    Jr. Dr. 56001 507-385-6500 PCC ISJ 2 2

    HP Blue Earth Mankato MN 2657

    Mayo Clinic Health System Mankato -

    Eastridge

    101 Martin Luther King

    Jr Dr. 56001 507-385-6500 PCC ISJ 4 4

    P1 Blue Earth Mankato MN MH147

    Mayo Clinic Health System Mankato -

    Eastridge

    101 Martin Luther King

    Jr. Dr. 56001 507-385-6500 PCC ISJ 1 1

    BC Blue Earth Mankato MN M181588 Mankato Clinic 1230 E. Main St. 56002 507-625-1811 PCC MAN 2 2

    HP Blue Earth Mankato MN 2621 Mankato Clinic 1230 E Main St 56002 507-625-1811 PCC MAN 2 2

    P1 Blue Earth Mankato MN NA295 Mankato Clinic 1230 E. Main St. 56002 507-625-1811 PCC MAN 2 2

    BC Blue Earth Mankato MN M181588

    Mankato Clinic - Wickersham Health

    Campus 1421 Premiere Dr. 56001 507-385-4000 PCC MAN 2 2

    HP Blue Earth Mankato MN 2627

    Mankato Clinic - Wickersham Health

    Campus 1421 Premier Dr. 56001 507-385-4000 PCC MAN 2 2

    P1 Blue Earth Mankato MN NA422

    Mankato Clinic at Wickersham Health

    Campus 1421 Premier Dr. 56001 507-385-4000 PCC MAN 2 2

    BC Blue Earth Mankato MN O172438 Open Door Health Center 309 Holly Lane 56001 507-388-2120 PCC ISW 2 2

    HP Blue Earth Mankato MN 3336 Open Door Health Center 309 Holly Ln Ste 101 56001 507-388-2120 PCC ISW 2 2

    P1 Blue Earth Mankato MN NA627 Open Door Health Center 309 Holly Lane 56001 507-388-2120 PCC ISW 2 2

    BC Blue Earth Mapleton MN M182735 Mapleton Family Practice 305 Main St. NE 56065 507-524-3835 PCC MAN 2 2

    HP Blue Earth Mapleton MN 2624 Mapleton Family Practice 305 Main St E 56065 507-524-3835 PCC MAN 2 2

    P1 Blue Earth Mapleton MN NA298 Mapleton Family Practice Clinic 305 Main St. N.E. 56065 507-524-3835 PCC MAN 2 2

    2017 MN Advantage Network October 10, 2016 Page 7

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    denotes clinic moved to

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    HP Bon Homme Avon SD 2571 Bon Homme Family Practice - Avon 130 N Main St 57315 605-286-3888 PCC AVH 2 2

    P1 Bon Homme Avon SD AH164 Bon Homme Family Practice - Avon Main St. 57315 605-286-3888 PCC AVH 2 2

    HP Bon Homme Scotland SD 2609 Scotland Medical Clinic 610 Billars St 57059 605-583-2227 PCC AVH 2 2

    P1 Bon Homme Scotland SD AH160 Scotland Medical Clinic 610 Billars St. 57059 605-583-2227 PCC AVH 2 2

    HP Bon Homme Tyndall SD 2570 Bon Homme Family Practice - Tyndall 410 W 16th Ave 57066 605-589-3322 PCC AVH 2 2

    P1 Bon Homme Tyndall SD AH163 Bon Homme Family Practice - Tyndall 410 W. 16th Ave. 57066 605-589-3322 PCC AVH 2 2

    HP Bottineau Westhope ND 2944 Trinity Community Clinic - Westhope 310 2nd Ave E 58793 701-245-6638 PCC INW 2 2

    P1 Bottineau Westhope ND TH103 Trinity Community Clinic - Westhope 310 2nd Ave. E. 58793 701-245-6638 PCC INW 2 2

    HP Bowman Bowman ND 2998 Bowman Clinic 608 Hwy 12 W 58623 701-523-3271 PCC INW 2 2

    HP Bowman Bowman ND 2876 Southwest Medical Clinic 12 6th Ave SW 58623 701-523-3226 PCC INW 2 2

    P1 Bowman Bowman ND NA505 Southwest Medical Clinic 12 6th Ave. S.W. 58623 701-523-3226 PCC INW 2 2

    HP Bowman Scranton ND 3003 Scranton Clinic 211 Main St 58653 701-275-6336 PCC INW 2 2

    HP Brookings Brookings SD 2536 Avera Medical Group Brookings 400 22nd Ave 57006 605-697-9500 PCC AVH 2 2

    P1 Brookings Brookings SD AH166

    Avera Medical Group Brookings Affiliated

    with Brookings Health System 400 22nd Ave. 57006 605-697-9500 PCC AVH 2 2

    BC Brookings Brookings SD C202816 Sanford Clinic Brookings

    922 - 22nd Avenue

    South 57006 605-697-1900 PCC SAN 2 2

    HP Brookings Brookings SD 2730 Sanford Clinic Brookings 922 22nd Ave S 57006 605-697-1900 PCC SAN 2 2

    HP Brookings Elkton SD 2277 Avera Medical Group - Elkton 203 Elk St 57026 605-542-7701 PCC AVH 2 2

    P1 Brookings Elkton SD AH133 Avera Medical Group - Elkton 203 Elk St. 57026 605-542-7701 PCC AVH 2 2

    HP Brookings Volga SD 2648 Avera Medical Group - Volga 210 Kasan Ave 57071 605-627-5701 PCC AVH 2 2

    P1 Brookings Volga SD AH227 Volga Medical Clinic 210 Kasan Avenue 57071 605-697-9500 PCC AVH 2 2

    P1 Brookings White SD AH229

    Brookings Health System White Medical

    Clinic 302 E 5th St. 57276 605-629-3333 PCC AVH 2 2

    P1 Brown Aberdeen SD AH222 Avera Medical Group Dakota Medical Clinic 815 1st Ave. S.E. 57401 605-622-2535 PCC AVH 2 2

    HP Brown Aberdeen SD 3204 Avera Aberdeen Family Physicians 105 S. State St., #113 57401 605-225-0378 PCC AVH 2 2

    P1 Brown Aberdeen SD AH189 Avera Aberdeen Family Physicians 105 S. State St., #113 57401 605-225-0378 PCC AVH 2 2

    HP Brown Aberdeen SD 3090

    Avera Medical Group Internal Medicine

    Aberdeen 815 1st Ave. SE, #104 57401 605-622-5458 PCC AVH 2 2

    P1 Brown Aberdeen SD AH185

    Avera Medical Group Internal Medicine

    Aberdeen 815 1st Ave. SE, #104 57401 605-622-5458 PCC AVH 2 2

    P1 Brown Aberdeen SD AH230 NSU Health Services 1200 S. Jay St. 57401 605-622-2857 PCC AVH 2 2

    2017 MN Advantage Network October 10, 2016 Page 8

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    denotes clinic moved to

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    HP Brown Aberdeen SD 3046 Sanford Children's Aberdeen Clinic

    3015 3rd Ave SE Ste

    120 57401 605-725-6700 PD SAN 2 2

    P1 Brown Aberdeen SD SV150 Sanford Children's Aberdeen Clinic

    3015 3rd Ave. S.E.,

    #120 57401 605-725-6708 PCC SAN 2 2

    HP Brown Aberdeen SD 3159 Sanford Aberdeen Clinic 3015 3rd Ave SE 57401 605-725-1700 PCC SAN 2 2

    P1 Brown Aberdeen SD SV155 Sanford Aberdeen Clinic 3015 3rd Ave. S.E. 57401 605-725-1700 PCC SAN 2 2

    BC Brown Comfrey MN S052736 Sleepy Eye Medical Clinic Comfrey Clinic 104 Brown St. West 56019 507-877-5300 PCC ISW 3 3

    HP Brown Groton SD 3050 Avera Medical Group Groton 8 E Hwy 12 57445 605-397-4242 PCC AVH 2 2

    BC Brown New Ulm MN N021212 New Ulm Medical Center 1217 8th St. N. 56073 507-217-5000 PCC ULM 3 2

    HP Brown New Ulm MN 387 New Ulm Medical Center 1217 8th St N 56073 507-233-1000 PCC ULM 3 4

    P1 Brown New Ulm MN AM173 New Ulm Medical Center 1217 8th St. N. 56073 507-217-5000 PCC ULM 2 4

    BC Brown Sleepy Eye MN S051211 Sleepy Eye Medical Clinic 400 4th Ave. NW 56085 507-794-3691 PCC ISW 3 3

    HP Brown Sleepy Eye MN 389 Sleepy Eye Medical Clinic 400 4th Ave NW 56085 507-794-3691 PCC ISW 3 3

    P1 Brown Sleepy Eye MN MR145 Sleepy Eye Medical Clinic 400 4th Ave. N.W. 56085 507-794-3691 PCC ISW 3 3

    BC Brown Springfield MN S501590 Mayo Clinic Health System - Springfield 625 North Jackson 56087 507-723-6201 PCC MAY 4 4

    HP Brown Springfield MN 390 Mayo Clinic Health System - Springfield 625 N Jackson 56087 507-723-4231 PCC MAY 4 4

    P1 Brown Springfield MN MH121 Mayo Clinic Health System - Springfield 625 N. Jackson Ave. 56087 507-723-4231 PCC MAY 4 4

    HP Brule Chamberlain SD 2749

    Dakota Family Medical Center (Avera

    Medical Group Chamberlain) 101 S Front St 57325 605-234-6584 PCC AVH 2 2

    P1 Brule Chamberlain SD AH170 Dakota Family Medical Center 101 S. Front St. 57325 605-234-6584 PCC AVH 2 2

    HP Brule Chamberlain SD 2504 Sanford Chamberlain Clinic 300 S Byron Blvd 57325 605-734-6551 PCC SAN 2 2

    P1 Brule Chamberlain SD SV153 Sanford Chamberlain Clinic 300 S. Byron Blvd. 57325 605-234-6551 PCC SAN 2 2

    HP Brule Kimball SD 2721 Sanford Clinic - Kimball 109 S Main St 57355 605-778-6296 PCC SAN 2 2

    P1 Brule Kimball SD SV127 Sanford Clinic - Kimball 109 Main St. 57355 605-778-6296 PCC SAN 2 2

    BC Buffalo Alma WI L282447

    Mayo Clinic Health System Lake City -

    Alma Clinic 204 S. Main St. 54610 608-685-3241 PCC MAY 4 4

    HP Buffalo Alma WI 878

    Mayo Clinic Health System Lake City -

    Alma Clinic 204 S. Main St. 54610 608-685-3241 PCC MAY 4 4

    P1 Buffalo Alma WI MH126

    Mayo Clinic Health System Lake City -

    Alma Clinic 204 S. Main St. 54610 608-685-3241 PCC MAY 4 4

    HP Buffalo Mondovi WI 2601

    Mayo Clinic Health System Oakridge -

    Osseo Clinic 700 Buffalo St 54755 715-926-4858 PCC MAY 4 4

    2017 MN Advantage Network October 10, 2016 Page 9

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    Final 2017 Cost Level (*

    denotes clinic moved to

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    HP Burke Bowbells ND 3395

    Northland Community Health Center -

    Bowbells 18 Main St SW 58721 701-377-6400 PCC INW 2 2

    HP Burleigh Bismarck ND 3323 Biron D. Baker Family Medicine

    4401 Coleman Street,

    Suite 107 58501 701-751-4340 PCC INW 2 2

    HP Burleigh Bismarck ND 3441 Independent Doctors, PC

    4535 Northern Sky

    Drive 58501 701-712-3000 PCC INW 2 2

    P1 Burleigh Bismarck ND NA632 Independent Doctors, PC

    4535 Northern Sky

    Drive 58503 701-712-3000 PCC INW 2 2

    HP Burleigh Bismarck ND 2970 Sanford North Clinic 2830 N Washington 58503 701-323-6400 PCC MER 2 2

    P1 Burleigh Bismarck ND SV236 Sanford North Clinic 2830 N Washington 58503 701-323-6400 PCC MER 2 2

    HP Burleigh Bismarck ND 2972 Sanford South Clinic 1040 Tacoma Ave 58504 701-323-6990 PCC MER 2 2

    P1 Burleigh Bismarck ND SV233 Sanford South Clinic 1040 Tacoma Ave. S. 58504 701-323-6990 PCC MER 2 2

    HP Burleigh Bismarck ND 3008 Center for Family Medicine - Bismarck 701 E Rosser Ave 58501 701-751-9500 PCC INW 2 2

    HP Burleigh Bismarck ND 3028 Jeffrey Smith, MD 1033 Basin Ave 58504 701-223-6613 PCC INW 2 2

    P1 Burleigh Bismarck ND SV239 Sanford Seventh and Thayer 209 N. 7th St. 58501 701-323-5590 PCC MER 2 2

    HP Burleigh Bismarck ND 2994 Mid Dakota Clinic 401 N 9th St 58501 701-530-6000 PCC INW 2 2

    HP Burleigh Bismarck ND 2995 Mid Dakota Clinic Gateway Mall 2700 State St 58503 701-530-6000 PCC INW 2 2

    HP Burleigh Bismarck ND 2996 Mid Dakota Clinic Kirkwood Mall 727 Kirkwood Mall 58504 701-530-6000 PCC INW 2 2

    HP Burleigh Bismarck ND 2997 Mid Dakota Clinic University of Mary 7500 University Dr. 58504 701-355-8288 PCC INW 2 2

    HP Burleigh Bismarck ND 2969 Sanford Clinic - Bismarck 222 N 7th St 58501 701-323-5201 PCC MER 2 2

    P1 Burleigh Bismarck ND SV232 Sanford Clinic - Bismarck 222 N. 7th St. 58501 701-323-6000 PCC MER 2 2

    BC Burnett Grantsburg WI B182263 Burnett Medical Center Clinic

    257 West St. George

    Ave. 54840 715-463-5317 PCC IWI 2 2

    HP Burnett Grantsburg WI 531 Burnett Medical Center Clinic

    257 W Saint George

    Ave 54840 715-463-5317 PCC IWI 2 2

    P1 Burnett Grantsburg WI NA340 Burnett Medical Center Clinic 257 W. St. George Ave 54840 715-463-5317 PCC IWI 2 2

    BC Burnett Siren WI S021022 Shell Lake Clinic - Siren 7728 W. Main St. 54872 715-349-2910 PCC IWI 2 2

    HP Burnett Siren WI 2781 Shell Lake Clinic - Siren 7728 W Main St 54872 715-349-2910 PCC IWI 2 2

    P1 Burnett Siren WI NA293 Shell Lake Clinic - Siren 7728 Main St. 54872 715-349-2910 PCC IWI 2 2

    BC Burnett Webster WI S522152 Ingalls Family Medicine Clinic 7456 Main St. W. 54893 715-866-4271 PCC IWI 2 2

    HP Burnett Webster WI 2542 Ingalls Family Medicine Clinic 7456 Main St W 54893 715-866-4271 PCC IWI 2 2

    P1 Burnett Webster WI NA341 Ingalls Family Medicine Clinic 7456 Main St. W. 54893 715-866-4271 PCC IWI 2 2

    2017 MN Advantage Network October 10, 2016 Page 10

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    e (P

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    denotes clinic moved to

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    HP Butte Belle Fourche SD 3287 Belle Fourche Regional Medical Clinic 2200 13th Ave 57717 605-892-2701 PCC ISW 3 3

    HP Butte Pine Ridge SD 3295 Newell Regional Medical Clinic 1201 E Hwy 18 57770 605-867-3353 PCC ISW 3 3

    BC Carlton Cloquet MN M441954 Min No Aya Win Clinic 927 Trettel Lane 55720 218-879-1227 PCC INE 3 4

    HP Carlton Cloquet MN 3230 Min No Aya Win Clinic 927 Trettel Ln 55720 218-879-1227 PCC INE 3 4

    BC Carlton Cloquet MN N041299 Raiter Clinic 417 Skyline Blvd 55720 218-879-1271 PCC NST 2 2

    HP Carlton Cloquet MN 143 Raiter Clinic 417 Skyline Blvd 55720 218-879-1271 PCC NST 2 2

    P1 Carlton Cloquet MN NS105 Raiter Clinic 417 Skyline Blvd. 55720 218-879-1271 PCC NST 2 2

    BC Carlton Cromwell MN N042506 Cromwell Medical Clinic 5565 Hwy. 210 55726 218-644-3811 PCC NST 2 2

    HP Carlton Cromwell MN 3110 Cromwell Medical Clinic 5565 Hwy 210 55726 218-644-3811 PCC NST 2 2

    P1 Carlton Cromwell MN NS116 Cromwell Medical Clinic 5565 Hwy. 210 55726 218-722-8802 PCC NST 2 2

    BC Carlton Moose Lake MN G241295

    Gateway Family Health Clinic - Moose

    Lake 4570 County Hwy 61 55767 218-485-4491 PCC GAT 2 2*

    HP Carlton Moose Lake MN 137

    Gateway Family Health Clinic - Moose

    Lake 4570 County Hwy 61 55767 218-485-4491 PCC GAT 2 2*

    P1 Carlton Moose Lake MN NA496

    Gateway Family Health Clinic - Moose

    Lake 4570 Cty. Hwy. 61 55767 218-485-4491 PCC GAT 2 2*

    BC Carver Chanhassen MN P181366 Park Nicollet Clinic - Chanhassen 300 Lake Drive East 55317 952-993-4300 PCC PKN 4 2

    HP Carver Chanhassen MN 2700 Park Nicollet Clinic - Chanhassen 300 Lake Dr. E 55317 952-993-4300 PCC PKN 2 2

    P1 Carver Chanhassen MN PN111 Park Nicollet Clinic - Chanhassen 300 Lake Drive East 55317 952-993-4300 PCC PKN 4 2

    BC Carver Chanhassen MN A262239 Allina Health Chanhassen Clinic 7770 Dell Road, #110 55317 952-428-0200 PCC ALL 3 2

    HP Carver Chanhassen MN 726 Allina Health Chanhassen Clinic 7770 Dell Rd Ste 110 55317 952-428-0200 PCC ALL 3 4

    P1 Carver Chanhassen MN AM180 Allina Health Chanhassen Clinic 7770 Dell Road, #110 55317 952-428-0200 PCC ALL 2 4

    BC Carver Chanhassen MN R352542 Ridgeview Chanhassen Clinic 7907 Powers Blvd. 55317 952-934-0570 PCC IMT 2 3

    HP Carver Chanhassen MN 975 Ridgeview Chanhassen Clinic 7907 Powers Blvd 55317 952-934-0570 PCC IMT 2 3

    P1 Carver Chanhassen MN NA103 Ridgeview Chanhassen Clinic 7907 Powers Blvd. 55317 952-934-0570 PCC IMT 2 3

    BC Carver Chaska MN A262489 Allina Health Chaska Clinic

    111 Hundertmark Road,

    #220 55318 952-448-2020 PCC ALL 3 2

    HP Carver Chaska MN 424 Allina Health Chaska Clinic

    111 Hundertmark Rd

    Ste 220 55318 952-448-2050 PCC ALL 3 4

    P1 Carver Chaska MN AM158 Allina Health Chaska Clinic 111 Hundertmark Road 55318 952-448-2050 PCC ALL 2 4

    BC Carver Chaska MN L051392 Lakeview Clinic - Chaska

    110105 Pioneer Trail,

    Ste 100 55318 952-556-0120 PCC LAK 2 2

    HP Carver Chaska MN 2402 Lakeview Clinic - Chaska

    110105 Pioneer Trl Ste

    100 55318 952-556-0120 PCC LAK 2 2

    2017 MN Advantage Network October 10, 2016 Page 11

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    Final 2017 Cost Level (*

    denotes clinic moved to

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    P1 Carver Chaska MN NA237 Lakeview Clinic - Chaska

    110105 Pioneer Trail,

    Ste 100 55318 952-556-0120 PCC LAK 2 2

    BC Carver Chaska MN R352542 Ridgeview Chaska Clinic

    111 Hundertmark Road,

    115N 55318 952-361-2447 PCC IMT 2 3

    HP Carver Chaska MN 3411 Ridgeview Chaska Clinic 111 Hundertmark Rd 55318 952-361-2447 PCC IMT 2 3

    P1 Carver Chaska MN NA607 Ridgeview Chaska Clinic

    111 Hundertmark Rd.,

    #240 55318 952-361-2450 PCC IMT 2 3

    BC Carver Chaska MN F261078 South Lake Pediatrics - Chaska

    111 Hundertmark Rd.,

    #210 55318 952-401-8300 PD PED 2 2

    HP Carver Chaska MN 3256 South Lake Pediatrics - Chaska

    111 Hundertmark Rd

    Ste 210 55318 952-401-8300 PD PED 2 2

    P1 Carver Chaska MN CP157 South Lake Pediatrics - Chaska

    111 Hundertmark Road,

    #210 55318 952-401-8300 PD PED 2 2

    BC Carver Chaska MN V071086 Valley Family Practice 822 Yellow Brick Rd 55318 952-448-3303 PCC IMT 2 3

    HP Carver Chaska MN 973 Valley Family Practice 822 Yellow Brick Rd 55318 952-448-3303 PCC IMT 2 3

    P1 Carver Chaska MN NA559 Valley Family Practice 822 Yellow Brick Rd. 55318 952-448-3303 PCC IMT 2 3

    BC Carver Chaska MN W242009 Wayzata Children's Clinic - Chaska

    111 Hundertmark Rd.,

    #420 55318 952-448-3847 PD PED 2 2

    HP Carver Chaska MN 2532 Wayzata Children's Clinic - Chaska

    111 Hundertmark Rd

    Ste 420 55318 952-448-3847 PD PED 2 2

    P1 Carver Chaska MN CP149 Wayzata Children's Clinic - Chaska

    111 Hundertmark Rd.,

    #420 55318 952-448-3847 PD CHI 2 2

    BC Carver

    Norwood

    Young

    America MN L051392 Lakeview Clinic West - Norwood 406 Faxon Road 55368 952-467-2888 PCC LAK 2 2

    HP Carver

    Norwood

    Young

    America MN 499 Lakeview Clinic West - Norwood 406 Faxon Rd 55368 952-467-2888 PCC LAK 2 2

    P1 Carver Norwood MN NA147 Lakeview Clinic West - Norwood 406 Faxon Rd. 55368 952-467-2888 PCC LAK 2 2

    BC Carver Waconia MN L051392 Lakeview Clinic - Waconia 424 State Hwy. 5 W. 55387 952-442-4461 PCC LAK 2 2

    HP Carver Waconia MN 551 Lakeview Clinic - Waconia 424 State Hwy 5 W 55387 952-442-4461 PCC LAK 2 2

    P1 Carver Waconia MN NA148 Lakeview Clinic - Waconia 424 State Hwy 5 W 55387 952-442-4461 PCC LAK 2 2

    BC Carver Watertown MN C462270 Catalyst Medical Clinic - Watertown 204 Lewis Ave. S., #201 55388 952-955-1963 PCC IMT 2 3

    2017 MN Advantage Network October 10, 2016 Page 12

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    denotes clinic moved to

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    HP Carver Watertown MN 2538 Catalyst Medical Clinic - Watertown

    204 Lewis Ave S Ste

    201 55388 952-955-1963 PCC IMT 2 3

    P1 Carver Watertown MN NA359 Catalyst Medical Clinic - Watertown 204 Lewis Ave. S., #201 55388 952-955-1963 PCC IMT 2 3

    BC Carver Watertown MN L051392 Lakeview Clinic - Watertown 309 Jefferson Ave SW 55388 952-955-1921 PCC LAK 2 2

    HP Carver Watertown MN 553 Lakeview Clinic - Watertown 309 Jefferson Ave SW 55388 952-955-1921 PCC LAK 2 2

    P1 Carver Watertown MN NA146 Lakeview Clinic - Watertown 309 Jefferson Ave. S.W. 55388 952-955-1921 PCC LAK 2 2

    BC Cass Cass Lake MN F132680 Sanford Bemidji Cass Lake Clinic

    219 Grant Utley Ave

    NW 56633 218-335-2559 PCC MER 2 2

    HP Cass Cass Lake MN 886 Sanford Bemidji Cass Lake Clinic

    219 Grant Utley Ave

    NW 56633 218-335-2559 PCC MER 2 2

    P1 Cass Cass Lake MN SV175 Sanford Bemidji Cass Lake Clinic

    219 Grant Utley Ave.

    N.W. 56633 218-335-2559 PCC MER 2 2

    BC Cass Casselton ND D011113 Essentia Health - Casselton Clinic 5 9th Ave. North 58012 701-347-4445 PCC DCH 1 1

    HP Cass Casselton ND 998 Essentia Health - Casselton Clinic 5 9th Ave N 58012 701-347-4445 PCC DCH 1 1

    P1 Cass Casselton ND DC159 Essentia Health - Casselton Clinic 5 9th Ave. N. 58012 701-347-4445 PCC DCH 1 1

    BC Cass Fargo ND I011776 Family HealthCare Center - Fargo 301 NP Ave 58108 701-271-3344 PCC INW 2 2

    HP Cass Fargo ND 220 Family HealthCare Center - Fargo 301 NP Ave 58102 701-271-3344 PCC INW 2 2

    BC Cass Fargo ND I012308 Independent Family Doctors 1700 Gold Dr., #160 58103 701-234-9400 PCC INW 2 2

    HP Cass Fargo ND 3041 Independent Family Doctors 1711 Gold Dr. Ste 160 58103 701-234-9400 PCC INW 2 2

    BC Cass Fargo ND D011113 Essentia Health - 32nd Ave. Clinic 3000 32nd Ave SW 58108 701-364-8000 PCC DCH 1 1

    HP Cass Fargo ND 2575 Essentia Health - 32nd Ave. Clinic 3000 32nd Ave SW 58103 701-364-8000 PCC DCH 1 1

    P1 Cass Fargo ND DC154 Essentia Health - 32nd Ave. Clinic 3000 32nd Ave. S. 58103 701-364-8000 PCC DCH 1 1

    BC Cass Fargo ND D012819 Essentia Health - 52nd Avenue Clinic

    4110 - 51st Avenue

    South 58104 701-364-3100 PCC DCH 1

    HP Cass Fargo ND 3623 Essentia Health - 52nd Avenue Clinic

    4110 - 51st Avenue

    South 58104 701-364-3100 PCC DCH 1

    BC Cass Fargo ND D011113 Essentia Health - South University Clinic 1702 S. University Dr. 58103 701-364-3300 PCC DCH 1 1

    HP Cass Fargo ND 997 Essentia Health - South University Clinic 1702 S University Dr. 58103 701-364-3300 PCC DCH 1 1

    P1 Cass Fargo ND DC155 Essentia Health - South University Clinic 1702 S. University Dr. 58103 701-364-3300 PCC DCH 1 1

    2017 MN Advantage Network October 10, 2016 Page 13

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    denotes clinic moved to

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    BC Cass Fargo ND D011339 Essentia Health - West Acres Clinic 3902 - 13th Ave. S. 58103 701-364-6628 PCC DCH 1 1

    HP Cass Fargo ND 368 Essentia Health - West Acres Clinic 3902 13th Ave S 58103 701-364-6600 PCC DCH 1 1

    P1 Cass Fargo ND DC156 Essentia Health - West Acres Clinic 3902 13th Ave. S. 58103 701-364-6628 PCC DCH 1 1

    BC Cass Fargo ND I102280 Internal Medicine Associates - Fargo 1707 Gold Drive S 58103 701-280-2033 PCC INW 2 2

    HP Cass Fargo ND 3058 Internal Medicine Associates - Fargo

    1707 Gold Dr. S Ste

    101 58103 701-280-2033 PCC INW 2 2

    P1 Cass Fargo ND SV174 Sanford Broadway Medical Building 736 Broadway 58122 701-234-2000 PCC MER 2 2

    HP Cass Fargo ND 2976 Pediatric Arts Clinic, PC

    2829 University Dr. S

    Ste 101 58103 701-478-4722 PD INW 2 2

    P1 Cass Fargo ND HN123 Pediatric Arts Clinic, PC

    2829 University Drive

    S., Ste 101 58103 701-478-4722 PCC INW 2 2

    BC Cass Fargo ND I012351 Plains Medical Clinic 3290 - 20th St. South 58104 701-499-4800 PCC INW 2 2

    HP Cass Fargo ND 3042 Plains Medical Clinic 3290 20th St S 58104 701-499-4800 PCC INW 2 2

    BC Cass Fargo ND F131121 Sanford Broadway Clinic 801 Broadway North 58122 701-234-2000 PCC MER 2 2

    HP Cass Fargo ND 881 Sanford Broadway Clinic 801 Broadway N 58122 701-234-2000 PCC MER 2 2

    P1 Cass Fargo ND SV173 Sanford Broadway Clinic 801 Broadway N. 58122 701-234-2000 PCC MER 2 2

    BC Cass Fargo ND F131121 Sanford Children's Southwest Clinic 2701 13th Ave. S 58103 701-234-3600 PD MER 2 2

    HP Cass Fargo ND 884 Sanford Children's Southwest Clinic 2701 13th Ave S 58103 701-234-3600 PD MER 2 2

    P1 Cass Fargo ND SV176 Sanford Children's Southwest Clinic 2701 13th Ave. S. 58103 701-234-3600 PCC MER 2 2

    HP Cass Fargo ND 3359

    Sanford Clinic Internal Medicine at Family

    Wellness 2960 Seter Pkwy 58104 701-234-8800 PCC MER 2 2

    BC Cass Fargo ND F131121 Sanford North Fargo Clinic

    2601 Broadway St.

    North 58102 701-234-2900 PCC MER 2 2

    HP Cass Fargo ND 882 Sanford North Fargo Clinic 2601 N Broadway 58102 701-234-2900 PCC MER 2 2

    P1 Cass Fargo ND SV194 Sanford North Fargo Clinic 2601 Broadway 58102 701-234-2900 PCC MER 2 2

    BC Cass Fargo ND F131121 Sanford Clinic - South University Drive 1720 S. University Dr. 58103 701-280-4150 PCC MER 2 2

    P1 Cass Fargo ND SV206 Sanford South University 1720 S. University Dr. 58103 701-280-4140 PCC MER 2 2

    BC Cass Fargo ND F131121 Sanford Southpointe Clinic 2400 32nd Ave. S. 58103 701-234-8800 PCC MER 2 2

    HP Cass Fargo ND 883 Sanford Southpointe Clinic 2400 32nd Ave S 58103 701-234-8800 PCC MER 2 2

    P1 Cass Fargo ND SV199 Sanford Southpointe Clinic 2400 32nd Ave. S. 58103 701-234-8800 PCC MER 2 2

    HP Cass Fargo ND 3272 Stellar Healthcare 827 28th St S Ste B 58103 701-364-3660 PCC INW 2 2

    2017 MN Advantage Network October 10, 2016 Page 14

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    Primary Care

    Clinic Number Clinic Address Zip Phone Typ

    e (P

    CC

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    P1 Cass Fargo ND HN125 Stellar Healthcare 827 28th St. S., Unit B 58103 701-364-3660 PCC INW 2 2

    BC Cass Hackensack MN P222503 Essentia Health - Hackensack Clinic 110 Third St. South 56452 218-675-5044 PCC PIN 1 1

    HP Cass Hackensack MN 3122 Essentia Health - Hackensack Clinic 110 3rd St S 56452 218-675-5044 PCC PIN 1 1

    P1 Cass Hackensack MN DC137 Essentia Health - Hackensack Clinic 110 3rd St. S. 56452 218-675-5044 PCC PIN 1 1

    BC Cass Longville MN L191981

    Cuyuna Regional Medical Center -

    Longville 180 Jordan Lane 56655 218-363-3300 PCC CUY 3 2

    HP Cass Longville MN 2391

    Cuyuna Regional Medical Center -

    Longville 180 Jordan Ln 56655 218-363-3300 PCC CUY 3 2

    P1 Cass Longville MN NA245

    Cuyuna Regional Medical Center -

    Longville 180 Jordan Lane 56655 218-363-3300 PCC CUY 3 2

    BC Cass Pillager MN L142440 Lakewood Clinic - Pillager 653 Pillsbury St. N., #1 56473 218-746-4550 PCC LKW 2 2

    HP Cass Pillager MN 2610 Lakewood Clinic - Pillager 653 Pillsbury St Ste 1 56473 218-746-4550 PCC LKW 2 2

    P1 Cass Pillager MN NA392 Lakewood Clinic - Pillager 653 Pillsbury St. N., #1 56473 218-746-4550 PCC LKW 2 2

    BC Cass Pillager MN P222349

    Essentia Health St. Joseph's - Pillager

    Clinic

    680 Pillsbury Street

    North 56473 218-746-4527 PCC PIN 1 1

    HP Cass Pillager MN 2634

    Essentia Health St. Joseph's - Pillager

    Clinic

    680 Pillsbury Street

    North 56473 218-746-4527 PCC PIN 1 1

    P1 Cass Pillager MN DC140

    Essentia Health St. Joseph's - Pillager

    Clinic

    680 Pillsbury Street

    North 56473 218-746-4527 PCC PIN 1 1

    BC Cass Pine River MN P221774

    Essentia Health St. Joseph's - Pine River

    Clinic 415 Barclay Ave. 56474 218-587-4416 PCC PIN 1 1

    HP Cass Pine River MN 2635

    Essentia Health St. Joseph's - Pine River

    Clinic 415 Barclay Ave 56474 218-587-4416 PCC PIN 1 1

    P1 Cass Pine River MN DC141

    Essentia Health St. Joseph's - Pine River

    Clinic 415 Barclay Ave. 56474 218-587-4416 PCC PIN 1 1

    BC Cass Remer MN D071177 Essentia Health - Remer Clinic 9 Birch St. 56672 218-566-1441 PCC SMD 2 2

    HP Cass Remer MN 2362 Essentia Health - Remer Clinic 9 Birch St 56672 218-566-1441 PCC SMD 2 2

    P1 Cass Remer MN DC117 Essentia Health - Remer Clinic 9 Birch St. 56672 218-566-1441 PCC SMD 4 4

    BC Cass Walker MN S752719 Essentia Health - Walker Clinic 110 D Michigan Ave. W. 56484 218-547-3452 PCC DCH 1 1

    HP Cass Walker MN 367 Essentia Health - Walker Clinic 110 D Michigan Ave 56484 218-547-3452 PCC DCH 1 1

    P1 Cass Walker MN DC150 Essentia Health - Walker Clinic

    110 D Michigan Ave.

    NW 56484 218-547-3452 PCC DCH 1 1

    BC Cass Walker MN F132681 Sanford Health Walker Clinic 614 Michigan Ave. 56484 218-547-3938 PCC MER 2 2

    2017 MN Advantage Network October 10, 2016 Page 15

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    Clinic Number Clinic Address Zip Phone Typ

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    HP Cass Walker MN 2387 Sanford Health Walker Clinic 614 Michigan Ave 56484 218-547-3938 PCC MER 2 2

    P1 Cass Walker MN SV204 Sanford Health Walker Clinic 614 Michigan Ave. 56484 218-547-7700 PCC MER 2 2

    BC Cass West Fargo ND D012053 Essentia Health - West Fargo Clinic 1401 13th Ave. E. 58078 701-364-8900 PCC DCH 1 1

    HP Cass West Fargo ND 054 Essentia Health - West Fargo Clinic 1401 13th Ave E 58078 701-364-8900 PCC DCH 1 1

    P1 Cass West Fargo ND DC157 Essentia Health - West Fargo Clinic 1401 13th Ave. S. 58078 701-364-8900 PCC DCH 1 1

    HP Cass West Fargo ND 3627 Family Healthcare Center - West Fargo

    726 - 13th Avenue

    South 58078 701-271-3344 PCC INW 2 2

    BC Cass West Fargo ND F131121 Sanford West Fargo Clinic 1220 Sheyenne St. 58078 701-234-4445 PCC MER 2 2

    HP Cass West Fargo ND 601 Sanford West Fargo Clinic 1220 Sheyenne St 58078 701-234-4445 PCC MER 2 2

    P1 Cass West Fargo ND SV205 Sanford West Fargo Clinic 1220 Sheyenne St. 58078 701-234-4445 PCC MER 2 2

    HP Cavalier Langdon ND 2813 Langdon Clinic 901 2nd St 58249 701-256-6120 PCC INW 2 2

    P1 Cavalier Langdon ND NA417 Langdon Clinic 901 2nd St. 58249 701-256-6156 PCC INW 2 2

    HP Charles Mix Geddes SD 2474 Geddes Medical Clinic/Avera Health 322 S Main Ave 57342 605-337-3197 PCC AVH 2 2

    P1 Charles Mix Geddes SD AH129 Geddes Medical Clinic/Avera Health 322 Main 57342 605-337-3197 PCC AVH 2 2

    HP Charles Mix Lake Andes SD 2324 Avera St. Benedict CRHC - Lake Andes 756 E Lake St 57356 605-487-7878 PCC AVH 2 2

    P1 Charles Mix Lake Andes SD AH137 Avera St. Benedict CRHC/Lake Andes 756 E. Lake St. 57356 605-487-7878 PCC AVH 2 2

    HP Charles Mix Platte SD 2476 Platte Medical Clinic/Avera Health 601 E 7th St Ste 3 57369 605-337-2633 PCC AVH 2 2

    P1 Charles Mix Platte SD AH128 Platte Medical Clinic/Avera Health 601 E. 7th St., #3 57369 605-337-2633 PCC AVH 2 2

    HP Charles Mix Wagner SD 3276 Bubak Medical Clinic 517 3rd St SW 57380 605-384-5457 PCC ISW 3 3

    P1 Charles Mix Wagner SD NA646 Prairie Health Clinic - Wagner

    310 West SD Highway

    46 57380 605-384-4577 PCC ISW 3 3

    HP Charles Mix Wagner SD 3255 Wagner Community Clinic - Avera 513 3rd St SW 57380 605-384-3418 PCC AVH 2 2

    P1 Charles Mix Wagner SD AH205 Wagner Community Clinic - Avera 513 3rd St. S.W. 57380 605-384-3418 PCC AVH 2 2

    HP Cherokee Marcus IA 2804 Marcus Clinic/Avera 101 E Pine 51035 712-376-4181 PCC AVH 2 2

    P1 Cherokee Marcus IA AH176 FVH Family Medicine Clinics-Marcus 101 E. Pine 51035 712-376-4181 PCC AVH 2 2

    HP Chippewa Bloomer WI 2596

    Mayo Clinic Health System Chippewa

    Valley - Bloomer Clinic 1501 Thompson St 54724 715-568-4650 PCC MAY 4 4

    HP Chippewa Bloomer WI 3177 Marshfield Clinic Bloomer Center 1711 York St 54724 715-568-6220 PCC IWI 2 2

    HP Chippewa Cadott WI 2817 Marshfield Clinic Cadott Center 305 S Hwy 27 54727 715-289-3102 PCC IWI 2 2

    HP Chippewa

    Chippewa

    Falls WI 2784 Eau Claire Medical Clinic, SC 2829 Cty Hwy I Ste 2A 54729 715-839-9280 PCC IWI 2 2

    HP Chippewa

    Chippewa

    Falls WI 2599

    Mayo Clinic Health System Chippewa

    Valley - Chippewa Valley Clinic 611 1st Ave 54729 715-720-4400 PCC MAY 4 4

    2017 MN Advantage Network October 10, 2016 Page 16

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    HP Chippewa

    Chippewa

    Falls WI 2818 Marshfield Clinic Chippewa Center 2655 Cty Hwy I 54729 715-726-4200 PCC IWI 2 2

    HP Chippewa

    Chippewa

    Falls WI 3164 Marshfield Clinic Lake Hallie Center 12961 27th Ave 54729 715-738-3700 PCC IWI 2 2

    HP Chippewa

    Chippewa

    Falls WI 3425

    Sacred Heart - Prevea Health - Chippewa

    Falls 2509 County Hwy I 54729 715-723-9138 PCC IWI 2 2

    P1 Chippewa

    Chippewa

    Falls WI NA626

    Sacred Heart - Prevea Health - Chippewa

    Falls 2509 County Hwy. I 54729 715-723-8633 PCC IWI 2 2

    HP Chippewa

    Chippewa

    Falls WI 2735 Sunrise Family Care Clinic

    2829 County Hwy I Ste

    2 54729 715-726-3096 PCC IWI 2 2

    P1 Chippewa

    Chippewa

    Falls WI NA551 Sunrise Family Care Clinic 2829 County Hwy, I, #2 54729 715-726-3096 PCC IWI 2 2

    BC Chippewa Clara City MN M211591 Clara City Clinic 330 W. Center St. 56222 320-847-3711 PCC ISW 2* 2*

    HP Chippewa Clara City MN 791 Clara City Clinic 330 Center Ave W 56222 320-847-3711 PCC ISW 2* 2*

    P1 Chippewa Clara City MN MR105 Clara City Clinic 330 W. Center 56222 320-847-3711 PCC ISW 2* 2*

    HP Chippewa Cornell WI 2820 Marshfield Clinic Cornell Center 600 Woodside Ave 54732 715-239-6344 PCC IWI 2 2

    BC Chippewa Milan MN M211591 Milan Clinic 237 2nd St. 56256 320-734-4632 PCC ISW 2* 2*

    HP Chippewa Milan MN 793 Milan Clinic 237 2nd St 56262 320-734-4632 PCC ISW 2* 2*

    P1 Chippewa Milan MN MR107 Milan Clinic 237 2nd St. 56262 320-734-4632 PCC ISW 2* 2*

    BC Chippewa Montevideo MN M211591

    Chippewa County Montevideo Hosp. &

    Clinic 824 N. 11th St. 56265 320-269-6435 PCC ISW 2* 2*

    HP Chippewa Montevideo MN 790

    Chippewa County Montevideo Hosp. &

    Clinic 824 N 11th St 56265 320-269-6435 PCC ISW 2* 2*

    P1 Chippewa Montevideo MN MR104

    Chippewa County Montevideo Hosp. &

    Clinic 824 N. 11th St. 56265 320-269-6435 PCC ISW 2* 2*

    HP Chippewa Stanley WI 2870 Ministry Medical Group - Stanley 1120 Pine St 54768 715-644-5530 PCC IWI 2 2

    HP Chippewa Stanley WI 3409

    Pine Grove Family Practice Associates -

    Stanley 425 N Franklin St 54768 715-709-0034 PCC IWI 2 2

    BC Chisago Chisago City MN F262761 Fairview Clinics - Chisago City 11725 Stinson Ave. 55013 651-257-8499 PCC FAI 2 2

    HP Chisago Chisago City MN 425 Fairview Clinics - Chisago City 11725 Stinson Ave 55013 651-257-8499 PCC FAI 2 3

    P1 Chisago Chisago City MN FP105 Fairview Clinics - Chisago City 11725 Stinson Ave. 55013 651-257-8499 PCC FAI 2 2

    2017 MN Advantage Network October 10, 2016 Page 17

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    e (P

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    BC Chisago North Branch MN A262180 Allina Health North Branch Clinic 38986 14th Ave. 55056 651-674-0055 PCC ALL 3 2

    HP Chisago North Branch MN 298 Allina Health North Branch Clinic 38986 14th Ave 55056 651-674-0055 PCC ALL 3 4

    P1 Chisago North Branch MN AM146 Allina Health North Branch Clinic 38986 14th Ave. 55056 651-674-0055 PCC ALL 2 4

    BC Chisago North Branch MN F262762 Fairview Clinics - North Branch 5366 - 386th St. 55056 651-674-8353 PCC FAI 2 2

    HP Chisago North Branch MN 705 Fairview Clinics - North Branch 5366 386th St 55056 651-674-8353 PCC FAI 2 3

    P1 Chisago North Branch MN FP106 Fairview Clinics - North Branch 5366 386th Street 55056 651-674-8353 PCC FAI 2 2

    BC Chisago Rush City MN F262763 Fairview Clinics - Rush City 760 W. 4th St. 55069 320-358-4784 PCC FAI 2 2

    HP Chisago Rush City MN 226 Fairview Clinics - Rush City 760 W 4th St 55069 320-358-4784 PCC FAI 2 3

    P1 Chisago Rush City MN FP167 Fairview Clinics - Rush City 760 W. 4th St. 55069 320-358-4784 PCC FAI 2 2

    BC Chisago Wyoming MN F261229 Fairview Clinics - Wyoming 5200 Fairview Blvd. 55092 651-982-7600 PCC FAI 2 2

    HP Chisago Wyoming MN 706 Fairview Clinics - Wyoming 5200 Fairview Blvd 55092 651-982-7600 PCC FAI 2 3

    P1 Chisago Wyoming MN FP174 Fairview Clinics - Wyoming 5200 Fairview Blvd. 55092 651-982-7600 PCC FAI 2 2

    BC Chisago Lindstrom MN S522688

    St. Croix Regional Medical Center -

    Lindstrom 12375 Lindstrom Lane 55045 651-400-2240 PCC IWI 2 2

    HP Chisago Lindstrom MN 3331

    St. Croix Regional Medical Center -

    Lindstrom 12375 Lindstrom Ln 55045 651-400-2240 PCC IWI 2 2

    P1 Chisago Lindstrom MN NA592

    St. Croix Regional Medical Center -

    Lindstrom 12375 Lindstrom Lane 55045 651-400-2240 PCC IWI 2 2

    HP Clark Clark SD 2743 Sanford Clinic - Clark 211 N Commercial St 57225 605-532-3676 PCC SAN 2 2

    P1 Clark Clark SD SV141 Sanford Clinic - Clark 211 N. Commercial St. 57225 605-532-3676 PCC SAN 2 2

    HP Clark Colby WI 2819 Marshfield Clinic Colby Abbottsford Center 111 Dehne Dr. 54421 715-223-2331 PCC IWI 2 2

    HP Clark Greenwood WI 2823 Marshfield Clinic Greenwood Center 102 W Cannery St 54437 715-267-6600 PCC IWI 2 2

    HP Clark Greenwood WI 2788 Memorial Medical Center 201 S Main St 54437 715-267-3200 PCC IWI 2 2

    HP Clark Loyal WI 2789 Memorial Medical Center 502 E Elm St 54446 715-225-8551 PCC IWI 2 2

    HP Clark Neillsville WI 2785 Eau Claire Medical Clinic, SC 216 Sunset Pl 54456 715-743-3101 PCC IWI 2 2

    HP Clark Neillsville WI 2787 Memorial Medical Center 216 Sunset Pl 54456 715-743-3101 PCC IWI 2 2

    HP Clark Owen WI 2871 Ministry Medical Group - Owen 6 Johnson St 54460 715-229-2177 PCC IWI 2 2

    2017 MN Advantage Network October 10, 2016 Page 18

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    HP Clark Thorp WI 2872 Ministry Medical Group - Thorp 704 S Clark St 54771 715-669-7279 PCC IWI 2 2

    BC Clay Barnesville MN L372550

    Lake Region Healthcare - Barnesville Area

    Clinic 209 2nd St SE 56514 218-354-2111 PCC FFM 3 2*

    HP Clay Barnesville MN 233

    Lake Region Healthcare - Barnesville Area

    Clinic 209 2nd St SE 56514 218-354-2111 PCC FFM 3 2*

    P1 Clay Barnesville MN NA612

    Lake Region Healthcare - Barnesville Area

    Clinic 209 2nd St SE 56514 218-736-8000 PCC FFM 2 2*

    BC Clay Hawley MN F132578 Sanford Hawley Clinic 1412 Main St 56549 218-483-3564 PCC MER 2 2

    HP Clay Hawley MN 589 Sanford Hawley Clinic 1412 Main St 56549 218-483-3564 PCC MER 2 2

    P1 Clay Hawley MN SV185 Sanford Hawley Clinic 1412 Main St. 56549 218-483-3564 PCC MER 2 2

    HP Clay Moorhead MN 3043 Family HealthCare Center - Concordia 901 S 8th St 56560 218-299-3662 PCC INW 2 2

    BC Clay Moorhead MN D011251 Essentia Health - Moorhead Clinic 801 Belsly Blvd. So. 56560 218-236-1151 PCC DCH 1 1

    HP Clay Moorhead MN 361 Essentia Health - Moorhead Clinic 801 Belsly Blvd S 56560 701-364-6800 PCC DCH 1 1

    P1 Clay Moorhead MN DC158 Essentia Health - Moorhead Clinic 801 Belsly Blvd. S. 56560 701-364-8900 PCC DCH 1 1

    BC Clay Moorhead MN F132578 Sanford Moorhead Clinic 4000 - 28th Ave. South 56560 701-234-3200 PCC MER 2 2

    HP Clay Moorhead MN 588 Sanford Moorhead Clinic 4000 28th Ave S 56560 701-234-3200 PCC MER 2 2

    P1 Clay Moorhead MN SV192 Sanford Moorhead Clinic 4000 28th Ave. S.

    56560-

    7460 218-234-3200 PCC MER 2 2

    HP Clay Spencer IA 2547

    Avera Medical Group Spencer a

    Department of Spencer Hospital 116 E 11th St Ste 101 51301 712-264-3500 PCC AVH 2 2

    P1 Clay Spencer IA AH233

    Avera Medical Group Spencer a

    Department of Spencer Hospital 116 E. 11th St. Ste 101 51301 712-264-3500 PCC AVH 2 2

    BC Clay Ulen MN F132739 Sanford Clinic - Ulen 108 Viking Ave. W. 56585 218- 596-8867 PCC MER 2 2

    HP Clay Ulen MN 216 Sanford Clinic - Ulen 108 Viking Ave W 56585 218-596-8867 PCC MER 2 2

    P1 Clay Ulen MN SV201 Sanford Clinic - Ulen 108 Viking Ave. W. 56585 218-596-8867 PCC MER 2 2

    HP Clay Vermillion SD 2322 Olson Medical Clinic 1330 E Main St 57069 605-624-5666 PCC ISW 3 3

    HP Clay Vermillion SD 2313 Sanford Clinic Vermillion 20 S Plum 57069 605-624-9111 PCC SAN 2 2

    P1 Clay Vermillion SD SV124 Sanford Clinic Vermillion 20 S. Plum St. 57069 605-624-9111 PCC SAN 2 2

    HP Clay Vermillion SD 3079 Vermillion Medical Clinic 101 S Plum 57069 605-624-8643 PCC ISW 3 3

    P1 Clay Vermillion SD SV158 Vermillion Family Planning 15 S. Plum 57069 605-368-8681 PCC SAN 2 2

    BC Clearwater Bagley MN F372730 Essentia Health - Bagley Clinic 121 Central St. West 56621 218-694-6281 PCC DCH 1 1

    HP Clearwater Bagley MN 3201 Essentia Health - Bagley Clinic 121 Central St W 56621 218-694-6281 PCC DCH 1 1

    2017 MN Advantage Network October 10, 2016 Page 19

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    P1 Clearwater Bagley MN DC167 Essentia Health - Bagley Clinic 121 Central Ave. S.E. 56621 218-694-6281 PCC DCH 1 1

    BC Clearwater Bagley MN F132603 Sanford Bagley Clinic 1656 Central St. W. 56621 218-694-2384 PCC MER 2 2

    HP Clearwater Bagley MN 2713 Sanford Bagley Clinic 1656 Central St W 56621 218-694-2384 PCC MER 2 2

    P1 Clearwater Bagley MN SV217 Sanford Bagley Clinic 1656 Central St. W. 56621 218-694-2384 PCC MER 2 2

    BC Clearwater Clearbrook MN F132603 Sanford Bagley Clearbrook Clinic 22 Elm St. SW 56634 218-776-3124 PCC MER 2 2

    HP Clearwater Clearbrook MN 2714 Sanford Bagley Clearbrook Clinic 22 Elm St 56634 218-776-3124 PCC MER 2 2

    P1 Clearwater Clearbrook MN SV216 Sanford Bagley Clearbrook Clinic 22 Elm St. 56634 218-776-3124 PCC MER 2 2

    HP Codington Watertown SD 2513 Brown Clinic Northridge 511 14th Ave NE 57201 605-886-8482 PCC AVH 3 3

    P1 Codington Watertown SD AH218 Brown Clinic 511 14th Ave. 57201 605-886-8482 PCC AVH 2 2

    HP Codington Watertown SD 2420 Brown Clinic PLLP 506 1st Ave SE 57201 605-886-8482 PCC AVH 3 3

    P1 Codington Watertown SD AH217 Brown Clinic 506 1st Ave. S.E. 57201 605-886-8482 PCC AVH 2 2

    HP Codington Watertown SD 2452 Sanford Clinic -Watertown 901 4th St NW 57201 605-886-8471 PCC SAN 2 2

    P1 Codington Watertown SD SV123 Sanford Clinic - Watertown 901 4th St. N.W. 57201 605-886-8471 PCC SAN 2 2

    BC Cook Grand Marais MN C161268 Sawtooth Mountain Clinic 513 Fifth Ave. W 55604 218-387-2330 PCC INE 2* 2*

    HP Cook Grand Marais MN 2961 Sawtooth Mountain Clinic 513 5th Ave W 55604 218-387-2330 PCC INE 2* 2*

    HP Cook

    Grand

    Portage MN 2981 Grand Portage Health Services 62 Upper Rd 55605 218-475-2235 PCC INE 2* 2*

    HP Cook Tofte MN 2980 Birch Grove Clinic

    9 Good Neighbor Hill

    Rd 55615 218-663-7263 PCC INE 2* 2*

    P1 Corson McLaughlin SD NA638 West River Health Clinic 103 First Avenue East 57436 605-823-4253 PCC ISW 3 3

    HP Cottonwood

    Mountain

    Lake MN 2336 Sanford Clinic Mountain Lake 308 N 8th St 56159 507-427-3332 PCC SAN 2 2

    P1 Cottonwood

    Mountain

    Lake MN SV109 Sanford Clinic Mountain Lake 308 8th St. N. 56159 507-427-3332 PCC SAN 2 2

    BC Cottonwood Westbrook MN W222108 Sanford Clinic -Westbrook 920 Bell Ave. 56183 507-274-1150 PCC SAN 2 2

    HP Cottonwood Westbrook MN 2334 Sanford Clinic -Westbrook 920 Bell Ave 56183 507-274-1150 PCC SAN 2 2

    P1 Cottonwood Westbrook MN SV115 Sanford Clinic - Westbrook 920 Bell Avenue 56183 507-274-1150 PCC SAN 2 2

    BC Cottonwood Windom MN O111624 Avera Medical Group Windom 820 Second Ave. North 56101 507-831-1703 PCC AVH 2 2

    HP Cottonwood Windom MN 2480 Avera Medical Group Windom 820 2nd Ave N 56101 507-831-1703 PCC AVH 2 2

    P1 Cottonwood Windom MN AH143 Avera Medical Group Windom 820 2nd Ave. N. 56101 507-831-1703 PCC AVH 2 2

    2017 MN Advantage Network October 10, 2016 Page 20

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    BC Cottonwood Windom MN B091593 Hartberg Medical Clinic 2170 Hospital Dr. 56101 507-831-1422 PCC ISW 3 3

    P1 Cottonwood Windom MN NA219 Hartberg Medical Clinic 2170 Hospital Dr. 56101 507-831-1422 PCC ISW 3 3

    BC Cottonwood Windom MN W081581 Windom Family Medical Center

    2170 Hospital Drive,

    Suite A 56101 507-831-2550 PCC ISW 2 2

    HP Cottonwood Windom MN 3029 Windom Family Medical Center 2170 Hospital Dr. 56101 507-831-2550 PCC ISW 2 2

    P1 Cottonwood Windom MN NA322 Windom Family Medical Center 2170 Hospital Drive 56101 507-831-2550 PCC ISW 2 2

    BC Cottonwood Windom MN C202012 Sanford Clinic Windom 591 2nd Ave. 56101 507-831-2223 PCC SAN 2 2

    HP Cottonwood Windom MN 2309 Sanford Clinic Windom 591 2nd Ave N 56101 507-831-2223 PCC SAN 2 2

    P1 Cottonwood Windom MN SV104 Sanford Clinic Windom 591 2nd Ave. 56101 507-831-2223 PCC SAN 2 2

    HP Crawford

    Prairie Du

    Chien WI 2592

    Mayo Clinic Health System Franciscan

    Healthcare - Prairie Du Chien 800 E Blackhawk Ave 53821 608-326-0808 PCC MAY 4 4

    P1 Crawford

    Prairie Du

    Chien WI FS112

    Mayo Clinic Health System Franciscan

    Healthcare - Prairie du Chien 800 E. Blackhawk Ave. 53821 608-326-0808 PCC MAY 4 4

    HP Crawford

    Prairie Du

    Chien WI 2679

    Gundersen Lutheran Prairie Du Chien

    Clinic 610 E Taylor St 53821 608-326-6466 PCC GUN 4 4

    HP Crawford

    Soldiers

    Grove WI 3199 Kickapoo Valley Medical Clinic 102 Sunset Ave 54655 608-624-5203 PCC IWI 2 2

    BC Crow Wing Baxter MN C532592

    Cuyuna Regional Medical Center - Baxter

    Clinic 13205 Isle Drive, # 200 56425 218-546-7700 PCC CUY 3 2

    HP Crow Wing Baxter MN 3380

    Cuyuna Regional Medical Center - Baxter

    Clinic 13205 Isle Drive, #200 56425 218-546-7000 PCC CUY 3 2

    P1 Crow Wing Baxter MN NA595

    Cuyuna Regional Medical Center - Baxter

    Clinic 13205 Isle Drive, # 200 56425 218-546-7000 PCC CUY 3 2

    HP Crow Wing Baxter MN 3444 Embrace Women's Health Clinic 13495 Elder Drive, #140 56425 218-454-1754 PCC ECP 1 1

    P1 Crow Wing Baxter MN NA639 Embrace Women's Health Clinic 13495 Elder Drive, #140 56425 218-454-1754 PCC ECP 1 1

    BC Crow Wing Baxter MN P222600 Essentia Health St. Joseph's - Baxter Clinic 13060 Isle Drive 56425 218-828-2880 PCC BRA 1 2

    HP Crow Wing Baxter MN 3343 Essentia Health St. Joseph's - Baxter Clinic 13060 Isle Dr. 56425 218-828-2880 PCC BRA 1 2

    P1 Crow Wing Baxter MN DC165 Essentia Health St. Joseph's - Baxter Clinic 13060 Isle Dr. 56425 218-828-2880 PCC BRA 1 2

    BC Crow Wing Brainerd MN P222522

    Essentia Health St. Joseph's - Brainerd

    Clinic 2024 South Sixth St 56401 218-828-7100 PCC BRA 1 2

    HP Crow Wing Brainerd MN 2611

    Essentia Health St. Joseph's - Brainerd

    Clinic 2024 S 6th St 56401 218-828-7100 PCC BRA 1 2

    2017 MN Advantage Network October 10, 2016 Page 21

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    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    P1 Crow Wing Brainerd MN DC135

    Essentia Health St. Joseph's - Brainerd

    Clinic 2024 S. 6th St. 56401 218-828-7100 PCC BRA 1 2

    BC Crow Wing Crosby MN C532592 Cuyuna Regional Medical Center - Crosby 320 East Main St. 56441 218-546-7000 PCC CUY 3 2

    HP Crow Wing Crosby MN 2384 Cuyuna Regional Medical Center - Crosby 320 East Main St. 56441 218-546-7000 PCC CUY 3 2

    P1 Crow Wing Crosby MN NA564 Cuyuna Regional Medical Center - Crosby 320 East Main St. 56441 218-546-7000 PCC CUY 3 2

    P1 Crow Wing Crosby MN NA568 Advanced Integrative Medicine PLLC 5 W. Main St. 56441 218-546-7333 PCC ICM 3 2

    BC Crow Wing Crosslake MN P222103

    Essentia Health St. Joseph's - Crosslake

    Clinic 35205 County Road 3 56442 218-692-1010 PCC PIN 1 1

    HP Crow Wing Crosslake MN 2632

    Essentia Health St. Joseph's - Crosslake

    Clinic 35205 County Rd 3 56442 218-692-1010 PCC PIN 1 1

    P1 Crow Wing Crosslake MN DC136

    Essentia Health St. Joseph's - Crosslake

    Clinic 35205 Cty. Rd. 3 56442 218-692-1010 PCC PIN 1 1

    HP Crow Wing Emily MN 3406 Essentia Health St. Joseph's - Emily Clinic 20918 Cty Rd 1 56447 218-763-4800 PCC PIN 1 1

    BC Crow Wing Garrison MN M202731 Mille Lacs Family Clinic - Garrison

    27378 State Highway

    18 56450 320-692-5599 PCC ICM 3 2

    HP Crow Wing Garrison MN 2798 Mille Lacs Family Clinic - Garrison 27378 State Hwy 18 56450 320-692-5599 PCC ICM 3 2

    P1 Crow Wing Garrison MN NA463 Mille Lacs Family Clinic - Garrison 27378 State Hwy. 18 56450 320-692-5599 PCC ICM 3 2

    BC Crow Wing Garrison MN R122534 Riverwood Garrison Clinic

    27278 State Highway

    18 56450 320-525-3400 PCC RRC 4 4

    HP Crow Wing Garrison MN 3017 Riverwood Garrison Clinic 27278 State Hwy 18 56450 320-525-3400 PCC RRC 4 4

    P1 Crow Wing Garrison MN NA479 Riverwood Garrison Clinic 27278 State Hwy. 18 56450 320-525-3400 PCC RRC 4 4

    BC Crow Wing Pequot Lakes MN P221647

    Essentia Health St. Joseph's - Pequot

    Lakes Clinic 4317 W. Woodman St. 56472 218-568-4416 PCC PIN 1 1

    HP Crow Wing Pequot Lakes MN 2636

    Essentia Health St. Joseph's - Pequot

    Lakes Clinic 4317 W Woodman St 56472 218-568-4416 PCC PIN 1 1

    P1 Crow Wing Pequot Lakes MN DC138

    Essentia Health St. Joseph's - Pequot

    Lakes Clinic 4317 W. Woodman St. 56472 218-568-4416 PCC PIN 1 1

    HP Custer Custer SD 3286 Custer Regional Medical Clinic 1041 Montgomery St 57730 605-673-4150 PCC ISW 3 3

    BC Dakota Apple Valley MN A311107 Apple Valley Medical Clinic 14655 Galaxie Ave. 55124 952-432-6161 PCC APP 2 2

    HP Dakota Apple Valley MN 404 Apple Valley Medical Clinic 14655 Galaxie Ave 55124 952-432-6161 PCC APP 2 2

    P1 Dakota Apple Valley MN NA443 Apple Valley Medical Clinic 14655 Galaxie Ave. 55124 952-432-6161 PCC APP 2 2

    2017 MN Advantage Network October 10, 2016 Page 22

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    BC Dakota Apple Valley MN E252235 Eagan Valley Pediatrics

    14135 Cedar Ave. S.,

    #100 55124 952-432-4373 PD PED 2 2

    HP Dakota Apple Valley MN 2501 Eagan Valley Pediatrics

    14135 Cedar Ave S Ste

    100 55124 952-432-4373 PD PED 2 2

    P1 Dakota Apple Valley MN CP146 Eagan Valley Pediatrics

    14135 Cedar Ave. S.,

    #100 55124 952-432-4373 PD CHI 2 2

    BC Dakota Apple Valley MN F261759 Fairview Clinics - Apple Valley 15650 Cedar Ave. S. 55124 952-997-4100 PCC FAI 2 2

    HP Dakota Apple Valley MN 804 Fairview Clinics - Apple Valley 15650 Cedar Ave S 55124 952-997-4100 PCC FAI 2 3

    P1 Dakota Apple Valley MN FP104 Fairview Clinics - Apple Valley 15650 Cedar Ave. S. 55124 952-997-4100 PCC FAI 2 2

    HP Dakota Apple Valley MN 403 HealthPartners Apple Valley Clinic 15290 Pennock Ln 55124 952-967-7250 PCC HPR 1 1

    BC Dakota Burnsville MN F261095 Burnsville Family Physicians

    625 E. Nicollet Blvd.,

    #100 55337 952-435-0303 PCC FAI 2 2

    HP Dakota Burnsville MN 417 Burnsville Family Physicians

    625 E Nicollet Blvd Ste

    100 55337 952-435-0303 PCC IMT 2 3

    P1 Dakota Burnsville MN FP103 Burnsville Family Physicians

    625 E. Nicollet Blvd.,

    #100 55337 952-435-0303 PCC FAI 2 2

    BC Dakota Burnsville MN F262538 Fairview Clinics - Burnsville 303 Nicollet Blvd., #140 55337 952-460-4000 PCC FAI 2 2

    HP Dakota Burnsville MN 815 Fairview Clinics - Burnsville

    303 Nicollet Blvd Ste

    160 55337 952-460-4000 PCC FAI 2 3

    P1 Dakota Burnsville MN FP135 Fairview Clinics - Burnsville

    303 E. Nicollet Blvd.

    #160 55337 952-460-4000 PCC FAI 2 2

    BC Dakota Burnsville MN C491088

    Metropolitan Pediatric Specialists -

    Burnsville

    14050 Nicollet Ave.,

    #300 55337 952-435-2450 PD PED 2 2

    HP Dakota Burnsville MN 689

    Metropolitan Pediatric Specialists -

    Burnsville

    14050 Nicollet Ave Ste

    300 55337 952-435-2450 PD PED 2 2

    P1 Dakota Burnsville MN CP159

    Metropolitan Pediatric Specialists -

    Burnsville

    14050 Nicollet Avenue,

    #300 55337 952-435-2450 PD PED 2 2

    BC Dakota Burnsville MN P181366 Park Nicollet Clinic - Burnsville 14000 Fairview Drive 55337 952-993-8700 PCC PKN 4 2

    HP Dakota Burnsville MN 419 Park Nicollet Clinic - Burnsville 14000 Fairview Dr. 55337 952-993-8700 PCC PKN 2 2

    P1 Dakota Burnsville MN PN108 Park Nicollet Clinic - Burnsville 14000 Fairview Dr. 55337 952-993-8700 PCC PKN 4 2

    2017 MN Advantage Network October 10, 2016 Page 23

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    System2016 Cost

    Level

    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    BC Dakota Burnsville MN A262239 Allina Health Burnsville Clinic

    14000 Nicollet Ave. S.,

    #100 55337 952-428-0200 PCC ALL 3 2

    HP Dakota Burnsville MN 418 Allina Health Burnsville Clinic

    14000 Nicollet Ave S

    Ste 100 55337 952-428-0200 PCC ALL 3 4

    P1 Dakota Burnsville MN AM179 Allina Health Burnsville Clinic

    14000 Nicollet Ave., S.,

    #100 55337 952-428-0101 PCC ALL 2 4

    BC Dakota Burnsville MN F261571 Southdale Pediatric Associates - Burnsville

    501 E. Nicollet Blvd.,

    #200 55337 952-898-5900 PD PED 2 2

    HP Dakota Burnsville MN 420 Southdale Pediatric Associates - Burnsville

    501 E Nicollet Blvd Ste

    200 55337 952-898-5900 PD PED 2 2

    P1 Dakota Burnsville MN FP169 Southdale Pediatric Associates - Burnsville

    501 E. Nicollet Blvd.,

    #200 55337 952-898-5900 PCC FAI 2 2

    BC Dakota Eagan MN A262036 Allina Health Eagan Clinic

    1110 Yankee Doodle

    Rd. 55121 651-454-3970 PCC ALL 3 2

    HP Dakota Eagan MN 459 Allina Health Eagan Clinic

    1110 Yankee Doodle

    Rd 55121 651-454-3970 PCC ALL 3 4

    P1 Dakota Eagan MN AM129 Allina Health Eagan Clinic

    1110 Yankee Doodle

    Rd. 55121 651-454-3970 PCC ALL 2 4

    BC Dakota Burnsville MN E262674 Dakota Child & Family Clinic 2530 Horizon Drive 55337 651-209-8640 PCC IMT 2 3

    HP Dakota Burnsville MN 3075 Dakota Child & Family Clinic 2530 Horizon Dr. 55337 651-209-8640 PCC IMT 2 3

    P1 Dakota Burnsville MN NA589 Dakota Child and Family Clinic 2530 Horizon Dr. 55337 651-209-8640 PCC IMT 2 3

    BC Dakota Eagan MN F261196 Fairview Clinics - Eagan 1440 Duckwood Dr. 55122 651-688-7860 PCC FAI 2 2

    HP Dakota Eagan MN 433 Fairview Clinics - Eagan 1440 Duckwood Dr. 55122 651-406-8860 PCC FAI 2 3

    P1 Dakota Eagan MN FP110 Fairview Clinics - Eagan 1440 Duckwood Dr. 55122 651-406-8860 PCC FAI 2 2

    HP Dakota Eagan MN 3317 HealthPartners Eagan Clinic 1654 Diffley Rd Ste 100 55122 952-967-7477 PCC HPR 1 1

    BC Dakota Eagan MN P181366 Park Nicollet Clinic - Eagan 1885 Plaza Dr. 55122 952-993-4001 PCC PKN 4 2

    HP Dakota Eagan MN 434 Park Nicollet Clinic - Eagan 1885 Plaza Dr. 55122 952-993-4001 PCC PKN 2 2

    P1 Dakota Eagan MN PN110 Park Nicollet Clinic - Eagan 1885 Plaza Dr. 55122 952-993-4001 PCC PKN 4 2

    BC Dakota Eagan MN P451169 Pediatric & Young Adult Medicine - Eagan

    3470 Washington Drive,

    Suite 201 55123 651-227-7806 PD PED 2 2

    HP Dakota Eagan MN 435 Pediatric & Young Adult Medicine- Eagan

    3470 Washington Dr.

    Ste 201 55122 651-227-7806 PD PED 2 2

    P1 Dakota Eagan MN CP112 Pediatric & Young Adult Medicine- Eagan

    3470 Washington Drive,

    #201 55122 651-227-7806 PD PED 2 2

    2017 MN Advantage Network October 10, 2016 Page 24

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    System2016 Cost

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    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    HP Dakota Eagan MN 851 Yankee Square Family Practice

    3460 Washington Dr.

    Ste 102 55122 651-452-9240 PCC IMT 2 3

    P1 Dakota Eagan MN NA294 Yankee Square Family Practice

    3460 Washington Dr.,

    #102 55122 651-452-9240 PCC IMT 2 3

    BC Dakota Farmington MN A262174 Allina Health Farmington Clinic

    21260 Chippendale

    Ave. W. 55024 651-463-7181 PCC ALL 3 2

    HP Dakota Farmington MN 452 Allina Health Farmington Clinic

    21260 Chippendale Ave

    W 55024 651-463-7181 PCC ALL 3 4

    P1 Dakota Farmington MN AM119 Allina Health Farmington Clinic

    21260 Chippendale

    Ave. W. 55024 651-463-7181 PCC ALL 2 4

    BC Dakota Farmington MN F262474 Fairview Clinics - Farmington

    19685 Pilot Knob Road,

    #100 55024 651-436-5100 PCC FAI 2 2

    HP Dakota Farmington MN 3057 Fairview Clinics - Farmington 19685 Pilot Knob Rd 55024 651-463-5100 PCC FAI 2 3

    P1 Dakota Farmington MN FP209 Fairview Clinics - Farmington

    19685 Pilot Knob Rd.,

    #100 55024 651-463-5100 PCC FAI 2 2

    BC Dakota Farmington MN N382459 FamilyHealth Medical Clinic of Farmington 4645 Knutsen Dr. 55024 507-646-1494 PCC IMT 2 2

    HP Dakota Farmington MN 2926 FamilyHealth Medical Clinic of Farmington 4645 Knutsen Dr. 55024 651-460-2300 PCC IMT 2 2

    P1 Dakota Farmington MN NA469 FamilyHealth Medical Clinic of Farmington 4645 Knutsen Dr. 55024 651-460-2300 PCC IMT 2 2

    BC Dakota Hastings MN A262468 Allina Health Hastings Nininger Road Clinic 1285 Nininger Road 55033 651-480-4200 PCC ALL 3 2

    HP Dakota Hastings MN 456 Allina Health Hastings Nininger Road Clinic

    1285 Nininger Rd Ste

    100 55033 651-480-4200 PCC ALL 3 4

    P1 Dakota Hastings MN AM156 Allina Health Hastings Nininger Road Clinic 1285 Nininger Rd. 55033 651-480-4200 PCC ALL 2 4

    BC Dakota Hastings MN A261244 Allina Health Hastings First Street Clinic 1210 W. 1st St. 55033 651-438-1800 PCC ALL 3 2

    HP Dakota Hastings MN 457 Allina Health Hastings First Street Clinic 1210 W 1st St 55033 651-438-1800 PCC ALL 3 4

    P1 Dakota Hastings MN AM120 Allina Health Hastings First Street Clinic 1210 W. 1st St. 55033 651-438-1800 PCC ALL 2 4

    BC Dakota

    Inver Grove

    Heights MN A261200 Allina Health Inver Grove Heights Clinic 5565 Blaine Ave. 55076 651-241-9400 PCC ALL 3 2

    HP Dakota

    Inver Grove

    Heights MN 555 Allina Health Inver Grove Heights Clinic 5565 Blaine Ave 55076 651-241-9400 PCC ALL 3 4

    P1 Dakota

    Inver Grove

    Heights MN AM167 Allina Health Inver Grove Heights Clinic 5565 Blaine Ave. 55076 651-241-9400 PCC ALL 2 4

    BC Dakota

    Inver Grove

    Heights MN F262557 Dakota Pediatric Clinic 5975 E. Carmen Ave. 55076 651-455-9697 PD PED 2 2

    HP Dakota

    Inver Grove

    Heights MN 611 Dakota Pediatric Clinic 5975 E Carmen Ave 55076 651-455-9697 PD PED 2 2

    2017 MN Advantage Network October 10, 2016 Page 25

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    System2016 Cost

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    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    P1 Dakota

    Inver Grove

    Heights MN CP104 Dakota Pediatrics, PA 5975 Carmen Ave E 55076 651-455-9697 PD CHI 2 2

    BC Dakota

    Inver Grove

    Heights MN E031120 Entira Family Clinics - Inver Grove Heights 2980 Buckley Way 55076 651-457-2748 PCC FAM 2 2

    HP Dakota

    Inver Grove

    Heights MN 763 Entira Family Clinics - Inver Grove Heights 2980 Buckley Way 55076 651-457-2748 PCC FAM 2 2

    P1 Dakota

    Inver Grove

    Heights MN FH100 Entira Family Clinics - Inver Grove Heights 2980 Buckley Way 55076 651-457-2748 PCC FAM 2 2

    HP Dakota

    Inver Grove

    Heights MN 463 HealthPartners Inver Grove Heights Clinic 5625 Cenex Dr. 55077 952-967-7472 PCC HPR 1 1

    HP Dakota

    Inver Grove

    Heights MN 340 Inver Grove Heights Family Medical Clinic 5972 Cahill Ave 55076 651-451-6954 PCC IMT 2 3

    P1 Dakota

    Inver Grove

    Heights MN NA183 Inver Grove Heights Family Medical Center 5972 Cahill Ave., #112 55076 651-451-6954 PCC IMT 2 3

    BC Dakota Lakeville MN F262377 Fairview Clinics - Lakeville 18580 Joplin Ave. 55044 952-892-9500 PCC FAI 2 2

    HP Dakota Lakeville MN 2637 Fairview Clinics - Lakeville 18580 Joplin Ave 55044 952-892-9500 PCC FAI 2 3

    P1 Dakota Lakeville MN FP192 Fairview Clinics - Lakeville 18580 Joplin Ave. 55044 952-892-9500 PCC FAI 2 2

    BC Dakota Lakeville MN N382475 FamilyHealth Medical Clinic -Lakeville 9974 214th St W 55044 507-646-8200 PCC IMT 2 2

    HP Dakota Lakeville MN 3049 FamilyHealth Medical Clinic -Lakeville 9974 214th St W 55044 952-469-0500 PCC IMT 2 2

    P1 Dakota Lakeville MN NA486 FamilyHealth Medical Clinic of Lakeville 9974 214th St. W. 55044 507-646-8200 PCC IMT 2 2

    BC Dakota Lakeville MN A262239 Allina Health Lakeville Clinic 17599 Kenwood Tr. 55044 952-428-0200 PCC ALL 3 2

    HP Dakota Lakeville MN 729 Allina Health Lakeville Clinic 20795 Keokuk Ave 55044 952-428-0200 PCC ALL 3 4

    P1 Dakota Lakeville MN AM181 Allina Health Lakeville Clinic 20795 Keokuk Ave. 55044 952-428-0200 PCC ALL 2 4

    BC Dakota Lakeville MN P181366 Park Nicollet Clinic - Lakeville 18432 Kenrick Ave. 55044 952-469-3393 PCC PKN 4 2

    HP Dakota Lakeville MN 3303 Park Nicollet Clinic - Lakeville 18432 Kenrick Ave 55044 952-993-8800 PCC PKN 2 2

    P1 Dakota Lakeville MN PN125 Park Nicollet Clinic - Lakeville 18432 Kenrick Ave. 55044 952-993-3123 PCC PKN 4 2

    BC Dakota Rosemount MN F262517 Fairview Clinics - Rosemount 15075 Cimarron Ave. 55068 651-322-8800 PCC FAI 2 2

    HP Dakota Rosemount MN 3178 Fairview Clinics - Rosemount 15075 Cimarron Ave 55068 651-322-8800 PCC FAI 2 3

    P1 Dakota Rosemount MN FP211 Fairview Clinics - Rosemount 15075 Cimarron Ave. 55068 651-322-8800 PCC FAI 2 2

    P1 Dakota Rosemount MN NA507 Rosemount Family Physicians

    15120 Chippendale

    Ave., #201 55068 651-423-4114 PCC IMT 2 3

    BC Dakota West St. Paul MN A261761 Allina Health West St. Paul Clinic 150 E. Emerson Ave. 55118 651-552-3800 PCC ALL 3 2

    2017 MN Advantage Network October 10, 2016 Page 26

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    System2016 Cost

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    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    HP Dakota West St. Paul MN 528 Allina Health West St. Paul Clinic 150 E Emerson Ave 55118 651-241-1800 PCC ALL 3 4

    P1 Dakota West St. Paul MN AM130 Allina Health West St. Paul Clinic 150 E. Emerson Ave. 55118 651-241-1800 PCC ALL 2 4

    BC Dakota West St. Paul MN E031112 Entira Family Clinics - West St. Paul 234 E. Wentworth Ave. 55118 651-455-2940 PCC FAM 2 2

    HP Dakota West St. Paul MN 762 Entira Family Clinics - West St. Paul 234 E Wentworth Ave 55118 651-455-2940 PCC FAM 2 2

    P1 Dakota West St. Paul MN FH104 Entira Family Clinics - West St. Paul 234 E. Wentworth Ave. 55118 651-455-2940 PCC FAM 2 2

    BC Dakota West St. Paul MN F262378 Mendakota Pediatrics

    1880 Livingston Ave.,

    #102 55118 651-552-7999 PD PED 2 2

    HP Dakota West St. Paul MN 2639 Mendakota Pediatrics

    1880 Livingston Ave

    Ste 102 55118 651-552-7999 PD PED 2 2

    P1 Dakota West St. Paul MN CP152 Mendakota Pediatrics

    1880 Livingston Ave.,

    #102 55118 651-552-7999 PD CHI 2 2

    BC Dakota West St. Paul MN P422613 Children's West St. Paul 1547 Livingston Ave. 55118 651-451-8050 PD PED 2 2

    HP Dakota West St. Paul MN 898 Children's West St. Paul 1547 Livingston Ave 55118 651-451-8050 PD PED 2 2

    P1 Dakota West St. Paul MN CP110 Children's West St. Paul Clinic 1547 Livingston Ave. 55118 651-451-8050 PD CHI 2 2

    HP Davison Mitchell SD 3327

    Avera Medical Group Internal Medicine

    Mitchell 1900 Grassland Drive 57301 605-995-7000 PCC AVH 2 2

    P1 Davison Mitchell SD AH204

    Avera Medical Group Internal Medicine

    Mitchell 1900 Grassland Drive 57301 605-995-7000 PCC AVH 2 2

    HP Davison Mitchell SD 3328

    Avera Medical Group Family Medicine

    Mitchell 1900 Grassland Drive 57301 605-995-7000 PCC AVH 2 2

    P1 Davison Mitchell SD AH203

    Avera Medical Group Family Medicine

    Mitchell 1900 Grassland Drive 57301 605-995-7000 PCC AVH 2 2

    HP Davison Mitchell SD 3176 Avera Medical Group Pediatrics Mitchell 1900 Grassland Drive 57301 605-995-7000 PD AVH 2 2

    P1 Davison Mitchell SD AH186 Avera Medical Group Pediatrics Mitchell 1900 Grassland Drive 57301 605-995-7000 PD AVH 2 2

    HP Davison Mitchell SD 3445 Mitchell Clinic

    818 West Havens

    Street 57301 605-996-7526 PCC ISW 3 3

    HP Davison Mitchell SD 3242 Sanford Health Mitchell Clinic

    2100 Highland Way Ste

    K 57301 605-996-0400 PCC SAN 2 2

    2017 MN Advantage Network October 10, 2016 Page 27

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    System2016 Cost

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    Final 2017 Cost Level (*

    denotes clinic moved to

    2 for access)

    P1 Davison Mitchell SD SV159 Sanford Clinic - Mitchell

    2100 Highland Way,

    Ste. K

    57301-

    6409 605-996-0400 PCC SAN 2 2

    HP Day Waubay SD 2503 Avera Medical Group Waubay 80 N Main St 57273 605-947-3422 PCC AVH 2 2

    P1 Day Waubay SD AH144 Avera Medical Group Waubay 80 N. Main St. 57273 605-947-3422 PCC AVH 2 2

    HP Day Webster SD 2686 Sanford Clinic Webster 101 Peabody Dr. 57274 605-345-4141 PCC SAN 2 2

    HP Deuel Clear Lake SD 2459 Sanford Clear Lake Clinic 701 3rd Ave S 57226 605-874-2141 PCC SAN 2 2

    P1 Deuel Clear Lake SD SV119 Sanford Clear Lake Clinic 701 3rd Ave. S. 57226 605-874-2141 PCC SAN 2 2

    P1 Dewey Timber Lake SD NA637 West Dakota Health Center 906 Main Street 57656 605-865-3277 PCC ISW 3 3

    HP Dickey Ellendale ND 3218 Avera Clinic of Ellendale 240 Main St 58436 701-349-3666 PCC AVH 2 2

    P1 Dickey Ellend