OKLAHOMA WORKERS' COMPENSATION COMMISSION ...2021/03/01  · Date: 03/01/2021 LIST OF QUALIFIED...

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMS Date: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 08:15 (Alphabetical by Specialty) Page: 1 As of January 1, 2021 Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of Exam Board Certified Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts Tulsa Tulsa, OK74132-1823 [email protected] (credentialing) Excl. Body Parts/Svcs: Contact: None Phone: (918) 447-9300 Fax: (918) 447-9308 American Board of Anesthesiology T Anesthesiology Blake D Christensen, D.O. PO Box 514 Spine Oklahoma City Norman, OK73070-0514 [email protected] Excl. Body Parts/Svcs: Contact: Marleen Abdomen, Gynecology/Urology Phone: (405) 751-0011 Fax: (405) 751-7246 American Board of Anesthesiology- Anesthesiology & Pain Medicine T R MITF Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management Tulsa Tulsa, OK74137 [email protected] Excl. Body Parts/Svcs: Contact: Kara all except pain management cases Phone: (918) 477-5942 Fax: ( ) - American Osteopathic Board of Anesthesiology & Pain Management T * Physician has multiple specialties.

Transcript of OKLAHOMA WORKERS' COMPENSATION COMMISSION ...2021/03/01  · Date: 03/01/2021 LIST OF QUALIFIED...

Page 1: OKLAHOMA WORKERS' COMPENSATION COMMISSION ...2021/03/01  · Date: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESP Time: 08:15 (Alphabetical by Specialty)

OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 1

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology C. Scott Anthony, D.O. 6802 S Olympia Ave Ste 100 pain management - all body parts TulsaTulsa, OK74132-1823

[email protected] (credentialing) Excl. Body Parts/Svcs:Contact: NonePhone: (918) 447-9300 Fax: (918) 447-9308

American Board of AnesthesiologyT

Anesthesiology Blake D Christensen, D.O. PO Box 514 Spine Oklahoma CityNorman, OK73070-0514

[email protected] Excl. Body Parts/Svcs:Contact: Marleen Abdomen, Gynecology/UrologyPhone: (405) 751-0011 Fax: (405) 751-7246

American Board of Anesthesiology-Anesthesiology & Pain Medicine

T R MITF

Anesthesiology Gerald R. Hale, D.O. 2448 E 81 Ste 363 pain management TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Kara all except pain management casesPhone: (918) 477-5942 Fax: ( ) -

American Osteopathic Board ofAnesthesiology & Pain Management

T

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 2

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Alina Justiz, Anesthesiology 4117 NW 122nd Street, Suite 100 NormanOklahoma City, OK73120

[email protected]: Anna TackPhone: (405) 463-3380 Fax: ( ) -

American Board of AnesthesologyT

Anesthesiology Rafael Justiz, Anesthesiology 4117 NW 122nd St., Suite C OKLAHOMACITY/NORMANOklahoma City, OK73120

[email protected]: Anna TackPhone: (405) 463-3380 Fax: ( ) -

American Board of Anesthesiologyw/pain managment

T R MITF

Anesthesiology Jayen H. Patel, M.D. 2811 E 15 Street Ste 102 pain management, neck, back, Tulsaextremities, nervous system,Tulsa, OK 7410-4headache, joints, [email protected]

Contact: appt deskExcl. Body Parts/Svcs:Phone: (918) 935-3240 Fax: (918) 935-3241PTSD, psychological trauma

American Board of AnesthesiologyT

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 3

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Terrell R. Phillips, D.O. 401 SW 80 Street Bld D Ste 200 Pain Management Oklahoma CityOklahoma City, OK73139

Excl. Body Parts/Svcs:Contact: none within specialtyPhone: (405) 601-4227 Fax: (405) 601-4237

American Osteopathic Board ofAnesthesiology

T R MITF

Anesthesiology Brian Torgerson, M.D. 3336 E 32nd St #220 pain management TulsaTulsa, OK74135

[email protected]: Erin Al-HammamiPhone: (918) 255-7246 Fax: (918) 255-7000

Anesthesiology and Pain ManagementT

Anesthesiology Adam J. Wallace, M.D. 3336 E 32nd St #220 pain management TulsaTulsa, OK74135

[email protected] Excl. Body Parts/Svcs:Contact: Danielle, Bre , & Christy nonePhone: (918) 255-7246 Fax: (918) 255-7000

Certification UnknownT

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 4

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Anesthesiology Traci L. White, M.D. 6802 S Olympia Avenue Ste 100 Pain Management Only TulsaTulsa, OK74132

Contact: Danielle PiercePhone: (918) 513-3225 Fax: (918) 447-9308

American Board ofAnesthesiology/Pain Medicine

T

Chiropractic Seyoung Kim, D.C. 3435 NW 50th St. spine (neck, back) Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Kristen NonePhone: (405) 942-4040 Fax: (405) 773-4267

Certification UnknownT R

Chiropractic James Daniel Post, D.C. 4141 NW Expressway Ste 180 all chiropractics-spine Oklahoma CityOklahoma City, OK73116

[email protected]: CathyPhone: (405) 840-8900 Fax: (405) 840-8990

Certification UnknownT

Chiropractic Corey Stubbs, D.C. 9709 E 79th Street TulsaTulsa, OK74133

[email protected]: Traci LawleyPhone: (918) 994-4061 Fax: ( ) -

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 5

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Dentistry Bryan Chrz, D.D.S. 505 N 14 St all dental PerryPerry, OK73077

[email protected]: Shelley WileyPhone: (580) 336-2255 Fax: (580) 236-0362

American Board of ForensicOdonyology

T R MITF

Dentistry Steven W. Hogg, D.D.S. 423 W Washington St mouth, teeth, jaw Broken ArrowBroken Arrow, OK74012

[email protected] Excl. Body Parts/Svcs:Contact: Dr. Hogg NonePhone: (918) 645-3924 Fax: (918) 362-9997

Certification UnknownT R MITF

Family Medicine Jeffrey Cunningham, M.D.* 2408 E 81st Street, Suite 290 Head/Concussion TulsaTulsa, OK74137

Contact: MichellePhone: (918) 855-1255 Fax: ( ) -

American Board Family Medicine /Sports Medicine

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 6

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Family Medicine John Ellis, MD 5100 N Brookline Ave #465 Occupational & Legal Medicine, OKCEntire BodyOklahoma City, OK73112

[email protected]. Body Parts/Svcs:Contact: KellyeyesPhone: (405) 917-5336 Fax: ( ) -

American Board of Family MedicineT R MITF

Family Medicine Jason M. Leinen, M.D.* 3110 SW 89th Suite 102 all family & sports medicine, pain Oklahoma Citymanagement (evaluate all bodyOklahoma City, OK73159parts)[email protected]

Contact: SchedulerExcl. Body Parts/Svcs:Phone: (405) 703-3611 Fax: (405) 703-3711none

American Board of Family MedicineT

Family Medicine Michael L. Winzenread, M.D. 105 S Bryant Ste 310 all EdmondEdmond, OK73034

[email protected] Excl. Body Parts/Svcs:Contact: Kari Hill NonePhone: (405) 757-5211 Fax: ( ) -

American Board of Family Practice R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 7

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Family Practice Lance E. Rosson, D.O. 1211 N Shartel Ste 1104 all Oklahoma CityOklahoma City, OK73103

NONE Excl. Body Parts/Svcs:Contact: Sharon NonePhone: (405) 236-1900 Fax: (405) 236-0362

American Board of Family PhysiciansT R MITF

Hand Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139

[email protected]. Body Parts/Svcs:Contact: Alice Mata or Becky Tokarall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists

American Board of Plastic Surgery &Am Bd Plastic Surg of Hand

T R MITF

Hand Surgery Carolyn Berg, MD 2408 E 81st Street, Suite 290 Hand, Wrist, Elbow and Forearm TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Susan Spine, Knee, Ankles, Neck, Shoulder

ahd HumerusPhone: (918) 855-1255 Fax: (918) 494-9397

American Board of SurgeryT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 8

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery James F. Bischoff, M.D.* 2448 East 81st Street Suite1200 Hands TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Naomi Traczyk spine, elbows, shoulders, feet,

ankles, knees, hips, rate onlyPhone: (918) 900-6432 Fax: (918) 392-7057cases

American Board of OrthopedicSurgery

T R MITF

Hand Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 Shoulder, Elbow, Hand, Wrist TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Melissa Revis Knee, Ankle, Hip, Spine, Neck,

PelvisPhone: (918) 925-3268 Fax: (918) 301-4293

American Osteopathic Board ofOrthopedic Surgery

T R

Hand Surgery Charles H. Funderburk, M.D.* 9600 Broadway Extension hands, shoulders, elbows, knees, Oklahoma Ctiy,wrists, forearm EdmondOklahoma City, OK73114

[email protected]. Body Parts/Svcs:Contact: LaDonna or Claudianeck, back, hips, feetPhone: (405) 230-9125 Fax: (405) 230-9119

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 9

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Greg Halko, M.D.* 3301 NW 50 hands, wrists, elbows ONLY Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) , shoulders or

lower extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopedicSurgery

T R MITF

Hand Surgery Daron C. Hitt, M.D. 3110 SW 89th St., Suite 200A Hand, Forearm up to, but not Oklahoma Cityincluding elbow.Oklahoma City, OK73159--790

[email protected]. Body Parts/Svcs:Contact: SchedulerAcutal elbow, unless for plasticsPhone: (405) 486-6800 Fax: (405) 426-6441

American Board of SurgeryT R

Hand Surgery Stephen W. Mihalsky, M.D. 105 S Bryant Ste 407 Hand Surgery- Elbow, Wrist, Hand EdmondEdmond, OK73034

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler Neck and ShoulderPhone: (405) 348-5060 Fax: (405) 364-8750

American Board of Surgery of theHand, American Board of Surgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 10

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery David B. Mokhtee, M.D. 4802 S. 109th E. Ave. fingers to elbows TulsaTulsa, OK74146

[email protected] Excl. Body Parts/Svcs:Contact: Denise 918-392-1403 Everything except Hand and Wrist-

pathology proximal to the elbowPhone: (918) 392-1400 Fax: (918) 392-1401

American Board of Surgery - HandSurgery

T

Hand Surgery M. Sean O'Brien, D.O.* 3110 SW 89th St., Suite 200C Knees, elbows, hands and shoulders Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler feet and anklePhone: (405) 759-2663 Fax: ( ) -

American Osteopathic Board ofOrthopedic Surgery

T R

Hand Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand, arm Oklahoma CityOklahoma City, OK73112-4418

[email protected] Excl. Body Parts/Svcs:Contact: Barbara Jones Non-Upper Extremity, Back, Knees,

FeetPhone: (405) 945-4888 Fax: (405) 945-4889

American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 11

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Hand Surgery Richard A. Ruffin, M.D.* 3301 NW 50TH ST hands, wrists, elbows, shoulders, Oklahoma CityfingersOklahoma City, OK73112

[email protected]. Body Parts/Svcs:Contact: Central SchedulingSpinePhone: (405) 947-0911 Fax: (405) 947-4263

American Board of OrthopedicSurgery, Hand Surgery

T R

Hand Surgery David Rush, M.D.* 9600 Broadway Ext Elbow, Wrist & Hand OKLAHOMA CITY &NORMANOklahoma City, OK73114

Excl. Body Parts/Svcs:Contact: LaDonna Siler Neck, BAck, Shoulder, Hip, Knee,

Ankle & FootPhone: (405) 230-9237 Fax: ( ) -

American Board of OrthopedicSurgery

T R

Hand Surgery Garrett Watts, M.D. 10507 E 91st Street Suite 350 hands, wrists, elbows, arm Broken ArrowTulsa, OK74133

[email protected] Excl. Body Parts/Svcs:Contact: Candace Rudd spine, neck, lower extremitiesPhone: (918) 451-3000 Fax: (918) 451-2700

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 12

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Internal Medicine S.A. Chaudhry, M.D. 5611 Mosteller Dr All Parts of the Body Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Dr. Chaudry Genitals and Female Pelvic OrgansPhone: (405) 843-2345 Fax: (405) 843-8237

American Board of Internal MedicineT R

Internal Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St Internal Medicine-All body parts TulsaTulsa, OK74107

Excl. Body Parts/Svcs:Contact: Rhonda Pulmonary and Chemical exposure,

including moldPhone: (918) 742-4881 Fax: (918) 742-5854

Internal MedicineT R MITF

Neurology Gabriel Pitman, D.O. 401 SW 80 STE 201 Neurology-Head and Spine, Oklahoma Cityperipheral nerveOklahoma City, OK73139

[email protected]: Paula ByrdPhone: (405) 632-9090 Fax: ( ) -

American Board of NeurologyT

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 13

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neuropsychology - Clinical John Linck, PhD 920 Stanton L Young Suite 3445 Clinical neuropsycholgy (cognition Oklahoma City& emotional)Oklahoma City, OK73104

[email protected]. Body Parts/Svcs:Contact: Garyall but listedPhone: (405) 271-4488 Fax: ( ) -

Clinical NeuropsychologyT R MITF

Neuropsychology - Clinical Russell Pella, PhD 7146 S Braden Ave Suite 500 clinical neuropsychology TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: scheduler all but neuropsychology and

psychiatricPhone: (918) 488-6165 Fax: ( ) -

American Board of ClinicalNeuropsychology

R MITF

Neuropsychology Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehab Neuropsychology-Brain, TulsaNervous System, all behavioralTulsa, OK74136aspects of physicale psychologicaltraumaContact: Suzan

Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:Children

Certification UnknownT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 14

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neuropsychology Terry G. Shaw, Ph.D. PO Box 3010 head, traumatic brain injury, Tulsapsychological overlayMcAlester, OK74502

[email protected]. Body Parts/Svcs:Contact: Maryall excluded except parts listed asPhone: (918) 488-6165 Fax: (918) 488-8021specialty

American Board of ProfessionalNeuropsychology

R

Neuropsychology Adam G. Sherman, Ph.D. 5512 S Lewis Ave, Ste 8 all within specialty TulsaTulsa, OK74105

[email protected] Excl. Body Parts/Svcs:Contact: Susan NonePhone: (918) 712-2885 Fax: (918) 712-9019

Certification UnknownT R

Neurosurgery Daniel Boedeker, M.D. 6767 S Yale Ave Ste A Brain, Thoracic, Lumbar, Cervical TulsaSpine, Carpal TunnelTulsa, OK74136

[email protected]. Body Parts/Svcs:Contact: Jacci Carpioall except specialtyPhone: (918) 491-3527 Fax: (918) 491-3542

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 15

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Christopher G. Covington, M.D. Attn: Sheila Harless spine, brain, carpel tunnel Tulsa6802 S Olympia Ave Ste 300

[email protected] Tulsa, OK74063 Excl. Body Parts/Svcs:Contact: Sheila, Melissa extremitiesPhone: (918) 749-0762 Fax: (918) 744-4246

American Board of NeurologicalSurgery

T

Neurosurgery Joseph Bridger Cox, M.D. 4120 W. Memeorial Rd Neck, Back, Wrist (carpal tunnel) OKCOklahoma City, OK73120

[email protected] Excl. Body Parts/Svcs:Contact: Shehan Shoulders, Knees, lower extremitiesPhone: (405) 748-3300 Fax: ( ) -

American Board of NeurologicalSurgery

T R

Neurosurgery Emily D. Friedman, M.D. 3130 SW 89th Street, Ste. 100 Cerical, Thoracic and Lumbar Spine Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Esther Berger all body parts not specifiedPhone: (405) 395-2633 Fax: (405) 286-0176

American Board of NeurologicalSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 16

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Steven E. Gaede, M.D. 1423 Terrace Dr. #4646 spine, brain, peripheral nerve TulsainjuryTulsa, OK74159

[email protected]. Body Parts/Svcs:Contact: Schedulernon-spine orthopedic casesPhone: (918) 640-6739 Fax: ( ) -

American Board of NeurologicalSurgery

T

Neurosurgery Michael Hahn, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), wrist (carpal Oklahoma Citytunnel)Oklahoma City, OK73120

[email protected]. Body Parts/Svcs:Contact: Tammy Blehmshoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T

Neurosurgery Daniel Harwell, MD 6802 S Olympia Ave #300 spine, brain and carpal tunnel TulsaTulsa, OK74132

[email protected] Excl. Body Parts/Svcs:Contact: Sheila Harless or Melissa Lars extremitiesPhone: (918) 749-0762 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 17

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Brent N. Hisey, M.D. 800 NW 9th Street, Suite 201 spine (neck, back), brain, carpal Oklahoma CitytunnelOklahoma City, OK73106Excl. Body Parts/Svcs:Contact: MarieNothing outside of cervical,Phone: (405) 979-7875 Fax: (405) 979-7880lumbar, and brain

American Board of NeurologicalSurgery

T R MITF

Neurosurgery Kyle Mangels, M.D. 6802 S Olympia Ave Ste 300 Back, Neck, Brain, Carpal Tunnel, TulsaUlnar NerveTulsa, OK74132

[email protected]. Body Parts/Svcs:Contact: Sheila Harless/Melissa LarsonLegs, Hips, JointsPhone: (918) 749-0762 Fax: (918) 744-4246

American Board of NeurologicalSurgery

T R

Neurosurgery John S. Marouk, D.O. 2128 S Atlanta PL Ste 100 spine, brain only TulsaTulsa, OK74114

[email protected] Excl. Body Parts/Svcs:Contact: Rachel Caudle all other body partsPhone: (918) 583-5131 Fax: (918) 592-0670

American Osteopathic Board ofSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 18

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Jeffrey Nees, M.D. 3110 SW 89th Street Suite 200E Spine, peripheral nerve OKCOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: scheduler ectensive spine deformityPhone: (405) 486-6720 Fax: ( ) -

American Board of NeurologicalSurgery

T R

Neurosurgery Stan Pelofsky, M.D. 4120 W Memorial Rd Ste 300 Head, Neck, Back, Wrist (Carpal Oklahoma CityTunnel)Oklahoma City, OK73120

[email protected]. Body Parts/Svcs:Contact: Tammyshoulders, kneesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T R

Neurosurgery Ryan F. Rahhal, M.D. 2408 E 81st Street, Suite 290 brain, spine (thoracic, lumbar, & Tulsa orcervical), carpal tunnel StillwaterTulsa, OK74137

[email protected]. Body Parts/Svcs:Contact: Michelleall ot neurosurgicalPhone: (918) 855-1255 Fax: (918) 494-9397

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 19

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Robert L. Remondino, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists (carpal tunnel) Oklahoma CityOklahoma City, OK73120

[email protected] Excl. Body Parts/Svcs:Contact: Marlea Lynch shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T R

Neurosurgery W. Emery Reynolds, M.D. 4120 W Memorial Ste 202 head, spine Oklahoma CityOklahoma City, OK73120

NONEContact: SondraPhone: (405) 755-3540 Fax: (405) 755-7001

American Board of NeurologicalSurgery

T

Neurosurgery Brian E. Snell, M.D. 4120 W Memorial Rd Ste 300 spine (neck, back), wrist (carpal Oklahoma Citytunnel)Oklahoma City, OK73120

[email protected]. Body Parts/Svcs:Contact: Karryshoulders, knees, hips, elbowsPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 20

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Caple A Spence, M.D. 8121 National Ave Ste 210 brain, spine, peripheral nerves MWCMidwest City, OK73110

[email protected]: RethaPhone: (405) 455-3393 Fax: (405) 455-7162

American Board of NeurologicalSurgery

T

Neurosurgery Ryan Tackla, MD 6802 S Olympia Ave #300 spine, brain, carpal tunnel TulsaTulsa, OK74132

[email protected] Excl. Body Parts/Svcs:Contact: Sheila or Melissa extremitiesPhone: (918) 749-0762 Fax: ( ) -

Certification UnknownT

Neurosurgery Michael Thambuswamy, MD 6802 S Olympia Ave Suite #300 spine, brain, carpal tunnel, ulnar Tulsaneuropathy, peripheral nervesTulsa, OK74132

credentialing @osbi.netExcl. Body Parts/Svcs:Contact: Sheila or MelissaorthopedicPhone: (918) 749-0762 Fax: ( ) -

Certification UnknownT

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 21

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Frank J. Tomecek, M.D. 6802 S Olympia Ave Ste 300 Back, Neck, Brain, Carpal Tunnel, TulsaUlnar NerveTulsa, OK74132

[email protected]. Body Parts/Svcs:Contact: Sheila or MelissaLegs, Hips, JointsPhone: (918) 749-0762 Fax: (918) 749-8531

American Board of NeurologicalSurgery

T R

Neurosurgery Benjamin T. White, M.D. 4120 W Memorial Rd Ste 300 head, neck, back, wrist (carpal Oklahoma Citytunnel)Oklahoma City, OK73120

[email protected]. Body Parts/Svcs:Contact: Beccashoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T R

Neurosurgery Robert J. Wienecke, M.D. 4120 W Memorial Rd Ste 300 neck, back, wrists{carpal tunnel) Oklahoma CityOklahoma City, OK73120

[email protected] Excl. Body Parts/Svcs:Contact: Marlea shoulders, knees, lower extremitiesPhone: (405) 748-3300 Fax: (405) 749-1671

American Board of NeurologicalSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 22

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Neurosurgery Gregory L. Wilson, D.O. 9709 E 79 Street South brain, neck, back TulsaTulsa, OK74133

[email protected]: Traci LawleyPhone: (918) 994-4061 Fax: (918) 994-4095

Am Board of OsteopathicNeurological Surgery

T R

Neurosurgery Shihao Zhang, M.D. 6767-A S Yale Ave Brain, Spine, Peripheral Nerve for TulsaCTRTulsa, OK74136

[email protected]. Body Parts/Svcs:Contact: Shanna NeumanALL OTHERSPhone: (918) 491-3528 Fax: ( ) -

Certification UnknownT R

Occupational Medicine William R. Gillock, M.D. 7170 S Braden Ste 175 all body parts TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Sharon or Sandy nonePhone: (918) 481-0994 Fax: (918) 494-6747

American Board of Internal Medicine& Preventive Medicine

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 23

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine John W. Hallford, D.O. 5682 W Skelly Dr occupational medicine/General TulsaPracticeTulsa, OK74107

[email protected]. Body Parts/Svcs:Contact: Meyon WardnonePhone: (918) 446-1891 Fax: (918) 446-1894

American Osteopathic Board ofFamily Physicians

R MITF

Occupational Medicine William D. Jones, M.D. 707 NW 13 St all occupational medicine (rating Oklahoma Cityonly)Oklahoma City, OK73103

[email protected]. Body Parts/Svcs:Contact: Jeannefemale reproductive system andPhone: (405) 521-8604 Fax: (405) 521-8605pediatrics

Certification Unknown R MITF

Occupational Medicine John A. Munneke, M.D., DDS 36 W Memorial Ste B9 Physical Medicine-Pain Management Oklahoma CityOklahoma City, OK73114

[email protected] Excl. Body Parts/Svcs:Contact: JoAnne Thacker PulmonaryPhone: (405) 755-9702 Fax: (405) 755-9718

Certification UnknownT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 24

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine Robert Paul, M.D. 7107 S Yale Avenue #229 all within specialty TulsaTulsa, OK74136

[email protected] Excl. Body Parts/Svcs:Contact: Linda PsychiatricPhone: (918) 496-1991 Fax: ( ) -

Certification Unknown R MITF

Occupational Medicine Carl B. Pettigrew, D.O. 6521 S Western Avenue all Oklahoma CityOklahoma City, OK73139

[email protected] Excl. Body Parts/Svcs:Contact: Karen NonePhone: (405) 239-7766 Fax: (405) 235-4895

Certification UnknownT R MITF

Occupational Medicine J. A. Snelling, D.O. PO Box 702738 Orthopedic-Knees, Ankles, Lower TulsaSpineTulsa, OK74170

noneExcl. Body Parts/Svcs:Contact: MargaretCardiac-RespiratoryPhone: (918) 749-3187 Fax: (918) 491-9925

American Board of FamilyPhysicians, Am Board of PreventiveMed.

R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 25

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Occupational Medicine Kenneth R. Trinidad, D.O.* 1006 W 23 St Internal Medicine-All body parts TulsaTulsa, OK74107

Excl. Body Parts/Svcs:Contact: Rhonda Pulmonary and Chemical exposure,

including moldPhone: (918) 742-4881 Fax: (918) 742-5854

Internal MedicineT R MITF

Optometry Carolanne Roach, O.D. 1350 SW 89th St, Ste D2 Specializing in brain injuries, Oklahoma Citystrokes, concussions, low vision,Oklahoma City, OK73159superficial eye injuries ([email protected] foreign bodies)Contact: Linda Roach / Kristen Hoaglin

Phone: (405) 703-3163 Fax: ( ) -Excl. Body Parts/Svcs:Eye injuries with need forsiginificant need for surgicalinterventi

OptometryT R MITF

Orthopedic Surgery Kasra Ahmadinia, M.D. 2408 E 81st Street, Suite 290 Neck and Spine TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Susan head, hand, Shoulder, Knee, Ankle,

Elbow, hipPhone: (918) 855-1255 Fax: ( ) -

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 26

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775

American Board of OrthopedicSurgery

T

Orthopedic Surgery John W. Anderson, M.D. 3301 NW 50 St Foot/Ankle, Knee Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Angela Back, Neck, Shoulders, Elbow,

Wrist, HipPhone: (405) 947-0911 Fax: (405) 948-5177

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Clint Justin Basener, D.O.* 6130 E 81ST Street Shoulders, Knees, Hips, Legs, TulsaAnkles, Feet, Elbows, Hands, ArmsTulsa, OK74137

[email protected]: AngiePhone: (918) 583-4400 Fax: (918) 583-7908

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 27

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery James F. Bischoff, M.D.* 2448 East 81st Street Suite1200 Hands TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Naomi Traczyk spine, elbows, shoulders, feet,

ankles, knees, hips, rate onlyPhone: (918) 900-6432 Fax: (918) 392-7057cases

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery David Bobb, M.D. 825 E Robinson all except back & head Norman/MooreNorman, OK73071

[email protected] Excl. Body Parts/Svcs:Contact: Donna back & headPhone: (405) 364-7900 Fax: ( ) -

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery James Lee Bond, M.D. 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hips NormanNorman, OK73072

Excl. Body Parts/Svcs:Contact: Anne Miles foot, anklePhone: (405) 515-8086 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 28

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Bradford Boone, M.D.* 2408 E 81st Street, Suite 290 knees, shoulders, elbows TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown spine, hips, feet, ankles, hands &

rate only casesPhone: (918) 494-2665 Fax: (918) 494-9397

American Board of OrthopedicSurgery/Sports Medicine

T R

Orthopedic Surgery R. Tyler Boone, M.D. 2408 E 81st Street, Suite 290 neck, back TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown hands, hips, knees, feet, ankles

shoulders, elbows, no rate only casPhone: (918) 494-2665 Fax: (918) 494-9397

American Board of OrthopedicSurgery/AmBd Ortho Surg of theSpine

T R

Orthopedic Surgery Steven P. Brantley, M.D. 3301 NW 50th ST, STE 100 Knees, Shoulders, Wrists, Ankles Oklahoma Cityand ElbowsOklahoma City, OK73112-5627

[email protected]. Body Parts/Svcs:Contact: central schedulingSpine (neck and back) , Hips andPhone: (405) 947-0911 Fax: ( ) -Hands

American Board Orthopaedic SurgeryT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 29

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Christopher A. Browne, M.D. 2488 E 81st Street, Suite 290 hips, knees TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown hands, spine, feet, ankles,

shoulders, elbows, no rate onlyPhone: (918) 494-2665 Fax: (918) 494-9397cases

American Board of OrthopedicSurgery

T R

Orthopedic Surgery James D. Cash, M.D.* 2448 East 81st Street, Suite 1520 knees, shoulders TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Hip, Hand, Elbow, Ankle, Feet,

SpinePhone: (918) 900-2520 Fax: (918) 900-2521

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Brian Chalkin, D.O.* 1809 E 13 St Ste 100 Shoulder, Elbow, Hand, Wrist TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Melissa Revis Knee, Ankle, Hip, Spine, Neck,

PelvisPhone: (918) 925-3268 Fax: (918) 301-4293

American Osteopathic Board ofOrthopedic Surgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 30

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Brian Clowers, M.D. 3400 W Tecumseh Ste 101 foot, ankle OKC, NormanNorman, OK73072

Excl. Body Parts/Svcs:Contact: Anne Miles all except foot & anklePhone: (405) 515-8086 Fax: ( ) -

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Jimmy Harold Conway, M.D. 10001 S Western Ste 101 shoulder, knees Oklahoma CityOklahoma City, OK73139-2997

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler elbows, feet, handsPhone: (405) 692-3749 Fax: (405) 692-3789

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Steven D. Coupens, M.D. 9800 Broadway Extension Suite 201 all body parts Oklahoma CityOklahoma City, OK73114

[email protected]: Phone: (405) 427-6776 Fax: (405) 424-5415

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 31

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Thomas G. Craven, M.D. 2408 East 81st St, Ste 290 Neck and Spine TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Deidre Knee, Ankle, Elbow, Hand, Wrist,

HipPhone: (918) 855-1255 Fax: (918) 494-9355

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Kevin M. Dukes, M.D. 4802 S 109 E Ave shoulders TulsaTulsa, OK74146

[email protected] Excl. Body Parts/Svcs:Contact: James Taffee all but shoulderPhone: (918) 392-1403 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

Orthopedic Surgery Scott J. Dunitz, M.D. 4802 S 109 E Ave Orthopedic Surgery-Total Joint TulsaReconstruction-Hip and KneeTulsa, OK74146

[email protected]: Denis 918-392-1403Phone: (918) 392-1403 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 32

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Winston Fong, M.D. 9600 Broadway Extension Back and Neck ONLY OKC, EdmondOklahoma City, OK73114

[email protected] or [email protected] Excl. Body Parts/Svcs:Contact: LaDonna / Claudia all except spine

(shoulders,elbows,hands,wrist,hips,Phone: (405) 230-9237 Fax: (405) 230-9119knees,ankles/f

American Board of OrthopaedicSurgery

T R

Orthopedic Surgery Jeff A. Fox, M.D.* 2408 E 81st Street, Suite 290 knees, ankles, elbow, shoulders TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Danette head and spinePhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Charles H. Funderburk, M.D.* 9600 Broadway Extension hands, shoulders, elbows, knees, Oklahoma Ctiy,wrists, forearm EdmondOklahoma City, OK73114

[email protected]. Body Parts/Svcs:Contact: LaDonna or Claudianeck, back, hips, feetPhone: (405) 230-9125 Fax: (405) 230-9119

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 33

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Robert A. German, M.D. 9600 Broadway Extension knees, shoulders, elbows, ankles, Oklahoma City,arms, legs NormanOklahoma City, OK73114

[email protected]. Body Parts/Svcs:Contact: LaDonna / Claudiaspine, neckPhone: (405) 230-9237 Fax: (405) 230-9119

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Greg Halko, M.D.* 3301 NW 50 hands, wrists, elbows ONLY Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: central scheduling spine, (neck, back) , shoulders or

lower extremitiesPhone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Kevin Wayne Hargrove, M.D. 101 S Saints Blvd Ste 101 Orthopaedic Surgery; Sports EdmondMedicince-Shoulders and kneesEdmond, OK73034

[email protected]. Body Parts/Svcs:Contact: Makenzi or TashaSurgical Spine CasesPhone: (405) 513-8326 Fax: (405) 513-7739

American Board of OrthopedicSurgery

T MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 34

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Bryan Hawkins, M.D.* 2408 E 81st Street, Suite 290 ankles TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Deidre neck, spine, wrists, handsPhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Randall L. Hendricks, M.D. 2408 E 81st Street, Suite 290 neck, spine TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Danette shoulders, elbows, hips, knees

hands, wrists, anklePhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Gregory R. Holt, M.D. 1809 E 13 St Ste 100 hips, knees, shoulders, ankles TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Melissa Back, NeckPhone: (918) 925-3268 Fax: (918) 582-6060

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 35

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Christopher Shane Hume, D.O. 3115 SW 89th spine (neck & back) Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Andrea all except specialityPhone: (405) 427-3705 Fax: ( ) -

Board EligibleT R MITF

Orthopedic Surgery Antoine I. Jabbour, M.D. 4802 S 109 E Ave knees, shoulders TulsaTulsa, OK74146

[email protected] Excl. Body Parts/Svcs:Contact: Melissa Matthews backs or necksPhone: (918) 392-1400 Fax: (918) 392-1401

American Board of OrthopedicSurgery

T

Orthopedic Surgery Thomas P. Janssen, M.D. 9600 Broadway Extension knees, hips, shoulders, feet, hands Oklahoma CityOklahoma City, OK73114

[email protected] Excl. Body Parts/Svcs:Contact: Claudia or LaDonna neck,backPhone: (405) 230-9125 Fax: (405) 230-9119

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 36

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Daniel J. Jones, M.D. 8100 S Walker Ave Bldg A knee, shoulder, foot,egs, arms, Oklahoma CityelbowsOklahoma City, OK73139

[email protected]. Body Parts/Svcs:Contact: Alice Mataspine, neck, feet, anklesPhone: (405) 632-4468 Fax: (405) 632-4317

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Paul Kammerlocher, Orthopedic 3115 SW 89th St. FEET and ANKLES Oklahoma CityOklahoma City, OK73159-7901

Contact: Phone: (405) 486-6900 Fax: ( ) -

American Boaard of OrthopedicSurgery

T

Orthopedic Surgery Michael E. Kiehn, M.D. 3301 NW 50 St Knees and Shoulders Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Central Scheduling Feet, Hands, Back, HipsPhone: (405) 947-0911 Fax: (405) 942-5043

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 37

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Norman,hip Oklahoma CityNorman, OK73072Excl. Body Parts/Svcs:Contact: Anne Milesfoot, anklePhone: (405) 515-8086 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R

Orthopedic Surgery Zakary A. Knutson, M.D. 3400 W Tecumseh Ste 101 hips, knees, shoulders, elbows, Norman, Edmondhands anklesNorman, OK73072Excl. Body Parts/Svcs:Contact: Ann MilesfootPhone: (405) 515-8086 Fax: ( ) -

Certification UnknownT R

Orthopedic Surgery Mark F. Kowalski, M.D. 4140 W Memorial Rd Ste 308 Shoulders, Arms, Elbows, Hands, Oklahoma CityHips, Legs, Knees, Ankles, and FeetOklahoma City, OK73120Excl. Body Parts/Svcs:Contact: Laura Shelton, Diane EnglesNeck and BackPhone: (405) 749-7031 Fax: (405) 749-7036

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 38

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Sarat Kunapuli, D.O. 2408 E 81st Street, Suite 290 Knees and hips TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Shari McKown all except listedPhone: (918) 494-2665 Fax: (918) 494-9397

American Osteopathic AssociationT R

Orthopedic Surgery Ronald S. LaButti, D.O.* 2408 E 81st Street, Suite 290 Total Joint Reconstruction, Hip and TulsaKneeTulsa, OK74137

[email protected]. Body Parts/Svcs:Contact: DanetteHead, Shoulder, Ankle, Elbow, Hand,Phone: (918) 855-1255 Fax: (918) 494-9388Spine

American Osteopathic Aacademy ofOrthopedics

T R MITF

Orthopedic Surgery Bradley J. Lawson, M.D. 10507 E 91st ST, STE 350 ankle, shoulder, hip, knee, feet, TULSAelbow, hand, wristTulsa, OK74133Excl. Body Parts/Svcs:Contact: Francine CalvertnonePhone: (918) 451-3000 Fax: (918) 451-2700

American Board of OrthopaedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 39

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Brian A. Levings, D.O. 8100 S Walker Ave Bldg A arms, legs, shoulders, knees, Oklahoma CityelbowsOklahoma City, OK73139

[email protected]. Body Parts/Svcs:Contact: Alic Mataback, neck, feet, anklesPhone: (405) 632-4468 Fax: (405) 632-4317

American Osteopathic Board ofOrthopaedic Surgery

T R MITF

Orthopedic Surgery Alan G. Lewis, M.D. 2448 East 81st Street, Suite 1520 feet and knees TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Everything but feet and kneesPhone: (918) 900-2520 Fax: (918) 900-2521

Premier Orthopedic Specialists ofTulsa

T

Orthopedic Surgery J. Patrick Livingston, M.D. 1211 N Shartel Suite 800 orthopedic surgery, neck, back, Oklahoma Cityshoulders, hips, arms, legs, hands,Oklahoma City, OK73103feet

Contact: DorisExcl. Body Parts/Svcs:Phone: (405) 463-0407 Fax: (405) 463-0425head, brain, lungs, hearturogenital, gastrointestinal

American Board of OrthopedicSurgery

R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 40

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Jay D. Lorton, M.D. 2408 E 81st Street, Suite 290 knees, shoulders, elbows TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown spine, hands, hips, feetPhone: (918) 494-2665 Fax: (918) 494-9397

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Paul D. Maitino, D.O. 3110 SW 89 Street Ste 200D hips, knees, shoulders Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Myra headPhone: (405) 680-5633 Fax: (405) 735-6435

Orthopedic SurgeryT R MITF

Orthopedic Surgery Bradley Margo, M.D. PO BOX 268981 shoulders, knees Oklahoma City,Norman, EdmondOklahoma City, OK73126-8981

[email protected] Excl. Body Parts/Svcs:Contact: Claudia backs, necks, hips, feet, handsPhone: (405) 230-9125 Fax: (405) 230-9119

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 41

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Robert Marsh, D.O. 2408 E 81st Street, Suite 290 all body parts but spine and neck TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown spine and neckPhone: (918) 494-2665 Fax: (918) 494-9397

American Osteopathic AssociationT R

Orthopedic Surgery James C. Mayoza, M.D. 6122 E 61 St Orthopedic surgery all body parts TulsaTulsa, OK74136-2117

Contact: Nicci or MorgiePhone: (918) 492-3133 Fax: (918) 493-2215

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Yogesh Mittal, M.D. 1809 E 13 St Ste 100 Orthopedic Surgeon-Total Joint- TulsaKnees-HipsTulsa, OK74104

[email protected]. Body Parts/Svcs:Contact: Melissa RevisspinePhone: (918) 925-3268 Fax: (918) 301-4293

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 42

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Mac E. Moore, M.D. 3130 S.W. 89th Street Suite 100 shoulders, elbows, knees Oklahoma CityOklahoma City, OK73159

Excl. Body Parts/Svcs:Contact: Scheduler lumbar/cervicalPhone: (405) 692-3737 Fax: (405) 692-3707

American Board of OrthopaedicSurgery

T R MITF

Orthopedic Surgery Jeffrey R. Morris, D.O.* 6130 E 81st Street shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74137Excl. Body Parts/Svcs:Contact: Angie Foyilneck, spinePhone: (918) 583-4400 Fax: (918) 583-7908

American Osteopathic Board ofOrthopedfic Surgery

T R MITF

Orthopedic Surgery Gerardo Myrin, MD 3115 SW 89th Orthopedic Oklahoma CityOklahoma City, OK73159

[email protected]: schedulerPhone: (405) 486-6880 Fax: ( ) -

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 43

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Ryan L. Nelson, D.O 9800 Broadway Extension, Suite 201 Orthopedic Surgery (Shoulder, EdmondElsbow, Knee, Trauma/Fractures Hip,Oklahoma City, OK73114Wrist, Ankle)[email protected]

Contact: SchedulerExcl. Body Parts/Svcs:Phone: (405) 330-8847 Fax: ( ) -none

Certification UnknownT R

Orthopedic Surgery David E. Nonweiler, M.D. 2408 E 81st Street, Suite 290 shoulders, knees TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Sheri Neck and SpinePhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery M. Sean O'Brien, D.O.* 3110 SW 89th St., Suite 200C Knees, elbows, hands and shoulders Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler feet and anklePhone: (405) 759-2663 Fax: ( ) -

American Osteopathic Board ofOrthopedic Surgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 44

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery James M. Odor, M.D. 14100 Parkway Commons Dr Ste 200 Spine surgery (Neck and entire Oklahoma CitySpine)Oklahoma City, OK73134

[email protected]. Body Parts/Svcs:Contact: Andrea TiffanyAmything NOT connected with thePhone: (405) 242-4345 Fax: (405) 242-4333spine (neck and back)

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery L. Todd Olsen, D.O. Olsen Orthopedics knees, shoulders MIDWEST CITY1140 S Douglas Blvd

[email protected] Midwest City, OK73130 Excl. Body Parts/Svcs:Contact: Andrea backsPhone: (405) 869-4035 Fax: (405) 733-7820

American Osteopathic Board ofOrthopedic Surgery

T R MITF

Orthopedic Surgery Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 Orthopedics; Sports Medicine TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Melissa 918-925-3268 Back, Foot/ankle, handPhone: (918) 582-6800 Fax: ( ) -

American Osteopathic BoardT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 45

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Kris Parchuri, D.O. 8165 S Mingo Road Ste 201 spine TulsaTulsa, OK74133

[email protected] Excl. Body Parts/Svcs:Contact: Tasha hands, wrists, feet, elbows, anklesPhone: (918) 286-3124 Fax: (539) 664-4288

AOAT R MITF

Orthopedic Surgery Andrew B Parkinson, M.D. 14100 Parkway Commons Dr. Suite 101 Neck, Back, Spine Oklahoma CityOklahoma City, OK73134

Excl. Body Parts/Svcs:Contact: central scheduling All Excpet SpecialityPhone: (405) 463-3370 Fax: (405) 463-3371

American Board of OrthopaedicSurgery

T

Orthopedic Surgery Ghazi M. Rayan, M.D.* 3366 NW Expressway Ste 700 shoulder, elbow, wrist, hand, arm Oklahoma CityOklahoma City, OK73112-4418

[email protected] Excl. Body Parts/Svcs:Contact: Barbara Jones Non-Upper Extremity, Back, Knees,

FeetPhone: (405) 945-4888 Fax: (405) 945-4889

American Board of OrthopedicSurgery/ Am Bd of Ortho Surg ofHand

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 46

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Vytautas M. Ringus, M.D. 825 E Robinson foot and ankle NormanNorman, OK73071

[email protected] Excl. Body Parts/Svcs:Contact: Taylor nonePhone: (405) 364-7900 Fax: (405) 310-6866

Certification UnknownT R MITF

Orthopedic Surgery Richard A. Ruffin, M.D.* 3301 NW 50TH ST hands, wrists, elbows, shoulders, Oklahoma CityfingersOklahoma City, OK73112

[email protected]. Body Parts/Svcs:Contact: Central SchedulingSpinePhone: (405) 947-0911 Fax: (405) 947-4263

American Board of OrthopedicSurgery, Hand Surgery

T R

Orthopedic Surgery Blake Shockley, M.D. 2408 E 81st Street, Suite 290 shoulder, elbow, hip, knee and Tulsa areaankleTulsa, OK74137

[email protected]. Body Parts/Svcs:Contact: Deidrespine, handPhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 47

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Sheryl C. Smith, M.D. 3115 SW 89TH Street foot, ankle Oklahoma CityOklahoma City, OK73159-7901

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler all except foot & anklePhone: (405) 419-5610 Fax: ( ) -

Certification UnknownT

Orthopedic Surgery Cheng-Lun Soo, M.D. 9821 S May Ave Suite B spine, neck, lumbar, cervical Oklahoma CityOklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Celia Williams all except neck and backPhone: (405) 631-4263 Fax: (405) 703-1583

American Board of OrthopedicSurgery

T R MITF

Orthopedic Surgery Wesley Michael Stotler, D.O. 4802 S 109 E Ave foot, ankle TulsaTulsa, OK74146

[email protected] Excl. Body Parts/Svcs:Contact: Liz Klawitter all except feet and anklesPhone: (918) 392-1403 Fax: (918) 392-1401

American Osteopathic Board ofOrthopedic Surgery

T

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 48

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedic Surgery Robert S. Unsell, M.D. 10001 S Western Ste 101 hands, wrist, elbows Oklahoma CityOklahoma City, OK73139

[email protected] Excl. Body Parts/Svcs:Contact: Shoulders, Spine, Lower ExtremityPhone: (405) 692-3700 Fax: (405) 923-3783

Certification UnknownT R MITF

Orthopedic Surgery Jeremy Woodson, M.D. PO Box 268981 Shoulders, Elbows, Hips, Knees, OKC and LawtonAnklesOKC, OK73126-8981

[email protected]. Body Parts/Svcs:Contact: LaDonna SilerNecks and BacksPhone: (405) 230-9237 Fax: ( ) -

American Board of OrthopedicSurgery

T R

Orthopedic Surgery Gregory J. Zeiders, D.O. 3414 NW 135TH ST hands, wrists, elbows, shoulders, Edmondfeet, ankles, knees, hipsOklahoma City, OK73120

[email protected]. Body Parts/Svcs:Contact: LindsayComplex Hand or SpinePhone: (405) 753-1100 Fax: (405) 753-5370

American Osteopathic Board ofOrthopedic Surgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 49

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics Jeffrey Cunningham, M.D.* 2408 E 81st Street, Suite 290 Head/Concussion TulsaTulsa, OK74137

Contact: MichellePhone: (918) 855-1255 Fax: ( ) -

American Board Family Medicine /Sports Medicine

T R MITF

Orthopedics Joel M. Davis, M.D. 941 W I-35 Frontage Rd Bldg 164 Foot and Ankle EdmondEdmond, OK73034

[email protected] Excl. Body Parts/Svcs:Contact: Kristi SpinePhone: (405) 768-1600 Fax: ( ) -

Certification UnknownT R MITF

Orthopedics William Bentley Edmonds, M.D. 9600 Broadway Extension foot, ankle Oklahoma City,Edmond, NormanOklahoma City, OK73114

[email protected] Excl. Body Parts/Svcs:Contact: LaDonna Sigler all except foot and anklePhone: (405) 230-9237 Fax: (405) 230-9119

American Board of OrthopaedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 50

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics David Holden, M.D. 9600 Broadway Extension knees & shoulders only Oklahoma City,NormanOklahoma City, OK73114

[email protected] Excl. Body Parts/Svcs:Contact: Lynn Stokes Spine, Neck, Hip, Ankles, Feet,

Elbows, HandsPhone: (405) 230-9466 Fax: (405) 230-9119

American Board of OrthopaedicSurgery & Sports Medicine

T

Orthopedics Michael Brandon Johnson, M.D. 9800 Broadway Extension Suite 203 all within specialty OKCOklahoma City, OK73114

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler SpinePhone: (405) 424-5417 Fax: (405) 424-5418

Certification UnknownT

Orthopedics Faustino Kazenske, D.O. 3301 NW 50th Street shoulders, knees, elbows, hips and Oklahoma CityanklesOklahoma City, OK73112Excl. Body Parts/Svcs:Contact: Central Schedulinghands, feet, backPhone: (405) 947-0911 Fax: ( ) -

American Board Orthopaedic SurgeryT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 51

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics Richard Kirkpatrick, M.D.* 3400 W Tecumseh Rd Ste 101 knees, shoulders, elbows, hands, Oklahoma City,hip NormanNorman, OK73072Excl. Body Parts/Svcs:Contact: Anne Milesfoot, anklePhone: (405) 515-8086 Fax: (405) 360-6769

American Board of OrthopaedicSurgery

T R

Orthopedics Laura R. Luick, M.D. 3115 SW 89th Street FOOT & ANKLE OKLAHOMA CITYOklahoma City,, OK73159-7901

Contact: SchedulerPhone: (405) 486-6800 Fax: ( ) -

OK State Med Board/BOC Certified inAthletic Train

T R

Orthopedics David Rush, M.D.* 9600 Broadway Ext Elbow, Wrist & Hand OKLAHOMA CITY &NORMANOklahoma City, OK73114

Excl. Body Parts/Svcs:Contact: LaDonna Siler Neck, BAck, Shoulder, Hip, Knee,

Ankle & FootPhone: (405) 230-9237 Fax: ( ) -

American Board of OrthopedicSurgery

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 52

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Orthopedics Austin Taylor, M.D. PO Box 268981 Shoulders, Knees, Hips OKC and EDMONDOklahoma City, OK73126-8981

[email protected] Excl. Body Parts/Svcs:Contact: LaDonna Siler Neck, Back, Elbows, Wrists, Hands,

Ankles, FeetPhone: (405) 230-9237 Fax: ( ) -

American Board of OrthopedicSurgery

T R

Otolaryngology Alen Munson Fuller, M.D. 1725 E 19 St Ste 100 Hearing Loss Non Surgical TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Betsi surgical casesPhone: (918) 742-7376 Fax: (918) 743-2117

American Board of OtolaryngologyT R

Otolaryngology Tom A Hamilton, D.O. 6802 S Olympia Ave W Ste 200 Ear, Nose and Throat TulsaTulsa, OK74132

[email protected] Excl. Body Parts/Svcs:Contact: Martha or Doris All OthersPhone: (918) 388-9740 Fax: ( ) -

AOBOOT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 53

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Donald E. Adams, M.D. 1616 S Kelly pain management EdmondRehabilitation Edmond, OK73013-3651

[email protected] Excl. Body Parts/Svcs:Contact: Joann feet, anklesPhone: (405) 330-0015 Fax: (405) 330-0092

American Board of Medicine &Rehabilitation & Pain Medicine

T R

Physical Medicine and Archana Barve, M.D. 3613 NW 56 STREET STE 140 sports medicine, physical medicine Oklahoma CityRehabilitation & rehabilitationOklahoma City, OK73112

[email protected]: Stacey/SergioPhone: (405) 949-6481 Fax: (405) 795-5909

American Board of PhysicalMedicine/Rehabilitation

T MITF

Physical Medicine and Michael S. Brown, M.D. 4120 W Memorial Rd Ste 118 physiatry - head (skeletal), neck, Oklahoma CityRehabilitation spine upper and lower extremities,Oklahoma City, OK73120

nerve and joint [email protected]: Cecylia/Jean

Excl. Body Parts/Svcs:Phone: (405) 748-4700 Fax: (405) 748-5638narcotic pain management, RSD

American Academy of PhysicalMedicine/Rehab

T R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 54

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Aaron McGuire, DO 5591 S Lewis Ave muskuloskeletal system, spinal cord Tulsa andRehabilitation injury, traumatic brain injury Oklahoma CityTulsa and Oklahoma City, OK74105

[email protected]: Phone: (918) 488-8285 Fax: ( ) -

Physical Medicine andRehabilitation

T R MITF

Physical Medicine and Darryl Dermot Robinson, M.D. 3110 SW 89 Ste 102 Physical Medicine and Rehab Oklahoma CityRehabilitation Oklahoma City, OK73159

[email protected] Excl. Body Parts/Svcs:Contact: Scheduler NonePhone: (405) 703-4950 Fax: (405) 703-4955

American Board of Physical Medicineand Rehab-Pain Management

T R

Physical Medicine and Kathleen Sisler, Orthopedic/Amputations 12800 S Memorial Dr., Ste D P M & R, EMGS, SPINE, PERIPHERALTULSARehabilitation JOINTS, AMPUTATIONSBixby, OK74008

[email protected]. Body Parts/Svcs:Contact: DeidreTRAUMATIC BRAINPhone: (915) 855-1255 Fax: ( ) -INJURY/CONCUSSIONS/SCI (SPINAL CORDINJURY)

American Board of Physical Medicineand Rehab

T

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 55

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Physical Medicine and Jonathan B. Stone, D.O. 700 NW 7 Street Ste 115 all within speciality chronic Oklahoma CityRehabilitation medication management, continuingOklahoma City, OK73102

medical [email protected]: LisaPhone: (405) 601-5899 Fax: (405) 601-5903

American Board of Physical Medicineand Rehabilitation

T

Physical Medicine and D. Brent Tipton, M.D. 5100 N Brookline Ste 530 muscles and nerves Oklahoma CityRehabilitation Oklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Leti Ramirez heart, lungs, GI, Renal, medical

maintenance, pain managementPhone: (405) 604-6652 Fax: (405) 604-6653

American Board of PhysicalMedicine/Rehabilitation/Electrodiagnos

T R

Plastic Surgery Mehdi N. Adham, M.D.* 8100 S Walker Ave Bldg A plastic & reconstructive surgery of Oklahoma Cityhands and wristsOklahoma City, OK73139

[email protected]. Body Parts/Svcs:Contact: Alice Mata or Becky Tokarall except plastic surgery ofPhone: (405) 632-4468 Fax: (405) 632-4317hands/wrists

American Board of Plastic Surgery &Am Bd Plastic Surg of Hand

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 56

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Podiatry Andronica Handie, Podiatry 9709 E 79th Street Foot and Ankle surgery TULSATulsa, OK74133

[email protected]: Traci LawleyPhone: (918) 994-4061 Fax: ( ) -

American Board of PodiatricMedicine

T R

Podiatry Scott Morris, DPM 3001 S Telephone Rd Suite B foot and ankle MooreMoore, OK73160

Contact: MaryPhone: (405) 794-6691 Fax: ( ) -

Certification UnknownT

Podiatry Richard J Traczyk, II, D.P.M. 4205 McAuley Blvd Ste 465 foot, ankle Oklahoma CityOklahoma City, OK73120

[email protected] Excl. Body Parts/Svcs:Contact: Lanae No ankle fusionsPhone: (405) 755-7600 Fax: (405) 755-7680

ABMSPT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 57

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychiatry Siavash Nael, M.D. 4720 S Western Ave Chronic Pain Management, psychiatry Oklahoma CityOklahoma City, OK73109-3834

[email protected] Excl. Body Parts/Svcs:Contact: Susie Jones No longer do inpatient

admissions/treatmentPhone: (405) 634-5529 Fax: (405) 634-1673

American Board of Pyschiatry andNeurology

T R

Psychology - Clinical Faust Bianco, Jr., Ph.D.* 7146 S Braden Ave Ste 500 Rehab Neuropsychology-Brain, TulsaNervous System, all behavioralTulsa, OK74136aspects of physicale psychologicaltraumaContact: Suzan

Phone: (918) 746-0794 Fax: (918) 746-0717Excl. Body Parts/Svcs:Children

Certification UnknownT R MITF

Psychology - Clinical David E. Johnsen, Ph.D. 2601 NW Expway Ste 410 W Neuropsychology, Psychology, Oklahoma CityChronic Pain (head/brain)Oklahoma City, OK73112

[email protected]: Sarah BaskervillePhone: (405) 755-8576 Fax: (405) 755-6026

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 58

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Psychology - Clinical Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082

[email protected]. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021

Certification UnknownT R MITF

Psychology Stephen D. Carella, Ph.D. 3035 NW 63 Ste 103 psychological overlay Oklahoma CityOklahoma City, OK73116

[email protected] Excl. Body Parts/Svcs:Contact: Becky Provide only outpatient evaulations

and treatmentPhone: (405) 840-4212 Fax: (405) 840-4258

Certification UnknownT

Psychology Edgar J. Kranau, Ph.D.* PO Box 14082 psychological overlay, pain TulsamanagementTulsa, OK74159-4082

[email protected]. Body Parts/Svcs:Contact: selfNonePhone: (918) 712-9020 Fax: (918) 712-9021

Certification UnknownT R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 59

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Pulmonary Diseases Dennis M. Parker, M.D. 3366 NW Expressway Ste 660 pulmonary (lungs) Oklahoma CityOklahoma City, OK73112

Excl. Body Parts/Svcs:Contact: Lisa Burgess 405-947-3345 all except respiratory diseasePhone: (405) 947-3345 Fax: (405) 949-0849

American Board of InternalMedicine, Am Bd - Pulmonary Disease

T

Sports Medicine Gary B. Anderson, M.D.* 3301 NW 50 St knees, shoulders, hips, elbows Oklahoma CityOklahoma City, OK73112

[email protected] Excl. Body Parts/Svcs:Contact: Scheduling spine (back, neck), handsPhone: (405) 947-0911 Fax: (405) 947-0775

American Board of OrthopedicSurgery

T

Sports Medicine Clint Justin Basener, D.O.* 6130 E 81ST Street Shoulders, Knees, Hips, Legs, TulsaAnkles, Feet, Elbows, Hands, ArmsTulsa, OK74137

[email protected]: AngiePhone: (918) 583-4400 Fax: (918) 583-7908

Certification UnknownT R

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 60

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Bradford Boone, M.D.* 2408 E 81st Street, Suite 290 knees, shoulders, elbows TulsaTulsa, OK74137

Excl. Body Parts/Svcs:Contact: Sheri McKown spine, hips, feet, ankles, hands &

rate only casesPhone: (918) 494-2665 Fax: (918) 494-9397

American Board of OrthopedicSurgery/Sports Medicine

T R

Sports Medicine James D. Cash, M.D.* 2448 East 81st Street, Suite 1520 knees, shoulders TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Hip, Hand, Elbow, Ankle, Feet,

SpinePhone: (918) 900-2520 Fax: (918) 900-2521

American Board of OrthopedicSurgery

T R

Sports Medicine Jeffrey Cunningham, M.D.* 2408 E 81st Street, Suite 290 Head/Concussion TulsaTulsa, OK74137

Contact: MichellePhone: (918) 855-1255 Fax: ( ) -

American Board Family Medicine /Sports Medicine

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 61

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Jeff A. Fox, M.D.* 2408 E 81st Street, Suite 290 knees, ankles, elbow, shoulders TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Danette head and spinePhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Sports Medicine Bryan Hawkins, M.D.* 2408 E 81st Street, Suite 290 ankles TulsaTulsa, OK74137

[email protected] Excl. Body Parts/Svcs:Contact: Deidre neck, spine, wrists, handsPhone: (918) 855-1255 Fax: (918) 494-9388

American Board of OrthopedicSurgery

T R MITF

Sports Medicine Ronald S. LaButti, D.O.* 2408 E 81st Street, Suite 290 Total Joint Reconstruction, Hip and TulsaKneeTulsa, OK74137

[email protected]. Body Parts/Svcs:Contact: DanetteHead, Shoulder, Ankle, Elbow, Hand,Phone: (918) 855-1255 Fax: (918) 494-9388Spine

American Osteopathic Aacademy ofOrthopedics

T R MITF

* Physician has multiple specialties.

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OKLAHOMA WORKERS' COMPENSATION COMMISSION AND COURT OF EXISTING CLAIMSDate: 03/01/2021 LIST OF QUALIFIED INDEPENDENT MEDICAL EXAMINERS Rpt ID: IMESPTime: 08:15 (Alphabetical by Specialty) Page: 62

As of January 1, 2021

Specialty Physician/Contact Info Mailing Address Body Parts/Type of Services/ City of ExamBoard Certified

Sports Medicine Jason M. Leinen, M.D.* 3110 SW 89th Suite 102 all family & sports medicine, pain Oklahoma Citymanagement (evaluate all bodyOklahoma City, OK73159parts)[email protected]

Contact: SchedulerExcl. Body Parts/Svcs:Phone: (405) 703-3611 Fax: (405) 703-3711none

American Board of Family MedicineT

Sports Medicine Jeffrey R. Morris, D.O.* 6130 E 81st Street shoulder, hand, wrist, hip, knee, Tulsaankles & total joint replacementsTulsa, OK74137Excl. Body Parts/Svcs:Contact: Angie Foyilneck, spinePhone: (918) 583-4400 Fax: (918) 583-7908

American Osteopathic Board ofOrthopedfic Surgery

T R MITF

Sports Medicine Victor R. Palomino, D.O.* 1809 E 13 St Ste 100 Orthopedics; Sports Medicine TulsaTulsa, OK74104

[email protected] Excl. Body Parts/Svcs:Contact: Melissa 918-925-3268 Back, Foot/ankle, handPhone: (918) 582-6800 Fax: ( ) -

American Osteopathic BoardT R

* Physician has multiple specialties.