2025 HEDIS EVENT REQUEST
Provider Name
*
Practice Name
*
NPI #
Address
*
Territory
*
Point of Contact
*
Phone Number
*
E-mail
*
Does your office have space for the team to set up a resource table and also a private area to complete screenings?
Yes
No
Does your office have in house lab services or lab drawing capabilities?
Yes
No
Does your parking lot have a least 8 parking spaces with a 14ft height clearance?
YES
NO
Who is your Provider Performance Representative?
Eric Gant
Carla Santos
Carlos Rodriguez
Shelia Miller-Larry
Juan Perozo
Cinnamon Radke
HEDIS Event
Select a date and start time.
*
Less than 2 weeks
Location
*
Health Plans Accepted At Your Office
All Health Plans
Wellpoint
Wellpoint Medicaid
Aetna
Cigna
SCAN
Other
Who is your PR Rep?
SW/West-Britni Davis bdavis@integranethealth.com 832-320-3993
North/NE/NW- Patricia Hernandez phernandez@integranethealth.com 832-320-3992
Central-Eric Gant egant@integranethealth.com 832-320-3976
South/SE/East- Monique Tillis mtillis@integranethealth.com 832-320-3967
DFW-North-Jack Russell jrussell@integranethealth.com 972-764-0971
SA- Jack Russell jrussell@integranethealth.com 972-764-0971
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