2024 HEDIS EVENT REQUEST
Provider Name
*
Practice Name
*
NPI #
Address
*
Territory
*
Point of Contact
*
Phone Number
*
E-mail
*
Does your office have extra space for IntegraNet to have an information table, private office or area to conduct pre and post appointment discussions?
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 14ft height clearance?
YES
NO
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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