MSSP Required Public SACN Reporting Page

Organizational Information

ACO Participants:

Participant Legal Business Name	ACO Participant in Joint Venture (Y or N)
ACCESS ENDOCRINOLOGY LLC	N
ADVANCED SURGICAL & WEIGHT LOSS INSTITUTE LLC	N
ANAND BALASUBRAMANIAN, M.D., P.A.	N
ASIAN AMERICAN HEALTH COALITION OF THE GREATER HOUSTON AREA	N
BRIAN J.DEONARINE, MD PA	N
CHAVEZ JO INTERNAL MEDICINE P.A.	N
CHINYERE N. AWA, MD, PA	N
DAVID L. BARNES, MD, APMC	N
DEREK PAUL	N
DIAGNOSTIC AFFILIATES OF NORTHEAST HOUSTON, PLLC	N
DR KAUSHAL K GUPTA MD PA	N
DR. JENNIFER JOHNSON-CALDWELL, M.D.,P.A.	N
ESTEBAN N. BERBERIAN, MD, P.A.	N
FAMILY HEALTH CENTER AT PORT ST JOHN LLC	N
FLORIDA EYE INSTITUTE PA	N
HOSPITALIST SERVICES PLLC	N
INDIAN RIVER PRIMARY CARE	N
ISLAND FAMILY HEALTH LLC	N
KALPANA GORTHI MD PLLC	N
KNIGHT NEUROLOGY LLC	N
LAWRENCE G ROBINSON MD PA	N
MANSOORA A. SHEIKH MD, P.A.	N
MICHAEL V SHELTON MD PA	N
MICHAEL VENAZIO	N
NITIN MAHAJAN MD PA CORP	N
ONE SOURCE MEDICAL MANAGEMENT INC.	N
OZ HEALTHCARE PLLC	N
PEDRO ESPAT	N
PHYSICIAN GROUP OF ARKANSAS, INC.	N
PRESTIGE CARDIOLOGY CONSULTANTS LLC	N
QUALITY HEALTH CARE INC OF FLORIDA	N
RAYMOND DUONG MD PA	N
ROBERTA ROSE	N
SAATIAH JAFFRY MD LLC	N
SAMER N ROY, MD LLC	N
SANSONS FAMILY MEDICINE INC	N
SEBASTIAN ID CARE LLC	N
SPACE COAST CARDIOLOGY CONSULTANTS	N
STACEY JONES	N
STAR INTERNAL MEDICINE AND ASSOCIATES INC	N
TALBERT GENERAL SURGERY LLC	N
TUDOR M SCRIDON MD PL	N
UNITY FAMILY CLINIC PA	N

ACO Governing Body:

Board Member	Member's Voting Power	Membership Type	ACO Participant Legal Business Name/DBA, if Applicable
Joseph Weinstein, MD (Chair)	14%	ACO Participant Representative	Dr. Harish Sadhwani, Quality Health Care, Inc. of Florida
Sanjay Shetty, MD	14%	ACO Participant Representative	Dr. Edgard Chavez, Chavez JO Internal Medicine
Michael Callum, MD	14%	ACO Participant Representative	Dr. Tudor M. Scridon MD, PL
Brian Dunn	14%	ACO Participant Representative	Physician Group of Arkansas
Daniel Knell	14%	ACO Participant Representative	Physician Group of Arkansas
Andrew Herman	14%	ACO Participant Representative	Marshall S Sanson, MD
Phillip Smith III (Beneficiary)	14%	Medicare Beneficiary Representative

Key ACO clinical and administrative leadership:

Leadership Member	Role
Joseph Weinstein, MD	Chief Physician Executive Officer, Clinical Lead
John Donlan	President
Andrew Herman	Chief Financial Officer, Financial Lead
Matthew Pezzulich	Vice President, Compliance and Privacy Officer/ Steward Integrated Care Network (SICN)
Michael Jarjour	Vice President, Technology, HIT Lead
Michael Lenahen	Vice President, Care Coordination
Bianca Belcher	Vice President, Clinical Operations, Quality of Care Lead
Jason Worthen	Vice President, Medicare ACO

Associated Committees and Committee Leadership:

Committee Name	Committee Leader Name and Position
SACN Compliance Committee	Dr. Joseph Weinstein, Committee Chair, Chief Physician Executive Officer

PY2022 Amount of Shared Savings/Losses: TBD

PY2022 Shared Savings Distribution: TBD

PY2022 Quality Performance Results: TBD

Payment Rule Waivers

• Skilled Nursing Facility (SNF) 3-day Rule Waiver:
  • Yes, our ACO uses the SNF 3-Day Rule Waiver, pursuant to 42 CFR §425.612.