CARDIN HEALTHCARE, A MEDICAL GROUP, INC.

Contractor

Code: 171W00000X

Family Medicine

Code: 207Q00000X

Pediatrics

Code: 208000000X

Clinic/Center — Adult Mental Health

Code: 261QM0850X

Clinic/Center — Adolescent and Children Mental Health

Code: 261QM0855X

Case Manager/Care Coordinator

Code: 171M00000X