ACO Name and Location

 

California Clinical Partners Accountable Care Organization, LLC

2112 South Congress Avenue, Suite 202
Palm Springs, FL 33406

ACO Primary Contact

Contact Name:
Karla Cruz, MHSA. Project Manager
Primary Contact Phone Number:
(787) 342-1454
Primary Contact Email Address:

Kcruz@advancedaco.com

ACO Participants (PDF)

ACO Participants in joint ventures between ACO professionals and hospitals

ACO participants are not in joint ventures with other ACO professionals and/or hospitals.
Medicare Shared Savings Program
2018 Governing Body Template

ACO ID: A4709
ACO Legal Business Name: California Clinical Partners Accountable Care Organization, LLC

Member Last Name
Member First Name
Member Title/Position
Member Voting Power
Membership Type
ACO Participant TIN Legal Business Name
1
Bansal
Radhey
Voting Member*
6.66%
ACO Participant Representative
Radhey S. Bansal, MD. INC
2
Berry
Ravi
Voting Member*
6.66%
ACO Participant Representative
Riverside Medical Clinic INC
3
Castillo
Ruben
Voting Member*
6.66%
Medicare Beneficiary Representative
N/A
4
Gisi
Sylvia
Voting Member*
6.66%
ACO Participant Representative
Silvia A. Gisi, M.D. INC
5
Hizon
Jerry
Voting Member*
6.66%
ACO Participant Representative
Hizon Medical Corporation
6
Jemmoua
Karmal
Voting Member*
6.66%
Stake Holder
N/A
7
Kwon
Tony
Voting Member*
6.66%
ACO Participant Representative
Riverside Medical Clinic
8
Lori
Lane
Voting Member*
6.66%
Stake Holder
N/A
9
Odubela
Abayomi
Voting Member*
6.66%
ACO Participant Representative
Abayomi Odubela, M.D. A Professional Corporation
10
Phillips
Lily
Voting Member*
6.66%
ACO Participant Representative
Grace Family Medical Group
11
Prabaker
Venu
Voting Member*
6.66%
ACO Participant Representative
Venu Prabaker MD INC
12
Rodriguez
George
Voting Member*
6.66%
ACO Participant Representative
Graybill Medical Group INC.
13
Sivalingam
Kanagaratnam
Voting Member*
6.66%
ACO Participant Representative
Sivalingam Medical Group INC.
14
Tiangco
Irineo
Voting Member*
6.66%
ACO Participant Representative
Galleria Medical
15
Yun
Jonathan
Voting Member*
6.66%
ACO Participant Representative
Livingswater’s Medical Clinic

Key ACO clinical and administrative leadership

Position
Name
ACO Executive
David Klebonis
Medical Director
Jonathan Yun
Compliance Officer
David Klebonis
Quality Assurance/Improvement Officer
Thomas J. Leach

Types of ACO Participants, or combinations of participants, that formed the ACO

A network of individual practices of ACO professionals.

Shared Savings and Losses

Amount of Shared Savings/Losses

— N/A

How Shared Savings Are Distributed

— N/A

Quality Performance Results

Our ACO did not participate in the Shared Savings Program in the 2018 performance year, therefore this
section is not applicable at this time.

Payment Rule Waivers

  • • Skilled Nursing Facility (SNF) 3-day Rule Waiver:
    •  Yes, our ACO does use the SNF 3-Day Rule Waiver, pursuant to 42 CFR 425.612.
  • Waiver for Payment for Telehealth Services:
    • No, our ACO clinicians do not provide telehealth services using the flexibilities under 42
      CFR 425.612(f) and 42 CFR 425.613.