PHYSICIAN OWNERSHIP DISCLOSURE FORM NOTICE TO PATIENTS
In accordance with Federal ASC Regulations 42 C.F.R. § 416.50(b), the following ownership disclosure is made in advance of the procedure.
We would like to advise you that the following physicians are owners and have financial interest in the Bergan Mercy Surgery Center.
|Nagi Ayoub, M.D.||Foot & Ankle Center of Nebraska|
|Bradley Copple, D.P.M.||Robert Greenhagen, D.P.M|
|Griffith Evans, M.D.||Patrick Nelson, D.P.M|
|Glenn Gardner, M.D.||Jordan Sikes, D.P.M|
|Michael McNamara, M.D.||Jonathan Rouse, D.P.M|
|Susanne Sasse, M.D.||Collin Pehde, D.P.M|
|Tyrus Soares, M.D.|
|Joseph Wolpert, M.D.|
This information is being provided to help you make an informed decision regarding your plan of care. You have the right to choose your healthcare provider and are not required to use the Bergan Mercy Surgery Center. We will help you in identifying an alternative health care facility if you so choose.