IM Program List Help

Looking for advice on IM program list and signals. MD applicant from a low-to-mid-tier school in the Midwest. I am in an accelerated 3 year program. I am looking to go to a program that would allow me to have choices for fellowship. I am especially interested in rheumatology. I am a non-traditional student who worked in the arts and owned my own business for 11 years prior to medical school.

Step: P/258

Clerkships: All honors on rotations so far. Medicine sub-I next month due to 3-year program time crunch. Letters from program director of small Midwest IM program, and two hospitalists.

Research: One peer-reviewed publication as first author. Three poster presentations as first author. Two poster presentations as non-first author. One oral presentation.

Extracurriculars: Significant volunteerism especially before medical school. Significant leadership experiences.

Honors: Selected for AOA but not for GHHS

Geo Prefs: West North Central, South Atlantic, Mountain

I'm overwhelmed by the fact that it seems unlikely to get interviews at programs you don't signal. Are there any programs I am missing that I should add? Is this too high-reaching of a list? Do I need more community programs? Any suggestions on signaling?

I should mention I moved the programs around from what Admit.org suggested because it seems like they had programs in too low of categories. For example University of Wisconsin were put at the baseline level and I moved up to target.