Aetna "Select Provider" Listing - High-Tech Radiology Charlotte - January, 2013 CATAWBA COUNTY

Transcription

1 Aetna "Select Provider" Listing - High-Tech Radiology NORTH CAROLINA ANSON COUNTY Wadesboro Anson Community Hospital , Morven Road Wadesboro, NC Phone: BURKE COUNTY Morganton Blue Ridge HealthCare Imaging, LLC , South Sterling Street Morganton, NC Phone: Grace Hospital 2201 South Sterling Street Morganton, NC Phone: / Fax: , Valdese Valdese General Hospital 720 Malcolm Blvd. Valdese, NC Phone: , CABARRUS COUNTY Concord Access Medical Imaging, PLLC , Gateway Lane Concord, NC Phone: / Fax: Carolinas Medical Center - North East 920 Church Street North, Suite 255 Phone: , PET , North Carolina Diagnostic Imaging- Cabarrus , Bradley Street Northeast Phone: / Fax: Copperfield Blvd. Phone: , CATAWBA COUNTY Hickory Frye Regional Medical Center , North Center Street Hickory, NC Phone: / Fax: FryeCare 1781 Tate Blvd. Southeast, Suite 101 Hickory, NC Phone: , OMR, CT , CLEVELAND COUNTY Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: Shelby Cleveland Regional Medical Center 201 East Grover Street Phone: , PET , Delta Park Drive Phone: / Fax: , GASTON COUNTY Gastonia Gaston Memorial Hospital , Court Drive Phone: / Fax: , PET Gaston Radiology, PA , Court Drive Phone: / Fax: , Aberdeen Blvd. Phone: / Fax: , Aberdeen Blvd. Phone: / Fax: , Summit Crossing Place, Suite 107 Phone: / Fax: , Summit Crossing Place, Suite 108 Phone: / Fax: , Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: , Cox Road Phone: / Fax: , Cox Road Phone: / Fax: Geodax Imaging, LLC 660 Summit Crossing Place Phone: / Fax: , , Summit Crossing Place Phone: , Cox Road Phone: / Fax: Gastoni 920 Cox Road, Suite 101 Phone: / Fax: , IREDELL COUNTY Mooresville Gaston Radiology, PA , Welton Way Phone: / Fax: Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: / Fax: , Statesville Davis Regional Medical Center 218 Old Mocksville Road Statesville, NC Phone: , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 1 of 3

2 Aetna "Select Provider" Listing - High-Tech Radiology LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: MECKLENBURG COUNTY Charlotte , Blythe Blvd., Suite 602 Phone: , Crescent at Ballantyne John J Delaney Drive, Suite 130 Phone: / Fax: , Cameron Valley Pkwy., Suite 1000-B Phone: / Fax: Carolinas Medical Center 1000 Blythe Blvd., PET , Carolinas Medical Center-Mercy 2001 Vail Avenue Phone: , Carolinas Medical Center-Pineville Phone: , Carolinas Medical Center-University 8800 North Tryon Street , , John J. Delaney Drive, Suite 100 Phone: / Fax: , Randolph Road Phone: , Randolph Road Phone: , East Arrowhead Drive, Suite W3 Charlotte, NC Phone: / Fax: , North Tryon Street, Suite 100 Phone: Presbyterian Breast Center 1718 East 4th Street Phone: Svcs: CT , Presbyterian Hospital 200 Hawthorne Lane Phone: , PET , , Steele Creek-Diagnostic Center Steelcroft Pkwy., Suite 1100 Charlotte, NC Phone: , Ballantyne Corporate Place Phone: , , Diagnostic Center-Museum , , Presbyterian Imaging Ctr-South Park 6324 Fairview Road, Suite 120 A Phone: / Fax: , Fairview Road, Suite 120 A Phone: / Fax: Presbyterian Medical Plaza , , , Suite 200 Phone: Presbyterian Orthopaedic Hospital 1901 Randolph Road Phone: , Randolph Radiology 1918 Randolph Road Phone: Svcs: CT , Huntersville Statesville Road, Suite 110 Phone: / Fax: , Gilead Road, Suite 140 Phone: , Presbyterian Hospital Huntersville Gilead Road Phone: , PET , Matthews Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: / Fax: , Park Center Drive, Suite 200 & 300 Phone: , Presbyterian Hospital-Matthews 1500 Matthews Township Pkwy. Phone: , PET , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 2 of 3

3 Aetna "Select Provider" Listing - High-Tech Radiology ROWAN COUNTY Salisbury Rowan Regional Medical Center , Mocksville Avenue Salisbury, NC Phone: , PET UNION COUNTY Indian Trail Union West MRI Center , West Highway 74, Suite C Indian Trail, NC Phone: , West Hwy. 74, Suite C Indian Trail, NC Phone: Monroe CMC-Union 600 Hospital Drive Phone: , PET , Circle Drive Phone: , Diagnostic Center-Monroe 2000 Wellness Blvd., Suite 1100 Monroe, NC Phone: , Note(s): These procedures may require preauthorization. Aetna's radiology management vendors may have more current information that will replace the information contained within this List. Effective January 1, 2012, Aetna requires all providers administering high-tech radiology services to be accredited by the American College of Radiology and/or the Intersocietal Accreditation Commission. Any provider who performs these services but is not accredited at the time of service may not be eligible for payment. Aetna s radiology management vendors will offer alternative accredited providers in accordance with these standards. MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 3 of 3

4 Aetna "Select Provider" Listing - Low-Tech Radiology NORTH CAROLINA ANSON COUNTY Wadesboro Anson Community Hospital , Morven Road Wadesboro, NC Phone: BURKE COUNTY Morganton Grace Hospital , South Sterling Street Morganton, NC Phone: / Fax: Valdese Valdese General Hospital 720 Malcolm Blvd. Valdese, NC Phone: , CABARRUS COUNTY Concord Carolinas Medical Center - North East , Church Street North, Suite 255 Phone: Copperfield Blvd. Phone: , CATAWBA COUNTY Hickory Frye Regional Medical Center , North Center Street Hickory, NC Phone: / Fax: FryeCare 1781 Tate Blvd. Southeast, Suite 101 Hickory, NC Phone: Svcs: X, US, S, BD, M , CLEVELAND COUNTY Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: Shelby Cleveland Regional Medical Center 201 East Grover Street Phone: , Delta Park Drive Phone: / Fax: , GASTON COUNTY Gastonia Charlotte Radiology Breast Center , South New Hope Road, Suite 4 Phone: / Fax: Gaston Memorial Hospital 2525 Court Drive Phone: / Fax: , Gaston Radiology, PA , Court Drive Phone: / Fax: , Aberdeen Blvd. Phone: / Fax: , Aberdeen Blvd. Phone: / Fax: , Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: , Summit Crossing Place, Suite 107 Phone: / Fax: , Summit Crossing Place, Suite 108 Phone: / Fax: , Cox Road Phone: / Fax: , Cox Road Phone: / Fax: Insight Imaging, LLC 2555 Court Drive, Suite 45 Phone: Svcs: US , , Summit Crossing Place Phone: , Cox Road Phone: / Fax: Gastoni 920 Cox Road, Suite 101 Phone: / Fax: , IREDELL COUNTY Mooresville Gaston Radiology, PA , Welton Way Phone: / Fax: Lake Norman Regional Medical Center 171 Fairview Road Phone: , Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: / Fax: , Statesville Davis Regional Medical Center 218 Old Mocksville Road Statesville, NC Phone: , Iredell Memorial Hospital 557 Brookdale Drive Statesville, NC Phone: , LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 1 of 3

5 Aetna "Select Provider" Listing - Low-Tech Radiology MECKLENBURG COUNTY Charlotte , Blythe Blvd., Suite 602 Phone: , Crescent at Ballantyne John J Delaney Drive, Suite 130 Phone: / Fax: , Cameron Valley Pkwy., Suite 1000-B Phone: / Fax: Carolinas Medical Center 1000 Blythe Blvd , Carolinas Medical Center-Mercy 2001 Vail Avenue Phone: , Carolinas Medical Center-Pineville Phone: , Carolinas Medical Center-University 8800 North Tryon Street , Charlotte Radiology Breast Center Park Road, Suite 208 Phone: / Fax: Svcs: US, M , Charlotte Radiology Carolinas Medical Center - Pineville , Phone: / Fax: Charlotte Radiology Mobile Breast Center , Morehead Medical Drive, Suite 150 Phone: / Fax: Insight Imaging, LLC 1901 Roxborough Road, Suite 200 Phone: / Fax: Svcs: US , , John J. Delaney Drive, Suite 100 Phone: / Fax: , Randolph Road Phone: , Randolph Road Phone: , East Arrowhead Drive, Suite W3 Charlotte, NC Phone: / Fax: , North Tryon Street, Suite 100 Phone: Presbyterian Breast Center , Ballantyne Corporate Place Phone: , East 4th Street Phone: , , Presbyterian Hospital 200 Hawthorne Lane Phone: , , Steele Creek-Diagnostic Center Steelcroft Pkwy., Suite 1100 Charlotte, NC Phone: , Ballantyne Corporate Place Phone: , Diagnostic Center-Museum , , , Presbyterian Imaging Ctr-South Park 6324 Fairview Road, Suite 120 A Phone: / Fax: , Fairview Road, Suite 120 A Phone: / Fax: Presbyterian Medical Plaza , , , Suite 200 Phone: Randolph Radiology 1918 Randolph Road Phone: , Huntersville Statesville Road, Suite 110 Phone: / Fax: , Gilead Road, Suite 140 Phone: , Presbyterian Breast Screening at Huntersville , Gilead Road Drive, Suite 310 Phone: , Northcross Drive Phone: X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 2 of 3

6 Aetna "Select Provider" Listing - Low-Tech Radiology Matthews Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: / Fax: , Charlotte Radiology Breast Center AdBel Medical Plaza , Matthews-Township Pkwy., Suite 310 Phone: / Fax: Park Center Drive, Suite 200 & 300 Phone: , Presbyterian Hospital-Matthews 1500 Matthews Township Pkwy. Phone: , ROWAN COUNTY Salisbury Rowan Regional Medical Center , Mocksville Avenue Salisbury, NC Phone: UNION COUNTY Monroe Charlotte Radiology Breast Center , East Franklin Street, Suite 1 Phone: / Fax: Svcs: US, M CMC-Union 600 Hospital Drive Phone: , Circle Drive Phone: , Diagnostic Center-Monroe 2000 Wellness Blvd., Suite 1100 Monroe, NC Phone: , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 3 of 3

7 Aetna "Select Provider" Listing - Ambulatory Surgery NORTH CAROLINA CABARRUS COUNTY Concord Eye Surgery and Laser Clinic, P.A , Lake Concord Road Northeast Phone: Gateway Ambulatory Surgery Center, LLC , Northeast Gateway Court Phone: North Church Street , CATAWBA COUNTY Hickory Frye Surgery Center , th Street Circle Southeast Hickory, NC Phone: Svcs: GEN, OPT, ORP, UR Gastroenterology Associates, P.A. - Endoscopy Unit , North Center Street, Suite 300 Hickory, NC Phone: / Fax: CLEVELAND COUNTY Shelby Cleveland Ambulatory Service , North Lafayette Street Phone: GASTON COUNTY Gastonia CaroMont Specialty Surgery , Court Drive Phone: / Fax: , Court Drive , Court Street / Fax: IREDELL COUNTY Mooresville Surgical Center at Lake Norman , Medical Park Road, Suite 100 Phone: , North Main Street Mooresville, NC Phone: Fairview Road , Statesville Iredell Surgical Center 1720 Davie Avenue Statesville, NC Phone: , PHC Endoscopy 208 Old Mocksville Road Statesville, NC Phone: / Fax: , LINCOLN COUNTY Lincolnton , Gamble Drive Lincolnton, NC MECKLENBURG COUNTY Charlotte Carolina Center for Specialty Surgery , Brunswick Avenue Phone: / Fax: Carolina Endoscopy Center-Pineville Park Road Phone: / Fax: , Carolina Endoscopy Center-University 101 W.T. Harris Blvd., Suite 3215 Phone: / Fax: , Carolinas Gastroenterology Center- Ballantyne , John J. Delaney Drive, Suite 120 Phone: / Fax: Carolinas Gastroenterology Center- Medical Center Plaza , Blythe Blvd., Suite 400 Phone: Carolinas Surgery Center - Wendover 449 North Wendover Road Phone: / Fax: , Charlotte Plastic Surgery Center, PA 2215 Randolph Road Phone: / Fax: , Endoscopy Services Centers Charlotte/Billingsley , Billingsley Road, Suite 200 Phone: / Fax: Healthsouth Surgery Center of Charlotte , Randolph Road Phone: / Fax: , Randolph Road, 2nd Floor Phone: / Fax: Midtown Surgical Center 1918 Randolph Road, Suite 740 Phone: , Presbyterian Same Day Surgery Center 1800 East 4th Street Phone: , Presbyterian Sameday Surgery Center at Ballantyne , Ballantyne Corporate Place Phone: Southpark Surgical Center, LLC 6035 Fairview Road, Suite 300 Phone: , , Blythe Blvd., Suite 200 / Fax: , , Steele Croft Parkway Charlotte, NC , Randolph Road , Vail Avenue GEN - General Surgery EN - Endoscopy INF - Infertility LT - Lithotripsy OPT - Opthalmology ORP - Orthopedics BA - Bariatric UR - Urology 1 of 2

8 Aetna "Select Provider" Listing - Ambulatory Surgery , North Tryon Street Davidson 705 Griffith Street, Suite 205 Davidson, NC / Fax: , Huntersville Presbyterian Endoscopy Center at Huntersville, LLC , Holly Crest Lane Phone: Presbyterian Same Day Surgery Center Gilead Road, Suite 240 Phone: , Matthews 1500 Matthews Township Pkwy. Phone: , ROWAN COUNTY Salisbury Salisbury VAMC , Brenner Avenue Salisbury, NC Phone: STANLY COUNTY Albemarle , Yadkin Street Albemarle, NC UNION COUNTY Monroe Carolina Endoscopy Center- Monroe , East Sunset Road Phone: / Fax: Carolina Endoscopy Center-University 1321 East Sunset Drive Phone: / Fax: , Presbyterian Same Day Surgery Center Monroe, LLC , Wellness Blvd., Suite 2100 Monroe, NC Phone: Hospital Drive , Note(s): Some ambulatory procedures require the physician to notify Aetna prior to performing services (e.g., colonoscopy and other scope procedures). These procedures were not used to determine this listing. GEN - General Surgery EN - Endoscopy INF - Infertility LT - Lithotripsy OPT - Opthalmology ORP - Orthopedics BA - Bariatric UR - Urology 2 of 2

9 Aetna "Select Provider" Listing - Sleep Studies NORTH CAROLINA CABARRUS COUNTY Concord Carolinas Medical Center - North East , Church Street North, Suite 255 Phone: CATAWBA COUNTY Hickory Frye Regional Medical Center , North Center Street Hickory, NC Phone: / Fax: CLEVELAND COUNTY Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: GASTON COUNTY Gastonia Gaston Memorial Hospital , Court Drive Phone: / Fax: LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: MECKLENBURG COUNTY Charlotte Carolinas Medical Center , Blythe Blvd. Carolinas Medical Center-Mercy 2001 Vail Avenue Phone: , Carolinas Medical Center-Pineville Phone: , Carolinas Medical Center-University 8800 North Tryon Street , Sleepwell, Inc Carmel Commons Blvd., Suite 120 Charlotte, NC Phone: / Fax: , Matthews Sleep Success Technology, Inc 3041 Senna Drive, Suite B Phone: , UNION COUNTY Monroe CMC-Union , Hospital Drive Phone: of 1