Aetna "Select Provider" Listing - High-Tech Radiology Charlotte - January, 2012

Transcription

1 Aetna "Select Provider" Listing - High-Tech Radiology 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 , South Sterling Street Morganton, NC Phone: / Fax: Valdese Valdese General Hospital , Malcolm Blvd. Valdese, NC Phone: Access Medical Imaging, PLLC , Gateway Lane, NC Phone: / Fax: Carolinas Medical Center - North East , Church Street North, Suite 255 Phone: , PET North Carolina Diagnostic Imaging- Cabarrus , Bradley Street Northeast Phone: / Fax: CATAWBA COUNTY Frye Regional Medical Center , North Center Street Phone: / Fax: FryeCare , Tate Boulevard SE, Suite 101, NC Phone: , OMR, CT, EN Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: Shelby Cleveland Regional Medical Center , East Grover Street Phone: , PET , Delta Park Drive Phone: / Fax: GASTON COUNTY Gastonia G Gaston Memorial Hospital 2525 Court Drive Phone: / Fax: , CNM, PET , Court Drive Phone: / Fax: , Aberdeen Blvd , Gaston Hematology & Oncology 610 Aberdeen Blvd , Summit Crossing Place, Suite 108 Phone: / Fax: , Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: , Summit Crossing Place, Suite 107 Phone: / Fax: , Cox Road Phone: / Fax: , The Diagnostic Center 655 Cox Road Phone: / Fax: Geodax Imaging, LLC , Summit Crossing Place Phone: / Fax: , Cox Road Phone: / Fax: , Gastoni 920 Cox Road, Suite 101 Phone: / Fax: IREDELL COUNTY Mooresville , Welton Way Phone: / Fax: , Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: / Fax: Statesville Davis Regional Medical Center , Old Mocksville Road Statesville, NC Phone: LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography

2 Aetna "Select Provider" Listing - High-Tech Radiology , Crescent at Ballantyne John J Delaney Drive, Suite 130 Phone: / Fax: , Cameron Valley Pkwy., Suite 1000-B Phone: / Fax: Carolinas Medical Center , Blythe Blvd., NC 28203, PET Carolinas Medical Center-Mercy , Vail Avenue Phone: Carolinas Medical Center-Pineville , Park Road Phone: Carolinas Medical Center-University , North Tryon Street Radiology Diagnostic Imaging Center , East 7th Street , John J. Delaney Drive, Suite 100 Phone: / Fax: , Randolph Road Phone: , East Arrowhead Drive, Suite W3, NC Phone: / Fax: Presbyterian Hospital , Hawthorne Lane Phone: , PET , Steele Creek-Diagnostic Center Steelcroft Pkwy., Suite 1100, NC Phone: , Phone: , Randolph Road Phone: , Medical Plaza Drive Phone: , Mecklen 6324 Fairview Road, Suite 120 A Phone: / Fax: Presbyterian Medical Plaza , Medical Plaza Drive, Suite 200 Phone: Presbyterian Orthopaedic Hospital , Randolph Road Phone: Svcs: CT Randolph Radiology , Randolph Road Phone: Svcs: CT , Statesville Road, Suite 110 Phone: / Fax: Presbyterian Hospital , Gilead Road Phone: , PET Matthews , Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: / Fax: Presbyterian Hospital-Matthews , Matthews Township Pkwy. Phone: , PET ROWAN COUNTY Salisbury Rowan Regional Medical Center , Mocksville Avenue Salisbury, NC Phone: , PET Indian Trail Union West MRI Center , West Highway 74, Suite C Indian Trail, NC Phone: CMC-Union , Hospital Drive Phone: , PET , Diagnostic Center Wellness Blvd., Suite 1100, NC Phone: Note(s): These procedures may require pre-authorization. Aetna's radiology management vendors may have more current information that will supersede the information contained within this List. MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 2 of 2

3 Aetna "Select Provider" Listing - High-Tech Radiology 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 performing these services who has not been accredited at the time of service will not be eligible for payment. Therefore, Aetna s radiology management vendors will offer alternative providers who have been determined to be accredited 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 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 , Malcolm Blvd. Valdese, NC Phone: Carolinas Medical Center - North East , Church Street North, Suite 255 Phone: CATAWBA COUNTY Frye Regional Medical Center , North Center Street Phone: / Fax: FryeCare , Tate Boulevard SE, Suite 101, NC Phone: Svcs: X, US, S, BD, M Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: Shelby Cleveland Regional Medical Center , East Grover Street Phone: , Delta Park Drive Phone: / Fax: GASTON COUNTY Gastonia Gaston Memorial Hospital 2525 Court Drive Phone: / Fax: Radiology Breast Center , South New Hope Road, Suite , Court Drive Phone: / Fax: , Aberdeen Blvd , Gaston Hematology & Oncology 610 Aberdeen Blvd , Summit Crossing Place, Suite 108 Phone: / Fax: , Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: , Summit Crossing Place, Suite 107 Phone: / Fax: , Cox Road Phone: / Fax: , The Diagnostic Center 655 Cox Road Phone: / Fax: Insight Imaging, LLC , Court Drive, Suite 45 Phone: Svcs: US X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography , Cox Road Phone: / Fax: , Gastoni 920 Cox Road, Suite 101 Phone: / Fax: Svcs: X, US IREDELL COUNTY Mooresville , Welton Way Phone: / Fax: Lake Norman Regional Medical Center , Fairview Road Phone: , Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: / Fax: Svcs: X, US Statesville Davis Regional Medical Center , Old Mocksville Road Statesville, NC Phone: Iredell Memorial Hospital , Brookdale Drive Statesville, NC Phone: LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: , Crescent at Ballantyne John J Delaney Drive, Suite 130 Phone: / Fax:

5 Aetna "Select Provider" Listing - Low-Tech Radiology , Cameron Valley Pkwy., Suite 1000-B Phone: / Fax: Carolinas Medical Center , Blythe Blvd., NC Carolinas Medical Center-Mercy , Vail Avenue Phone: Carolinas Medical Center-Pineville , Park Road Phone: Carolinas Medical Center-University , North Tryon Street Radiology Diagnostic Imaging Center , East 7th Street Insight Imaging, LLC 1901 Roxborough Road, Suite 200 Phone: / Fax: Svcs: US , , John J. Delaney Drive, Suite 100 Phone: / Fax: , Randolph Road Phone: , East Arrowhead Drive, Suite W3, NC Phone: / Fax: Presbyterian Breast Center , Phone: , East 4th Street Phone: , Randolph Road Phone: , Medical Plaza Drive Phone: Presbyterian Hospital , Hawthorne Lane Phone: , Steele Creek-Diagnostic Center Steelcroft Pkwy., Suite 1100, NC Phone: , Phone: , Randolph Road Phone: , Medical Plaza Drive Phone: , Mecklen 6324 Fairview Road, Suite 120 A Phone: / Fax: Svcs: X, US Presbyterian Medical Plaza , Medical Plaza Drive, Suite 200 Phone: Randolph Radiology , Randolph Road Phone: , Statesville Road, Suite 110 Phone: / Fax: Presbyterian Breast Screening at , Gilead Road Drive, Suite 310 Phone: Svcs: M , Northcross Drive Phone: Svcs: M Matthews , Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: / Fax: Radiology Breast Center AdBel Medical Plaza , Matthews-Township Pkwy., Suite 310 Svcs: M Presbyterian Hospital-Matthews , Matthews Township Pkwy. Phone: ROWAN COUNTY Salisbury Rowan Regional Medical Center , Mocksville Avenue Salisbury, NC Phone: CMC-Union , Hospital Drive Phone: , Diagnostic Center Wellness Blvd., Suite 1100, NC Phone: X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 2 of 2

6 Aetna "Select Provider" Listing - Ambulatory Surgery Eye Surgery and Laser Clinic, P.A , Lake Road Northeast Phone: Gateway Ambulatory Surgery Center, LLC , Northeast Gateway Court Phone: Catawba COUNTY Frye Surgery Center , th Street Circle, SE, NC Phone: Svcs: GEN, OPT, ORP, UR Gastroenterology Associates, P.A. - Endoscopy Unit , North Center Street, Suite 300 Phone: / Fax: Shelby Cleveland Ambulatory Service , North Lafayette Street Phone: IREDELL COUNTY Mooresville Surgical Center at Lake Norman , Medical Park Road, Suite 100 Phone: Statesville Iredell Surgical Center , Davie Avenue Statesville, NC Phone: PHC Endoscopy , Old Mocksville Road Statesville, NC Phone: / Fax: Carolina Center for Specialty Surgery , Brunswick Avenue Phone: / Fax: Carolina Endoscopy Center-Pineville , Park Road Phone: / Fax: Carolina Endoscopy Center-University , 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, NC Phone: Carolinas Surgery Center - Randolph , Randolph Road, Suite 200 Phone: / Fax: Carolinas Surgery Center - Wendover , North Wendover Road Phone: / Fax: Plastic Surgery Center, PA , Randolph Road Phone: / Fax: Endoscopy Services Centers /Billingsley , Billingsley Road, Suite 200 Phone: / Fax: Midtown Surgical Center , Randolph Road, Suite 740 Phone: Presbyterian Same Day Surgery Center , East 4th Street Phone: Presbyterian Sameday Surgery Center at Ballantyne , Phone: Southpark Surgical Center, LLC , Fairview Road, Suite 300 Phone: Carolina Endoscopy Center , Statesville Road, Suite 114 Phone: / Fax: Presbyterian Endoscopy Center at, LLC , Holly Crest Lane Phone: Presbyterian Same Day Surgery Center , Gilead Road, Suite 240 Phone: ROWAN COUNTY Salisbury Salisbury VAMC , Brenner Avenue Salisbury, NC Phone: Carolina Endoscopy Center , East Sunset Road Phone: / Fax: Healthsouth Surgery Center of Carolina Endoscopy Center-University , , Randolph Road, 2nd Floor 1321 East Sunset Drive Phone: / Fax: Phone: / Fax: 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

7 Aetna "Select Provider" Listing - Sleep Studies Carolinas Medical Center - North East , Church Street North, Suite 255 Phone: Carolinas Sleep Specialist , Penny Lane Phone: / Fax: , Lee Ann Drive Phone: / Fax: CATAWBA COUNTY Frye Regional Medical Center , North Center Street Phone: / Fax: Kings Mountain Kings Mountain Hospital , West King Street Kings Mountain, NC Phone: / Fax: LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln , McAlister Road Lincolnton, NC Phone: Carolinas Medical Center , Blythe Blvd., NC Carolinas Medical Center-Mercy , Vail Avenue Phone: Carolinas Medical Center-Pineville , Park Road Phone: Carolinas Medical Center-University , North Tryon Street Carolinas Sleep Specialist , Abbey Place, NC Phone: / Fax: , Bannington Road, Suite A, NC Phone: / Fax: SleepMed, Inc. dba Digitrace Care Services , Center Drive, Suite 240, NC Phone: Sleepwell, Inc , Carmel Commons Blvd., Suite 120, NC Phone: / Fax: Advanced Respiratory and Sleep Medicine, PLLC , Birkdale Commons Pkwy., Suite 210 Phone: / Fax: Matthews Novant Sleep Services , Matthews Township Pkwy. Phone: Sleep Success Technology, Inc , Senna Drive, Suite B Phone: CMC-Union , Hospital Drive Phone: