Aetna "Select Provider" Listing - High-Tech Radiology ANSON COUNTY Wadesboro Anson Community Hospital 6380845, 158093 500 Morven Road Wadesboro, NC 28170 Phone: 704-694-5131 BURKE COUNTY Morganton Blue Ridge HealthCare Imaging, LLC 7493369, 158015 2201 South Sterling Street Morganton, NC 28655 Phone: 828-580-6721 Grace Hospital 6380595, 158015 2201 South Sterling Street Morganton, NC 28655 Phone: 828-580-5000 / Fax: 828-580-5039 Valdese Valdese General Hospital 4310462, 193511 720 Malcolm Blvd. Valdese, NC 28690 Phone: 828-874-2251 Access Medical Imaging, PLLC 7853923, 3242867 7756 Gateway Lane, NC 28027 Phone: 704-979-1264 / Fax: 704-979-1265 Carolinas Medical Center - North East 6380270, 1732761 920 Church Street North, Suite 255 Phone: 704-783-3000, PET North Carolina Diagnostic Imaging- Cabarrus 7290206, 3201769 925 Bradley Street Northeast Phone: 704-262-9885 / Fax: 704-262-9886 CATAWBA COUNTY Frye Regional Medical Center 6380470, 157974 420 North Center Street Phone: 828-315-5000 / Fax: 828-315-3901 FryeCare 9659795, 1000000293 1781 Tate Boulevard SE, Suite 101, NC 28602 Phone: 828-315-7030, OMR, CT, EN Kings Mountain Kings Mountain Hospital 6380505, 157986 706 West King Street Kings Mountain, NC 28086 Phone: 704-739-3601 / Fax: 704-739-0800 Shelby Cleveland Regional Medical Center 6380765, 2701320 201 East Grover Street Phone: 704-487-3000, PET 7508657, 9012016 101 Delta Park Drive Phone: 704-484-8007 / Fax: 704-484-0606 GASTON COUNTY Gastonia G Gaston Memorial Hospital 2525 Court Drive Phone: 704-834-2000 / Fax: 704-834-2500, CNM, PET 7544922, 2210703 2555 Court Drive Phone: 704-864-5550 / Fax: 704-864-7445 7544922, 4341077 2610 Aberdeen Blvd. 7544922, 3973255 Gaston Hematology & Oncology 610 Aberdeen Blvd. 7544922, 4481051 620 Summit Crossing Place, Suite 108 Phone: 704-865-0077 / Fax: 704-867-6401 7544922, 8072989 Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: 704-671-7730 7544922, 7493016 620 Summit Crossing Place, Suite 107 Phone: 704-671-7776 / Fax: 704-671-7721 7544922, 377135 631 Cox Road Phone: 704-864-7764 / Fax: 704-867-7894 7544922, 1862975 The Diagnostic Center 655 Cox Road Phone: 704-834-2050 / Fax: 704-834-2053 Geodax Imaging, LLC 5822620, 6451018 660 Summit Crossing Place Phone: 704-867-0735 / Fax: 704-853-1289 7508657, 245968 900 Cox Road Phone: 704-830-1047 / Fax: 704-830-1047 7456027, 7603714 -Gastoni 920 Cox Road, Suite 101 Phone: 704-862-7188 / Fax: 704-862-7197 IREDELL COUNTY Mooresville 7544922, 9702768 124 Welton Way Phone: 704-658-1050 / Fax: 704-658-1056 7456027, 3423838 -Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: 704-662-8580 / Fax: 704-662-8846 Statesville Davis Regional Medical Center 6380800, 850640 218 Old Mocksville Road Statesville, NC 28625 Phone: 704-873-0281 LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln 6380550, 9833897 433 McAlister Road Lincolnton, NC 28092 Phone: 980-212-2000 MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography
Aetna "Select Provider" Listing - High-Tech Radiology 7324542, 1402709 Crescent at Ballantyne 15110 John J Delaney Drive, Suite 130 Phone: 704-697-5000 / Fax: 704-697-5001 7324542, 3343411 4525 Cameron Valley Pkwy., Suite 1000-B Phone: 704-362-7076 / Fax: 704-362-7081 Carolinas Medical Center 6380225, 157900 1000 Blythe Blvd., NC 28203, PET Carolinas Medical Center-Mercy 6380230, 157901 2001 Vail Avenue Phone: 704-379-5000 Carolinas Medical Center-Pineville 6381715, 158123 10628 Park Road Phone: 704-543-2025 Carolinas Medical Center-University 6380250, 2710269 8800 North Tryon Street Radiology Diagnostic Imaging Center 4438437, 363683 2614 East 7th Street 7508657, 2932170 15825 John J. Delaney Drive, Suite 100 Phone: 704-341-5264 / Fax: 704-543-8402 7508657, 552328 1915 Randolph Road Phone: 704-339-1000 7508657, 4732580 210 East Arrowhead Drive, Suite W3, NC 28213 Phone: 704-599-2553 / Fax: 704-599-3343 Presbyterian Hospital 6380240, 157904 200 Hawthorne Lane Phone: 704-384-4000, PET 7145276, 3243512 Steele Creek-Diagnostic Center 13557 Steelcroft Pkwy., Suite 1100, NC 28278 Phone: 704-316-2880 7145276, 4342853 Phone: 704-384-1890 7145276, 9931569 2900 Randolph Road Phone: 704-384-7140 7145276, 5611146 8401 Medical Plaza Drive Phone: 704-384-1580 7456027, 1863749 -Mecklen 6324 Fairview Road, Suite 120 A Phone: 704-362-8444 / Fax: 704-362-3557 Presbyterian Medical Plaza 7325538, 3780634 8401 Medical Plaza Drive, Suite 200 Phone: 704-384-8226 Presbyterian Orthopaedic Hospital 9617616, 157946 1901 Randolph Road Phone: 704-316-2000 Svcs: CT Randolph Radiology 7865543, 587265 1918 Randolph Road Phone: 704-342-8226 Svcs: CT 7324542, 5852031 16455 Statesville Road, Suite 110 Phone: 704-895-3445 / Fax: 704-895-4846 Presbyterian Hospital 7385600, 4902127 10030 Gilead Road Phone: 704-316-4000, PET Matthews 7324542, 9792818 Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: 704-844-9040 / Fax: 704-841-3507 Presbyterian Hospital-Matthews 4497126, 395805 1500 Matthews Township Pkwy. Phone: 704-384-6500, PET ROWAN COUNTY Salisbury Rowan Regional Medical Center 6380735, 158057 612 Mocksville Avenue Salisbury, NC 28144 Phone: 999-999-9999, PET Indian Trail Union West MRI Center 7747807, 9012626 6030 West Highway 74, Suite C Indian Trail, NC 28079 Phone: 704-246-2989 CMC-Union 6380580, 158011 600 Hospital Drive Phone: 704-283-3100, PET 7145276, 7363382 Diagnostic Center- 2000 Wellness Blvd., Suite 1100, NC 28110 Phone: 704-316-1180 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
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
Aetna "Select Provider" Listing - Low-Tech Radiology ANSON COUNTY Wadesboro Anson Community Hospital 6380845, 158093 500 Morven Road Wadesboro, NC 28170 Phone: 704-694-5131 BURKE COUNTY Morganton Grace Hospital 6380595, 158015 2201 South Sterling Street Morganton, NC 28655 Phone: 828-580-5000 / Fax: 828-580-5039 Valdese Valdese General Hospital 4310462, 193511 720 Malcolm Blvd. Valdese, NC 28690 Phone: 828-874-2251 Carolinas Medical Center - North East 6380270, 1732761 920 Church Street North, Suite 255 Phone: 704-783-3000 CATAWBA COUNTY Frye Regional Medical Center 6380470, 157974 420 North Center Street Phone: 828-315-5000 / Fax: 828-315-3901 FryeCare 9659795, 1000000291 1781 Tate Boulevard SE, Suite 101, NC 28602 Phone: 828-315-7030 Svcs: X, US, S, BD, M Kings Mountain Kings Mountain Hospital 6380505, 157986 706 West King Street Kings Mountain, NC 28086 Phone: 704-739-3601 / Fax: 704-739-0800 Shelby Cleveland Regional Medical Center 6380765, 2701320 201 East Grover Street Phone: 704-487-3000 7508657, 9012016 101 Delta Park Drive Phone: 704-484-8007 / Fax: 704-484-0606 GASTON COUNTY Gastonia Gaston Memorial Hospital 2525 Court Drive Phone: 704-835-2000 / Fax: 704-835-2500 Radiology Breast Center 4438439, 1763109 530 South New Hope Road, Suite 4 7544922, 2210703 2555 Court Drive Phone: 704-864-5550 / Fax: 704-864-7445 7544922, 4341077 2610 Aberdeen Blvd. 7544922, 3973255 Gaston Hematology & Oncology 610 Aberdeen Blvd. 7544922, 4481051 620 Summit Crossing Place, Suite 108 Phone: 704-865-0077 / Fax: 704-867-6401 7544922, 8072989 Caromont Imaging Services 620 Summit Crossing Place, Suite 106 Phone: 704-671-7730 7544922, 7493016 620 Summit Crossing Place, Suite 107 Phone: 704-671-7776 / Fax: 704-671-7721 7544922, 377135 631 Cox Road Phone: 704-864-7764 / Fax: 704-867-7894 7544922, 1862975 The Diagnostic Center 655 Cox Road Phone: 704-834-2050 / Fax: 704-834-2053 Insight Imaging, LLC 7297452, 5902944 2555 Court Drive, Suite 45 Phone: 704-525-7005 Svcs: US X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 7508657, 245968 900 Cox Road Phone: 704-830-1047 / Fax: 704-830-1047 7456027, 7603714 -Gastoni 920 Cox Road, Suite 101 Phone: 704-862-7188 / Fax: 704-862-7197 Svcs: X, US IREDELL COUNTY Mooresville 7544922, 9702768 124 Welton Way Phone: 704-658-1050 / Fax: 704-658-1056 Lake Norman Regional Medical Center 4371483, 5571114 171 Fairview Road Phone: 704-660-4000 7456027, 3423838 -Mooresv 118 Gateway Blvd., Bldg. 6, Suite E Phone: 704-662-8580 / Fax: 704-662-8846 Svcs: X, US Statesville Davis Regional Medical Center 6380800, 850640 218 Old Mocksville Road Statesville, NC 28625 Phone: 704-873-0281 Iredell Memorial Hospital 6380805, 479795 557 Brookdale Drive Statesville, NC 28677 Phone: 704-873-5661 LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln 6380550, 9833897 433 McAlister Road Lincolnton, NC 28092 Phone: 980-212-2000 7324542, 1402709 Crescent at Ballantyne 15110 John J Delaney Drive, Suite 130 Phone: 704-697-5000 / Fax: 704-697-5001
Aetna "Select Provider" Listing - Low-Tech Radiology 7324542, 3343411 4525 Cameron Valley Pkwy., Suite 1000-B Phone: 704-362-7076 / Fax: 704-362-7081 Carolinas Medical Center 6380225, 157900 1000 Blythe Blvd., NC 28203 Carolinas Medical Center-Mercy 6380230, 157901 2001 Vail Avenue Phone: 704-379-5000 Carolinas Medical Center-Pineville 6381715, 158123 10628 Park Road Phone: 704-543-2025 Carolinas Medical Center-University 6380250, 2710269 8800 North Tryon Street Radiology Diagnostic Imaging Center 4438437, 363683 2614 East 7th Street Insight Imaging, LLC 1901 Roxborough Road, Suite 200 Phone: 800-890-2813 / Fax: 704-525-6250 Svcs: US 7297452, 7302530 7508657, 2932170 15825 John J. Delaney Drive, Suite 100 Phone: 704-341-5264 / Fax: 704-543-8402 7508657, 552328 1915 Randolph Road Phone: 704-339-1000 7508657, 4732580 210 East Arrowhead Drive, Suite W3, NC 28213 Phone: 704-599-2553 / Fax: 704-599-3343 Presbyterian Breast Center 7910560, 4342853 Phone: 704-384-1890 7910560, 52945 1718 East 4th Street Phone: 704-384-4177 7910560, 9931569 2900 Randolph Road Phone: 704-384-7140 7910560, 5611146 8401 Medical Plaza Drive Phone: 704-384-1580 Presbyterian Hospital 6380240, 157904 200 Hawthorne Lane Phone: 704-384-4000 7145276, 3243512 Steele Creek-Diagnostic Center 13557 Steelcroft Pkwy., Suite 1100, NC 28278 Phone: 704-316-2880 7145276, 4342853 Phone: 704-384-1890 7145276, 9931569 2900 Randolph Road Phone: 704-384-7140 7145276, 5611146 8401 Medical Plaza Drive Phone: 704-384-1580 7456027, 1863749 -Mecklen 6324 Fairview Road, Suite 120 A Phone: 704-362-8444 / Fax: 704-362-3557 Svcs: X, US Presbyterian Medical Plaza 7325538, 3780634 8401 Medical Plaza Drive, Suite 200 Phone: 704-384-8226 Randolph Radiology 7865543, 587265 1918 Randolph Road Phone: 704-342-8226 7324542, 5852031 16455 Statesville Road, Suite 110 Phone: 704-895-3445 / Fax: 704-895-4846 Presbyterian Breast Screening at 7685616, 6642216 10030 Gilead Road Drive, Suite 310 Phone: 704-384-8734 Svcs: M 7685616, 7510815 16630 Northcross Drive Phone: 704-384-4177 Svcs: M Matthews 7324542, 9792818 Adbel Plaza 1401 Matthews Township Pkwy., Suite 310 Phone: 704-844-9040 / Fax: 704-841-3507 Radiology Breast Center AdBel Medical Plaza 5282497, 4042722 1401 Matthews-Township Pkwy., Suite 310 Svcs: M Presbyterian Hospital-Matthews 4497126, 395805 1500 Matthews Township Pkwy. Phone: 704-384-6500 ROWAN COUNTY Salisbury Rowan Regional Medical Center 6380735, 158057 612 Mocksville Avenue Salisbury, NC 28144 Phone: 999-999-9999 CMC-Union 6380580, 158011 600 Hospital Drive Phone: 704-283-3100 7145276, 7363382 Diagnostic Center- 2000 Wellness Blvd., Suite 1100, NC 28110 Phone: 704-316-1180 X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 2 of 2
Aetna "Select Provider" Listing - Ambulatory Surgery Eye Surgery and Laser Clinic, P.A. 8382863, 251585 500 Lake Road Northeast Phone: 704-782-1127 Gateway Ambulatory Surgery Center, LLC 7545827, 3471803 1025 Northeast Gateway Court Phone: 704-920-7020 Catawba COUNTY Frye Surgery Center 7174714, 1000000292 214 18th Street Circle, SE, NC 28602 Phone: 828-322-9789 Svcs: GEN, OPT, ORP, UR Gastroenterology Associates, P.A. - Endoscopy Unit 9929166, 7630234 415 North Center Street, Suite 300 Phone: 828-328-3300 / Fax: 828-328-3288 Shelby Cleveland Ambulatory Service 5037144, 6570981 1100 North Lafayette Street Phone: 704-482-1331 IREDELL COUNTY Mooresville Surgical Center at Lake Norman 7599195, 6802038 131 Medical Park Road, Suite 100 Phone: 704-660-4570 Statesville Iredell Surgical Center 4476382, 370672 1720 Davie Avenue Statesville, NC 28677 Phone: 704-871-0081 PHC Endoscopy 9334299, 4380851 208 Old Mocksville Road Statesville, NC 28625 Phone: 704-838-8215 / Fax: 704-838-8234 Carolina Center for Specialty Surgery 7776862, 16099 1822 Brunswick Avenue Phone: 704-831-4400 / Fax: 704-831-4401 Carolina Endoscopy Center-Pineville 7264879, 253583 10520 Park Road Phone: 704-927-5756 / Fax: 704-927-5757 Carolina Endoscopy Center-University 7579849, 16052 101 W.T. Harris Blvd., Suite 3215 Phone: 704-927-1480 / Fax: 704-927-4286 Carolinas Gastroenterology Center- Ballantyne 7760871, 8582802 15110 John J. Delaney Drive, Suite 120 Phone: 704-512-2140 / Fax: 704-442-4667 Carolinas Gastroenterology Center- Medical Center Plaza 7570916, 3541343 1001 Blythe Blvd., Suite 400, NC 28203 Phone: 704-355-4178 Carolinas Surgery Center - Randolph 7591105, 3431641 3621 Randolph Road, Suite 200 Phone: 704-442-4670 / Fax: 704-364-4991 Carolinas Surgery Center - Wendover 7111395, 58851 449 North Wendover Road Phone: 704-442-4670 / Fax: 704-364-4991 Plastic Surgery Center, PA 7643695, 52239 2215 Randolph Road Phone: 704-372-6846 / Fax: 704-342-0752 Endoscopy Services Centers /Billingsley 7968924, 2671440 300 Billingsley Road, Suite 200 Phone: 704-927-6066 / Fax: 704-927-6069 Midtown Surgical Center 7137751, 1054071 1918 Randolph Road, Suite 740 Phone: 704-384-4920 Presbyterian Same Day Surgery Center 4448603, 365754 1800 East 4th Street Phone: 704-384-4200 Presbyterian Sameday Surgery Center at Ballantyne 9211074, 4342853 Phone: 704-316-2650 Southpark Surgical Center, LLC 7830518, 3172085 6035 Fairview Road, Suite 300 Phone: 704-295-3080 Carolina Endoscopy Center - 9927177, 6913271 16455 Statesville Road, Suite 114 Phone: 704-237-9290 / Fax: 704-237-9296 Presbyterian Endoscopy Center at, LLC 7580892, 5470885 16525 Holly Crest Lane Phone: 704-316-4007 Presbyterian Same Day Surgery Center 4448603, 9383607 10030 Gilead Road, Suite 240 Phone: 704-384-6225 ROWAN COUNTY Salisbury Salisbury VAMC 4304469, 186191 1601 Brenner Avenue Salisbury, NC 28144 Phone: 282-298-7911 Carolina Endoscopy Center- 7427910, 5503086 1321 East Sunset Road Phone: 704-261-1220 / Fax: 704-261-1223 Healthsouth Surgery Center of Carolina Endoscopy Center-University 7579849, 3111521 8381560, 4402681 2825 Randolph Road, 2nd Floor 1321 East Sunset Drive Phone: 704-377-1647 / Fax: 704-358-8267 Phone: 704-261-1220 / Fax: 704-261-1223 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
Aetna "Select Provider" Listing - Sleep Studies Carolinas Medical Center - North East 6380270, 1732761 920 Church Street North, Suite 255 Phone: 704-783-3000 Carolinas Sleep Specialist 9838594, 4613980 400 Penny Lane Phone: 704-707-4120 / Fax: 704-706-9520 9838594, 9683477 940 Lee Ann Drive Phone: 704-707-7120 / Fax: 704-248-8192 CATAWBA COUNTY Frye Regional Medical Center 6380470, 157974 420 North Center Street Phone: 828-315-5000 / Fax: 828-315-3901 Kings Mountain Kings Mountain Hospital 6380505, 157986 706 West King Street Kings Mountain, NC 28086 Phone: 704-739-3601 / Fax: 704-739-0800 LINCOLN COUNTY Lincolnton Carolinas Medical Center - Lincoln 6380550, 9833897 433 McAlister Road Lincolnton, NC 28092 Phone: 980-212-2000 Carolinas Medical Center 6380225, 157900 1000 Blythe Blvd., NC 28203 Carolinas Medical Center-Mercy 6380230, 157901 2001 Vail Avenue Phone: 704-379-5000 Carolinas Medical Center-Pineville 6381715, 158123 10628 Park Road Phone: 704-543-2025 Carolinas Medical Center-University 6380250, 2710269 8800 North Tryon Street Carolinas Sleep Specialist 9838594, 53054 1700 Abbey Place, NC 28209 Phone: 704-707-7120 / Fax: 704-248-8192 9838594, 6053951 6428 Bannington Road, Suite A, NC 28226 Phone: 704-540-4599 / Fax: 704-540-8774 SleepMed, Inc. dba Digitrace Care Services 7618325, 8783316 5550 77 Center Drive, Suite 240, NC 28217 Phone: 704-523-3489 Sleepwell, Inc. 7464732, 139695 10716 Carmel Commons Blvd., Suite 120, NC 28226 Phone: 704-541-4240 / Fax: 704-943-0898 Advanced Respiratory and Sleep Medicine, PLLC 9036460, 6032732 16627 Birkdale Commons Pkwy., Suite 210 Phone: 704-248-0000 / Fax: 704-731-0890 Matthews Novant Sleep Services 7828525, 4861139 1500 Matthews Township Pkwy. Phone: 704-384-6225 Sleep Success Technology, Inc 7793739, 3013168 3041 Senna Drive, Suite B Phone: 704-849-0841 CMC-Union 6380580, 158011 600 Hospital Drive Phone: 704-283-3100