Aetna "Select Provider" Listing - High-Tech Radiology Columbus - January, Grant Medical Center

Transcription

1 Aetna "Select Provider" Listing - High-Tech Radiology OHIO DELAWARE COUNTY Polaris Open MRI , Polaris Pkwy., OH Phone: , OMR Grady Memorial Hospital 561 West Central Avenue, OH Phone: , CNM, CT , 4389 FAIRFIELD COUNTY Lancaster Mount Carmel Imaging Center at River View , North Street, Suite 180 Phone: Svcs: PET Ohio Rehab and Diagnostic Center, Inc North Street, Suite 140 Phone: / Fax: , Pickerington Proscan Imaging of Pickerington, LLC 417 Hill Road North Pickerington, OH Phone: / Fax: , FRANKLIN COUNTY Bethel Road Open MRI, INC , Bethel Road, OH Phone: , OMR, CT Broad Street Imaging Center Insight Imaging DBA Broad Street Im 750 East Broad Street, OH Phone: / Fax: , CT , Doctors Hospital 5100 West Broad Street, OH Phone: , CNM, CT , Grant Medical Center 111 South Grant Avenue Phone: , CNM, CT , 5544 Mount Carmel Imaging Center at Big Run , Clime Road, Suite 120, OH Phone: Svcs: CT Ohio State University Hospitals , East Broad Street, OH Phone: , CNM, CT, PET , West 10th Avenue, OH Phone: , CNM, CT, PET , Taylor Avenue, OH Phone: , CNM, CT, PET Riverside Methodist Hospitals 3535 Olentangy River Road Phone: , CNM, CT, PET , 4282 Clear Image MRI/CT 4995 Bradenton Avenue, Suite 100 Phone: / Fax: , CT , Diagnostic Imaging, L.L.C Dale Drive, Suite 100 Phone: / Fax: , Methodist Hospital 7500 Hospital Drive Phone: / Fax: , CNM, CT , Gahanna ProScan Imaging Gahanna 425 Beecher Road, Suite B Gahanna, OH Phone: / Fax: , Worthington Extremity Imaging Partners, Inc North High Street, Suite 106 Worthington, OH Phone: / Fax: , GUERNSEY COUNTY Cambridge Cambridge Open MRI , Highland Avenue Cambridge, OH Phone: / Fax: , OMR Shared PET Imaging, LLC 1341 Clark Street Cambridge, OH Phone: / Fax: Svcs: PET , LICKING COUNTY Newark Medical Center of Newark , Tamarack Road Newark, OH Phone: , CNM, CT MADISON COUNTY London Madison County Hospital , North Main Street London, OH Phone: , CNM, CT MARION COUNTY Marion AccuRadiology, Inc , Avenue, Suite 105 Phone: / Fax: Marion ANC MRI 1000 McKinley Park Drive Phone: / Fax: , Marion ANC Radiology 1050 Avenue Phone: / Fax: , CNM, CT, PET , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 1 of 2

2 Aetna "Select Provider" Listing - High-Tech Radiology Marion General Hospital 1000 McKinley Park Drive Phone: / Fax: , CT , MUSKINGUM COUNTY Zanesville Northern Lights Imaging. L.L.C , Maple Street Phone: , CT ROSS COUNTY Chillicothe Proscan Imaging of Chillicothe , Proscan Imaging of Chillicothe 1200 North Bridge Street Phone: / Fax: 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 2 of 2

3 Aetna "Select Provider" Listing - Ambulatory Surgery OHIO DELAWARE COUNTY Grady Memorial Hospital , West Central Avenue, OH Phone: , INF, LT, OPT, UR Westerville Center for Surgical Dermatology Inc. 428 County Line Road West Westerville, OH Phone: / Fax: Svcs: Biopsy, laceration repairs, Skin Grafts , Polaris Surgery Center, LLC 300 Polaris Pkwy., Suite 110 Westerville, OH Phone: / Fax: Svcs: GEN, INF, ORP , FAIRFIELD COUNTY Canal Winchester Diley Ridge Medical Center , Diley Road Canal Winchester, OH Phone: / Fax: Lancaster River View Surgery Center 2401 North Street Phone: , ORP, UR , FRANKLIN COUNTY American Kidney Stone Management , Thomas Lane Phone: Central Ohio Endoscopy Center, LLC , Olentangy River Road Phone: / Fax: , West Broad Street, Suite 220, OH Phone: / Fax: , McNaughten Road, Suite 320 Phone: / Fax: , McNaughten Road, Suite 320-A Phone: / Fax: Central Ohio Urology Group, Inc East Broad Street, Suite 407 Phone: / Fax: Svcs: UR , 5649 Central Ohio Urology Surgery Center, LLC , Plaza Properties Blvd., Suite 310, OH Phone: / Fax: , UR , Plaza Properties Blvd., Suite 320, OH Phone: / Fax: , UR Cleveland Avenue Professional Corporation, LLC , Cleveland Avenue, OH Phone: / Fax: Svcs: GEN, EN, UR , North Brice Road, Suite 210 Phone: / Fax: Svcs: GEN, EN, UR Eye Surgery Center 5965 East Broad Street, Suite 460 Phone: , Doctors Hospital 5100 West Broad Street, OH Phone: , INF, LT, OPT, ORP, UR , Downtown Endoscopy Center 700 East Broad Street, 1st Floor Phone: , East Surgery Center 50 McNaughten Road, Suite 102 Phone: , Eastside Surgery Center 4850 East Main Street Phone: / Fax: , INF, LT, OPT, ORP, UR , Eye Center Of, LLC 262 Neil Avenue, Suite 500 Phone: / Fax: , Grant Medical Center 111 South Grant Avenue Phone: Svcs: INF, OPT, ORP , 5544 Green Street Surgery Center, LLC 120 South Green Street, OH Phone: / Fax: Svcs: GEN, EN, OPT, ORP, UR , Knightsbridge Surgery Center, LTD 4845 Knightsbridge Blvd., Suite 110 Phone: / Fax: , LT, ORP, UR , Mid Ohio Surgery Center 99 North Brice Road, Suite 160 Phone: / Fax: , Mt. Carmel East Hospital 6001 East Broad Street Phone: Svcs: GEN, EN, INF, LT, OPT, ORP, BA, UR , Mt. Carmel West Hospital 793 West State Street, Suite 700, OH Phone: , INF, LT, ORP, BA, UR , Ohio Gastroenterology Group, Inc. 777 West State Street, Suite 402, OH Phone: / Fax: , Ohio Orthopedic Surgery Institute, L.L.C , Sawmill Road, OH Phone: Svcs: ORP Ohio State University Hospitals , East Broad Street, OH Phone: , West 10th Avenue, OH Phone: GEN - General Surgery EN - Endoscopy INF - Infertility LT - Lithotripsy OPT - Opthalmology ORP - Orthopedics BA - Bariatric UR - Urology 1 of 3

4 Aetna "Select Provider" Listing - Ambulatory Surgery , Taylor Avenue, OH Phone: Ohio Surgery Center, LLC. 930 Bethel Road Phone: , Riverside Methodist Hospitals 3535 Olentangy River Road Phone: , INF, ORP, UR , 4282 Taylor Station Surgical Center 275 Taylor Station Road Phone: , OPT, ORP , The Sullivan Centre for Plastic & Reconstr Surgery , Olentangy River Road, OH Phone: Upper Arlington Surgery Center 2240 Northbank Drive, OH Phone: / Fax: , ORP, Multi Specialty , Affiliated Ambulatory Surgery Center, LLC , Shawan Falls Drive Phone: Svcs: Biopsy, laceration repairs, Skin Grafts Central Ohio Endoscopy Center, LLC 6670 Perimeter Drive, Suite 200 Phone: / Fax: , Methodist Hospital 7500 Hospital Drive Phone: / Fax: Svcs: GEN, EN, INF, LT, OPT, ORP , OSU Internal Medicine, LLC dba Stoneridge Endoscop , Stoneridge Lane Phone: Groveport Barix Clinics of Ohio 3964 Hamilton Square Blvd. Groveport, OH Phone: / Fax: , BA , New Albany Central Ohio Surgical Institute, L.L.C West Campus Oval Phone: / Fax: Svcs: GEN, EN, OPT, ORP , Mount Carmel New Albany Surgical Hospital , Smiths Mill Road Phone: New Albany Surgery Center 5040 Forest Drive, Suite 100 Phone: / Fax: , Westerville Mt. Carmel St. Ann's 500 South Cleveland Avenue Westerville, OH Phone: , LICKING COUNTY Newark Bloomberg Eye Center , West Main Street Newark, OH Phone: Svcs: ORP Medical Center of Newark 2000 Tamarack Road Newark, OH Phone: , LT, OPT, UR , MARION COUNTY Marion Marion Area Health Center , Avenue Phone: Svcs: GEN, EN, OPT, ORP Marion General Hospital 1000 McKinley Park Drive Phone: / Fax: , New Horizons Surgery Center 1167 Independence Avenue Phone: Svcs: GEN, EN, ORP, UR , MUSKINGUM COUNTY Zanesville AlternaCare, Inc , North Maple Avenue Phone: Genesis Bethesda Hospital 2951 Maple Avenue Phone: , InSight Surgery & Laser Center, LLC 2935 Maple Avenue Phone: / Fax: , PICKAWAY COUNTY Circleville Berger Hospital , North Pickaway Street Circleville, OH Phone: Svcs: GEN, EN, LT, UR Ohio Eye Surgery Center 210 Sharon Road, Suite B Circleville, OH Phone: , Physicians Ambulatory Surgery Center 1235 South Court Street Circleville, OH Phone: / Fax: Svcs: GEN, EN, ORP , PIKE COUNTY Waverly Pike Community Hospital , Dawn Lane, Suite 4 Waverly, OH Phone: / Fax: ROSS COUNTY Chillicothe Ohio Valley Surgery Center LLC , State Route 159 Phone: Svcs: ORP GEN - General Surgery EN - Endoscopy INF - Infertility LT - Lithotripsy OPT - Opthalmology ORP - Orthopedics BA - Bariatric UR - Urology 2 of 3

5 Aetna "Select Provider" Listing - Ambulatory Surgery Ross Surgery Center, Inc. 50 North Plaza Blvd. Phone: / Fax: , Southern Ohio Eye Surgery Center LLC 159 East Second Street Phone: , SCIOTO COUNTY Portsmouth Portsmouth Surgery Center , Gay Street Portsmouth, OH Phone: / Fax: UNION COUNTY Marysville Memorial Hospital of Union County , London Avenue Marysville, OH Phone: 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 3 of 3

6 Aetna "Select Provider" Listing - Sleep Studies OHIO COSHOCTON COUNTY Coshocton Coshocton County Memorial Hospital , Orange Street Coshocton, OH Phone: DELAWARE COUNTY University Sleep Medicine, LLC , Antares Avenue, B1, OH Phone: / Fax: Grady Memorial Hospital 561 West Central Avenue, OH Phone: , 4389 at , OhioHealth Blvd., Suite 240, OH Westerville 300 Polaris Pkwy., Suite 2450 Westerville, OH , FAIRFIELD COUNTY Lancaster Fairfield Medical Center , North Ewing Street Phone: Pickerington , Clint Drive, Suite 200 Pickerington, OH , Clint Drive Pickerington, OH FRANKLIN COUNTY Capital Sleep Center, LTD , MacKenzie Drive, OH Phone: / Fax: Community Health Regional Sleep Disorders Center , South High Street, OH Phone: / Fax: Eastside Sleep Diagnostic Center 99 North Brice Road, Suite 350 Phone: , Grant Medical Center 111 South Grant Avenue Phone: , 5544 Mid Ohio Sleep Center, Inc Airport Drive, Suite 120, OH Phone: / Fax: , Ohio State University Hospitals , East Broad Street, OH Phone: , West 10th Avenue, OH Phone: , Taylor Avenue, OH Phone: OhioHealth Sleep Services at Riverside 3535 Olentangy River Road, Suite 200 Phone: , , Bethel Road Phone: / Fax: , Bethel Road, Suite C , Flint Road, Suite C, OH Phone: / Fax: at Grant , East State Street, Suite 425 at the Millhon Clinic , Olentangy River Road, Suite 200, OH at Upper Arlington , Mackenzie Drive, OH Riverside Methodist Hospitals 3535 Olentangy River Road Phone: , 4282 Ohio Sleep Medicine Institute 4975 Bradenton Avenue Phone: / Fax: , at , Hospital Drive, Suite 270 Gahanna Central Ohio Sleep Medicine, LTD 4625 Morse Road, Suite 200 Gahanna, OH Phone: / Fax: , Grove City 2041 Stringtown Road Grove City, OH Phone: / Fax: , New Albany Ohio Sleep Medicine Institute 7277 Smiths Mill Road, Suite 200 Phone: / Fax: , HOCKING COUNTY Logan Hocking Valley Community Hospital , State Route 664 North Logan, OH Phone: MADISON COUNTY London Madison County Hospital , North Main Street London, OH Phone: of 2

7 MARION COUNTY Marion Circadian Sleep Center Inc , Avenue, Suite 105 Phone: / Fax: Marion ANC Sleep Lab 1050 Avenue Phone: / Fax: , ROSS COUNTY Chillicothe Adena Regional Medical Center , Hospital Road Phone: / Fax: Aetna "Select Provider" Listing - Sleep Studies 2 of 2