Aetna "Select Provider" Listing - High-Tech Radiology Orlando - January, University Center Imaging

Transcription

1 Aetna "Select Provider" Listing - High-Tech Radiology FLORIDA BREVARD COUNTY Indian Harbour Beach Beach Medical Imaging , South Patrick Drive Indian Harbour Beach, FL Phone: / Fax: Coastline Imaging, Inc , Medical Park Drive, Suite 101 Phone: , West Eau Gallie Blvd., Suite 104, FL Phone: / Fax: , , South Harbor City Blvd., Suite 520 Phone: / Fax: University Center Imaging , West Hibiscus Blvd., Suite 100 Phone: / Fax: , North Wickham Road, Suite 100, FL Phone: / Fax: Svcs: MR, CNM, CT Wuesthoff Baytree Imaging 7970 North Wickham Road, Suite 102, FL Phone: /Fax: , PET Merritt Island Merritt Island , North Sykes Creek Pkwy. Merritt Island, FL Phone: / Fax: Palm Bay Florida Diagnostic Imaging, INC 5201 Babcock Street Northeast, Suite 5 Palm Bay, FL Phone: / Fax: , University Center Imaging 590 Malabar Road, Suite 6 Palm Bay, FL Phone: Svcs: MR, CNM, CT , Port St. John Florida East Coast Imaging, 5005 Port St. John Pkwy. Port St. John, FL Phone: / Fax: , PET , Rockledge Open MRI of Rockledge 1978 Rockledge Blvd., Suite 101 Rockledge, FL Phone: / Fax: Rockledge MRI and PET Center, 1910 Rockledge Blvd., Suite 102 Rockledge, FL Phone: / Fax: , PET , , Viera Viera Diagnostic Center , Spyglass Court, Suite 260 Viera, FL Phone: / Fax: LAKE COUNTY Clermont , Mohawk Road Clermont, FL Phone: / Fax: Clermont Radiology, , Oakley Seaver Drive Clermont, FL Phone: / Fax: , PET Treasure Coast Medical Services, Inc , East Hwy. 50, Suite A Clermont, FL Phone: / Fax: Svcs: CNM Eustis Diagnostic Outpatient Center 2603 Kurt Street Eustis, FL Phone: , Lady Lake , U.S. Hwy. 441, Suite 201 Phone: / Fax: Leesburg , North 1st Street Phone: / Fax: Diagnostic Outpatient Ctrs II, Inc , Doctors Center Phone: / Fax: , Leesburg Regional Medical Center 600 East Dixie Avenue Phone: / Fax: , PET , East Dixie Avenue Phone: / Fax: , PET and Breast , Leesburg Regional Medical Center 600 East Dixie Avenue Phone: , CNM, CT, PET , East Dixie Avenue Phone: / Fax: , CNM, CT, PET Radiology Associates of Central Florida , Leesburg Regional Medical Center 600 East Dixie Avenue Phone: , East Dixie Avenue Phone: / Fax: MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 1 of 4

2 Aetna "Select Provider" Listing - High-Tech Radiology Mt. Dora Physicians Imaging-Mt. Dora, 3615 Lake Center Drive Mt. Dora, FL Phone: / Fax: , Tavares Open MRI of, Inc Nightingale Lane, Suite A1 Tavares, FL Phone: / Fax: , The Villages Lake Med Imaging and Breast Ctr 1400 US Hwy. 441 North Phone: / Fax: , PET , and Breast , Lake Med Imaging and Breast Ctr 1400 US Hwy. 441 North Phone: / Fax: , CNM, CT, PET Radiology Associates of Central Florida Lake Med Imaging and Breast Ctr 1400 US Hwy. 441 North Phone: / Fax: , ORANGE COUNTY Apopka Emery Medical Solutions , East Semoran Blvd. Apopka, FL Phone: / Fax: Svcs: MR, CNM, CT Maitland MD Diagnostic Specialist, 668 North Avenue, Suite 1005 Maitland, FL Phone: / Fax: , Ocoee A1 Imaging of Ocoee 9440 West Colonial Drive, Suite 12 Phone: / Fax: , Boston Diagnostic Imaging , Blackwood Avenue Phone: / Fax: , PET , Ocoee Commerce Parkway Phone: / Fax: , PET , Citrus Oaks Office Center 9582 West Colonial Drive Phone: / Fax: , CNM, CT, PET , A1 Imaging of 500 North Semoran Blvd., Suite 103, FL Phone: / Fax: , Advanced 3-D Diagnostics Inc. 930 South Orange Avenue, Suite 1 Phone: / Fax: , Advanced Diagnostic Group 6388 Silver Star Road, Suite 1-A, FL Phone: / Fax: Svcs: MR , Altamonte Springs Diagnostic Imaging , S. Semoran Blvd., Suite D, FL Phone: , , West Colonial Drive, Suite C, FL Phone: / Fax: , S. Kirkman Road, Suite , FL Phone: Boston Diagnostic Imaging South Orange Avenue Phone: / Fax: , , Park Center Drive, 110, FL Phone: / Fax: , Oakwater Circle Phone: / Fax: , West Kaley Street Phone: / Fax: , North Alafaya Trail, FL Phone: / Fax: , CNM, CT, PET , University Blvd., FL Phone: / Fax: , PET , South Orange Avenue Phone: / Fax: Lake Underhill Road, Suite 101, FL Phone: / Fax: , Sand Lake Imaging, L.L.L.P Turkey Lake Road, FL Phone: / Fax: , Stand-Up MRI of 2010 South Orange Avenue Phone: / Fax: , Park, P , Turkey Lake Road, 109, FL Phone: / Fax: Womens Center for Radiology, P.A North Mills Avenue, FL Phone: / Fax: Svcs: MR , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 2 of 4

3 Aetna "Select Provider" Listing - High-Tech Radiology , South Orange Avenue Phone: / Fax: Svcs: MR Winter Park Advanced Imaging Center of Winter Park, LTD , West Fairbanks Avenue, MRI SUITE Phone: / Fax: Orange Avenue, Suite 200 Phone: / Fax: , West Fairbanks Avenue Phone: / Fax: , Florida Radiology Centers 483 North Semoran Blvd., Suite 104 Phone: / Fax: , NSI Winter Park 2111 Glenwood Drive, Suite 101 Phone: / Fax: , Park, P , North Lakemont Avenue Phone: OSCEOLA COUNTY Kissimmee A1 Imaging of Kissimmee , North John Young Pkwy. Phone: / Fax: Advanced Diagnostic Group 56 West Oak Street Phone: / Fax: Svcs: MR , Altamonte Springs Diagnostic Imaging 819 East Oak Street, Suite C Kissimmee, FL Phone: / Fax: , West Oak Street Phone: / Fax: , Health Imaging Services, 313 West Bass Street Phone: / Fax: , Diagnostic Center 506 West Cherry Street Phone: / Fax: , East Oak Street Kissimmee, FL Phone: / Fax: , Soca Imaging, Inc. Kissimmee Outpatient Center , West Oak Street Phone: / Fax: Svcs: MR, CNM, CT SEMINOLE COUNTY Altamonte Springs Altamonte Springs Diagnostic Imaging , South Westmonte Drive, Suite 1118 Phone: / Fax: , Boston Diagnostic Imaging 398 East Altamonte Drive Altamonte Springs, FL Phone: / Fax: , PET , , Douglas Avenue, Suite 1014 Phone: / Fax: , Douglas Avenue, Suite 1110 Phone: / Fax: Lake Mary Cyrus Diagnostic Imaging 165 Waymont Court Phone: , CNM, CT, PET , South International Pkwy., Suite 1351 Phone: / Fax: , Soca Imaging, Inc. Lake Mary Imaging Center, Inc. 917 Rinehart Road, Suite 1051 Phone: / Fax: , Longwood Diagnostic Center 450 West State Road 434, Suite 102 Longwood, FL Phone: / Fax: , Park, P , , West State Road 434, Suite 110 Longwood, FL Phone: / Fax: Oviedo 1000 West Broadway, Suite 104 Phone: , Red Bug Lake Road Phone: / Fax: , Sanford Open MRI of Sanford 303 West 1st Street Sanford, FL Phone: / Fax: , Winter Springs 1049 Willa Springs Drive, Suite 1051 Winter Springs, FL Phone: / Fax: , Vincon Diagnostic Center 5732 Canton Cove Winter Springs, FL Phone: / Fax: , MR - Closed MRI OMR - Open MRI CNM - Cardio Nuclear Medicine CT - CAT Scan PET - Positron Emission Tomography 3 of 4

4 Aetna "Select Provider" Listing - High-Tech Radiology SUMTER COUNTY The Villages , The Villages Regional Hospital 1451 El Camino Real Phone: / Fax: , PET , Old Camp Road, Bldg. 120, Suite 122 Phone: / Fax: , PET and Breast , The Villages Regional Hospital 1451 El Camino Real Phone: , CNM, CT, PET , Old Camp Road, Bldg. 120, Suite 122 Phone: / Fax: , CNM, CT, PET Radiological Inst of the Villages County Road 101 Phone: / Fax: Svcs: CT, PET , , Santa Barbara Blvd., Unit D Phone: / Fax: Svcs: CT, PET Radiology Associates of Central Florida , The Villages Regional Hospital 1451 El Camino Real Phone: , Old Camp Road, Bldg. 120, Suite 122 Phone: / Fax: VOLUSIA COUNTY Daytona Beach Twin Lakes Imaging Center , LPGA Blvd., Suite 110 Daytona Beach, FL Phone: / Fax: Deltona LAD Imaging, - HCA Affiliate 1555 Saxon Blvd., Suite 401 Deltona, FL Phone: / Fax: , New Smyrna Beach New Smyrna Imaging, L.L.C. 405 East 3rd Avenue New Smyrna Beach, FL Phone: / Fax: Svcs: MR , Orange City Mid Florida Radiology Centers P.A. 955 Town Center Drive, Suite 200 Orange City, FL Phone: / Fax: , PET , Ormond Beach Stand-Up MRI & Diagnostic Center, P.A , Stand-up MRI and Diagnostic Center, PA 555 West Granada Blvd. Phone: / Fax: Port Orange Port Orange Imaging Center 1195 Dunlawton Avenue Port Orange, FL Phone: / Fax: Svcs: MR, CNM, CT , 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 4 of 4

5 Aetna "Select Provider" Listing - Low-Tech Radiology FLORIDA BREVARD COUNTY Indian Harbour Beach Beach Medical Imaging , South Patrick Drive Indian Harbour Beach, FL Phone: / Fax: , FL, US, S Atlantis Diagnostic Center 1344 South Apollo Blvd., Suite 102 Phone: , Coastline Imaging, Inc , Medical Park Drive, Suite 101 Phone: , West Eau Gallie Blvd., Suite 104, FL Phone: / Fax: , FL, US, S, M Neuro Imaging Institute 27 East Hibiscus Blvd. Phone: / Fax: , S, BD, M , , , South Harbor City Blvd., Suite 520 Phone: / Fax: Tepas Breast Center 1140 Broadband Drive Phone: / Fax: Svcs: US, M , University Center Imaging , West Hibiscus Blvd., Suite 100 Phone: / Fax: , North Wickham Road, Suite 100, FL Phone: / Fax: Wuesthoff Baytree Imaging 7970 North Wickham Road, Suite 102, FL Phone: /Fax: Merritt Island Merritt Island , North Sykes Creek Pkwy. Merritt Island, FL Phone: / Fax: , FL, US Palm Bay Florida Diagnostic Imaging, INC 5201 Babcock Street Northeast, Suite 5 Palm Bay, FL Phone: / Fax: , BD, M University Center Imaging 590 Malabar Road, Suite 6 Palm Bay, FL Phone: , , Rockledge First Ultrasound, Inc. 138 South Woods Drive, Suite 101 Rockledge, FL Phone: / Fax: Svcs: US Rockledge MRI and PET Center, 1910 Rockledge Blvd., Suite 102 Rockledge, FL Phone: / Fax: , S, M , , Viera Viera Diagnostic Center , Spyglass Court, Suite 260 Viera, FL Phone: / Fax: , S, BD, M LAKE COUNTY Clermont , Mohawk Road Clermont, FL Phone: / Fax: Clermont Radiology, , Oakley Seaver Drive Clermont, FL Phone: / Fax: Eustis Diagnostic Outpatient Center 2603 Kurt Street Eustis, FL Phone: , BD , Lady Lake , U.S. Hwy. 441, Suite 201 Phone: / Fax: Leesburg , North 1st Street Phone: / Fax: , S, M Diagnostic Outpatient Ctrs II, Inc , Doctors Center Phone: / Fax: , S, M , Leesburg Regional Medical Center 600 East Dixie Avenue Phone: / Fax: , East Dixie Avenue Phone: / Fax: and Breast , Leesburg Regional Medical Center 600 East Dixie Avenue Phone: , East Dixie Avenue Phone: / Fax: Mt. Dora Physicians Imaging-Mt. Dora, 3615 Lake Center Drive Mt. Dora, FL Phone: / Fax: , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 1 of 4

6 Aetna "Select Provider" Listing - Low-Tech Radiology The Villages Lake Med Imaging and Breast Ctr 1400 US Hwy. 441 North Phone: / Fax: , and Breast , Lake Med Imaging and Breast Ctr 1400 US Hwy. 441 North Phone: / Fax: ORANGE COUNTY Apopka Emery Medical Solutions , East Semoran Blvd. Apopka, FL Phone: / Fax: , S, M Maitland MD Diagnostic Specialist, 668 North Avenue, Suite 1005 Maitland, FL Phone: / Fax: , Ocoee Boston Diagnostic Imaging , Blackwood Avenue Phone: / Fax: , Ocoee Commerce Parkway Phone: / Fax: , , Citrus Oaks Office Center 9582 West Colonial Drive Phone: / Fax: , M Advanced 3-D Diagnostics Inc. 930 South Orange Avenue, Suite 1 Phone: / Fax: , Advanced Diagnostic Group 6388 Silver Star Road, Suite 1-A, FL Phone: / Fax: , Altamonte Springs Diagnostic Imaging , S. Semoran Blvd., Suite D, FL Phone: , , West Colonial Drive, Suite C, FL Phone: / Fax: , S. Kirkman Road, Suite , FL Phone: Boston Diagnostic Imaging South Orange Avenue Phone: / Fax: , Park Center Drive, 110, FL Phone: / Fax: , FL, US, S, M , , Quadrangle Blvd., FL Phone: / Fax: , West Kaley Street Phone: / Fax: , North Alafaya Trail, FL Phone: / Fax: , University Blvd., FL Phone: / Fax: , South Orange Avenue Phone: / Fax: , FL, US 7806 Lake Underhill Road, Suite 101, FL Phone: / Fax: , Sand Lake Imaging, L.L.L.P Turkey Lake Road, FL Phone: / Fax: , Stand-Up MRI of 2010 South Orange Avenue Phone: / Fax: , Park, P , Turkey Lake Road, 109, FL Phone: / Fax: Womens Center for Radiology, P.A , North Mills Avenue, FL Phone: / Fax: , S, BD, M , South Orange Avenue Phone: / Fax: , S, BD, M Winter Park 1295 Orange Avenue, Suite 200 Phone: / Fax: , West Fairbanks Avenue Phone: / Fax: , Florida Radiology Centers 483 North Semoran Blvd., Suite 104 Phone: / Fax: , BD , NSI Winter Park 2111 Glenwood Drive, Suite 101 Phone: / Fax: , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 2 of 4

7 Aetna "Select Provider" Listing - Low-Tech Radiology Park, P , North Lakemont Avenue Phone: Weston Diagnostics 1320 South Avenue, Suite 4 Phone: Svcs: US , OSCEOLA COUNTY Celebration Mammography Screening Centers, Inc , Celebration Blvd., Suite 403 Celebration, FL Phone: / Fax: Svcs: M Kissimmee Advanced Diagnostic Group 56 West Oak Street Phone: / Fax: , Altamonte Springs Diagnostic Imaging 819 East Oak Street, Suite C Kissimmee, FL Phone: / Fax: , West Oak Street Phone: / Fax: , Health Imaging Services, 313 West Bass Street Phone: / Fax: , S, M , Medisound Inc. 301 North John Young Pkwy. Phone: / Fax: , Diagnostic Center 506 West Cherry Street Phone: / Fax: , East Oak Street Kissimmee, FL Phone: / Fax: , S, M , Soca Imaging, Inc. Kissimmee Outpatient Center 1503 West Oak Street Phone: / Fax: , SEMINOLE COUNTY Altamonte Springs , South Westmonte Drive, Suite 1118 Phone: / Fax: Boston Diagnostic Imaging 398 East Altamonte Drive Altamonte Springs, FL Phone: / Fax: , , Douglas Avenue, Suite 1014 Phone: / Fax: , Douglas Avenue, Suite 1110 Phone: / Fax: Casselberry Specialty Imaging Services, Inc Howell Branch Road Casselberry, FL Phone: / Fax: , S, BD , Geneva Women's Mobile Medical Services, 760 Valley Stream Drive Geneva, FL Phone: / Fax: Svcs: M , Lake Mary Cyrus Diagnostic Imaging 165 Waymont Court Phone: , BD, M , South International Pkwy., Suite 1351 Phone: / Fax: , Soca Imaging, Inc. Lake Mary Imaging Center, Inc. 917 Rinehart Road, Suite 1051 Phone: / Fax: , S, BD, M , Longwood Heart Study Center, Inc. 755 West State Road 434, Suite A Longwood, FL Phone: / Fax: Svcs: US , Diagnostic Center 450 West State Road 434, Suite 102 Longwood, FL Phone: / Fax: , BD , Park, P238325, , West State Road 434, Suite 110 Longwood, FL Phone: / Fax: Oviedo 1000 West Broadway, Suite 104 Phone: , Red Bug Lake Road Phone: / Fax: , Winter Springs 1049 Willa Springs Drive, Suite 1051 Winter Springs, FL Phone: / Fax: , Vincon Diagnostic Center 5732 Canton Cove Winter Springs, FL Phone: / Fax: , SUMTER COUNTY The Villages , The Villages Regional Hospital 1451 El Camino Real Phone: / Fax: X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 3 of 4

8 Aetna "Select Provider" Listing - Low-Tech Radiology , Old Camp Road, Bldg. 120, Suite 122 Phone: / Fax: and Breast , The Villages Regional Hospital 1451 El Camino Real Phone: , Old Camp Road, Bldg. 120, Suite 122 Phone: / Fax: Radiological Inst of the Villages 1580 Santa Barbara Blvd., Unit D Phone: / Fax: , M , County Road 101 The Villages, FL Phone: / Fax , M VOLUSIA COUNTY Daytona Beach Twin Lakes Imaging Center , LPGA Blvd., Suite 110 Daytona Beach, FL Phone: / Fax: Deltona LAD Imaging, - HCA Affiliate 1555 Saxon Blvd., Suite 401 Deltona, FL Phone: / Fax: , Morningstar Medical, Inc. 840 Deltona Blvd., Suite O Deltona, FL Phone: / Fax: Svcs: US , Orange City Mid Florida Radiology Centers P.A. 955 Town Center Drive, Suite 200 Orange City, FL Phone: / Fax: , FL, US, S, M , Ormond Beach Florida Hospital Imaging 335 Clyde Morris Blvd. Phone: / Fax: , S, BD, M , Stand-Up MRI & Diagnostic Center, P.A , Stand-up MRI and Diagnostic Center, PA 555 West Granada Blvd. Phone: / Fax: Port Orange Port Orange Imaging Center 1195 Dunlawton Avenue Port Orange, FL Phone: / Fax: , Suncoast Imaging of Port Orange 1680 Dunlawton Avenue Port Orange, FL Phone: / Fax: , X - X-Ray FL - Fluoroscopy US - Ultrasound S - Sonogram BD - Bone Density M - Mammography 4 of 4

9 FLORIDA BREVARD COUNTY Atlantic Surgery and Laser Center, , North Wickham Road, FL Phone: / Fax: Brevard Surgery Center 665 Apollo Blvd. Phone: , GI Center 1051 South Hickory Street, Suite K Phone: / Fax: Svcs: EN, ENT , Same Day Surgery , South Apollo Blvd. Phone: / Fax: Svcs: GEN, EN, LT, OPT, ORP, BA, UR, Nasal Endoscopy Surgery Center, LP 1340 Medical Park Drive, Suite 101 Phone: Svcs: GEN, EN, OPT, ORP, GYN , The Eye Institute Surgery Center 1995 West Nasa Blvd., Suite 200, FL Phone: / Fax: The Surgery Center of 1401 Apollo Blvd. South, Suite B Phone: / Fax: Svcs: EN, ENT , Merritt Island Ambulatory Surgical Care 1045 North Courtenay Pkwy. Merritt Island, FL Phone: , Aetna "Select Provider" Listing - Ambulatory Surgery Courtenay Same Day Surgery 2400 North Courtenay Pkwy., Suite 2 Merritt Island, FL Phone: / Fax: Svcs: GEN, OPT , Rockledge Space Coast Endoscop 1974 Rockledge Blvd., Suite 102 Rockledge, FL Phone: Svcs: EN , INDIAN RIVER COUNTY Sebastian Riverside Surgery Center, Inc , U.S. Hwy. 1 Sebastian, FL Phone: / Fax: LAKE COUNTY Clermont Clermont Ambulatory Surgical Center , Citrus Tower Blvd., Suite 100 Clermont, FL Phone: / Fax: Lady Lake TLC Outpatient Surgery & Laser Center dba KZMSS Again, LLLP , West Guava Street Phone: / Fax: Svcs: GEN, OPT, ORP, ENT,Podiatry Ophthalmology Ctr of Brevard, LP d/b/a ASC of Brev , East New Haven Avenue Leesburg Phone: / Fax: Lake Surgery & Endoscopy Center , County Road 44 Leg A Leesburg, FL , Phone: / Fax: Svcs: EN, EGD/Colonoscopy Mt. Dora Mid Florida Surgery Center US Hwy. 441 Mt. Dora, FL Phone: / Fax: , ORANGE COUNTY Maitland Children's Surgery Center, , Concourse Pkwy. South, Suite 100 Maitland, FL Phone: / Fax: , UR MNH GI Surgical Center, 1101 North Maitland Avenue, Suite 2 Maitland, FL Phone: / Fax: Svcs: Gastro , Park Place Surgery Center 2450 Maitland Center Pkwy., Suite 100 Maitland, FL Phone: / Fax: Svcs: ORP, Podiatry, ENT , Citrus Ambulatory Surgery Center 2861 South Delaney Avenue, Suite B Phone: / Fax: Svcs: EN, Colonoscopy , Filutowski Eye Institute, P.A South Hiawassee Road, Suite 101, FL Phone: / Fax: , Lakeside Surgery Center , North Mills Avenue, FL Phone: / Fax: Svcs: GEN, ORP, UR, Podiatry,ENT,GastroInterlology,GYN Millenia Surgery Center, , South Vineland Road, Suite 150, FL Phone: Svcs: Podiatry/ENT , Vineland Road, Suite 150, FL Phone: / Fax: Svcs: Podiatry/ENT Center for Outpatient Surgery 1405 South Orange Avenue, Suite 400 Phone: Svcs: EN, ORP, Podiatry , Ophthalmology Center, 105 Bonnie Loch Court Phone: / Fax: , Sand Lake Surgery Center, LP , Sandlake Commons Blvd., FL Phone: Svcs: GEN, OPT, ORP, GYN,ENT,GastroInterology GEN - General Surgery EN - Endoscopy INF - Infertility LT - Lithotripsy OPT - Opthalmology ORP - Orthopedics BA - Bariatric UR - Urology 1 of 2

10 Aetna "Select Provider" Listing - Ambulatory Surgery Surgical Licensed Ward 110 West Underwood Street, Suite B Phone: / Fax: Svcs: Gastroenterology , Urological Ambulatory Surgery Center 1812 North Mills Avenue, FL Phone: Svcs: UR , Winter Park Birthing Cottage of Winter Park 434 Grove Avenue Phone: , UR, ENT , Physician's Surgical Care Center 2056 Aloma Avenue, Suite 200 Phone: Svcs: ORP, ENT , University Surgical Center, LTD University Blvd., Suite 100 Phone: Svcs: ENT/Plastic Surgery , OSCEOLA COUNTY Celebration Celebration Surgery Center , Celebration Place, Suite 408 Celebration, FL Phone: , GastroIntestinal, ENT, Hand Kissimmee Doctors Surgery Center, L.L.P. 921 North Main Street Kissimmee, FL Phone: / Fax: , GastroIntestinal , Kissimmee Endoscopy Center 715 Oak Commons Blvd. Phone: / Fax: Svcs: EN, Colonoscopy , SEMINOLE COUNTY Altamonte Springs Florida Eye Clinic Ambulatory Surgery Center , Boston Avenue Altamonte Springs, FL Phone: / Fax: Palm Endoscopy Center 623 Maitland Avenue, Suite 1100 Altamonte Springs, FL Phone: / Fax: , Lake Mary Filutowski Eye Institute, P.A Greenwood Blvd. Phone: / Fax: , Lake Mary Surgery Center, 460 St. Charles Court Phone: / Fax: , ORP, UR, ENT/Plastic , Lake Mary Surgical Center 1070 Greenwood Blvd. Phone: / Fax: , SUMTER COUNTY Lady Lake Endosurg Outpatient Center , North US Hwy. 441 Phone: / Fax: Svcs: Endoscopy VOLUSIA COUNTY Daytona Beach Atlantic Surgery Center , Health Blvd. Daytona Beach, FL Phone: / Fax: Svcs: GEN, LT, OPT, ORP, UR, Podiatry, Gynecology Filutowski Eye Institute, P.A. 110 Yorktowne Drive Daytona Beach, FL Phone: / Fax: , Sunrise Surgical Center 110 Yorktowne Drive Daytona Beach, FL Phone: / Fax: , Orange City Blue Springs Surgery Center 1053 Medical Center Drive, Suite 201 Orange City, FL Phone: / Fax: Svcs: GEN, OPT, ORP, ENT,Podiatry, GI , Orange City Surgery Center, 975 Town Center Drive Orange City, FL Phone: / Fax: , GI, Podiatry , Ormond Beach Physicians Ambulatory Surgical Center , Clyde Morris Blvd., Suite B Phone: / Fax: Svcs: EN, OPT, ORP, UR, Podiatry/Colonoscopy Tomoka Surgery Center, 345 Clyde Morris Blvd., Suite 300 Phone: / Fax: , VESC AKA Volusia Endoscopy and Surgery Center , Memorial Circle, Suite G Phone: / Fax: Svcs: Endoscopy Port Orange Port Orange Endoscopy & Surgery Center, Inc , Dunlawton Avenue, Suite 100 Port Orange, FL Phone: / Fax: Svcs: GastroInterology The Surgery Center of Volusia, L.L.C Clyde Morris Blvd., Suite 500 Port Orange, FL Phone: / Fax: Svcs: GEN, EN, ORP, Plastic/Colonoscopy , 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

11 Aetna "Select Provider" Listing - Sleep Studies FLORIDA BREVARD COUNTY Bay Area Sleep Associates, , West Hibiscus, Suite 100 Phone: / Fax: Space Coast Sleep Disorders Center, , Classic Court, Suite , , FL Phone: / Fax: , East Avenue Phone: , West Eau Gallie Blvd., FL Titusville 407 South Washington Avenue, Suite 2 Titusville, FL Phone: / Fax: , LAKE COUNTY Clermont Sleep Telemedicine Services , East Hwy. 50, Suite A Clermont, FL Phone: / Fax: Lady Lake Advanced Sleep Diagnostics Center Us Hwy. 441, Suite 905 Phone: / Fax: , Sleep Telemedicine Services Oakland Hills Professional Center U.S. 441, Bldg. 800 Suite 803 Phone: / Fax: , Umatilla State Road 19 Umatilla, FL Phone: , ORANGE COUNTY Ocoee Sleep Telemedicine Services , Boren Drive, Suite 400 Phone: / Fax: Sleep Care Solutions of Central FL University Blvd., Suite 409, FL Phone: , Sleep Telemedicine Services 1900 North Mills Avenue, Suite 104, FL Phone: / Fax: , North Orange Avenue, Suite B, FL , Cypress Crossing Drive, FL , Lake Baldwin Lane, FL Universal Sleep Disorder Centers, Inc Turkey Lake Road, Suite 1-1, FL Phone: / Fax: , Winter Park Sleep Care Solutions of Central FL 1561 West Fairbanks Avenue Mri Suite Phone: / Fax: , OSCEOLA COUNTY Kissimmee Central Florida Sleep Centers , North Central Avenue Phone: / Fax: , West Oak Street Phone: / Fax: Sleep Telemedicine Services 721 Oak Commons Blvd., Suite C Phone: / Fax: , SEMINOLE COUNTY Altamonte Springs Sleepmed, Inc. Dba Digitrace Care Services , Douglas Avenue, Suite 101 Phone: / Fax: , Douglas Avenue, Suite 109 Phone: / Fax: Oviedo Falcon Sleep Center 120 Alexandria Blvd., Suite 19 Phone: / Fax: , Burnsed Place, Suite , VOLUSIA COUNTY Daytona Beach Shores Advanced Sleep Diagnostics Center , South Atlantic Avenue Daytona Beach Shores, FL Phone: / Fax: Deland 901 North Stone Street Deland, FL , Orange City 201 South Volusia Avenue Orange City, FL Phone: / Fax: , Ormond Beach Advanced Sleep Diagnostics Center 26 North Beach Street, Suite C Phone: , of 1