A B C D E F G H I J K L M N O Total MRI Outpt No Inpt No ... · Concord (Alliance Healthcare...

Table 17E-1: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents

Service Type Service Site (Provider/Owner)CON #Total MRI

Scans

Inpt

Contrast

Inpt No

Contrast

Outpt

ContrastService Area

Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast

A B C D E F G H I J K L M N O

1,649Hospital

Fixed

G-006214-00 6,929 2719424,067Alamance Alamance Regional Medical Center 8,1822 2.00

225Mobile 768 00543Alamance Alamance Regional Outpatient

Imaging Center 8580 0.19

5Mobile G-7038-04 190 00185Alamance EmergeOrtho, P.A. (Alliance

Healthcare Services)1920 0.05

223Mobile 758 00535Alamance MedCenter - Mebane 8470 0.18

5Mobile G-7038-04 153 00148Alamance UNC Hospitals-Burlington (Alliance


74Mobile Grandfathered 272 00198Alamance University of North Carolina

(Alliance Healthcare Services)3020 0.07

7Mobile Grandfathered 26 0019Alamance University of North Carolina


Alamance 9,096 10,5652 4,1182.54 4,159 1

No Service Site

Alexander 1,716 0

15Mobile Grandfathered 101 1085Alleghany Alleghany Memorial Hospital


Alleghany 101 1080 1,7160.06 108 0

11Mobile F-006868-03 67 0254Anson Atrium Health-Anson (Carolinas

Imaging Services, LLC)720 0.04

Anson 67 720 1,7160.04 72 0

239Hospital

Fixed

D-008162-08 988 8175593Ashe Ashe Memorial Hospital, Inc. 1,1781 1.00

Ashe 988 1,1781 3,7751.00 1,178 0

69Mobile Grandfathered 366 28287Avery Charles A Cannon Memorial

Hospital (Alliance Healthcare

Services)

3980 0.21

Avery 366 3980 1,7160.21 398 0

477Hospital

Fixed

Q-005992-99 1,908 1281751,128Beaufort Vidant Beaufort Hospital 2,2711 1.00

0Mobile Grandfathered 0 000Beaufort Vidant Pungo Hospital (Alliance


Beaufort 1,908 2,2711 3,7751.00 2,271 0

No Service Site

Bertie 1,716 0

105Mobile M-006605-02 380 00275Bladen Bladen Healthcare, LLC (Mobile

Imaging of North Carolina, LLC)4220 0.22

79Mobile 339 421235Bladen Cape Fear Valley-Bladen County

Hospital 3820 0.20

Bladen 719 8040 1,7160.42 804 0

232Hospital

Fixed

Grandfathered (Alliance) 764 113518Brunswick J. Arthur Dosher Memorial Hospital 8671 1.00

944Hospital

Fixed

O-006658-02 3,624 1293282,223Brunswick Novant Health Brunswick Medical

Center 4,2361 1.00

222Freestand-

ing Fixed

Grandfathered (installed

mobile)772 87535Brunswick Arthur Dosher Memorial Hospital


DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


103Mobile Grandfathered Scanner 1,390 001,287Brunswick EmergeOrtho (InSight Imaging) 1,4310 0.31

85Mobile Grandfathered (Alliance) 322 54228Brunswick J. Arthur Dosher Memorial Hospital 3620 0.07

436Mobile F-007001-04 839 00403Brunswick New Hanover Regional Medical

(Alliance Healthcare Services)1,0130 0.19

0Mobile O-006434-01 156 00156Brunswick Novant Health Imaging South (Cape

Fear Diagnostic Imaging, Inc.)1560 0.03

0Mobile 133 00133Brunswick Novant Health Imaging South

Brunswick (Cape Fear Diag.

Imaging)

1330 0.03

Brunswick 8,000 9,0683 4,4623.63 2,498 0

532Hospital

Fixed

1,280 00748Buncombe Mission Childrens 1,4931 1.00

847Hospital

Fixed

2,188 001,341Buncombe Mission Hospital - Carolina Spine &

Neurosurgery 2,5271 1.00

1,691Hospital

Fixed

8,363 2,0032,0572,612Buncombe Mission Hospital - Main 11,4652 2.00

376Hospital

Fixed

B-006215-00 937 28721658Buncombe Mission Hospital - St. Joseph

Campus 1,4031 1.00

54Freestand-

ing Fixed

B-006643-02 2,685 002,631Buncombe EmergeOrtho- Blue Ridge Division

(InSight Imaging)2,7071 1.00

2,422Freestand-

ing Fixed

B-004178-90 5,234 002,812Buncombe Mission Imaging Services (Mission

Imaging Services LLC)6,2031 1.00

3,144Freestand-

ing Fixed

B-006646-01 5,406 002,262Buncombe Mission Imaging Services (Mission

Imaging Services LLC)6,6641 1.00

0Freestand-

ing Fixed

B-005492-96 3,755 000Buncombe Open MRI and Imaging of Asheville

(Asheville Open MRI, Inc)01 1.00

0Freestand-

ing Fixed

B-006440-01 2,081 000Buncombe Open MRI and Imaging of Asheville

(Asheville Open MRI, Inc)01 1.00

0Freestand-

ing Fixed

B-006440-01 4,733 000Buncombe Open MRI of Asheville (Asheville

Open MRI, Inc)00.00

15Mobile Grandfathered 368 00353Buncombe Margaret R Pardee Memorial

Hospital (Alliance Healthcare

Services)

3740 0.08

69Mobile 215 00146Buncombe Mission Hospital - Carolina Spine &

Neurosurgery 2430 0.04

0Mobile Grandfathered 0 000Buncombe Open MRI & Imaging of Asheville

(King's Medical Group)00 0.00

Buncombe/Graham/Madison/Yancey 37,245 33,07710 4,80510.12 3,268 0

825Hospital

Fixed

E-006961-03; E-007203-

052,815 2563321,402Burke Carolinas HealthCare System Blue

Ridge - Main 3,4831 1.00

381Hospital

Fixed

1,123 00742Burke Carolinas HealthCare System Blue

Ridge - Valdese 1,2751 1.00

405Mobile E-007066-04 1,827 001,422Burke Blue Ridge-Hickory (Blue Ridge

Radiology Associates, P.A.)1,9890 0.44

67Mobile E-8230-08 1,512 001,445Burke EmergeOrtho - Morganton (Carolina

Orthopaedic Specialists)1,5390 0.37

Burke 7,277 8,2862 4,1182.81 2,949 0

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


2,462Hospital

Fixed

6,526 004,064Cabarrus Carolinas Healthcare System

Northeast - Copperfield Imaging

Center

7,5112 2.00

1,981Hospital

Fixed

F-005933-98; F-006629-

02; F-007086-049,192 1,3913,3042,516Cabarrus Carolinas Healthcare System

Northeast - Main 12,4192 2.00

375Hospital

Fixed

1,277 00902Cabarrus Carolinas Healthcare System

Northeast - MRI 1,4271 1.00

7Freestand-

ing Fixed

F-5916-98 176 00169Cabarrus Cabarrus Diagnostic Imaging

(Novant Health Imaging Cabarrus)1791 1.00

239Freestand-

ing Fixed

F-7859-07 1,554 001,315Cabarrus Carolinas Healthcare System -

Kannapolis (Union Medical

Services, LLC)

1,6501 1.00

147Mobile 1,163 001,016Cabarrus Carolina Neuro & Spine Assoc -

Concord (Alliance Healthcare

Services)

1,2220 0.24

125Mobile F-008237-08 666 00541Cabarrus Mecklenburg Diagnostic Imaging,

Inc. - Cabarrus (Mecklenburg

Diagnostic Imaging, Inc.)

7160 0.14

28Mobile F-005723-97 50 0022Cabarrus Mecklenburg Neurology - Concord

(InSight Imaging)610 0.01

275Mobile G-007065-04 1,305 001,030Cabarrus Novant Health Cabarrus (Novant

Health Forsyth Medical Center)1,4150 0.27

5Mobile Grandfathered 15 0010Cabarrus Novant Health Imaging Cabarrus


212Mobile Grandfathered 2,288 002,076Cabarrus OrthoCarolina, P.A. (Alliance

Healthcare Services)2,3730 0.48

Cabarrus 24,212 28,9897 4,8058.14 3,561 0

442Hospital

Fixed

2,579 1324131,592Caldwell Caldwell Memorial Hospital 3,0271 1.00

113Mobile E-8230-08 1,329 001,216Caldwell EmergeOrtho - Lenoir (Carolina


Caldwell 3,908 4,4011 3,7751.35 3,260 0

1,116Hospital

Fixed

P-005282-95 3,527 2143551,842Carteret Carteret General Hospital 4,2871 1.00

434Freestand-

ing Fixed

P-8049-03 1,823 001,389Carteret Seashore Imaging, LLC (Seashore

Imaging)1,9971 1.00

0Mobile O-006434-01 399 00399Carteret Carolina Center For Surgery (Cape

Fear Diagnostic Imaging, Inc.)3990 0.10

0Mobile O-006434-01 543 00543Carteret Moore Orthopedics and Sports

(Cape Fear Diagnostic Imaging, Inc.)5430 0.13

Carteret 6,292 7,2252 4,1182.23 3,240 0

1,217Hospital

Fixed

2,504 001,287Catawba Catawba Valley Medical Center -

Imaging Center 2,9911 1.00

641Hospital

Fixed

2,622 371781829Catawba Catawba Valley Medical Center -

Main 3,4881 1.00

608Hospital

Fixed

2,033 001,425Catawba Frye Regional Medical Center - Tate

Campus 2,2761 1.00

727Hospital

Fixed

2,845 429729960Catawba Frye Regional Medical Center- Main 3,7711 1.00

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


250Mobile E-8230-08 1,845 001,595Catawba EmergeOrtho - Hickory (Carolina


34Mobile E-8230-08 336 00302Catawba EmergeOrtho - Newton (Carolina

Orthopaedic Specialists)3500 0.07

711Mobile E-004812-93; E-005922-

98; E-007856-071,553 00842Catawba Frye Regional Medical Center 1,8370 0.32

686Mobile 1,483 00797Catawba Frye Regional Medical Center - Tate

Campus 1,7570 0.31

229Mobile G-006271-00 2,930 002,701Catawba OrthoCarolina Hickory (Alliance


Catawba 18,151 21,4364 4,8055.69 3,767 0

211Mobile G-7038-04 719 2114473Chatham Chatham Hospital (Alliance


Chatham 719 8260 1,7160.42 826 0

498Hospital

Fixed

A-006767-03 1,728 10491,171Cherokee Erlanger Murphy Medical Center 1,9551 1.00

Cherokee/Clay 1,728 1,9551 3,7751.00 1,955 0

552Hospital

Fixed

R-008168-08 1,998 65681,313Chowan Vidant Chowan Hospital 2,2981 1.00

Chowan 1,998 2,2981 3,7751.00 2,298 0

445Hospital

Fixed

C-006915-03 1,458 37145831Cleveland Atrium Health Kings Mountain 1,7241 1.00

1,259Hospital

Fixed

4,236 2336592,085Cleveland Carolinas HealthCare System

Cleveland 5,1901 1.00

0Mobile Grandfathered 999 00999Cleveland OrthoCarolina-Shelby (Alliance


Cleveland 6,693 7,9122 4,1182.24 3,532 0

449Hospital

Fixed

O-006426-01 2,304 1904111,254Columbus Columbus Regional Healthcare

System 2,8001 1.00

Columbus 2,304 2,8001 3,7751.00 2,800 0

859Hospital

Fixed

3,846 3421,0241,621Craven CarolinaEast Medical Center 4,8731 1.00

731Hospital

Fixed

2,004 6151,252Craven CarolinaEast Medical Center -

Diiagnostic Center 2,3071 1.00

1,094Freestand-

ing Fixed

P-008108-08 3,385 002,291Craven Coastal Carolina Health Care

Imaging Center (Coastal Carolina

Health Care, P.A.)

3,8231 1.00

957Freestand-

ing Fixed

P-006764-03 3,641 002,684Craven Coastal Carolina Health Care

Imaging Center (Coastal Carolina

Health Care, P.A.)

4,0241 1.00

Craven/Jones/Pamlico 12,876 15,0264 4,8054.00 3,757 0

1,151Hospital

Fixed

7,989 1,1883,6991,951Cumberland Cape Fear Valley Medical Center 10,8793 3.00

1,151Hospital

Fixed

M-006603-02 7,989 1,1883,6991,951Cumberland Cape Fear Valley Medical Center 10,8793 3.00

1,046Freestand-

ing Fixed

M-007924-07 5,101 004,055Cumberland Carolina Imaging of Fayetteville 5,5191 1.00

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


999Freestand-

ing Fixed

M-005899-98 4,927 003,928Cumberland Carolina Imaging of Fayetteville 5,3271 1.00

1,105Freestand-

ing Fixed

M-005905-98 6,293 005,188Cumberland Valley Regional Imaging (Medical

Imaging Center)6,7351 1.00

737Freestand-

ing Fixed

Grandfathered 4,196 003,459Cumberland Valley Regional Imaging (Medical

Imaging Center)4,4911 1.00

0Mobile 0 000Cumberland Cape Fear Valley Medical Center 00 0.00

Cumberland 36,495 43,83110 4,80510.00 4,383 0

819Hospital

Fixed

R-007329-05 2,297 52611,365Dare The Outer Banks Hospital, Inc. 2,6911 1.00

15Mobile R-006293-00 83 0068Dare Sentara Kitty Hawk Advanced

Imaging Center (Sentara Albemarle

Regional Medical Center)

890 0.02

Dare 2,380 2,7801 3,7751.02 2,725 0

805Hospital

Fixed

G-006443-01 3,102 641402,093Davidson Lexington Medical Center 3,5311 1.00

496Hospital

Fixed

G-006826-03 2,781 1503041,831Davidson Novant Health Thomasville Medical

Center 3,2211 1.00

Davidson 5,883 6,7522 4,1182.00 3,376 0

0Hospital

Fixed

0 000Davie Davie Medical Center 01 1.00

618Mobile Grandfathered 2,014 38741,284Davie Davie County Hospital (Alliance


Davie 2,014 2,3211 3,7751.53 1,517 0

307Mobile Q-6884-03 1,189 203159520Duplin Duplin General Hospital Inc.

(Alliance Healthcare Services &

University Health Systems of Eastern

NC)

1,5380 0.69

Duplin 1,189 1,5380 1,7160.69 1,538 0

2,989Hospital

Fixed

Grandfathered; J-006207-

009,034 7251,3114,009Durham Duke Regional Hospital 11,3342 2.00

18,722Hospital

Fixed

J-005589-97; J-006109-

99; J-008030-07; J-

008275-08; J-008466-10;

J-008663-11; J-001112-

15

36,299 6,0253,5887,964Durham Duke University Hospital - Main 50,0439 9.00

408Hospital

Fixed

1,920 001,512Durham Duke University Hospital -

Southpoint Clinic 2,0831 1.00

655Freestand-

ing Fixed

J-006760-03 1,908 001,253Durham Durham-Independence Park

(Durham Diagnostic Imaging-

Independence Park)

2,1701 1.00

412Freestand-

ing Fixed

J-007031-04 5,432 005,020Durham EmergeOrtho 5,5971 1.00

71Freestand-

ing Fixed

J-008107-08 1,372 001,301Durham EmergeOrtho 1,4001 1.00

757Mobile Grandfathered 1,969 001,212Durham Duke Regional Hospital (Alliance


1,935Mobile 2,962 001,027Durham Duke University Hospital - Lenox

Baker 3,7360 0.62

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


0Mobile 1,061 001,061Durham Duke University Hospital - Page

Road 1,0610 0.22

113Mobile O-006665-02 408 00295Durham Durham - Southpark (Cape Fear

Mobile Imaging, LLC)4530 0.08

0Mobile Grandfathered 0 000Durham Durham Diagnostic - Independence

Park (King's Medical Group)00 0.00

143Mobile M-006605-02 578 00435Durham Durham Diagnostic Imaging at

Triangle Medical Park (Mobile

Imaging of North Carolina, LLC)

6350 0.12

0Mobile J-008453-09 125 00125Durham EmergeOrtho 1250 0.03

234Mobile Grandfathered 380 00146Durham Raleigh Neurology Imaging


Durham/Caswell 63,448 81,38315 4,80516.56 4,914 1

503Hospital

Fixed

L-008327-09 2,074 2452491,077Edgecombe Vidant Edgecombe Hospital 2,5711 1.00

Edgecombe 2,074 2,5711 3,7751.00 2,571 0

9,956Hospital

Fixed

G-007083-04; G-008372-

0922,536 3,6522,8186,110Forsyth North Carolina Baptist Hospital 30,5676 6.00

1,428Hospital

Fixed

10,721 2,4223,6413,230Forsyth Novant Health Forsyth Medical

Center 14,6862 2.00

302Hospital

Fixed

1,458 21401,095Forsyth Novant Health Forsyth Medical

Center-Clemmons 1,6121 1.00

415Hospital

Fixed

1,564 93180876Forsyth Novant Health Forsyth Medical

Center-Kernersville 1,8761 1.00

500Hospital

Fixed

1,886 001,386Forsyth Novant Health Forsyth Medical

Center-Novant Health Imaging

Kernersville

2,0861 1.00

3,482Hospital

Fixed

Grandfathered; G-

007387-057,789 004,307Forsyth Novant Health Forsyth Medical


Maplewood

9,1822 2.00

1,235Freestand-

ing Fixed

G-006893-03 5,208 003,973Forsyth Novant Health Imaging Piedmont

(Piedmont Imaging, LLC)5,7021 1.00

1,200Freestand-

ing Fixed

Grandfathered 5,002 003,782Forsyth Novant Health Imaging Piedmont

(Piedmont Imaging, LLC)5,4621 1.00

1,927Freestand-

ing Fixed

G-007780-07 6,203 004,276Forsyth Wake Forrest Baptist Imaging

(Wake Forest Baptist Imaging)6,9741 1.00

107Mobile G-7053-04 514 00407Forsyth Cone Health MedCenter

Kernersville (Alamance Regional

Medical Center)

5570 0.11

3Mobile G-7038-04 40 0037Forsyth Cone Health MedCenter-

Kernersville (Alliance Healthcare

Services)

410 0.01

58Mobile F-005723-97 222 00164Forsyth Forsyth Imaging Center (InSight

Imaging)2450 0.05

529Mobile 2,201 001,672Forsyth Novant Health Forsyth Medical

Center-Mobile MRI 2,4130 0.46

37Mobile G-007723-06 517 00480Forsyth OrthoCarolina Kernersville

(OrthoCarolina, P.A.)5320 0.11

385Mobile G-007723-06 4,399 004,014Forsyth OrthoCarolina Winston Salem

(OrthoCarolina, P.A.)4,5530 0.92

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


00 000Forsyth 2019 SMFP Need Determination 01 1.00

Forsyth 70,260 86,48817 4,80518.66 4,635 0

No Service Site

Franklin 1,716 0

1,900Hospital

Fixed

F-006620-02 7,052 1,2741,9191,959Gaston CaroMont Regional Medical Center 9,5991 1.00

1,481Hospital

Fixed

F-006622-02 3,691 002,210Gaston CaroMont Regional Medical Center

(CIS Belmont) 4,2831 1.00

1,276Hospital

Fixed

2,724 001,448Gaston CaroMont Regional Medical Center-

CaroMont Imaging Services Summit 3,2341 1.00

0Hospital

Fixed

0 000Gaston The Diagnostic Center 01 1.00

396Freestand-

ing Fixed

F-008793-12 2,744 002,348Gaston Novant Health Imaging Gastonia

(Mecklenburg Diagnostic Imaging

LLC)

2,9021 1.00

600Mobile F-008000-07 1,822 001,222Gaston MRI Specialists (MRI Specialists of

the Carolinas, LLC)2,0620 0.38

105Mobile F-008000-07 374 00269Gaston MRI Specialists (MRI Specialists of

the Carolinas, LLC)4160 0.08

30Mobile Grandfathered 424 00394Gaston OrthoCarolina, P.A. (Alliance


45Mobile Grandfathered 468 00423Gaston OrthoCarolina-Gastonia (Alliance


Gaston 19,299 23,4195 4,8055.65 4,145 0

191Hospital

Fixed

K-010064-12 1,229 44160834Granville Granville Health System 1,4051 1.00

0Mobile J-007043-04 87 33540Granville Central Regional Hospital

(WakeMed Health and Hospitals)1350 0.02

Granville 1,316 1,5401 3,7751.02 1,509 0

1,497Hospital

Fixed

10,369 1,5403,9633,369Guilford Cone Health-Moses H. Cone

Memorial Hospital 13,7853 3.00

1,814Hospital

Fixed

3,974 4076161,137Guilford Cone Health-Wesley Long Hospital 5,2721 1.00

1,508Hospital

Fixed

G-005924-98 6,234 6411,4942,591Guilford High Point Regional Health 7,9482 2.00

2,671Freestand-

ing Fixed

G-007269-05 0 00925Guilford Cornerstone Imaging (Cornerstone

Health Care, PA)4,6641 1.00

2,074Freestand-

ing Fixed

Grandfathered 5,281 003,207Guilford Greensboro Imaging (Diagnostic

Radiology & Imaging, LLC)6,1111 1.00

1,942Freestand-

ing Fixed

4,876 002,934Guilford Greensboro Imaging (Diagnostic


1,545Freestand-

ing Fixed

G-006952-03 4,056 002,511Guilford Greensboro Imaging (Diagnostic


372Freestand-

ing Fixed

G-008347-09 5,881 005,509Guilford Greensboro Orthopaedics PA

(Greensboro Orthopaedics, P.A.)6,0301 1.00

894Freestand-

ing Fixed

Grandfathered 4,268 003,374Guilford Triad Imaging (Novant Health

Imaging Triad)4,6261 1.00

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


164Mobile Grandfathered 506 00342Guilford Cone MedCenter High Point-

Greensboro (Alliance Healthcare

Services)

5720 0.11

564Mobile 1,702 001,138Guilford Carolina Neuro and Spine Assoc

Greensboro (Alliance Healthcare

Services)

1,9280 0.35

11Mobile G-7038-04 46 0035Guilford Cone Health/MedCenter High Point


181Mobile 570 00389Guilford Cone Health-MedCenter High Point 6420 0.12

3Mobile Grandfathered 540 00537Guilford Cone MedCenter High Point


490Mobile Grandfathered 4,943 004,453Guilford SE Orthopaedic Specialists, PA


Guilford 53,246 67,63412 4,80513.70 4,937 1

275Hospital

Fixed

L-007257-05 1,579 28282994Halifax Halifax Regional Medical Center,

Inc. 1,8241 1.00

18Mobile J-008453-09 588 00570Halifax Northern Carolina Orthopaedic

(EmergeOrtho)5950 0.16

Halifax/Northampton 2,167 2,4191 3,7751.16 2,086 0

418Hospital

Fixed

1,771 1321611,060Harnett Betsy Johnson 2,1081 1.00

157Hospital

Fixed

810 64101488Harnett Central Harnett Hospital 9641 1.00

218Mobile M-006605-02 872 00654Harnett Carolina Regional Radiology

(Mobile Imaging of North Carolina,

LLC)

9590 0.21

Harnett 3,453 4,0322 4,1182.21 1,824 0

1,143Hospital

Fixed

A-005060-94; A-007807-

074,382 1563772,706Haywood Haywood Regional Medical Center 5,1152 2.00

Haywood 4,382 5,1152 4,1182.00 2,557 0

748Hospital

Fixed

2,607 1112281,520Henderson Advent Health Hendersonville 3,0861 1.00

2,155Hospital

Fixed

B-006004-99 5,968 2082863,319Henderson Margaret R. Pardee Memorial

Hospital 7,1112 2.00

Henderson 8,575 10,1973 4,4623.00 3,399 0

427Hospital

Fixed

Q-007213-05 1,848 1901961,035Hertford Vidant Roanoke-Chowan Hospital 2,2491 1.00

Hertford/Gates 1,848 2,2491 3,7751.00 2,249 0

0Hospital

Fixed

0 000Hoke Cape Fear Valley Hoke Hospital 01 1.00

0Hospital

Fixed

N-011284-17 0 000Hoke FirstHealth Moore Regional

Hospital - Hoke Campus 01 1.00

65Mobile O-006434-01 386 00321Hoke First Health Hoke Community

Hospital (Cape Fear Diagnostic

Imaging, Inc.)

4120 0.09

46Mobile H-006104-99 489 217424Hoke First Health Moore Regional

Hospital - Hoke (FirstHealth of the

Carolinas, Inc.)

5160 0.12

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


8Mobile J-007008-04 52 0044Hoke Frst Health Hoke Community

Hospital (Foundation Health Mobile

Imaging LLC)

550 0.01

Hoke 927 9832 4,1182.22 443 0

215Hospital

Fixed

F-006728-02 1,328 97250766Iredell Davis Regional Medical Center 1,5921 1.00

1,199Hospital

Fixed

F-005340-96 3,940 4485961,687Iredell Iredell Memorial Hospital 5,0061 1.00

871Hospital

Fixed

F-005815-98; F-006591-

023,077 2248011,181Iredell Lake Norman Regional Medical

Center 3,9252 2.00

1,032Freestand-

ing Fixed

F-006957-03 3,392 002,360Iredell Piedmont Healthcare (Alliance


133Mobile F-007164-04 714 00581Iredell Mooresville Diagnostic Imaging

(Presbyterian Mobile Imaging, LLC)7670 0.15

87Mobile Grandfathered 262 00175Iredell Novant Health Imaging Mooresville


105Mobile Grandfathered mobile unit 670 00565Iredell Novant Health Imaging Mooresville


254Mobile G-007065-04 896 00642Iredell Novant Health Mooresville (Novant

Health Forsyth Medical Center)9980 0.19

0Mobile Grandfathered 992 00992Iredell Ortho Carolina Mooresville


0Mobile Grandfathered 453 00453Iredell Ortho Carolina-Mooresville


614Mobile Grandfathered 1,583 00969Iredell Piedmont Healthcare (Alliance


Iredell 17,307 20,3755 4,8056.16 3,308 0

828Hospital

Fixed

A-006797-03; A-008195-

083,397 1022282,239Jackson Harris Regional Hospital 3,9012 2.00

Jackson 3,397 3,9012 4,1182.00 1,951 0

681Hospital

Fixed

J-007900-07 2,345 1152711,278Johnston Johnston Health-Clayton 2,8181 1.00

823Hospital

Fixed

3,267 2584631,723Johnston Johnston Health-Smithfield 3,9881 1.00

717Mobile J-008268-08 4,581 003,801Johnston Raleigh Radiology at Clayton

(Pinnacle Health Services of NC,

LLC)

4,8050 1.00

Johnston 10,193 11,6102 4,4623.00 3,870 0

296Hospital

Fixed

J-005901-98 2,043 652371,445Lee Central Carolina Hospital 2,3081 1.00

Lee 2,043 2,3081 3,7751.00 2,308 0

792Hospital

Fixed

2,786 3703481,276Lenoir UNC Lenoir Health Care 3,5381 1.00

Lenoir 2,786 3,5381 4,1181.00 3,538 0

966Hospital

Fixed

F-008081-08; F011440-

174,816 1907562,904Lincoln Carolinas HealthCare System Lincoln 5,6572 2.00

Lincoln 4,816 5,6572 4,1182.00 2,828 0

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


513Hospital

Fixed

2,060 19731,455Macon Angel Medical Center 2,3101 1.00

94Hospital

Fixed

A-007197-05 457 45354Macon Highlands-Cashiers Hospital 5001 1.00

20Mobile Grandfathered 319 00299Macon Duke LifePoint Harris Regional At

Franklin Med (Alliance Healthcare

Services)

3270 0.08

Macon 2,836 3,1362 4,1182.08 1,508 0

1Mobile Grandfathered 3 002Martin CHS - Martin General Hospital


50Mobile Q-6884-03 464 35406Martin CHS Martin General Hospital

(Alliance Healthcare Services &

University Health Systems of Eastern

NC)

4880 0.27

Martin 467 4920 1,7160.27 492 0

526Hospital

Fixed

C-007304-05 1,803 59631,155McDowell Mission Hospital McDowell 2,0861 1.00

123Mobile E-007066-04 731 00608McDowell Blue Ridge Marion (Blue Ridge

Radiology Associates, P.A.)7800 0.19

McDowell 2,534 2,8661 3,7751.19 2,408 0

1,606Hospital

Fixed

F-006830-03; F-011425-

177,164 6541,7633,141Mecklenburg Atrium Health Pineville 9,0352 2.00

1,218Hospital

Fixed

F-005919-98 4,722 2957862,423Mecklenburg Atrium Health University City 5,7601 1.00

6,079Hospital

Fixed

17,984 3,2524,2294,424Mecklenburg Carolinas Medical Center - Main 24,7094 4.00

1,023Hospital

Fixed

5,269 4501,4512,345Mecklenburg Carolinas Medical Center - Mercy 6,6191 1.00

2,119Hospital

Fixed

F-005580-97; F-008237-

086,328 2825393,388Mecklenburg Novant Health Huntersville Medical

Center 7,6172 2.00

2,350Hospital

Fixed

F-006379-01; F-008688-

117,011 3498343,478Mecklenburg Novant Health Matthews Medical

Center 8,5641 1.00

0Hospital

Fixed

0 000Mecklenburg Novant Health Mint Hill Medical

Center 01 1.00

938Hospital

Fixed

3,002 7122,045Mecklenburg Novant Health Presbyterian Medical

Center-Charlotte Orthopedic Hospital 3,3881 1.00

3,533Hospital

Fixed

F-002332-85 9,967 1,3162,1352,983Mecklenburg Novant Health Presbyterian Medical

Center-Main 13,2872 2.00

1,160Hospital

Fixed

3,041 001,881Mecklenburg Novant Health Presbyterian Medical


Museum

3,5051 1.00

487Freestand-

ing Fixed

F-008106-08 4,276 003,789Mecklenburg Carolina NeuroSurgery & Spine

Associates Charlotte (Carolina

NeuroSurgery & Spine Associates)

4,4711 1.00

1,359Freestand-

ing Fixed

F-007167-04 4,097 002,738Mecklenburg Carolinas Imaging Services-

Ballantyne (Carolinas Imaging

Services, LLC)

4,6411 1.00

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


255Freestand-

ing Fixed

F-011182-16 883 621601Mecklenburg Carolinas Imaging Services-

Huntersville (Carolinas Imaging

Services, LLC)

9981 1.00

1,588Freestand-

ing Fixed

F-005918-98 3,547 001,959Mecklenburg Carolinas Imaging Services-

Southpark (Carolinas Imaging

Services, LLC)

4,1821 1.00

873Freestand-

ing Fixed

F-007068-04 4,318 003,445Mecklenburg Novant Health Imaging

Southpark(Mecklenburg)

(Mecklenburg Diagnostic Imaging,

Inc.)

4,6671 1.00

377Freestand-

ing Fixed

F-10287-14 8,028 007,651Mecklenburg OrthoCarolina Ballantyne


1,605Freestand-

ing Fixed

J-006698-02 6,760 005,155Mecklenburg OrthoCarolina Spine Center


1,080Freestand-

ing Fixed

F-005748-97 3,311 002,231Mecklenburg PIC- Ballantyne (Novant Health

Imaging Ballantyne)3,7431 1.00

520Mobile F-006830-03; F-011425-

17997 00477Mecklenburg Atrium Health Pineville 1,2050 0.21

26Mobile F-006868-03 37 0011Mecklenburg Atrium Health- Pineville (Carolinas

Imaging Services, LLC)470 0.01

141Mobile F-005919-98 791 30166454Mecklenburg Atrium Health University City 9380 0.16

130Mobile F-006868-03 399 00269Mecklenburg Atrium Health,Carolina Neurological

(Carolinas Imaging Services, LLC)4510 0.08

193Mobile F-006734-03 1,479 001,286Mecklenburg Ballantyne (Carolina NeuroSurgery

& Spine Associates)1,5560 0.31

88Mobile 767 00679Mecklenburg Carolina Neurosurgery & Spine

Associates Charlotte (Alliance

Healthcare Services)

8020 0.16

979Mobile F-006734-03 4,772 003,793Mecklenburg Carolina NeuroSurgery & Spine

Associates-Charlotte (Carolina

NeuroSurgery & Spine Associates)

5,1640 0.99

683Mobile F-007040-04 2,165 6181,455Mecklenburg Carolinas Imaging Services-

Huntersville (Carolinas Imaging

Services, LLC)

2,4470 0.45

78Mobile 123 0045Mecklenburg Carolinas Medical Center - Main 1540 0.03

417Mobile Grandfathered 464 0047Mecklenburg Charlotte Eye, Eart, Nose & Throat


236Mobile F-005723-97 431 00195Mecklenburg Mecklenburg Neurological

Associates (InSight Imaging)5250 0.09

304Mobile Grandfathered mobile unit 887 00583Mecklenburg Novant Health Huntersville Medical

Center (King's Medical Group)1,0090 0.18

98Mobile Grandfathered 204 00106Mecklenburg Novant Health Huntersville Medical

Center (King's Medical Group)2430 0.04

96Mobile Grandfathered 703 00607Mecklenburg Novant Health Imaging Steele Creek


182Mobile Grandfathered 712 00530Mecklenburg Novant Health Imaging University


182Mobile Grandfathered mobile unit 660 00478Mecklenburg Novant Health Imaging University


63Mobile F-007164-04 216 00153Mecklenburg Novant Health Imaging University


DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


71Mobile F-007164-04 180 00109Mecklenburg Novant Health Imaging-Steele Creek


271Mobile Grandfathered 624 00353Mecklenburg Novant Health Matthews Medical

Center (King's Medical Group)7320 0.13

0Mobile Grandfathered 438 00438Mecklenburg OrthoCarolina (Alliance Healthcare

Services)4380 0.09

201Mobile F-007987-07 1,575 001,374Mecklenburg OrthoCarolina - Huntersville


0Mobile F-007987-07 2,634 002,634Mecklenburg OrthoCarolina Matthews


252Mobile F-007987-07 2,705 002,453Mecklenburg OrthoCarolina Mobile Spine


0Mobile Grandfathered 967 00967Mecklenburg OrthoCarolina, P.A. (Alliance


107Mobile Grandfathered 820 00713Mecklenburg OrthoCarolina-Spine Center


00 000Mecklenburg 2019 SMFP Need Determination 01 1.00

Mecklenburg 125,458 148,74125 4,80530.36 4,899 1

377Hospital

Fixed

D-006866-03 1,360 3428921Mitchell Blue Ridge Regional Hospital 1,5491 1.00

Mitchell 1,360 1,5491 3,7751.00 1,549 0

66Mobile J-007008-04 369 00303Montgomery First Health Montgomery Memorial

Hospital (Foundation Health Mobile

Imaging LLC)

3950 0.22

Montgomery 369 3950 1,7160.22 395 0

1,273Hospital

Fixed

H-005602-97; H-006846-

03; H-007097-0412,644 3752,2808,716Moore FirstHealth Moore Regional Hospital 14,3653 3.00

173Freestand-

ing Fixed

H-006845-03 5,517 005,344Moore Pinehurst Surgical Clinic PA


702Freestand-

ing Fixed

H-008365-09 2,449 001,747Moore Southern Pines Diagnostic Imaging

(Triad Imaging, LLC)2,7301 1.00

0Mobile Grandfathered 0 000Moore Southern Pines Diagnostic Imaging


Moore 20,610 22,6815 4,8055.00 4,536 0

1,035Hospital

Fixed

L-005908-98 4,741 2007162,790Nash Nash General Hospital 5,6012 2.00

101Mobile Grandfathered 214 00113Nash Boice- Willis Clinic (InSight

Imaging)2540 0.05

64Mobile Grandfathered 112 0048Nash Boice-Willis Clinic (InSight Imaging) 1380 0.03

0Mobile Grandfathered 10 0010Nash Carolina Regional Orthopaedics


0Mobile Grandfathered 241 00241Nash Carolina Regional Orthopaedics


Nash 5,318 6,2442 4,4622.13 2,932 0

1,220Hospital

Fixed

7,384 1,8123,0571,295New Hanover New Hanover Regional Medical

Center-Main Campus 10,5442 2.00

995Hospital

Fixed

2,052 001,057New Hanover New Hanover Regional Medical

Center-Medical Mall 2,4501 1.00

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


2,466Hospital

Fixed

5,289 34432,746New Hanover New Hanover Regional Medical

Center-Orthopedic Hospital 6,3201 1.00

360Freestand-

ing Fixed

O-007259-05 3,871 003,511New Hanover EmergeOrtho (OrthoWilmington PA) 4,0151 1.00

0Freestand-

ing Fixed

O-011063-15 0 000New Hanover Wilmington Health 01 1.00

445Mobile Grandfathered 1,968 001,523New Hanover Delaney Radiologists (InSight

Imaging)2,1460 0.41

0Mobile O-7254-05 639 00639New Hanover Delaney Radiologists (Porter's Neck

Imaging, LLC)6390 0.13

1,639Mobile O-7254-05 3,132 001,439New Hanover Delaney Radiologists (Porter's Neck

Imaging, LLC)3,7340 0.65

91Mobile Grandfathered 335 00244New Hanover Delany Radiologists (InSight

Imaging)3710 0.07

23Mobile Grandfathered Scanner 432 00409New Hanover EmergeOrtho (InSight Imaging) 4410 0.09

609Mobile F-007001-04 1,139 00530New Hanover New Hanover Regional Med-Health


158Mobile Grandfathered 316 00158New Hanover New Hanover Regional Medical -

North (Alliance Healthcare Services)3790 0.07

221Mobile Grandfathered 472 00251New Hanover New Hanover Regional Medical

Center (Alliance Healthcare

Services)

5600 0.10

201Mobile F-007001-04 428 00227New Hanover New Hanover Regional Medical

Center (Alliance Healthcare

Services)

5080 0.09

451Mobile O-006212-00 848 00397New Hanover New Hanover Regional Medical

Center-Brunswick Forest 1,0280 0.18

423Mobile 898 00475New Hanover New Hanover Regional Medical

Center-Military Cutoff 1,0670 0.19

8Mobile Grandfathered 21 0013New Hanover New Hanover Regional Medical

Center-Military Cutoff (Alliance

Healthcare Services)

240 0.00

751Mobile 1,435 00684New Hanover New Hanover Regional Medical

Center-North Campus 1,7350 0.30

0Mobile Grandfathered 2 002New Hanover Wilmington Health PLC - Porters


16Mobile Grandfathered 41 0025New Hanover Wilmington Health PLC - Porters


232Mobile Grandfathered 579 00347New Hanover Wilmington Health PLLC-Porters

Neck (Alliance Healthcare Services)6720 0.12

New Hanover 31,281 38,0676 4,8058.65 4,401 0

1,082Hospital

Fixed

3,629 863612,100Onslow Onslow Memorial Hospital 4,2751 1.00

277Freestand-

ing Fixed

P-008326-09 2,979 002,701Onslow Coastal Diagnostic Imaging

(Jacksonville Diagnostic Imaging,

Inc.)

3,0891 1.00

233Freestand-

ing Fixed

P-7324-05 2,431 002,209Onslow Coastal Diagnostic Imaging

(Jacksonville Diagnostic Imaging,

Inc.)

2,5351 1.00

19Mobile Grandfathered 51 0032Onslow Diagnostic Imaging Partners (InSight

Imaging)590 0.01

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


3Mobile Grandfathered 27 0024Onslow Diagnostic Imaging Partners (InSight

Imaging)280 0.01

0Mobile Grandfathered 0 000Onslow Onslow Memorial Hospital (Alliance


0Mobile Q-6884-03 0 000Onslow Onslow Memorial Hospital (Alliance

Healthcare Services & University

Health Systems of Eastern NC)

00 0.00

Onslow 9,117 9,9863 4,8053.02 3,307 0

1,940Hospital

Fixed

3,415 206621,207Orange University of North Carolina

Hospitals- Hillsborough 4,3811 1.00

10,871Hospital

Fixed

22,859 4,3302,4295,229Orange University of North Carolina

Hospitals- Medical Center 31,6436 6.00

4,623Hospital

Fixed

7,509 2062,860Orange University of North Carolina

Hospitals-Imaging Center 9,3772 2.00

483Freestand-

ing Fixed

Grandfathered 1,209 00726Orange Wake Radiology (Chapel Hill

Diagnostic Imaging)1,4021 1.00

Orange 34,992 46,80210 4,80510.00 4,680 0

846Hospital

Fixed

R-007623-06 3,732 1864012,299Pasquotank Sentara Albemarle Medical Center 4,3801 1.00

200Mobile R-006293-00 789 129568Pasquotank Sentara Albemarle Medical Center

(Sentara Albemarle Regional

Medical Center)

8820 0.21

Pasquotank/Camden/Currituck/Perquimans 4,521 5,2621 3,7751.21 4,349 1

3Mobile Grandfathered 9 024Pender Pender Memorial Hospital (Alliance






Pender 374 4390 1,7160.23 439 0

114Hospital

Fixed

459 1545285Person Person Memorial Hospital 5351 1.00

Person 459 5351 3,7751.00 535 0

2,436Hospital

Fixed

Q-005898-98; Q-006709-

02; Q-007658-06; Q-

008671-11

11,603 3,6753,4922,000Pitt Vidant Medical Center 16,9144 4.00

1,123Freestand-

ing Fixed

Replacement for #5324 4,014 002,891Pitt ECU Physicians MRI (Brody School

of Medicine at ECU)4,4631 1.00

1,996Freestand-

ing Fixed

5,441 003,445Pitt Greenville MRI LLC 6,2391 1.00

1,330Freestand-

ing Fixed

Q-006854-03 3,628 002,298Pitt Greenville MRI LLC 4,1601 1.00

1,462Freestand-

ing Fixed

Grandfathered 2,760 001,298Pitt Physicians East PA (King's Medical

Group)3,3451 1.00

60Mobile Grandfathered 2,188 002,128Pitt Orthopaedics East, Inc. (Alliance

Healthcare Services & University

Health Systems of Eastern NC)

2,2120 0.46

Pitt/Greene/Hyde/Tyrrell 29,634 37,3348 4,8058.46 4,413 0

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


164Mobile F-007040-04 1,005 751783Polk St. Lukes Hospital (Carolinas

Imaging Services, LLC)1,0970 0.59

Polk 1,005 1,0970 1,7160.59 1,097 0

153Hospital

Fixed

G-006817-03; G-008342-

091,144 388259344Randolph Randolph Hospital 1,6192 2.00

Randolph 1,144 1,6192 4,1182.00 810 0

0Hospital

Fixed

H-008193-08 0 000Richmond FirstHealth Moore Regional

Hospital - Hamlet (closed) 01 1.00

296Mobile H-006104-99 2,285 351301,824Richmond First Health Moore Regional Medical

Center - Richmond (FirstHealth of

the Carolinas, Inc.)

2,4830 0.61

Richmond 2,285 2,4831 3,7751.61 1,542 0

660Hospital

Fixed

N-005496-96; N-006606-

025,496 4531,4462,937Robeson Southeastern Regional Medical

Center 6,7012 2.00

219Mobile N-005496-96; N-006606-

02983 00764Robeson Southeastern Regional Medical

Center 1,0710 0.24

Robeson 6,479 7,7712 4,1182.24 3,469 0

593Hospital

Fixed

G-006691-02 2,978 1034921,790Rockingham Annie Penn Hospital 3,4941 1.00

297Hospital

Fixed

G-006297-00 1,634 551531,129Rockingham UNC Rockingham Health Care 1,8581 1.00

Rockingham 4,612 5,3522 4,1182.00 2,676 0

1,138Hospital

Fixed

6,056 2691,0073,642Rowan Novant Health Rowan Medical

Center-Main 7,1292 2.00

615Hospital

Fixed

3,376 332,755Rowan Novant Health Rowan Medical

Center-Novant Health Imaging 3,6262 2.00

Rowan 9,432 10,7554 4,8054.00 2,689 0

486Hospital

Fixed

C-006229-00; C-007298-

05; C-008313-092,314 2322071,389Rutherford Rutherford Regional Medical Center 2,7771 1.00

Rutherford 2,314 2,7771 3,7751.00 2,777 0

300Hospital

Fixed

M-007218-05 1,554 4841,166Sampson Sampson Regional Medical Center 1,7111 1.00

Sampson 1,554 1,7111 3,7751.00 1,711 0

589Hospital

Fixed

N-007805-07 3,011 683452,009Scotland Scotland Memorial Hospital 3,4391 1.00

0Mobile Grandfathered 1,145 001,145Scotland OrthoCarolina P.A. (Alliance


Scotland 4,156 4,5841 3,7751.30 3,526 0

702Hospital

Fixed

F-007461-06 2,918 953871,734Stanly Carolinas HealthCare System Stanly 3,4301 1.00

79Mobile F-006868-03 311 00232Stanly Atrium Health-West Stanly Imaging

(Carolinas Imaging Services, LLC)3430 0.08

Stanly 3,229 3,7721 3,7751.08 3,493 0

No Service Site

Stokes 1,716 0

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


600Hospital

Fixed

G-006792-03 3,003 1002522,051Surry Hugh Chatham Memorial Hospital 3,4241 1.00

459Hospital

Fixed

G-006569-02; G-008115-

082,673 793811,754Surry Northern Hospital of Surry County 3,0721 1.00

Surry 5,676 6,4962 4,1182.00 3,248 0

0Mobile Grandfathered 0 000Swain Duke LifePoint-Swain (Alliance


Swain 0 00 1,7160.00 0 0

433Hospital

Fixed

B-007019-04 1,747 26571,231Transylvania Transylvania Regional Hospital 1,9641 1.00

Transylvania 1,747 1,9641 3,7751.00 1,964 0

1,074Hospital

Fixed

F-005920-98 5,578 3311,5832,590Union Carolinas HealthCare System Union 6,9061 1.00

316Freestand-

ing Fixed

1,510 001,194Union Carolinas Healthcare Imaging

Services- Indian Trail (Union

Medical Services, LLC)

1,6361 1.00

0Freestand-

ing Fixed

F-11536-18 0 000Union Carolinas Healthcare System Union 01 1.00

0Mobile F-005920-98 628 0220408Union Carolinas HealthCare System Union 7160 0.14

28Mobile F-007164-04 289 00261Union Novant Health Imaging Monroe


6Mobile Grandfathered 920 00914Union OrthoCarolina, P.A. (Alliance


3Mobile Grandfathered 976 00973Union OrthoCarolina-Monroe (Alliance


221Mobile F-008237-08 799 00578Union PIC - Monroe (Mecklenburg

Diagnostic Imaging, Inc.)8870 0.18

Union 10,700 12,3453 4,4623.81 3,240 0

400Hospital

Fixed

K-006527-01; K-007839-

071,863 279438746Vance Maria Parham Medical Center 2,4211 1.00

0Mobile O-006665-02 407 00407Vance NC Diagnostic Imaging - Henderson

(Cape Fear Mobile Imaging, LLC)4070 0.11

Vance/Warren 2,270 2,8281 3,7751.11 2,548 0

4,554Hospital

Fixed

Grandfathered; J-008529-

1010,956 9069754,521Wake Duke Raleigh Hospital 13,8922 2.00

3,146Hospital

Fixed

8,624 1,3021,5032,673Wake Rex Hospital-Main 11,5252 2.00

191Hospital

Fixed

456 00265Wake Rex Hospital-UNC Rex Health Care

of Cary 5321 1.00

1,127Hospital

Fixed

3,763 4596861,491Wake WakeMed Cary Hospital 4,8551 1.00

2,408Hospital

Fixed

9,849 1,6412,0603,740Wake WakeMed-New Bern Avenue 12,9492 2.00

2,238Freestand-

ing Fixed

4,739 002,501Wake Raleigh Neurology Associates,P.A.

(Raleigh Neurology Associates)5,6341 1.00

2,213Freestand-

ing Fixed

Grandfathered 5,103 002,890Wake Raleigh Neurology Imaging


DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


1,781Freestand-

ing Fixed

Grandfathered 5,292 003,511Wake Raleigh Radiology Blue Ridge


1,920Freestand-

ing Fixed

Grandfathered 6,743 004,823Wake Raleigh Radiology Cary (Alliance


1,585Freestand-

ing Fixed

J-007289-05 7,477 005,892Wake Raleigh Radiology Cedarhurst


LLC)

8,1111 1.00

0Freestand-

ing Fixed

J-7605-06 106 00106Wake The Bone & Joint Surgery Clinic 1061 1.00

1,402Freestand-

ing Fixed

Grandfathered 2,884 001,482Wake Wake Radiology 3,4451 1.00

1,175Freestand-

ing Fixed

Grandfathered 3,653 002,478Wake Wake Radiology Diagnostic Imaging

Cary (Alliance Healthcare Services)4,1231 1.00

1,402Freestand-

ing Fixed

J-005783-97 2,884 001,482Wake Wake Radiology Raleigh MRI

Center (Wake Radiology)3,4451 1.00

1,046Freestand-

ing Fixed

Grandfathered UNIT

WITH dr TO INSTALL2,882 001,836Wake Wake Radiology-Garner (Alliance


0Mobile O-006665-02 703 00703Wake Cary Ortho (Cape Fear Mobile

Imaging, LLC)7030 0.15

677Mobile Grandfathered 1,732 001,055Wake Duke Health Raleigh Hospital


54Mobile Grandfathered 142 0088Wake Duke Health Raleigh Hospital


971Mobile Grandfathered; J-008529-

102,395 631,415Wake Duke Raleigh Hospital 2,7890 0.50

249Mobile Grandfathered 618 00369Wake Duke Raleigh Hospital (Alliance


22Mobile J-008453-09 931 00909Wake EmergeOrtho 9400 0.19

388Mobile J-008453-09 2,629 002,241Wake EmergeOrtho 2,7840 0.55

5Mobile Grandfathered 18 0013Wake EmergeOrtho, P.A. (Alliance


2Mobile Grandfathered 45 0043Wake EmergeOrtho, P.A. (Alliance


45Mobile O-006665-02 1,219 001,174Wake Orthopaedic Specialists of NC

(Cape Fear Mobile Imaging, LLC)1,2370 0.25

146Mobile J-007008-04 430 00284Wake Raleigh Neirosurgical Clinic

(Foundation Health Mobile Imaging

LLC)

4880 0.09

0Mobile Grandfathered 160 00160Wake Raleigh Orthopaedic Clinic (Alliance


0Mobile J-007756-06 585 00585Wake Raleigh Orthopaedic Clinic (Raleigh

Orthopaedic Clinic, PA)5850 0.12

0Mobile J-007756-06 1,829 001,829Wake Raleigh Orthopaedic Clinic (Raleigh

Orthopaedic Clinic, PA)1,8290 0.38

0Mobile J-007756-06 600 00600Wake Raleigh Orthopaedic Clinic Cary

(Raleigh Orthopaedic Clinic, PA)6000 0.12

0Mobile J-007756-06 700 00700Wake Raleigh Orthopaedic Clinic Garner

(Raleigh Orthopaedic Clinic, PA)7000 0.15

0Mobile Grandfathered 336 00336Wake Raleigh Orthopedic (Alliance


DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


0Mobile Grandfathered 211 00211Wake Raleigh Orthopedic (Alliance


357Mobile J-008268-08 779 00422Wake Raleigh Radiology at Cedarhurst Dr


LLC)

9220 0.16

486Mobile J-008268-08 2,404 001,918Wake Raleigh Radiology at Wake Forest


LLC)

2,5980 0.50

876Mobile 1,317 00441Wake Rex Hospital - Wakefield 1,6670 0.27

91Mobile J-007012-04 403 00312Wake Wake Radiology Cary (Wake

Radiology)4390 0.08

0Mobile J-007012-04 371 00371Wake Wake Radiology Fuquay-Varina

(Wake Radiology)3710 0.08

335Mobile J-007012-04 1,400 001,065Wake Wake Radiology Wake Forest

(Wake Radiology)1,5340 0.29

214Mobile 423 01208Wake WakeMed Apex Healthplex 5090 0.09

42Mobile J-007043-04 82 0040Wake WakeMed Apex Healthplex


0Mobile 0 000Wake WakeMed Brier Creek Healthplex 00 0.00

130Mobile 304 00174Wake WakeMed Garner Healthplex 3560 0.06

100Mobile Grandfathered 234 00134Wake WakeMed Garner Healthplex


23Mobile J-007043-04 72 0049Wake WakeMed Garner Healthplex


149Mobile 378 32224Wake WakeMed North 4410 0.08

140Mobile J-007043-04 377 00237Wake WakeMed North Family Health &

Women's Hospital (WakeMed

Health and Hospitals)

4330 0.08

188Mobile 628 00440Wake WakeMed Raleigh Medical Park 7030 0.13

98Mobile J-007043-04 318 00220Wake WakeMed Raleigh Medical Park


76Mobile Grandfathered 308 00232Wake WakeMed- Raleigh Medical Park


155Mobile Grandfathered 338 00183Wake WakeMed-Apex Healthplex


00 000Wake 2016 SMFP Need Determination 01 1.00

00 000Wake 2019 SMFP Need Determination 01 1.00

Wake 100,830 119,25820 4,80525.27 4,719 0

No Service Site

Washington 1,716 0

628Hospital

Fixed

D-006652-02 3,414 2871032,396Watauga Watauga Medical Center 3,9361 1.00

0Mobile G-006271-00 0 000Watauga OrthoCarolina-Boone NC (Alliance


Watauga 3,414 3,9361 4,4621.00 3,936 0

1,474Hospital

Fixed

P-006889-03; P-007447-

057,055 3164374,828Wayne Wayne Memorial Hospital, Inc. 8,0722 2.00

Wayne 7,055 8,0722 4,1182.00 4,036 0

DRAFT - 9/11/2019



Scans

Inpt

Contrast

Inpt No

Contrast

Outpt


Adjusted

Total

Area Avg

ProcsThreshold

MRI

Need

Fixed

Magnet

Fixed

Equiv

Outpt No

Contrast


529Hospital

Fixed

D-005911-98 2,571 772151,750Wilkes Wilkes Regional Medical Center 2,9301 1.00

Wilkes 2,571 2,9301 3,7751.00 2,930 0

913Hospital

Fixed

3,395 2644661,752Wilson Wilson Medical Center 4,1582 2.00

285Freestand-

ing Fixed

2,788 002,503Wilson Wilson Regional MRI (Wilson

Orthopedics and Neurology Center

PD)

2,9021 1.00

Wilson 6,183 7,0603 4,8053.00 2,353 0

No Service Site

Yadkin 1,716 0

Threshold 4+ Fixed Scanners = 4,805

3 Fixed Scanners = 4,462


1 Fixed Scanner = 3,775


910,132279.31245Total Total of Need Determinations 5

*Due to a settlement agreement, a CON (F-001184-16) was issued for F-008237-08 making it a fixed MRI scanner at Novant Health Huntersville Medical Center.

DRAFT - 9/11/2019

A B C D E F G H I J K L M N O Total MRI Outpt No Inpt No ... · Concord (Alliance Healthcare...

Documents

Transcript of A B C D E F G H I J K L M N O Total MRI Outpt No Inpt No ... · Concord (Alliance Healthcare...