Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1,097Hospital Fixed

G-006214-00 5,120 2058752,943Alamance Alamance Regional Medical Center 6,0732 2.00

127Mobile G-007053-04 712 00585Alamance Alamance Regional Mebane Outpatient - Mebane (Alamance Regional Medical Center)

7630 0.17

208Mobile G-007053-04 1,013 00805Alamance Alamance Regional Outpatient Imaging Center (Alamance Regional Medical Center)

1,0960 0.25

49Mobile G-006271-00 209 00160Alamance University of North Carolina (Alliance HealthCare Services)

2290 0.05

84Mobile Grandfathered 325 00241Alamance University of North Carolina (Alliance HealthCare Services)

3590 0.08

Alamance 7,379 8,5192 4,1182.55 3,341 020Mobile E-007059-04 67 0047Alexander Alexander Community Hospital

(Frye Regional Medical Center)750 0.04

Alexander 67 750 1,7160.04 75 05Mobile G-007038-04 44 1236Alleghany Alleghany Memorial Hospital

(Alliance HealthCare Services)480 0.03

6Mobile Grandfathered 98 1487Alleghany Alleghany Memorial Hospital (Alliance HealthCare Services)

1030 0.06

Alleghany 142 1500 1,7160.09 150 014Mobile F-006868-03 100 91859Anson Anson Community Hospital

(Carolinas Imaging Services, LLC)1200 0.06

Anson 100 1200 1,7160.06 120 0256Hospital

FixedD-008162-08 860 7041493Ashe Ashe Memorial Hospital, Inc. 1,0351 1.00

Ashe 860 1,0351 3,7751.00 1,035 085Mobile Grandfathered 378 526262Avery Charles A Cannon Memorial

Hospital [10/1/2011 - 6/15/2012] (Alliance HealthCare Services)

4260 0.20

36Mobile G-007038-04 219 820155Avery Charles A Cannon Memorial Hospital (Alliance HealthCare Services)

2480 0.13

0Mobile Grandfathered 4 112Avery Charles A Cannon Memorial Hospital (Alliance HealthCare Services)

50 0.00

Avery 601 6790 1,7160.33 679 0411Hospital

FixedQ-005992-99 1,587 102561,018Beaufort Vidant Beaufort Hospital 1,8551 1.00

2Mobile Grandfathered 16 2012Beaufort Vidant Pungo Hospital (Alliance HealthCare Services)

180 0.00

0Mobile Grandfathered 7 007Beaufort Vidant Pungo Hospital (Alliance HealthCare Services)

70 0.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

34Mobile Q-006884-03 216 46172Beaufort Vidant Pungo Hospital (Alliance HealthCare Services & University Health Systems of Eastern NC)

2350 0.06

Beaufort/Hyde 1,826 2,1161 3,7751.06 1,996 0No Service Site

Bertie 1,716 054Mobile M-006605-02 313 00259Bladen Bladen Healthcare LLC (Mobile

Imaging of North Carolina, LLC)3350 0.18

10Mobile J-007013-04 73 0063Bladen Cape Fear Valley - Bladen County Hospital [10/1/2011 - 12/31/2011] (WakeMed Health and Hospitals)

770 0.04

Bladen 386 4120 1,7160.22 412 0295Hospital

FixedGrandfathered (Alliance) 1,079 3521728Brunswick J. Arthur Dosher Memorial Hospital 1,2331 1.00

587Hospital Fixed

O-006658-02 2,840 1141981,941Brunswick Novant Health Brunswick Medical Center

3,2451 1.00

296Mobile Grandfathered 1,080 3722725Brunswick J. Arthur Dosher Memorial Hospital (Alliance HealthCare Services)

1,2370 0.26

279Mobile F-007001-04 785 00506Brunswick New Hanover Regional - Brunswick (Alliance HealthCare Services)

8970 0.19

Brunswick 5,784 6,6122 4,1182.45 2,699 01,257Hospital

FixedB-006869-03; B-008459-10

7,550 1,2692,2992,725Buncombe Mission Hospital - Memorial Campus

9,9882 2.00

232Hospital Fixed

B-006215-00 1,751 553578388Buncombe Mission Hospital - St. Joseph Campus

2,5171 1.00

1,889Freestand-ing Fixed

B-004178-90 5,398 003,509Buncombe Asheville MRI 6,1541 1.00

2,466Freestand-ing Fixed

B-006446-01 4,900 002,434Buncombe Asheville MRI 5,8861 1.00

8Freestand-ing Fixed

B-006643-02 655 00647Buncombe Asheville Orthopaedic Assoc. P.A. [10/1/2011 - 9/14/2012] (InSight Imaging)

6580 0.00

1,200Freestand-ing Fixed

B-005583-97 3,192 001,992Buncombe Carolina Spine & Neurosurgery Center

3,6721 1.00

17Freestand-ing Fixed

B-006643-02 166 00149Buncombe Marquis Imaging [9/17/2012 - 9/30/2012] (InSight Imaging)

1731 1.00

440Freestand-ing Fixed

B-006440-01 2,741 002,301Buncombe Open MRI of Asheville (Asheville Open MRI, Inc)

2,9171 1.00

834Freestand-ing Fixed

B-005492-96 5,197 004,363Buncombe Open MRI of Asheville (Asheville Open MRI, Inc)

5,5311 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

333Mobile Grandfathered 2,273 001,940Buncombe Marquis Diagnostic Imaging [10/1/2011 - 6/15/2012] (Alliance HealthCare Services)

2,4060 0.47

86Mobile Grandfathered 727 00641Buncombe Marquis Diagnostic Imaging (Alliance HealthCare Services)

7610 0.15

Buncombe/Graham/Madison/Yancey 34,550 40,6639 4,8059.62 4,227 0982Hospital

FixedE-006961-03; E-007203-05

3,522 1729221,446Burke Carolinas Medical Center - Blue Ridge

4,4212 2.00

801Mobile E-007066-04 2,351 001,550Burke Blue Ridge Radiology Associates, P.A.

2,6710 0.49

101Mobile E-008230-08 945 00844Burke Carolina Orthopaedic Specialists - Morganton (Carolina Orthopaedic Specialists)

9850 0.20

Burke 6,818 8,0782 4,8052.69 3,003 07,562Hospital

FixedF-005933-98; F-006629-02; F-007086-04

21,485 2,9932,2808,650Cabarrus Carolinas Medical Center - NorthEast

27,8165 5.00

237Freestand-ing Fixed

F-005916-98 1,510 001,273Cabarrus Cabarrus Diagnostic Imaging 1,6051 1.00

12Freestand-ing Fixed

F-007088-04 98 0086Cabarrus Charlotte Radiology Access Medical Imaging [10/1/2011 - 11/9/2011] (Charlotte Radiology, PA)

1030 0.00

0Freestand-ing Fixed

F-007859-07 0 000Cabarrus Southern Piedmont Imaging 01 1.00

42Mobile Grandfathered 259 00217Cabarrus Cabarrus Diagnostic Imaging (Foundation Health Mobile Imaging LLC)

2760 0.05

32Mobile Grandfathered 224 00192Cabarrus Cabarrus Diagnostic Imaging (Foundation Health Mobile Imaging LLC)

2370 0.05

164Mobile F-006734-03 767 00603Cabarrus Carolina NeuroSurgery & Spine Associates

8330 0.16

46Mobile F-006868-03 158 00112Cabarrus Carolinas Medical Center NorthEast (Carolinas Imaging Services, LLC)

1760 0.03

0Mobile Grandfathered 948 00948Cabarrus OrthoCarolina P.A. (Alliance HealthCare Services)

9480 0.20

Cabarrus 25,449 31,9937 4,8057.49 4,271 0756Hospital

FixedE-007222-05 2,141 131312942Caldwell Caldwell Memorial Hospital, Inc. 2,6731 1.00

146Mobile E-008230-08 1,283 001,137Caldwell Carolina Orthopaedic Specialists - Lenoir (Carolina Orthopaedic Specialists)

1,3410 0.34

0Mobile E-007066-04 115 00115Caldwell Lenoir Family Medicine (Blue Ridge Radiology Associates, P.A.)

1150 0.03

Caldwell 3,539 4,1291 3,7751.37 3,014 0

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1,218Hospital Fixed

P-005282-95 3,640 4093101,703Carteret Carteret General Hospital 4,5781 1.00

0Freestand-ing Fixed

P-008049-08 0 000Carteret Carteret General Hospital and Seashore Imaging

01 1.00

2Mobile Grandfathered 96 0094Carteret Carteret General Hospital (Alliance HealthCare Services)

970 0.02

0Mobile O-006434-01 800 00800Carteret Carteret Surgical Associates Inc. (Cape Fear Diagnostic Imaging, Inc.)

8000 0.19

Carteret 4,536 5,4752 4,1182.21 2,477 01,734Hospital

FixedE-007270-05 4,936 4215502,231Catawba Catawba Valley Medical Center 6,1862 2.00

1,280Hospital Fixed

E-004812-93; E-005922-98; E-007856-07

3,831 4253381,783Catawba Frye Regional Medical Center 4,8132 2.00

198Mobile E-008230-08 1,488 001,290Catawba Carolina Orthopaedic Specialists - Hickory (Carolina Orthopaedic Specialists)

1,5670 0.31

147Mobile E-008230-08 607 00754Catawba Carolina Orthopaedic Specialists - Newton (Carolina Orthopaedic Specialists)

9600 0.16

726Mobile E-007059-04 1,702 00976Catawba Frye Care - Tate Blvd. (Frye Regional Medical Center)

1,9920 0.35

297Mobile Grandfathered 2,378 002,081Catawba Hickory Orthopaedic Center (Alliance HealthCare Services)

2,4970 0.49

247Mobile Grandfathered 438 00191Catawba Neurology Associates (Alliance HealthCare Services)

5370 0.09

Catawba 15,380 18,5534 4,8055.40 3,436 024Mobile Grandfathered 104 51362Chatham Chatham Hospital (Alliance

HealthCare Services)1230 0.06

108Mobile Grandfathered 452 2443277Chatham Chatham Hospital (Alliance HealthCare Services)

5320 0.26

Chatham 556 6540 1,7160.32 654 0368Hospital

FixedA-006767-03 1,725 39441,274Cherokee Murphy Medical Center, Inc. 1,9211 1.00

Cherokee/Clay 1,725 1,9211 3,7751.00 1,921 0486Hospital

FixedR-008168-08 1,668 26261,130Chowan Vidant Chowan Hospital 1,8941 1.00

Chowan 1,668 1,8941 3,7751.00 1,894 01,518Hospital

FixedC-005725-97 4,266 4513681,929Cleveland Cleveland Regional Medical Center 5,3811 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

142Hospital Fixed

C-006915-03 672 7470386Cleveland Kings Mountain Hospital 8161 1.00

0Mobile Grandfathered 147 00147Cleveland Miller Orthopedic Shelby (Alliance HealthCare Services)

1470 0.04

0Mobile Grandfathered 738 00738Cleveland Miller Orthopedic- Shelby (Alliance HealthCare Services)

7380 0.18

20Mobile Grandfathered 101 0081Cleveland MRI Specialists of Carolina (Alliance HealthCare Services)

1090 0.02

43Mobile G-006271-00 227 00184Cleveland MRI Specialists of Carolina (Alliance HealthCare Services)

2440 0.06

Cleveland 6,151 7,4352 4,1182.30 3,233 0367Hospital

FixedO-006426-01 2,340 892971,587Columbus Columbus Regional Healthcare

System 2,6771 1.00

12Mobile F-007001-04 314 00302Columbus Atlantic Radiology Associates (Alliance HealthCare Services)

3190 0.08

0Mobile Grandfathered 12 0012Columbus Atlantic Radiology Associates (Alliance HealthCare Services)

120 0.00

57Mobile O-007340-05 1,066 001,009Columbus Waccamaw Ultrasound & Diagnostics

1,0890 0.28

Columbus 3,732 4,0961 3,7751.36 3,012 01,799Hospital

FixedP-005760-97 5,529 7107702,250Craven CarolinaEast Medical Center 7,1252 2.00

963Freestand-ing Fixed

P-008108-08 3,483 002,520Craven Coastal Carolina Health Care 3,8681 1.00

368Freestand-ing Fixed

P-006764-03 2,891 002,523Craven Coastal Carolina Health Care 3,0381 1.00

Craven/Jones/Pamlico 11,903 14,0314 4,8054.00 3,508 055Hospital

FixedM-006603-02 9,290 274,5944,614Cumberland Cape Fear Valley Medical Center 11,1713 3.00

1,026Freestand-ing Fixed

M-007924-07 6,583 005,557Cumberland Carolina Imaging of Fayetteville 6,9931 1.00

748Freestand-ing Fixed

M-005899-98 4,748 004,008Cumberland Carolina Imaging of Fayetteville 5,0551 1.00

631Freestand-ing Fixed

M-005905-98 2,953 002,322Cumberland Valley Regional Imaging (Medical Imaging Center dba Valley Regional Imaging)

3,2051 1.00

112Freestand-ing Fixed

M-005905-98 525 00413Cumberland Valley Regional Imaging (VRI) [10/1/2011 - 12/20/2011] (Medical Imaging Center dba Valley Regional

5700 0.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

659Freestand-ing Fixed

Grandfathered 3,085 002,426Cumberland Valley Regional Imaging (VRI) (Medical Imaging Center dba Valley Regional Imaging)

3,3491 1.00

1Mobile J-007008-04 9 008Cumberland Carolina Imaging of Fayetteville (Foundation Health Mobile Imaging LLC)

90 0.00

21Mobile Grandfathered 195 00174Cumberland Carolina Imaging of Fayetteville (Kings Medical Group)

2030 0.04

32Mobile F-005723-97 284 00252Cumberland Cross Creek Imaging [10/1/2011 - 12/15/2011] (InSight Imaging)

2970 0.06

0Mobile Grandfathered 12 0012Cumberland Kerner Radiology Assiciates (Alliance HealthCare Services)

120 0.00

15Mobile Grandfathered 278 00263Cumberland Kerner Radiology Associates (Alliance HealthCare Services)

2840 0.06

0Mobile F-007001-04 24 0024Cumberland Kerner Radiology Associates (Alliance HealthCare Services)

240 0.00

Cumberland 27,986 31,1737 4,8057.16 4,354 0526Hospital

FixedR-007329-05 1,614 7452962Dare The Outer Banks Hospital, Inc. 1,9041 1.00

145Mobile R-006293-00 555 00410Dare Regional Medical Services 6130 0.15

0Mobile R-006293-00 0 000Dare Spring Arbor (Regional Medical Services)

00 0.00

Dare 2,169 2,5171 3,7751.15 2,189 0536Hospital

FixedG-006443-01 2,496 402051,715Davidson Lexington Medical Center 2,8241 1.00

392Hospital Fixed

G-006826-03 2,337 1312811,533Davidson Novant Health Thomasville Medical Center

2,7111 1.00

Davidson 4,833 5,5352 4,1182.00 2,768 027Mobile G-006271-00 328 010291Davie Davie County Hospital (Alliance

HealthCare Services)3430 0.19

Davie 328 3430 1,7160.19 343 0162Mobile Q-006884-03 705 3946458Duplin Vidant Duplin Hospital (Alliance

HealthCare Services & University Health Systems of Eastern NC)

8190 0.41

Duplin 705 8190 1,7160.41 819 06,611Hospital

FixedJ-5589-97; J-6109-99; J-8030-07; J-8275-08; J-8466-10; J-8663-11

18,934 4,3892,1905,744Durham Duke University Hospital 25,9668 8.00

1,257Hospital Fixed

Grandfathered; J-006207-00

5,946 4211,2503,018Durham Durham Regional Hospital 7,2862 2.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1,074Freestand-ing Fixed

J-006760-03 3,176 002,102Durham Durham Diagnostic Imaging-Independence Park

3,6061 1.00

1,634Freestand-ing Fixed

J-006108-99 2,717 001,083Durham Lenox Baker Hospital (Duke University Hospital)

3,3711 1.00

1,656Freestand-ing Fixed

Grandfathered 2,753 001,097Durham Lenox Baker Hospital (Duke University Hospital)

3,4151 1.00

1,548Freestand-ing Fixed

J-007174-04 2,574 001,026Durham Lenox Baker Hospital (Duke University Hospital)

3,1931 1.00

1,798Freestand-ing Fixed

Grandfathered 2,989 001,191Durham Lenox Baker Hospital (Duke University Hospital)

3,7081 1.00

1,227Freestand-ing Fixed

J-006598-02 2,009 00782Durham Lenox Baker Hospital (Duke University Hospital)

2,5001 1.00

196Freestand-ing Fixed

J-007031-04 3,664 003,468Durham Triangle Orthopaedic Associates 3,7421 1.00

56Mobile M-006605-02 707 00651Durham Durham Diagnostic - South Park (Mobile Imaging of North Carolina, LLC)

7290 0.15

245Mobile Grandfathered 446 00201Durham Raleigh Neurology Imaging (Alliance HealthCare Services)

5440 0.09

4Mobile Grandfathered 6 002Durham Raleigh Neurology Imaging (Alliance HealthCare Services)

80 0.00

4Mobile J-008453-09 324 00320Durham Triangle Orthopaedic Associates 3260 0.07

Durham/Caswell 46,245 58,39317 4,80517.31 3,373 0345Hospital

FixedL-008327-09 1,836 2431861,062Edgecombe Vidant Edgecombe Hospital 2,2431 1.00

Edgecombe 1,836 2,2431 3,7751.00 2,243 010,496Hospital

FixedG-007083-04; G-008372-09

22,489 4,5991,3146,080Forsyth North Carolina Baptist Hospital 30,8926 6.00

2,888Hospital Fixed

G-004293-91; G-006588-02; G-007919-07

12,546 4,7582,2102,690Forsyth Novant Health Forsyth Medical Center

18,3923 3.00

501Hospital Fixed

D-008196-08 1,520 001,019Forsyth Novant Health Kernersville Imaging Center

1,7201 1.00

2,290Hospital Fixed

Grandfathered; G-007387-05

6,320 004,030Forsyth Novant Health Maplewood Imaging Center

7,2362 2.00

805Hospital Fixed

Grandfathered 2,844 002,039Forsyth Novant Health Winston-Salem Health Care

3,1661 1.00

948Freestand-ing Fixed

Grandfathered 3,877 002,929Forsyth Piedmont Imaging 4,2561 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1,359Freestand-ing Fixed

G-006893-03 5,562 004,203Forsyth Piedmont Imaging 6,1061 1.00

1,618Freestand-ing Fixed

G-007780-07 5,248 003,630Forsyth Wake Forest Baptist Imaging 5,8951 1.00

5Mobile G-006271-00 51 0046Forsyth Greensboro Imaging (Alliance HealthCare Services)

530 0.01

11Mobile Grandfathered 102 0091Forsyth Greensboro Imaging at Kernersville (Alliance HealthCare Services)

1060 0.02

81Mobile G-007065-04 249 00168Forsyth Novant Health Forsyth Medical Center Imaging Maplewood (Novant Health Forsyth Medical

2810 0.05

239Mobile G-007065-04 811 00572Forsyth Novant Health Kernersville Medical Center (Novant Health Forsyth Medical Center)

9070 0.17

495Mobile Grandfathered 474 0021Forsyth Orthopaedic Specialists of the Carolinas

7140 0.10

3,345Mobile Grandfathered 3,082 00263Forsyth Orthopaedic Specialists of the Carolinas

4,9460 0.70

00 000Forsyth 2010 SMFP Need Determination 01 1.00

Forsyth 65,175 84,67117 4,80518.05 4,691 0171Hospital

FixedK-007501-06 988 87145585Franklin Novant Health Franklin Medical

Center 1,1841 1.00

Franklin 988 1,1841 3,7751.00 1,184 01,989Hospital

FixedF-005577-97 7,010 1,5831,4182,020Gaston Gaston Memorial Hospital 9,6391 1.00

1,403Hospital Fixed

F-006620-02 3,452 002,049Gaston Gaston Memorial Hospital, CaroMont Imaging Services Belmont

4,0131 1.00

1,157Hospital Fixed

F-006622-02 3,063 001,906Gaston Gaston Memorial Hospital, CaroMont Imaging Services-Summit

3,5261 1.00

119Hospital Fixed

440 00321Gaston Gaston Memorial Hospital, The Diagnostic Center

4881 1.00

37Mobile Grandfathered 201 00164Gaston Gastonia North (Foundation Health Mobile Imaging LLC)

2160 0.04

143Mobile F-008237-08 700 00557Gaston Gastonia North (Mecklenburg Diagnostic Imaging, Inc.)

7570 0.15

40Mobile F-007164-04 260 00220Gaston Gastonia North (Presbyterian Mobile Imaging, LLC)

2760 0.05

113Mobile F-008000-07 366 00253Gaston MRI Specialists - Belmont (MRI Specialists of the Carolinas, LLC)

4110 0.08

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

582Mobile F-008000-07 1,788 001,206Gaston MRI Specialists - Gastonia (MRI Specialists of the Carolinas, LLC)

2,0210 0.37

0Mobile Grandfathered 665 00665Gaston OrthoCarolina P.A. (Alliance HealthCare Services)

6650 0.14

00 000Gaston 2011 SMFP Need Determination 01 1.00

Gaston 17,945 22,0125 4,8055.83 3,776 0180Hospital

FixedK-007190-04 1,361 301071,044Granville Granville Medical Center 1,5001 1.00

147Mobile J-007013-04 11 147360Granville Central Regional Hospital (WakeMed Health and Hospitals)

5210 0.04

Granville 1,372 2,0211 3,7751.04 1,943 01,350Hospital

FixedG-006299-00 8,522 1,4443,4622,226Guilford Cone Health 11,5622 2.00

932Hospital Fixed

G-005924-98 5,267 5431,5182,274Guilford High Point Regional Health System 6,6812 2.00

1,245Hospital Fixed

3,730 4467471,292Guilford Wesley Long Community Hospital 4,8841 1.00

1,277Freestand-ing Fixed

G-007269-05 4,182 002,905Guilford Cornerstone Imaging (Cornerstone Health Care, PA)

4,6931 1.00

476Freestand-ing Fixed

Grandfathered 1,649 001,173Guilford Greensboro Imaging (Diagnostic Radiology & Imaging, LLC)

1,8391 1.00

2,199Freestand-ing Fixed

Grandfathered 5,640 003,441Guilford Greensboro Imaging (Diagnostic Radiology & Imaging, LLC)

6,5201 1.00

2,008Freestand-ing Fixed

G-006952-03 4,836 002,828Guilford Greensboro Imaging (Diagnostic Radiology & Imaging, LLC)

5,6391 1.00

561Freestand-ing Fixed

G-008347-09 5,419 004,858Guilford Greensboro Orthopaedics, P.A. 5,6431 1.00

425Freestand-ing Fixed

Grandfathered 2,996 002,571Guilford Triad Imaging 3,1661 1.00

0Mobile G-007038-04 1 001Guilford Cone Health (Alliance HealthCare Services)

10 0.00

38Mobile Grandfathered 138 1396Guilford Cone Health (Alliance HealthCare Services)

1550 0.03

16Mobile G-006271-00 62 2242Guilford Cone Health (Alliance HealthCare Services)

710 0.01

71Mobile Grandfathered 251 615159Guilford Cone Health (Alliance HealthCare Services)

2900 0.05

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

575Mobile Grandfathered 2,028 001,453Guilford Cornerstone Healthcare, PA dba Cornerstone Imaging (InSight Imaging)

2,2580 0.42

6Mobile G-007038-04 90 0084Guilford Greensboro Spine & Scoliosis Center (Alliance HealthCare Services)

920 0.02

8Mobile Grandfathered 74 0066Guilford Greensboro Spine & Scoliosis Center (Alliance HealthCare Services)

770 0.02

2Mobile Grandfathered 52 0050Guilford Greensboro Spine & Scoliosis Center (Alliance HealthCare Services)

530 0.01

197Mobile Grandfathered 1,025 00828Guilford Guilford Neurologic Associates Inc. (Kings Medical Group)

1,1040 0.21

165Mobile G-007064-04 636 00471Guilford Premier Imaging, LLC (High Point Regional Health System)

7020 0.13

0Mobile G-007064-04 1 001Guilford Regional Physicians Neuroscience Center (High Point Regional Health System)

10 0.00

472Mobile Grandfathered 4,847 004,375Guilford SE Orthopaedic Specialists (Alliance HealthCare Services)

5,0360 1.00

0Mobile Grandfathered 13 0013Guilford SE Orthopaedic Specialists PA (Alliance HealthCare Services)

130 0.00

242Mobile Grandfathered 1,039 00797Guilford Triad Church Street (Foundation Health Mobile Imaging LLC)

1,1360 0.22

108Mobile G-006271-00 398 00290Guilford Vanguard Brain & Spine Specialists (Alliance HealthCare Services)

4410 0.08

92Mobile Grandfathered 264 00172Guilford Vanguard Brain & Spine Specialists (Alliance HealthCare Services)

3010 0.05

Guilford 53,160 62,35811 4,80513.25 4,706 0403Hospital

FixedL-007257-05 1,743 135207998Halifax Halifax Regional Medical Center,

Inc. 2,0951 1.00

53Mobile Grandfathered 643 00590Halifax Atlantic Radiology Associates (Alliance HealthCare Services)

6640 0.17

5Mobile Grandfathered 66 0061Halifax Atlantic Radiology Associates (Alliance HealthCare Services)

680 0.02

9Mobile Grandfathered 161 00152Halifax Atlantic Radiology Associates (Alliance HealthCare Services)

1650 0.04

2Mobile Grandfathered 54 0052Halifax Atlantic Radiology Associates (Alliance HealthCare Services)

550 0.01

Halifax/Northampton 2,667 3,0471 3,7751.24 2,457 0588Hospital

FixedM-006712-02; M-008287-09

2,413 3301941,301Harnett Betsy Johnson Hospital 2,9902 2.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

2Mobile Grandfathered 10 008Harnett Atlantic Radiology (Alliance HealthCare Services)

110 0.00

87Mobile Grandfathered 411 00324Harnett Atlantic Radiology Associates (Alliance HealthCare Services)

4460 0.10

203Mobile M-006605-02 941 00738Harnett Carolina Regional Radiology (Mobile Imaging of North Carolina, LLC)

1,0220 0.23

Harnett 3,775 4,4692 4,1182.33 1,918 01,117Hospital

FixedA-005060-94; A-007807-07

3,896 2002062,373Haywood Medwest Haywood 4,5852 2.00

Haywood 3,896 4,5852 4,1182.00 2,293 01,316Hospital

FixedB-006004-99 4,823 2072523,048Henderson Margaret R. Pardee Memorial

Hospital 5,6162 2.00

626Hospital Fixed

B-006012-99; B-007384-05

2,456 1102581,462Henderson Park Ridge Health 2,8981 1.00

Henderson 7,279 8,5133 4,4623.00 2,838 0395Hospital

FixedQ-007213-05 2,088 1711761,346Hertford Vidant Roanoke-Chowan Hospital 2,4531 1.00

Hertford/Gates 2,088 2,4531 3,7751.00 2,453 0No Service Site

Hoke 1,716 0269Hospital

FixedF-006728-02 1,845 2672251,084Iredell Davis Regional Medical Center 2,2561 1.00

1,241Hospital Fixed

F-005340-96 3,816 3763591,840Iredell Iredell Memorial Hospital, Inc. 4,7571 1.00

950Hospital Fixed

F-005815-98; F-006591-02

3,303 2054201,728Iredell Lake Norman Regional Medical Center

4,0152 2.00

37Freestand-ing Fixed

F-006957-03 198 00161Iredell Piedmont Healthcare P.A. [Temporary] (Alliance HealthCare Services)

2130 0.00

694Freestand-ing Fixed

F-006957-03 3,226 002,532Iredell Piedmont HealthCare P.A. (Piedmont HealthCare, P.A. & Alliance HealthCare Services, Inc.)

3,5041 1.00

0Mobile Grandfathered 11 0011Iredell Carolina Specialty Care (Foundation Health Mobile Imaging LLC)

110 0.00

182Mobile Grandfathered 906 00724Iredell Mooresville Diagnostic Imaging (Foundation Health Mobile Imaging LLC)

9790 0.19

232Mobile Grandfathered 1,320 001,088Iredell Mooresville Diagnostic Imaging (Kings Medical Group)

1,4130 0.27

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

0Mobile Grandfathered 10 0010Iredell Northshore Orthopedic & Sport (Alliance HealthCare Services)

100 0.00

0Mobile Grandfathered 368 00368Iredell Northshore Orthopedic & Sport (Alliance HealthCare Services)

3680 0.08

96Mobile Grandfathered 466 00370Iredell Piedmont Healthcare (Alliance HealthCare Services)

5040 0.10

4Mobile Grandfathered 34 0030Iredell Piedmont HealthCare P.A. (Alliance HealthCare Services)

360 0.01

3Mobile Grandfathered 19 0016Iredell Piedmont HealthCare P.A. (Alliance HealthCare Services)

200 0.00

Iredell 15,522 18,0855 4,8055.65 3,201 01,046Hospital

FixedA-006797-03; A-008195-08

3,824 891002,589Jackson Medwest Harris 4,3542 2.00

Jackson 3,824 4,3542 4,1182.00 2,177 01,180Hospital

FixedJ-006807-03; J-007900-07

5,726 4878413,218Johnston Johnston Memorial Hospital 6,9242 2.00

8Mobile Grandfathered 120 00112Johnston Eastern Carolina Medical Center (Alliance HealthCare Services)

1230 0.03

0Mobile Grandfathered 3 003Johnston Eastern Carolina Medical Center (Alliance HealthCare Services)

30 0.00

2Mobile Grandfathered 14 0012Johnston Eastern Carolina Medical Center (Alliance HealthCare Services)

150 0.00

0Mobile Grandfathered 519 00519Johnston Raleigh Radiology Clayton (InSight Imaging)

5190 0.12

89Mobile Grandfathered 630 00541Johnston Raleigh Radiology Clayton (InSight Imaging)

6660 0.14

Johnston 7,012 8,2502 4,4622.29 3,602 0527Hospital

FixedJ-005901-98 2,496 2643161,389Lee Central Carolina Hospital 3,0441 1.00

Lee 2,496 3,0441 3,7751.00 3,044 0641Hospital

Fixed2,790 3203441,485Lenoir Lenoir Memorial Hospital, Inc. 3,4401 1.00

0Freestand-ing Fixed

P-008147-08 0 000Lenoir Lenoir Imaging, LLC (Lenoir Imaging LLC)

01 1.00

Lenoir 2,790 3,4402 4,1182.00 1,720 0682Hospital

FixedF-008081-08 2,988 1273371,842Lincoln Carolinas Medical Center - Lincoln 3,4971 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

48Mobile F-005723-97 319 00271Lincoln Blue Ridge Radiology [10/1/2011 - 3/15/2012] (InSight Imaging)

3380 0.08

Lincoln 3,307 3,8351 3,7751.08 3,551 0387Hospital

FixedA-006828-03 1,174 5237698Macon Angel Medical Center, Inc. 1,3851 1.00

43Hospital Fixed

A-007197-05 360 14312Macon Highlands-Cashiers Hospital, Inc. 3801 1.00

11Mobile Grandfathered 148 00137Macon WestCare Health System (Alliance HealthCare Services)

1520 0.04

3Mobile G-007038-04 74 0071Macon WestCare Health System (Alliance HealthCare Services)

750 0.02

0Mobile Grandfathered 3 003Macon WestCare Health System (Alliance HealthCare Services)

30 0.00

Macon 1,759 1,9952 4,1182.06 969 01Mobile Grandfathered 12 1010Martin Martin General Hospital (Alliance

HealthCare Services)130 0.01

1Mobile Grandfathered 39 2333Martin Martin General Hospital (Alliance HealthCare Services)

420 0.02

34Mobile Q-006884-03 458 1023391Martin Martin General Hospital (Alliance HealthCare Services & University Health Systems of Eastern NC)

4890 0.27

Martin 509 5440 1,7160.30 544 0254Hospital

FixedC-007304-05 1,238 2765892McDowell The McDowell Hospital, Inc. 1,3871 1.00

McDowell 1,238 1,3871 3,7751.00 1,387 05,457Hospital

FixedF-005918-98; F-006493-01

16,414 3,5262,4794,952Mecklenburg Carolinas Medical Center 22,4094 4.00

1,509Hospital Fixed

F-005919-98 4,706 6785361,983Mecklenburg Carolinas Medical Center - University

6,0661 1.00

2,954Hospital Fixed

F-006830-03 10,537 1,5451,5374,501Mecklenburg Carolinas Medical Center Mercy/Pineville

13,5692 2.00

802Hospital Fixed

F-005575-97 2,430 19221,587Mecklenburg Novant Health Charlotte Orthopedic Hospital

2,7751 1.00

1,675Hospital Fixed

F-005580-97 6,248 2785403,755Mecklenburg Novant Health Huntersville Medical Center

7,3561 1.00

714Hospital Fixed

F-002332-85 2,400 001,686Mecklenburg Novant Health Imaging Museum 2,6861 1.00

1,878Hospital Fixed

F-006379-01; F-008688-11

5,788 3929642,554Mecklenburg Novant Health Matthews Medical Center

7,2382 2.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

2,147Hospital Fixed

F-006499-01 7,638 1,3812,1591,951Mecklenburg Novant Health Presbyterian Medical Center

10,4652 2.00

571Freestand-ing Fixed

F-007167-04 2,163 001,592Mecklenburg Carolinas Imaging Services-Ballantyne (Carolinas Imaging Services, LLC)

2,3911 1.00

827Freestand-ing Fixed

F-005918-98 2,804 001,977Mecklenburg Carolinas Imaging Services-Southpark (prev. Morrocroft) (Carolinas Imaging Services, LLC)

3,1351 1.00

564Freestand-ing Fixed

F-007068-04 3,496 002,932Mecklenburg Mecklenburg Diagnostic Imaging (dba PIC South Park) (Mecklenburg Diagnostic Imaging,

3,7221 1.00

100Freestand-ing Fixed

F-005748-97 621 00520Mecklenburg Mecklenburg Diagnostic Imaging (dba PIC South Park) (Mecklenburg Diagnostic Imaging,

6601 1.00

1,600Freestand-ing Fixed

F-006698-02 8,260 006,660Mecklenburg OrthoCarolina Spine Center (OrthoCarolina, P.A.)

8,9001 1.00

129Mobile F-006734-03 1,030 00901Mecklenburg Carolina NeuroSurgery & Spine Associates

1,0820 0.21

802Mobile F-006734-03 2,844 002,042Mecklenburg Carolina NeuroSurgery & Spine Associates

3,1650 0.59

446Mobile F-007040-04 1,476 001,030Mecklenburg Carolinas Imaging Services-Huntersville (Carolinas Imaging Services, LLC)

1,6540 0.31

325Mobile Grandfathered 912 00587Mecklenburg Carolinas Physician Network (Alliance HealthCare Services)

1,0420 0.19

22Mobile Grandfathered 78 0056Mecklenburg Carolinas Physician Network (Alliance HealthCare Services)

870 0.02

4Mobile Grandfathered 7 003Mecklenburg Carolinas Physician Network Inc (Alliance HealthCare Services)

90 0.00

808Mobile F-005723-97 1,641 00833Mecklenburg Mecklenburg Neurological Associates, P.A. (InSight Imaging)

1,9640 0.34

2Mobile Grandfathered 93 0091Mecklenburg Novant Health Imaging Ballantyne (Foundation Health Mobile Imaging LLC)

940 0.02

302Mobile F-006626-02 1,477 001,175Mecklenburg Novant Health Imaging Ballantyne (Jacksonville Diagnostic Imaging, Inc.)

1,5980 0.31

121Mobile F-006626-02 578 00457Mecklenburg Novant Health Imaging Steel Creek (Jacksonville Diagnostic Imaging, Inc.)

6260 0.12

1Mobile F-007164-04 3 002Mecklenburg Novant Health Imaging Steel Creek (Presbyterian Mobile Imaging, LLC)

30 0.00

94Mobile F-006626-02 350 00256Mecklenburg Novant Health Imaging University (Jacksonville Diagnostic Imaging, Inc.)

3880 0.07

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

347Mobile F-007164-04 1,304 00957Mecklenburg Novant Health Imaging University (Presbyterian Mobile Imaging, LLC)

1,4430 0.27

0Mobile F-007987-07 3,108 003,108Mecklenburg OrthoCarolina - Ballantyne (OrthoCarolina, P.A.)

3,1080 0.65

0Mobile F-007987-07 1,667 001,667Mecklenburg OrthoCarolina - Huntersville (OrthoCarolina, P.A.)

1,6670 0.35

0Mobile Grandfathered 146 00146Mecklenburg OrthoCarolina - Matthews (Alliance HealthCare Services)

1460 0.03

0Mobile Grandfathered 216 00216Mecklenburg OrthoCarolina - Matthews (Alliance HealthCare Services)

2160 0.04

0Mobile Grandfathered 1,393 001,393Mecklenburg OrthoCarolina P.A. (Alliance HealthCare Services)

1,3930 0.29

19Mobile F-007987-07 794 00775Mecklenburg OrthoCarolina Spine Center (OrthoCarolina, P.A.)

8020 0.17

0Mobile Grandfathered 229 00229Mecklenburg Oweida Orthopaedic Associates (Alliance HealthCare Services)

2290 0.05

182Mobile Grandfathered 1,323 001,141Mecklenburg Randolph Spine Center (Alliance HealthCare Services)

1,3960 0.28

Mecklenburg 94,174 113,48419 4,80523.31 4,868 1282Hospital

FixedD-006866-03 1,182 3428838Mitchell Blue Ridge Regional Hospital, Inc. 1,3331 1.00

Mitchell/Yancey 1,182 1,3331 3,7751.00 1,333 052Mobile H-006104-09 336 38273Montgomery FirstHealth Montgomery Memorial

Hospital (FirstHealth of the Carolinas, Inc.)

3620 0.20

Montgomery 336 3620 1,7160.20 362 02,723Hospital

FixedH-005602-97; H-006846-03; H-007097-04

12,596 7881,6757,410Moore FirstHealth Moore Regional Hospital

14,9863 3.00

529Freestand-ing Fixed

H-006845-03 4,086 003,557Moore Pinehurst Surgical Clinic PA (Alliance Healthcare Services and Pinehurst Surgical Clinic)

4,2981 1.00

0Freestand-ing Fixed

H-008365-09 0 000Moore Triad Imaging, Inc, dba Southern Pines Diagnostic Imaging

01 1.00

152Mobile O-006665-02 456 00304Moore Southern Pines Diagnostic Imaging (Cape Fear Mobile Imaging, LLC)

5170 0.09

346Mobile J-007008-04 1,269 00923Moore Southern Pines Diagnostic Imaging (Foundation Health Mobile Imaging LLC)

1,4070 0.26

Moore 18,407 21,2075 4,8055.35 3,964 0959Hospital

FixedL-005908-98 4,153 5124812,208Nash Nash General Hospital 5,1462 2.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

396Freestand-ing Fixed

L-007499-06 1,164 00768Nash Nash Open MRI (Nash Imaging, LLC)

1,3221 1.00

0Mobile Grandfathered 61 0061Nash Atlantic Radiology Associates (Alliance HealthCare Services)

610 0.01

0Mobile Grandfathered 260 00260Nash Carolina Regional Orthopaedics (Alliance HealthCare Services)

2600 0.06

0Mobile Grandfathered 79 0079Nash Carolina Regional Orthopaedics (Alliance HealthCare Services)

790 0.02

Nash 5,717 6,8683 4,4623.09 2,223 03,945Hospital

FixedO-006212-00 13,153 2,4591,6395,110New Hanover New Hanover Regional Medical

Center 17,3544 4.00

343Freestand-ing Fixed

O-007259-05 4,265 003,922New Hanover OrthoWilmington PA 4,4021 1.00

2Mobile Grandfathered 20 0018New Hanover Atlantic Radiology Associates (Alliance HealthCare Services)

210 0.00

0Mobile Grandfathered 0 000New Hanover Cape Fear Diagnostic Imaging, Inc. (Kings Medical Group)

00 0.00

0Mobile O-007254-05 1,431 001,431New Hanover Delaney Radiologists - Ashton (Porter's Neck Imaging, LLC)

1,4310 0.30

1,152Mobile Grandfathered 2,203 001,051New Hanover Delaney Radiologists - Medical Center (InSight Imaging)

2,6640 0.46

845Mobile O-007254-05 2,074 001,229New Hanover Delaney Radiologists - Medical Center (Porter's Neck Imaging, LLC)

2,4120 0.43

165Mobile F-007001-04 486 00321New Hanover New Hanover Regional Medical Center- Market Porters Neck (Alliance HealthCare Services)

5520 0.10

164Mobile F-007001-04 434 00270New Hanover New Hanover Regional Medical Center- Military Cutoff (Alliance HealthCare Services)

5000 0.09

172Mobile G-007038-04 468 00296New Hanover WHA Medical Clinic (Alliance HealthCare Services)

5370 0.10

893Mobile Grandfathered 2,333 001,440New Hanover WHA Medical Clinic PLLC (Alliance HealthCare Services)

2,6900 0.49

New Hanover 26,867 32,5625 4,8056.97 4,672 01,232Hospital

Fixed3,389 2333501,574Onslow Onslow Memorial Hospital, Inc. 4,2081 1.00

473Freestand-ing Fixed

P-007324-05 2,994 002,471Onslow Coastal Diagnostic Imaging (Jacksonville Diagnostic Imaging, Inc. dba Coastal Diagnostic Imaging)

3,1331 1.00

0Freestand-ing Fixed

P-008326-09 0 000Onslow Coastal Diagnostic Imaging (Jacksonville Diagnostic Imaging, Inc. dba Coastal Diagnostic Imaging)

01 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

369Mobile O-006434-01 2,194 001,825Onslow Coastal Diagnostic Imaging (Cape Fear Diagnostic Imaging, Inc.)

2,3420 0.49

0Mobile Grandfathered 283 03280Onslow Onslow Memorial Hospital (Alliance HealthCare Services)

2840 0.06

Onslow 8,860 9,9673 4,4623.55 2,808 014,639Hospital

FixedJ-5900-98; J-7028-04; J-7301-05; J-8136-08; J-8271-08; J-8391-09

28,782 5,4181,7826,943Orange University of North Carolina Hospital

39,6858 8.00

396Freestand-ing Fixed

Grandfathered 1,319 00923Orange Chapel Hill Diagnostic Imaging 1,4771 1.00

Orange 30,101 41,1629 4,8059.00 4,574 0775Hospital

FixedR-007623-06 3,226 1802761,995Pasquotank Albemarle Health: A Vidant Partner

in Health 3,7902 2.00

Pasquotank/Camden/Currituck/Perquimans 3,226 3,7902 4,1182.00 1,895 00Mobile Grandfathered 5 005Pender Pender Memorial Hospital

(Alliance HealthCare Services)50 0.00

20Mobile F-007001-04 50 2226Pender Pender Memorial Hospital (Alliance HealthCare Services)

600 0.03

50Mobile Grandfathered 191 45132Pender Pender Memorial Hospital (Alliance HealthCare Services)

2160 0.11

0Mobile Grandfathered 5 005Pender Pender Memorial Hospital (Alliance HealthCare Services)

50 0.00

Pender 251 2870 1,7160.14 287 04Mobile Grandfathered 19 0015Person Person County Memorial Hospital

(Alliance HealthCare Services)210 0.01

38Mobile Grandfathered 161 36115Person Person County Memorial Hospital (Alliance HealthCare Services)

1820 0.09

5Mobile Grandfathered 38 2724Person Person County Memorial Hospital (Alliance HealthCare Services)

440 0.02

81Mobile G-007038-04 404 2134268Person Person County Memorial Hospital (Alliance HealthCare Services)

4670 0.24

57Mobile Grandfathered 297 1021209Person Person County Memorial Hospital (Alliance HealthCare Services)

3360 0.17

Person 919 1,0500 1,7160.53 1,050 02,166Hospital

FixedQ-005898-98; Q-006709-02; Q-007658-06; Q-008671-11

11,222 3,5743,2212,261Pitt Vidant Medical Center 16,2364 4.00

1,882Freestand-ing Fixed

5,388 003,506Pitt Greenville MRI LLC 6,1411 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1,255Freestand-ing Fixed

Q-006854-03 3,593 002,338Pitt Greenville MRI LLC 4,0951 1.00

1,369Freestand-ing Fixed

5,047 003,678Pitt MRI of Eastern Carolina (East Carolina Neurology)

5,5951 1.00

23Freestand-ing Fixed

Grandfathered 2,296 002,273Pitt Physicians East PA (Kings Medical Group)

2,3051 1.00

0Mobile Grandfathered 8 008Pitt Orthopaedics East, Inc. (Alliance HealthCare Services)

80 0.00

40Mobile Grandfathered 1,207 001,167Pitt Orthopaedics East, Inc. (Alliance HealthCare Services)

1,2230 0.25

Pitt/Greene/Hyde/Tyrell 28,761 35,6038 4,8058.25 4,315 0137Mobile F-006868-03 948 1126774Polk St. Luke's Hospital (Carolinas

Imaging Services, LLC)1,0220 0.55

Polk 948 1,0220 1,7160.55 1,022 0910Hospital

FixedG-006817-03; G-008342-09

4,172 2212312,810Randolph Randolph Hospital, Inc. 4,8052 2.00

Randolph 4,172 4,8052 4,1182.00 2,403 093Hospital

FixedH-008193-08 467 2198255Richmond Sandhills Regional Medical Center 5601 1.00

218Mobile H-006104-09 1,519 14661,221Richmond FirstHealth Richmond Memorial Hospital (FirstHealth of the Carolinas, Inc.)

1,6440 0.40

Richmond 1,986 2,2041 3,7751.40 1,574 01,250Hospital

FixedN-005496-96; N-006606-02

6,598 5921,5303,226Robeson Southeastern Regional Medical Center

8,1842 2.00

5Mobile O-007340-05 442 00437Robeson Waccamaw Imaging (Waccamaw Ultrasound & Diagnostics)

4440 0.11

Robeson 7,040 8,6282 4,1182.11 4,089 0627Hospital

FixedG-006691-02 2,519 923411,426Rockingham Annie Penn Hospital 2,9471 1.00

591Hospital Fixed

G-006297-00 2,564 1082311,634Rockingham Morehead Memorial Hospital 2,9791 1.00

Rockingham 5,083 5,9262 4,1182.00 2,963 01,536Hospital

FixedF-005829-98; F-006919-03; F-008314-09

8,172 2248855,527Rowan Novant Health Rowan Medical Center

9,3204 4.00

0Mobile Grandfathered 179 00179Rowan HMA Pinnacle Orthopedic Associates (Alliance HealthCare Services)

1790 0.04

0Mobile Grandfathered 86 0086Rowan HMA Pinnacle Orthopedic Associates (Alliance HealthCare Services)

860 0.02

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

0Mobile F-007164-04 75 0075Rowan Romedical (Presbyterian Mobile Imaging, LLC)

750 0.02

0Mobile Grandfathered 75 0075Rowan Rowan Outpatient Imaging (Foundation Health Mobile Imaging LLC)

750 0.02

Rowan 8,587 9,7354 4,8054.10 2,374 0848Hospital

FixedC-006229-00; C-007298-05; C-008313-09

2,909 1762091,676Rutherford Rutherford Hospital, Inc. 3,4731 1.00

Rutherford 2,909 3,4731 3,7751.00 3,473 0361Hospital

FixedM-007218-05 1,905 8211,515Sampson Sampson Regional Medical Center,

Inc. 2,0641 1.00

Sampson 1,905 2,0641 3,7751.00 2,064 0448Hospital

FixedN-007805-07 3,297 1064382,305Scotland Scotland Memorial Hospital, Inc. 3,7362 2.00

0Mobile Grandfathered 910 00910Scotland OrthoCarolina P.A. (Alliance HealthCare Services)

9100 0.22

Scotland 4,207 4,6462 4,1182.22 2,093 0670Hospital

FixedF-007461-06 2,838 1183201,730Stanly Stanly Regional Medical Center 3,3281 1.00

Stanly 2,838 3,3281 3,7751.00 3,328 0No Service Site

Stokes 1,716 0596Hospital

FixedG-006792-03 2,819 874261,710Surry Hugh Chatham Memorial Hospital,

Inc. 3,2971 1.00

546Hospital Fixed

G-006569-02; G-008115-08

2,899 862272,040Surry Northern Hospital of Surry County 3,2772 2.00

Surry 5,718 6,5743 4,4623.00 2,191 0No Service Site

Swain 1,716 0357Hospital

FixedB-007019-04 1,987 561071,467Transylvania Transylvania Community Hospital,

Inc. 2,2171 1.00

Transylvania 1,987 2,2171 3,7751.00 2,217 0745Hospital

FixedF-005920-98 4,327 1508432,589Union Carolinas Medical Center-Union 5,0821 1.00

89Freestand-ing Fixed

F-006972-03 654 00565Union Union West MRI (Union Medical Services, LLC)

6901 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

0Mobile Grandfathered 714 00714Union OrthoCarolina P.A. (Alliance HealthCare Services)

7140 0.17

0Mobile Grandfathered 75 0075Union OrthoCarolina P.A. (Alliance HealthCare Services)

750 0.02

146Mobile Grandfathered 763 00617Union Presbyterian Imaging Center - Monroe (Foundation Health Mobile Imaging LLC)

8210 0.19

31Mobile F-008237-08 208 00177Union Presbyterian Imaging Center - Monroe (Mecklenburg Diagnostic Imaging, Inc.)

2200 0.05

Union 6,741 7,6032 4,1182.43 3,129 0685Hospital

FixedK-006527-01; K-007839-07

3,370 3034501,932Vance Maria Parham Medical Center 4,0662 2.00

0Mobile M-006605-02 380 00380Vance Henderson (Mobile Imaging of North Carolina, LLC)

3800 0.09

Vance/Warren 3,750 4,4462 4,1182.09 2,127 01,726Hospital

FixedGrandfathered; J-008529-10

4,562 4495031,884Wake Duke Raleigh Hospital 5,8132 2.00

2,246Hospital Fixed

J-006932-03 7,514 9611,4902,817Wake Rex Hospital, Inc. 9,7773 3.00

1,838Hospital Fixed

J-006368-01 9,480 1,0562,0404,546Wake WakeMed 11,8762 2.00

829Hospital Fixed

J-007119-04 3,658 4106071,812Wake WakeMed Cary Hospital 4,5601 1.00

2,069Freestand-ing Fixed

5,015 002,946Wake Raleigh Neurology Associates 5,8431 1.00

1,516Freestand-ing Fixed

Grandfathered 3,661 002,145Wake Raleigh Neurology Imaging (Alliance HealthCare Services)

4,2671 1.00

695Freestand-ing Fixed

Grandfathered 3,658 002,693Wake Raleigh Radiology (Alliance HealthCare Services)

3,6661 1.00

1,580Freestand-ing Fixed

J-007289-05 6,437 004,857Wake Raleigh Radiology Cedarhurst (Pinnacle Health Services of NC, LLC)

7,0691 1.00

824Freestand-ing Fixed

Grandfathered 2,886 002,044Wake Wake Radiology Diagnostic Imaging (Alliance Healthcare Services)

3,1981 1.00

1,715Freestand-ing Fixed

Grandfathered 4,051 002,336Wake Wake Radiology Raleigh MRI Center (Wake Radiology Diagnostic Imaging)

4,7371 1.00

1,267Freestand-ing Fixed

J-005783-97 2,994 001,727Wake Wake Radiology Raleigh MRI Center (Wake Radiology Diagnostic Imaging)

3,5011 1.00

154Freestand-ing Fixed

Grandfathered 627 00473Wake Wake Radiology-Garner (Alliance Healthcare Services)

6891 1.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

1Mobile Grandfathered 403 00402Wake Carolina Back Institute (InSight Imaging)

4030 0.08

7Mobile Grandfathered 19 0012Wake Cary Diagnostic (Alliance HealthCare Services)

220 0.00

6Mobile Grandfathered 23 0017Wake Cary Diagnostic Radiology (Alliance HealthCare Services)

250 0.00

3Mobile Grandfathered 4 001Wake Cary Diagnostic Radiology (Alliance HealthCare Services)

50 0.00

5Mobile G-007038-04 25 0020Wake Cary Diagnostic Radiology (Alliance HealthCare Services)

270 0.01

115Mobile Grandfathered 337 00222Wake Cary Diagnostic Radiology (Alliance HealthCare Services)

3830 0.07

27Mobile Grandfathered 87 0060Wake Cary Diagnostic Radiology [10/1/2011 - 11/30/2011] (Alliance HealthCare Services)

980 0.02

119Mobile Grandfathered 228 00109Wake Duke Health Raleigh Hospital (Alliance HealthCare Services)

2760 0.05

5Mobile Grandfathered 14 009Wake Duke Health Raleigh Hospital (Alliance HealthCare Services)

160 0.00

8Mobile Grandfathered 9 001Wake Duke Health Raleigh Hospital (Alliance HealthCare Services)

120 0.00

1Mobile Grandfathered 6 005Wake Duke Health Raleigh Hospital (Alliance HealthCare Services)

60 0.00

114Mobile Grandfathered 354 00240Wake Duke Radiology Knightdale (Alliance HealthCare Services)

4000 0.07

113Mobile Grandfathered 329 00216Wake Duke Radiology Knightdale (Alliance HealthCare Services)

3740 0.07

934Mobile Grandfathered 2,052 001,118Wake Duke Raleigh Hospital (Alliance HealthCare Services)

2,4260 0.43

1Mobile Grandfathered 6 005Wake MS Imaging of NC (Alliance HealthCare Services)

60 0.00

50Mobile Grandfathered 246 00196Wake MS Imaging of NC (Alliance HealthCare Services)

2660 0.05

4Mobile G-007038-04 22 0018Wake MS Imaging of NC (Alliance HealthCare Services)

240 0.00

0Mobile Grandfathered 4 004Wake MS Imaging of NC (Alliance HealthCare Services)

40 0.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

10Mobile Grandfathered 39 0029Wake MS Imaging of NC (Alliance HealthCare Services)

430 0.01

3Mobile Grandfathered 4 001Wake MS Imaging of NC (Alliance HealthCare Services)

50 0.00

18Mobile Grandfathered 59 0041Wake MS Imaging of NC (Alliance HealthCare Services)

660 0.01

155Mobile O-006665-02 1,041 00886Wake North Carolina Diagnostic Imaging - Cary (Cape Fear Mobile Imaging, LLC)

1,1030 0.22

0Mobile J-007757-06 681 00681Wake Raleigh Orthopaedic Clinic Cary (Raleigh Orthopaedic Clinic, PA)

6810 0.14

0Mobile J-007757-06 671 00671Wake Raleigh Orthopaedic Clinic Durant (Raleigh Orthopaedic Clinic, PA)

6710 0.14

0Mobile J-007757-06 728 00728Wake Raleigh Orthopaedic Clinic Garner (Raleigh Orthopaedic Clinic, PA)

7280 0.15

18Mobile J-007757-06 1,797 001,779Wake Raleigh Orthopaedic Clinic Glenwood (Raleigh Orthopaedic Clinic, PA)

1,8040 0.37

74Mobile O-006665-02 283 00209Wake Raleigh Radiology (Cape Fear Mobile Imaging, LLC)

3130 0.06

13Mobile Grandfathered 36 0023Wake Raleigh Radiology (Foundation Health Mobile Imaging LLC)

410 0.01

5Mobile Grandfathered 2,736 002,189Wake Raleigh Radiology LLC (Alliance HealthCare Services)

2,1960 0.57

5Mobile Grandfathered 22 0017Wake Raleigh Radiology Wake Forest [10/1/2011 - 11/5/2011] (InSight Imaging)

240 0.00

218Mobile Grandfathered 1,179 00961Wake Raleigh Radiology Wake Forest (InSight Imaging)

1,2660 0.25

346Mobile J-007284-05 1,144 10797Wake Rex Healthcare of Wakefield (Rex Hospital, Inc.)

1,2830 0.24

128Mobile J-008453-09 2,074 001,946Wake Triangle Orthopaedic Associates 2,1250 0.43

0Mobile J-008453-09 432 00432Wake Triangle Orthopeadics Associates (Triangle Orthopaedic Associates)

4320 0.09

1Mobile G-007038-04 19 0018Wake Triangle Orthopedic (Alliance HealthCare Services)

190 0.00

0Mobile Grandfathered 57 0057Wake Triangle Orthopedic (Alliance HealthCare Services)

570 0.01

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

3Mobile Grandfathered 299 00296Wake Triangle Orthopedic (Alliance HealthCare Services)

3000 0.06

0Mobile Grandfathered 6 006Wake Triangle Orthopedic (Alliance HealthCare Services)

60 0.00

0Mobile Grandfathered 12 0012Wake Triangle Orthopedic (Alliance HealthCare Services)

120 0.00

2Mobile Grandfathered 4 002Wake Wake Radiology (Alliance HealthCare Services)

50 0.00

121Mobile Grandfathered 897 00676Wake Wake Radiology Cary (Alliance HealthCare Services)

8450 0.19

19Mobile J-007012-04 125 00106Wake Wake Radiology Cary (Wake Radiology Diagnostic Imaging)

1330 0.03

0Mobile J-007012-04 19 0019Wake Wake Radiology Fuquay-Varina (Wake Radiology Diagnostic Imaging)

190 0.00

43Mobile Grandfathered 235 00192Wake Wake Radiology Garner (Alliance HealthCare Services)

2520 0.05

411Mobile J-007012-04 1,489 001,078Wake Wake Radiology Garner (Wake Radiology Diagnostic Imaging)

1,6530 0.31

5Mobile J-007012-04 157 00152Wake Wake Radiology North West Raleigh (Wake Radiology Diagnostic Imaging)

1590 0.03

79Mobile Grandfathered 520 00441Wake Wake Radiology Services, LLC (Alliance HealthCare Services)

5520 0.11

67Mobile J-007012-04 288 00221Wake Wake Radiology Wake Forest (Wake Radiology Diagnostic Imaging)

3150 0.06

0Mobile J-007013-04 8 008Wake WakeMed Brier Creek [8/13/2012 - 9/30/2012] (WakeMed Health and Hospitals)

80 0.00

334Mobile Grandfathered 1,146 48549Wake WakeMed Health and Hospitals (Alliance HealthCare Services)

1,0350 0.24

21Mobile Grandfathered 74 0053Wake WakeMed Medical Park (Alliance HealthCare Services)

820 0.02

295Mobile J-007013-04 839 00544Wake WakeMed North Healthplex (WakeMed Health and Hospitals)

9570 0.17

24Mobile J-007013-04 71 0047Wake WakeMed Raleigh Medical Park [6/26/2012 - 9/30/2012] (WakeMed Health and Hospitals)

810 0.01

Wake 77,902 89,04116 4,80520.83 4,275 01Mobile Grandfathered 6 023Washington Washington County Hospital

(Alliance HealthCare Services)70 0.00

Table 9P: MRI Fixed and Mobile Procedures by MRI Service Area with Tiered Thresholds and Fixed Equivalents - Draft 5/20/2013Service Type Service Site (Provider/Owner)CON # Total MRI

ScansInpt

ContrastInpt No Contrast

Outpt ContrastService Area Adjusted

TotalArea Avg

Procs Threshold MRI Need

Fixed Magnet

Fixed Equiv

Outpt No Contrast

47Mobile Q-006884-03 315 613249Washington Washington County Hospital (Alliance HealthCare Services & University Health Systems of

3440 0.18

Washington 321 3510 1,7160.18 351 0883Hospital

FixedD-006652-02 3,070 1302641,793Watauga Watauga Medical Center, Inc. 3,6332 2.00

0Mobile Grandfathered 566 00566Watauga OrthoCarolina (Alliance HealthCare Services)

5660 0.12

0Mobile Grandfathered 229 00229Watauga OrthoCarolina - Boone (Alliance HealthCare Services)

2290 0.05

Watauga 3,865 4,4282 4,8052.17 2,040 01,405Hospital

FixedP-006889-03; P-007447-05

6,310 2114564,238Wayne Wayne Memorial Hospital, Inc. 7,2232 2.00

7Mobile Grandfathered 249 00242Wayne Atlantic Radiology Association (Alliance HealthCare Services)

2520 0.06

Wayne 6,559 7,4752 4,1182.06 3,629 0474Hospital

FixedD-005911-98 2,697 522971,874Wilkes Wilkes Regional Medical Center 3,0471 1.00

Wilkes 2,697 3,0471 3,7751.00 3,047 01,490Hospital

Fixed3,683 3356281,230Wilson Wilson Medical Center 4,7981 1.00

553Freestand-ing Fixed

2,237 001,684Wilson Regional MRI of Wilson (Wilson Orthopedics and Neurology Center PD)

2,4581 1.00

0Freestand-ing Fixed

L-007624-06 0 000Wilson WilMed Imaging Services [Procedures reported with Wilson Medical Center]

01 1.00

Wilson 5,920 7,2563 4,4623.00 2,419 06Mobile G-006271-00 103 1888Yadkin Yadkin Valley Community Hospital

(Alliance HealthCare Services)1090 0.06

Yadkin 103 1090 1,7160.06 109 0

Threshold 4+ Fixed Scanners = 4,805 3 Fixed Scanners = 4,462 2 Fixed Scanners = 4,118 1 Fixed Scanner = 3,775 0 Fixed Scanners = 1,716

788,095260.49231Total Total of Need Determinations 1