Appendix A

Listing of providers covered by Northwell Health’s FAP:

Financial assistance is available only for services provided directly by a Northwell Health hospital facility or by a physician employed by Northwell Health. The following Northwell Health hospitals are covered under this policy:

 North Shore University Hospital  Staten Island University Hospital  Long Island Jewish Medical Center  Glen Cove Hospital  Long Island Jewish Forest Hills  Plainview Hospital  Long Island Jewish Valley Stream  South Shore University Hospital  Cohen Children’s Medical Center  Syosset Hospital  The Zucker Hillside Hospital  The Long Island Home  Orzac Center for Rehabilitation  Phelps Memorial Hospital Association  Huntington Hospital Association  Northern Westchester Hospital Assoc.  Lenox Hill Hospital  Peconic Bay Medical Center  Manhattan, Eye, Ear and Throat Hospital

The following Northwell Health hospital services that are performed by employed physicians are covered under this policy

 Substance Abuse;  Neurology;  Allergy Asthma, and Immunology;  Nuclear Medicine;  Arthritis;  Obstetrics & Gynecology;  Bariatric Services;  Ophthalmology;  Cancer;  Pain management;  Cardiovascular;  Pediatrics;  Occupational Health;  Pelvic Health;  Dentistry;  Pulmonary Medicine;  Oncology;  Radiation Oncology;  Dermatology;  Radiology;  Diabetes;  Rheumatology & Osteoporosis;  Ear, Nose, Throat;  Sleep Center;  Emergency Medicine;  Spine Center;  Endocrinology;  Surgical Services;  Family Medicine;  Telemedicine;  Emergency Medicine;  Thoracic Surgery;  Endocrinology;  Toxicology;  Gastroenterology;  Transplant Evaluation;  Maternal Services;  Urology;  Nephrology  Pathology;

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In addition, the following Northwell Health related organizations also adhere to the Northwell Health FAP:  Anesthesia Management Services, LLC  Brightwaters Gynecology, PC  Brooklyn Ambulatory Care, PC  Brooklyn Ambulatory Services, LLC  Carnegie Cardiovascular, PC  Community Drive Surgery, PC  DHCH, LLC  Endo Group, LLC  Endoscopy Center of Long Island  Greenwich Village Ambulatory Surgery Center, LLC  Krasnoff Consultative Services, LLC  Lakeville Surgery, PC  Lenox Hill Hospital Medical, PC  Lenox Hill Pathology, PC  Lenox Otolaryngology Head & Neck Surgery, PC  Lynbrook SC, LLC  Marcus Avenue Medical, PC  Medical Care of Queens, PC  Melville SC, LLC  North Shore LIJ Cardiovascular Medicine PC  North Shore LIJ Occupational Medicine PC  North Shore Medical Accelerator, PC  North Shore-LIJ Anesthesiology, PC  North Shore-LIJ Cardiology @ Deer Park, PC  North Shore-LIJ Clinical Integration Network IPA, LLC  North Shore-LIJ Heart Surgery, PC  North Shore-LIJ Internal Medicine at Lynbrook, PC  North Shore-LIJ Internal Medicine at New Hyde Park, PC  North Shore-LIJ Internal Medicine, PC  North Shore-LIJ Medical Group at Huntington, PC  North Shore-LIJ Medical Group at North Nassau, PC  North Shore-LIJ Medical Group at Syosset, PC  North Shore-LIJ Medical Group Urgent Medical Care, PC  North Shore-LIJ Medical Group, PC  North Shore-LIJ Medical, PC  North Shore-LIJ OB-GYN at Garden City, PC  North Shore-LIJ OB-GYN at New Hyde Park, PC Page | 2

 North Shore-LIJ OB-GYN, PC  North Shore-LIJ Pediatrics of Suffolk County, PC  North Shore-LIJ Radiology Services, PC  North Shore-LIJ Renal Ventures, LLC  North Shore-LIJ Urgent Care, PC  North Shore-LIJ Ventures GCSC, LLC  Northwell Health Melville ASC Ventures, LLC  Northwell Proton Therapy, PC  NSLIJ & Yale New Haven Medical Air Transport, LLC  Orlin & Cohen Medical Specialist Group  Peconic Cardiology, PC  Phelps Medical Services, PC  Physicians of University Hospital, PC  Population Health Management, LLC  Richmond ASC, LLC  South Shore Surgery Center, LLC  Suffolk Surgery Center  Suite 130 Plastic Surgery, PC  Surgical Specialty Center of Westchester, LLC  Synergy Health True North, LLC  True North Dialysis, LLC  True North II DC, LLC  True North IV DC, LLC  True North Urgent Care, LLC  True North V DC, LLC  United Medical Surgical, PC  Virtual Health Medicine, PC  Westchester Health Medical Management Services Organization, LLC  Westchester Health Medical, PC  Not-for-Profit Professional Corporations

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