MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FROM TO PROVIDER NAME STATUS NUMBER NUMBER MSA MSA 18C0001 52-0070 Mayo Clinic Health System - Eau Claire, Inc. Approved 20740 33460 18C0002 10-0022 Jackson Memorial Hospital Approved 33124 22744 18C0003 31-0032 Inspira Medical Center Vineland Approved 47220 12100 18C0004 24-0166 Mayo Clinic Health System - Fairmont Denied 24 31860 18C0005 44-0063 Johnson City Medical Center Approved 27740 11700 18C0006 26-0110 Southeast Hospital Denied 16020 16060 18C0006 26-0110 Southeast Hospital Denied 16020 41180 18C0007 46-0057 Park City Hospital Approved 46 41620 18C0008 39-0185 Lehigh Valley Hospital - Hazelton Approved 42540 10900 18C0009 31-0119 University Hospital Dismissed 18C0010 31-0031 Deborah Heart and Lung Center Denied 15804 35614 18C0011 38-0090 Bay Area Hospital Approved 38 21660 18C0012 17-0013 Hays Medical Center Approved 17 28 18C0013 37-0113 INTEGRIS Grove Hospital Approved 37 22220 18C0014 26-0186 Lake Regional Health System Approved 26 44180 18C0015 45-0465 Matagorda Regional Medical Center Approved 45 26420 18C0016 18-0043 Memorial Hospital Denied 18 30460 18C0017 34-0023 Park Ridge Health Approved 11700 24860 18C0018 52-0088 Saint Agnes Hospital Approved 22540 33340 18C0019 31-0002 Newark Beth Israel Medical Center Dismissed 18C0020 39-0133 Lehigh Valley Hospital Approved 10900 33874 18C0021 18-0005 Highlands Regional Medical Center Approved 18 26580 18C0022 39-0091 UPMC Northwest Medical Center Approved 39 38300 18C0024 34-0027 Lenoir Memorial Hospital, Inc. Approved 34 40580 18C0025 47-0001 Central Vermont Medical Center Approved 47 30 18C0026 15-0075 Bluffton Regional Medical Center Approved 23060 34620 18C0027 34-0024 Sampson Regional Medical Center Denied 34 48900 18C0028 36-0010 Union Hospital Association Approved 36 15940 18C0029 01-0005 Marshall Medical Center South Approved 01 13820 18C0030 07-0020 Middlesex Hospital Approved 25540 35300 18C0031 22-0073 Morton Hospital Approved 39300 14454 18C0032 51-0001 West Virginia University Hospitals, Inc. Approved 34060 38300 18C0033 25-0069 Rush Foundation Hospital Approved 25 46220 18C0034 25-0097 Southwest Mississippi Regional Medical Center Approved 25 12940 18C0035 39-0183 St. Luke's Miner's Memorial Hospital Approved 39 10900 18C0036 18-0048 Ephraim McDowell Regional Medical Center Approved 18 30460 18C0037 39-0048 Geisinger-Lewistown Hospital Approved 39 44300 18C0038 13-0018 Eastern Idaho Regional Medical Center Approved 26820 38540 18C0039 11-0125 Fairview Park Hospital Approved 11 31420 18C0040 15-0115 Memorial Hospital and Health Care Center Denied 15 21780 18C0041 18-0013 The Medical Center Denied 14540 34980 18C0042 44-0011 Blount Memorial Hospital Approved 28940 34 18C0043 11-0105 Colquitt Regional Medical Center Approved 11 45220 18C0044 17-0120 Labette Health Approved 17 27900 18C0045 37-0034 McAlester Regional Health Center Approved 37 46140 18C0046 18-0016 Jewish Hospital Shelbyville Denied 31140 30460 18C0047 01-0092 DCH Regional Medical Center Denied 46220 13820 18C0048 11-0150 Oconee Regional Medical Center Approved 11 12060 18C0049 11-0122 South Georgia Medical Center Approved 46660 45220 18C0050 11-0038 John D. Archbold Memorial Hospital Approved 11 45220 18C0051 01-0035 Cullman Regional Medical Center Approved 01 13820 18C0052 44-0059 Cookeville Regional Medical Center Approved 44 34980 18C0053 11-0002 Upson Regional Medical Center Approved 11 12060 18C0054 23-0030 MidMichigan Medical Center - Gratiot Approved 23 24340 18C0055 11-0001 Hamilton Medical Center Approved 19140 12060 18C0056 26-0006 Mosaic Life Care at St. Joseph Approved 41140 41140 18C0057 23-0037 Hillsdale Hospital Approved 23 11460 18C0058 05-0481 West Hills Hospital & Medical Center Approved 31084 37100 18C0059 01-0045 Fayette Medical Center Approved 01 13820 18C0060 39-0001 Geisinger - Community Medical Center Approved 42540 10900
Page 1 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0061 26-0074 Moberly Regional Medical Center Approved 26 17860 18C0062 10-0249 Seven Rivers Regional Medical Center Approved 26140 45300 18C0063 39-0237 Regional Hospital of Scranton Approved 42540 10900 18C0064 26-0034 Bates County Memorial Hospital Denied 28140 28140 18C0065 52-0177 Froedtert Memorial Lutheran Hospital Denied 33340 29404 18C0066 37-0056 Comanche County Memorial Hospital Denied 30020 36420 18C0067 24-0047 St. Luke's Hospital Approved 20260 33460 18C0068 32-0011 Presbyterian Espanola Hospital Approved 32 42140 18C0069 10-0023 Citrus Memorial Hospital Approved 26140 36100 18C0070 23-0075 Bronson Battle Creek Hospital Approved 12980 28020 18C0071 34-0131 CarolinaEast Medical Center Approved 35100 24780 18C0072 26-0050 SSM Health St. Francis Hospital Approved 26 41140 18C0073 29-0009 St. Mary's Regional Medical Center Approved 39900 05 18C0074 51-0050 Wheeling Hospital Approved 48540 38300 18C0075 26-0137 Freeman Health System Denied 27980 27900 18C0075 26-0137 Freeman Health System Denied 27980 22220 18C0076 07-0007 Lawrence + Memorial Hospital Approved 35980 35004 18C0077 26-0009 Bothwell Regional Health Center Approved 26 28140 18C0078 10-0062 Munroe Regional Medical Center Approved 36100 23540 18C0079 03-0119 Mercy Gilbert Medical Center Approved 38060 39140 18C0080 45-0044 UT Southwestern Medical Center Approved 19124 19124 18C0081 33-0164 Highland Hospital of Rochester Approved 40380 15380 18C0082 03-0036 Chandler Regional Medical Center Approved 38060 39140 18C0083 14-0067 Saint Francis Medical Center Approved 37900 14010 18C0084 33-0285 Strong Memorial Hospital Approved 40380 15380 18C0085 34-0141 New Hanover Regional Medical Center Approved 48900 48900 18C0086 05-0084 St Joseph's Medical Center Approved 44700 36084 18C0087 05-0058 Glendale Memorial Hospital & Health Center Approved 31084 37100 18C0088 03-0024 St. Joseph's Hospital & Medical Center Approved 38060 39140 18C0089 17-0068 Southwest Medical Center Approved 17 11100 18C0090 45-0080 Titus Regional Medical Center Denied 45 30980 18C0091 01-0078 Northeast Alabama Regional Medical Center Denied 11500 13820 18C0092 34-0050 Southeastern Regional Medical Center Approved 34 22180 18C0093 26-0025 Hannibal Regional Hospital Approved 26 41180 18C0094 03-0010 St. Mary's Hospital Approved 46060 38060 18C0095 42-0010 Carolina Pines Regional Medical Center Approved 22500 16740 18C0096 19-0164 Byrd Regional Hospital Approved 19 10780 18C0097 39-0079 Robert Packer Hospital Approved 39 13780 18C0098 44-0144 Tennova Healthcare - Harton Approved 44 34980 18C0099 10-0286 Physicians Regional Medical Center - Pine Ridge Approved 34940 15980 18C0100 36-0151 Affinity Medical Center Approved 15940 17460 18C0101 22-0035 North Shore Medical Center Approved 15764 14454 18C0102 15-0133 Kosciusko Community Hospital Approved 15 23060 18C0103 03-0114 Oro Valley Hospital Approved 46060 38060 18C0104 01-0040 Gadsden Regional Medical Center Approved 23460 13820 18C0105 05-0006 St. Joseph Hospital Approved 05 39820 18C0106 26-0175 Golden Valley Memorial Hospital Approved 26 28140 18C0107 36-0084 Aultman Hospital Approved 15940 17460 18C0108 52-0096 Wheaton Franciscan Healthcare - All Saints Denied 39540 29404 18C0109 52-0051 Columbia St. Mary's Hospital Milwaukee Denied 33340 29404 18C0110 05-0149 California Hospital Medical Center Approved 31084 37100 18C0111 17-0142 Via Christi Hospital Manhattan Approved 31740 45820 18C0112 36-0159 Adena Regional Medical Center Approved 36 18140 18C0113 03-0007 Verde Valley Medical Center Denied 39140 22380 18C0114 47-0024 Northwestern Medical Center, Inc. Approved 15540 15540 18C0115 38-0051 Salem Hospital Approved 41420 38900 18C0116 01-0150 L.V. Stabler Memorial Hospital Approved 01 33860 18C0117 26-0065 Mercy Hospital Springfield Denied 44180 41180 18C0117 26-0065 Mercy Hospital Springfield Denied 44180 28140 18C0118 01-0083 South Baldwin Regional Medical Center Approved 19300 37860
Page 2 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0119 26-0059 Mercy Hospital Lebanon Denied 26 41180 18C0119 26-0059 Mercy Hospital Lebanon Denied 26 44180 18C0120 36-0079 Kettering Medical Center Approved 19380 17140 18C0121 04-0118 NEA Baptist Memorial Hospital Denied 27860 32820 18C0122 33-0386 Catskill Regional Medical Center Approved 33 35084 18C0123 51-0024 Monongalia County General Hospital Approved 34060 38300 18C0124 39-0065 The Gettysburg Hospital Approved 23900 16540 18C0125 03-0011 St. Joseph's Hospital Approved 46060 38060 18C0126 10-0157 Lakeland Regional Medical Center Approved 29460 45300 18C0127 34-0028 Cape Fear Valley Medical Center Approved 22180 39580 18C0128 24-0071 District One Hospital Denied 24 33460 18C0129 37-0006 Alliance Health - Ponca City Approved 37 48620 18C0130 24-0088 Rice Memorial Hospital Approved 24 41060 18C0131 51-0071 Bluefield Regional Medical Center Approved 51 13980 18C0132 33-0222 Saratoga Hospital Approved 10580 47 18C0133 14-0040 Galesburg Cottage Hospital Approved 14 37900 18C0134 22-0077 Baystate Medical Center Approved 44140 49340 18C0135 39-0211 Sharon Regional Health System Denied 49660 17460 18C0136 26-0022 Northeast Regional Medical Center Approved 26 16 18C0137 16-0089 Ottumwa Regional Health Center Approved 16 26980 18C0138 32-0030 Artesia General Hospital Denied 32 36220 18C0139 04-0088 Medical Center South Arkansas Denied 04 33740 18C0140 45-0209 Northwest Texas Hospital Approved 11100 31180 18C0141 33-0094 Columbia Memorial Hospital Denied 33 38340 18C0142 39-0137 Wilkes-Barre General Hospital Approved 42540 10900 18C0143 03-0085 Northwest Medical Center Approved 46060 38060 18C0144 07-0015 New Milford Hospital Approved 07 14860 18C0145 18-0025 Flaget Memorial Hospital Denied 18 31140 18C0146 17-0203 Premier Surgical Institute Approved 17 22220 18C0147 51-0070 Raleigh General Hospital Approved 13220 16620 18C0148 23-0054 UP Health System - Marquette Approved 23 52 18C0149 30-0023 Exeter Hospital Approved 40484 15764 18C0150 38-0018 Asante Rogue Regional Medical Center Approved 32780 05 18C0151 42-0080 Hilton Head Hospital Approved 25940 42340 18C0152 14-0166 St. Mary's Hospital Approved 19500 16580 18C0153 42-0071 Self Regional Healthcare Approved 42 24860 18C0154 04-0062 Mercy Hospital Fort Smith Approved 22900 22220 18C0155 24-0069 Owatonna Hospital Approved 24 33460 18C0156 34-0068 Columbus Regional Healthcare System Approved 34 48900 18C0157 26-0064 SSM Health St. Mary's Hospital - Audrain Approved 26 27620 18C0158 44-0017 Holston Valley Medical Center Approved 28700 49 18C0159 01-0006 Eliza Coffee Memorial Hospital Denied 22520 25 18C0159 01-0006 Eliza Coffee Memorial Hospital Denied 22520 44 18C0159 01-0006 Eliza Coffee Memorial Hospital Denied 22520 22520 18C0160 04-0072 Baptist Health Medical Center - Stuttgart Denied 04 38220 18C0161 49-0013 Sentara Halifax Regional Hospital, Inc. Approved 49 31340 18C0162 26-0001 Mercy Hospital Joplin Approved 27900 22220 18C0163 26-0047 Capital Region Medical Center Approved 27620 27620 18C0164 26-0183 St. Francis Medical Center Denied 16020 41180 18C0165 33-0307 Cayuga Medical Center at Ithaca Approved 27060 27060 18C0166 05-0396 Santa Barbara Cottage Hospital Denied 42200 37100 18C0167 52-0011 Lakeview Medical Center Approved 52 20740 18C0168 36-0095 Blanchard Valley Hospital Approved 36 45780 18C0169 26-0113 Missouri Delta Medical Center Approved 26 14 18C0170 14-0058 Passavant Area Hospital Approved 14 41180 18C0171 44-0012 Wellmont Bristol Regional Medical Center Approved 28700 49 18C0172 33-0277 Corning Hospital Denied 33 27060 18C0173 03-0055 Kingman Regional Medical Center Approved 29420 39140 18C0174 11-0016 WellStar West Georgia Medical Center Approved 11 12060 18C0175 05-0335 Sonora Regional Medical Center Denied 05 33700
Page 3 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0176 45-0029 Laredo Medical Center Approved 29700 18580 18C0177 03-0012 Yavapai Regional Medical Center Approved 39140 39140 18C0178 36-0064 St. Elizabeth Youngstown Hospital Approved 49660 17460 18C0179 36-0086 Springfield Regional Medical Center Approved 44220 17140 18C0180 23-0022 Community Health Center of Branch County Approved 23 29620 18C0181 39-0063 University of Pittsburgh Medical Center- Hamot Withdrawn 18C0182 45-0119 South Texas Health System Approved 32580 15180 18C0183 33-0004 HealthAlliance Hospital Broadway Campus Denied 28740 20524 18C0183 33-0004 HealthAlliance Hospital Broadway Campus Denied 28740 35614 18C0184 25-0040 Singing River Health System Denied 25060 25060 18C0185 45-0346 Baptist Hospitals of Southeast Texas - Beaumont Campus Approved 13140 26420 18C0186 19-0027 CHRISTUS St. Patrick Hospital Approved 29340 13140 18C0187 45-0573 CHRISTUS Jasper Memorial Hospital Approved 45 13140 18C0188 51-0023 Weirton Medical Center Denied 48260 38300 18C0189 49-0116 LewisGale Hospital - Pulaski Denied 13980 13980 18C0190 49-0024 Carilion Roanoke Memorial Hospital Denied 40220 31340 18C0191 13-0049 Kootenai Health Denied 17660 44060 18C0192 49-0004 Sentara RMH Medical Center Approved 25500 16820 18C0193 19-0190 Caldwell Memorial Hospital Approved 19 33740 18C0194 45-0034 CHRISTUS St. Elizabeth Approved 13140 26420 18C0195 07-0024 Backus Hospital Approved 35980 35004 18C0196 45-0101 Hillcrest Baptist Medical Center Approved 47380 28660 18C0197 15-0010 St. Vincent Kokomo Denied 29020 26900 18C0198 52-0138 Aurora Saint Luke's Medical Center Denied 33340 29404 18C0199 52-0035 Aurora Sheboygan Memorial Medical Center Denied 43100 33340 18C0200 34-0091 The Moses H. Cone Memorial Hospital Approved 24660 20500 18C0201 05-0014 Sutter Amador Hospital Approved 05 40900 18C0202 16-0057 Great River Medical Center Approved 16 26980 18C0203 36-0068 The Toledo Hospital Approved 45780 11460 18C0204 44-0058 Southern Tennessee Regional Health System Winchester Approved 44 16860 18C0205 03-0069 Havasu Regional Medical Center Approved 29420 40140 18C0206 05-0424 Scripps Green Hospital Approved 41740 41740 18C0207 32-0005 San Juan Regional Medical Center Denied 22140 06 18C0208 45-0200 Wadley Regional Medical Center Approved 45500 43340 18C0209 05-0696 Keck Hospital of USC Approved 31084 37100 18C0210 33-0191 Glens Falls Hospital Approved 24020 47 18C0211 42-0018 Palmetto Health Richland Approved 17900 12260 18C0212 34-0002 Mission Hospital, Inc. Approved 11700 24860 18C0213 34-0047 North Carolina Baptist Hospital Denied 49180 24660 18C0214 01-0024 Jackson Hospital & Clinic, Inc. Approved 01 13820 18C0216 44-0068 Starr Regional Medical Center Athens Approved 44 16860 18C0217 14-0110 OSF Saint Elizabeth Medical Center Approved 14 16974 18C0218 19-0014 Teche Regional Medical Center Approved 19 29180 18C0219 34-0013 Rutherford Regional Medical Center Approved 34 16740 18C0220 33-0011 Our Lady of Lourdes Memorial Hospital, Inc. Approved 13780 13780 18C0221 01-0118 Vaughn Regional Medical Center Parkway Campus Approved 01 46220 18C0222 33-0023 Vassar Brothers Medical Center Dismissed 18C0223 25-0061 Yalobusha General Hospital Approved 25 32820 18C0224 39-0233 Hanover Hospital Approved 49620 49620 18C0225 49-0079 Memorial Hospital of Martinsville & Henry County Approved 49 24660 18C0226 42-0068 TRMC of Orangeburg & Calhoun Counties Approved 42 16700 18C0227 39-0045 Williamsport Regional Medical Center Approved 48700 14100 18C0228 27-0051 Kalispell Regional Medical Center Approved 27 33540 18C0229 05-0137 Kaiser Foundation Hospital - Panorama City Approved 31084 37100 18C0230 33-0273 Putnam Hospital Center Dismissed 18C0231 34-0073 Duke Raleigh Hospital Approved 39580 20500 18C0232 14-0189 Sarah Bush Lincoln Health Center Approved 14 16580 18C0233 01-0022 Cherokee Medical Center Approved 01 12060 18C0234 19-0167 Mercy Regional Medical Center Approved 19 10780 18C0235 18-0116 Jackson Purchase Medical Center Approved 18 16020
Page 4 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18C0236 22-0033 Beverly Hospital Withdrawn 18C0237 39-0110 Conemaugh Memorial Medical Center Denied 27780 11020 18C0238 34-0116 Frye Regional Medical Center Approved 25860 16740 18C0239 36-0141 Northside Medical Center Approved 49660 17460 18C0240 42-0026 Providence Hospital Approved 17900 12260 18C0241 32-0033 Los Alamos Medical Center Approved 32 10740 18C0242 04-0055 Sparks Regional Medical Center Approved 22900 37 18C0243 22-0015 The Cooley Dickinson Hospital, Inc. Approved 44140 49340 18C0244 14-0135 Decatur Memorial Hospital Approved 19500 44100 18C0245 33-0180 Samaritan Hospital Denied 10580 10580 18C0245 33-0180 Samaritan Hospital Denied 10580 47 18C0246 33-0057 St. Peter's Hospital Denied 10580 10580 18C0246 33-0057 St. Peter's Hospital Denied 10580 47 18C0247 10-0231 West Florida Hospital Denied 37860 18880 18C0248 22-0066 The Mercy Hospital Denied 44140 44140 18C0248 22-0066 The Mercy Hospital Denied 44140 49340 18C0249 36-0066 St. Ritas Medical Center Denied 30620 19380 18C0249 36-0066 St. Ritas Medical Center Denied 30620 30620 18C0250 34-0126 Wilson Medical Center Approved 34 24780 18C0251 10-0137 Heart of Florida Regional Medical Center Withdrawn 18C0252 01-0055 Flowers Hospital Approved 20020 10 18C0253 15-0015 Franciscan St. Anthony Health - Michigan City Denied 33140 16974 18C0254 50-0019 Providence Centralia Hospital Approved 50 45104 18C0255 34-0004 High Point Regional Hospital Denied 24660 20500 18C0255 34-0004 High Point Regional Hospital Denied 24660 16740 18C0256 44-0189 Regional Hospital of Jackson Approved 27180 32820 18C0257 01-0085 Decatur Morgan Hospital Denied 19460 19460 18C0257 01-0085 Decatur Morgan Hospital Denied 19460 44 18C0258 52-0004 Mayo Clinic Health System - Franciscan Medical Center La Crosse Approved 29100 40340 18G0001 Weber County (UT) Group Approved 36260 41620 46-0005 Ogden Regional Medical Center 46-0004 McKayDee Hospital Center 18G0002 Davis County (UT) Group Approved 36260 41620 46-0042 Lakeview Hospital 46-0041 Davis Hospital & Medical Center 18G0003 Monroe County (MI) Group) Approved 33780 11460 23-0099 Monroe Regional Hospital 18G0004 Riverside County (CA) Group Approved 40140 11244 05-0765 Kaiser Foundation Hospital - Moreno Valley 05-0701 Southwest Healthcare System 05-0684 Menifee Valley Medical Center 05-0686 Kaiser Foundation Hospital - Riverside 05-0102 Parkview Community Hospital 05-0390 Hemet Valley Medical Center 05-0573 Eisenhower Medical Center 05-0775 Temecula Valley Hospital 05-0534 John F. Kennedy Memorial Hospital 05-0329 Corona Regional Medical Center 05-0292 Riverside County Regional Medical Center 05-0243 Desert Regional Medical Center 05-0770 Loma Linda Unversity Medical Center Murrieta 05-0630 Inland Valley Regional Medical Center 05-0054 San Gorgonio Memorial Hospital 05-0423 Palo Verde Hospital 05-0022 Riverside Community Hospital
Page 5 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18G0005 McHenry County (IL) Group Approved 16974 29404 14-0176 Centegra Memorial Medical Center 14-0116 Centegra Northern Illinois Medical Center 18G0007 Cook County (IL) Group Approved 16974 29404 14-0065 Adventist La Grange Memorial Hospital 14-0250 Advocate South Suburban Hospital 14-0224 Presence St. Joseph Hospital 14-0010 Evanston Northwestern Healthcare 14-0206 Norwegian American Hospital 14-0208 Advocate Christ Medical Center 14-0290 St. Alexius Medical Center 14-0300 Provident Hospital of Cook County 14-0182 Advocate Illinois Masonic Medical Center 14-0281 Northwestern Memorial Hospital 14-0018 Mount Sinai Hospital Medical Center 14-0258 Alexian Brothers Medical Center 14-0181 South Shore Hospital 14-0252 Northwest Community Hospital 14-0251 Community First Medical Center 14-0172 Franciscan St. James Health 14-0240 Westlake Hospital 14-0158 Mercy Hospital & Medical Center 14-0177 Jackson Park Hospital 14-0095 Saint Anthony Hospital 14-0150 University of Illinois Hospital 14-0223 Advocate Lutheran General Hospital 14-0118 Metrosouth Medical Center 14-0068 Roseland Community Hospital 14-0080 Presence St. Francis Hospital 14-0054 MacNeal Hospital 14-0082 Louis A. Weiss Memorial Hospital 14-0083 Loretto Hospital 14-0180 Presence Saints Mary & Elizabeth Hospital 14-0179 Little Company of Mary Hospital 14-0191 Ingalls Memorial Hospital 14-0117 Presence Resurrection Medical Center 14-0008 Gottlieb Memorial Hospital 14-0119 Rush University Medical Center 14-0197 Methodist Hospital of Chicago 14-0048 Advocate Trinity Hospital 14-0114 Swedish Coventant Hospital 14-0062 Palos Community Hospital 14-0133 Holy Cross Hospital 14-0063 Rush Oak Park Hospital 14-0124 John H. Stroger Jr. Hospital of Cook County 14-0103 St. Bernard Hospital 14-0115 Thorek Memorial Hospital 14-0088 University of Chicago Medical Center 14-0049 West Suburban Hospital Medical Center 14-0276 Loyola University Medical Center
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CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18G0008 Summit County (OH) Group Approved 10420 17460 36-0241 Edwin Shaw Rehabilitation Institute 36-0150 Summa Western Reserve Hospital 36-0351 Crystal Clinic Orthopedic Center 36-0019 Summa Barberton Hospital 36-0020 Summa Health System 36-0027 Akron General Medical Center 18G0009 Johnson County (TX) Group Approved 23104 19124 67-0107 Baylor Emergency Medical Center 45-0148 Texas Health Harris Methodist Hospital Cleburne 18G0010 Tarrant County (TX) Group Approved 23104 19124 45-0039 TCHD d/b/a JPS Health Network 45-0419 Texas Health Harris Methodist Hospital Azle 67-0103 Medical Center of Alliance 45-0779 Texas Health Harris Methodist Hospital Southwest Fort Worth 67-0085 Texas Health Harris Methodist Alliance 67-0067 Baylor Othopedic & Spine Hospital at Arlington 67-0046 USMD Hospital at Fort Worth 67-0045 Cook Children's Northeast Hospital 67-0023 Methodist Mansfield Medical Center 45-0888 Texas Health Harris Methodist Hospital Southlake 45-0087 North Hills Hospital 45-0872 USMD Hospital of Arlington 67-0071 Texas Health Heart & Vascular Hospital Arlington 45-0880 Baylor Surgical Hospital at Fort Worth 45-0064 Texas Health Arlington Memorial Hospital 45-0677 Texas Health Huguley Hospital 45-0137 Baylor All Saints Medical Center 45-0563 Baylor Medical Center - Grapevine 45-0639 Texas Health Harris Methodist Hospital HEB 45-0672 Plaza Medical Center Fort Worth 45-0675 Medical Center of Arlington 45-0135 Texas Health Harris Methodist Hospital Fort Worth 18G0011 San Bernardino County (CA) Group Approved 40140 31084 05-0140 Kaiser Foundation Hospital Fontana Medical Center 05-0586 Chino Valley Medical Center 05-0245 Arrowhead Regional Medical Center 05-0300 St. Mary Medical Center 05-0129 St. Bernardine Medical Center 05-0089 Community Hospital of San Bernardino 05-0758 Montclair Hospital Medical Center 05-0272 Redlands Community Hospital 05-0298 Barstow Community Hospital 05-0279 Hi-Desert Medical Center 05-0709 Desert Valley Hospital 05-0517 Victor Valley Community Hospital 05-0327 Loma Linda University Medical Center 05-0099 San Antonio Regional Hospital 05-0778 Loma Linda University Children's Hospital
Page 7 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18G0012 Orange County (CA) Group Approved 11244 31084 05-0543 College Hospital Costa Mesa 05-0348 University of California Irvine Medical Center 05-0224 Hoag Memorial Hospital Presbyterian 05-0526 Huntington Beach Hospital 05-0746 Orange County Global Medical Center 05-0226 AMH Anaheim Regional Medical Center 05-0230 Garden Grove Hospital & Medical Center 05-0780 Foothill Regional Medical Center 05-0069 St. Joseph Hospital 05-0567 Mission Hospital Regional Medical Center 05-0589 Placentia Linda Hospital 05-0168 St. Jude Medical Center 05-0769 Hoag Orthopedic Institute 05-0609 Kaiser Foundation Hospital - Anaheim 05-0745 Chapman Global Medical Center 05-0426 West Anaheim Medical Center 05-0678 Orange Coast Memorial Medical Center 05-0603 Saddleback Memorial Medical Center 05-0548 Fairview Developmental Center 05-0580 La Palma Intercommunity Hospital 05-0570 Fountain Valley Regional Hospital & Medical Center 05-0747 South Coast Global Medical Center 05-0551 Los Alamitos Medical Center 05-0744 Anaheim Global Medical Center 18G0013 Essex County (NJ) Group Approved 35084 35614 31-0096 Prime Healthcare Services - St. Michael's LLC 31-0054 Montclair Hospital LLC d/b/as Hackensack UMC Mountainside 31-0076 Saint Barnabas Medical Center 31-0083 East Orange General Hospital 31-0009 Clara Maass Medical Center 31-0002 Newark Beth Israel Medical Center 31-0119 University Hospital 18G0014 St. Tammany Parish (LA) Group Approved 35380 25220 19-0256 Sterling Surgical Hospital 19-0267 Fairway Medical Center 19-0040 Slidell Memorial Hospital 19-0177 Lakeview Regional Medical Center 19-0250 Louisiana Heart Hospital 19-0204 Ochsner Medical Center - North Shore 19-0045 St. Tammany Parish Hospital 19-0270 Southern Surgical Hospital 18G0015 Putnam County (NY) Group Approved 20524 14860 33-0273 Putnam Hospital Center 18G0016 Jefferson County (AR) Group Approved 38220 30780 04-0071 Jefferson Regional Medical Center 18G0017 Cumberland County (PA) Group Approved 25420 23900 39-0058 Carlisle Regional Medical Center 39-0004 Holy Spirit Hospital 18G0018 Ottawa County (MI) Group Approved 24340 34740 23-0072 Holland Community Hospital 23-0174 North Ottawa Community Hospital 23-0003 Zeeland Community Hospital
Page 8 of 9 MEDICARE GEOGRAPHIC CLASSIFICATION REVIEW BOARD FFY 2018 DECISION LISTING
CASE PROVIDER FORM FROM TO PROVIDER NAME NUMBER NUMBER NO. MSA MSA 18G0019 Wayne County (MI) Group Denied 19804 11460 23-0270 Beaumont Hospital - Taylor 23-0024 Sinai-Grace Hospital 23-0146 Henry Ford Wyandotte Hospital 23-0176 Beaumont Hospital - Trenton 23-0273 Detroit Receiving Hospital & Univ. Health Center 23-0244 Garden City Hospital 23-0142 Beaumont Hospital - Wayne 23-0053 Henry Ford Hospital 23-0104 Harper University Hospital 23-0002 St. Mary Mercy Hospital 23-0089 Beaumont Hospital - Grosse Pointe 23-0020 Beaumont Hospital - Dearborn 23-0165 St. John Hospital & Medical Center 23-0297 Karmanos Cancer Hospital 18G0020 Berks County (PA) Group Approved 39740 33874 39-0316 Surgical Institute of Reading 39-0096 St. Joseph Medical Center 39-0044 Reading Hospital & Medical Center 18G0021 Middlesex County (MA) Group Approved 15764 14454 22-0098 Nashoba Valley Medical Center 22-0084 Emerson Hospital 22-0049 Marlborough Hospital 22-0063 Lowell General Hospital 22-0105 Winchester Hospital 22-0101 Newton-Wellesley Hospital 22-0070 Hallmark Health System 22-0171 Lahey Clinic Hospital, Inc. 22-0002 Mount Auburn Hospital 22-0175 Metrowest Medical Center 22-0011 Cambridge Health Alliance 18G0022 Worcester County (MA) Group Approved 49340 14454 22-0095 Heywood Hospital 22-0019 Harrington Memorial Hospital 22-0001 Health Alliance Hospital 22-0058 Clinton Hospital 22-0090 Milford Regional Medical Center 22-0163 UMass Memorial Medical Center, Inc. 22-0176 St. Vincent Hospital 22-0062 Adcare Hospital of Worcester, Inc. 18G0023 Portage County (OH) Group Denied 10420 17460 36-0078 UH Portage Medical Centerl 18G0024 Rockingham County (NH) Group Denied 40484 15764 30-0029 Portsmouth Regional Hospital 30-0017 Parkland Medical Center 18G0025 Solano County (CA) Group Approved 46700 36084 05-0073 Kaiser Foundation Hospital - Vallejo 05-0101 Sutter Solano Medical Center 05-0367 Northbay Medical Center 05-0767 Kaiser Foundation Hospital - Vacaville 18G0026 Dutchess County (NY) Group Approved 20524 14860 33-0023 Vassar Brothers Medical Center 33-0049 Northern Dutchess Hospital 18G0027 Bates County (MO) Group Denied 28140 28140 26-0034 Bates County Memorial Hospital 18G0028 Houston County (GA) Group Approved 47580 31420 11-0153 Perry Hospital 11-0069 Houston Medical Center 18G0029 Randolph County (NC) Group Approved 24660 49180 34-0123 Randolph Hospital
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