Q-METRIC Overuse of Imaging: Policy for ALARA Specific to Imaging Children Appendix A: 2012 Michigan Certificate of Need Annual Survey – Hospitals, Freestanding Facilities, and Host Sites Providing CT Services Facilities with Survey Name of Facility City Data 1 Allegan General Hospital Allegan 2 Allegiance Health Jackson X 3 Allegiance Health Outpatient Facility Jackson 4 Alpena Regional Medical Center Alpena 5 Aspirus Keweenaw Hospital Laurium 6 Aspirus Ontonagon Hospital Ontonagon 7 Aspirus Grand View Hospital Ironwood 8 Bald Mountain Diagnostic Imaging Lake Orion 9 Baraga County Memorial Hospital L’Anse 10 William Beaumont Hospital – Royal Oak Royal Oak X 11 Beaumont Hospital – Troy Troy X 12 Beaumont Macomb Macomb X 13 Beaumont Warren Warren X 14 Beaumont Medical Center, Lake Orion Lake Orion X 15 Beaumont Medical Center, West Bloomfield West Bloomfield X 16 Beaumont Hospital, Grosse Pointe Grosse Point X 17 Beaumont Outpatient Services (UnaSource Building) Troy X 18 Beckley Road Medical Imaging & Open MRI Battle Creek 19 Bell Memorial Hospital Ishpeming 20 Borgess Medical Center Kalamazoo 21 Borgess Pipp Hospital Kalamazoo 22 Borgess Lee Dowagiac 23 Botsford Hospital Farmington Hills 24 Bronson Methodist Hospital Kalamazoo X 25 Bronson Radiology Services Kalamazoo 26 Bronson Lakeview Hospital Paw Paw 27 Bronson – Battle Creek Battle Creek 28 Canton Health Center Canton 29 Caro Community Hospital Caro 30 Carson City Hospital Carson City 31 Center for Outpatient Services Lakeland 32 Central Medical Imaging Royal Oak 33 Charlevoix Area Hospital Charlevoix 34 Cheboygan Memorial Hospital Cheboygan 35 Chelsea Community Hospital Chelsea 36 Children's Specialty Center – Clinton Twp Clinton Township 37 Children’s Hospital of Michigan Detroit X Q-METRIC Overuse of Imaging, ALARA Policy Page 1 Facilities with Survey Name of Facility City Data 38 Chippewa County War Memorial Hospital Sault Ste. Marie 39 Clarkston Health Center Clarkston 40 Clinton Memorial Hospital St. Johns 41 Community Health Center of Branch County Coldwater 42 Covenant Medical Center Saginaw X 43 Crittenton Hospital Medical Center Rochester 44 CT Center of Flint LLC Flint 45 Dickinson County Healthcare System Iron Mountain 46 Doctor's Hospital of Michigan Pontiac 47 DMC Surgery Hospital Detroit 48 East Ann Arbor Health Center - UMHS Ann Arbor X 49 Eaton Rapids Medical Center Eaton Rapids 50 Emma L. Bixby Medical Center Adrian 51 Garden City Hospital Garden City 52 Genesys Regional Medical Center Grand Blanc 53 Genesys Physicians Integrated Diagnostic Burton 54 Genesys Physicians Integrated Diagnostic Clio 55 Genesys Physicians Integrated Diagnostic Grand Blanc 56 Greater Flint Imaging – Ballenger Flint 57 Greater Flint Imaging – Center Road Burton 58 Greater Flint Imaging – Lapeer Lapeer 59 Hackley Health at the Lakes Norton Shores 60 Harbor Beach Community Hospital Harbor Beach 61 Hayes Green Beach Memorial Hospital Charlotte 62 Henry Ford Hospital Detroit X 63 Henry Ford West Bloomfield Hospital West Bloomfield X 64 Henry Ford Macomb Health Center – Chesterfield Township Chesterfield X 65 Henry Ford Macomb Hospital Clinton Township X 66 Henry Ford Macomb Hospital – Warren Campus Warren X 67 Henry Ford Medical Center – Columbus – Novi Novi X 68 Henry Ford Cottage Hospital – Grosse Pointe Farms Grosse Pointe Farms X 69 Henry Ford Center for Health Services Brownstown X 70 Henry Ford Fairlane – Dearborn Dearborn X 71 Henry Ford Sterling Heights Sterling Heights X 72 Henry Ford Wyandotte Hospital Wyandotte X 73 Herrick Medical Center Tecumseh 74 Hillsdale Community Health Center Hillsdale 75 Hills and Dales General Hospital Saginaw 76 Holland Hospital Holland 77 Holland Hospital Medical Imaging Center Holland Q-METRIC Overuse of Imaging, ALARA Policy Page 2 Facilities with Survey Name of Facility City Data 78 Hurley Medical Center Flint X 79 Huron Memorial Hospital Bad Axe 80 Huron Valley CT Center Ypsilanti 81 Huron Valley – Sinai Hospital Commerce Township 82 Ingham Regional – Grand Ledge Radiology Grand Ledge 83 Kalkaska Memorial Health Center Kalkaska 84 Lakeland Community Hospital – Watervliet Watervliet 85 Lakeland Hospital – Niles Niles 86 Lakeland Hospital – St. Joseph St. Joseph 87 Mackinac Straits Health System, Inc. St. Ignace 88 Marlette Regional Hospital Marlette 89 McKenzie Memorial Hospital Sandusky 90 McLaren – Greater Lansing Hospital Lansing 91 McLaren Imaging Center Flint 92 McLaren Imaging Lapeer Lapeer 93 McLaren Imaging Flint 94 McLaren Bay Regional Medical Center Bay City 95 McLaren Northern Michigan Hospital Petoskey 96 McLaren Northern Michigan Petoskey 97 McLaren Flint Flint X 98 McLaren Oakland Pontiac 99 McLaren Oakland Clarkston Radiology Clarkston 100 Mecosta County Medical Center Big Rapids 101 Memorial HealthCare – Owosso Owosso 102 Memorial Medical Center of West Michigan Ludington 103 Mercy Health Partners – Hackley Campus Muskegon 104 Mercy Health Partners – Lakeshore Campus Shelby 105 Mercy Health Partners – Mercy Campus Muskegon 106 Mercy Hospital – Cadillac Cadillac 107 Mercy Hospital – Grayling Grayling 108 Mercy Memorial Hospital Monroe 109 Metropolitan Hospital Wyoming 110 Michigan Institute for Neurological Disorders Farmington Hills 111 Michigan Neurology Associates Clinton Township 112 MidMichigan Medical Center – Clare Clare X 113 MidMichigan Medical Center – Gladwin Gladwin X 114 MidMichigan Medical Center – Gratiot Alma X 115 MidMichigan Medical Center – Midland Midland X 116 Mid-Michigan MRI – Computed Tomography Lansing 117 Munising Memorial Hospital Munising Q-METRIC Overuse of Imaging, ALARA Policy Page 3 Facilities with Survey Name of Facility City Data 118 Munson Medical Center Traverse City X 119 North Ottawa Community Hospital Grand Haven 120 Oakland Imaging Services, PLLC Farmington Hills 121 Oaklawn Hospital Marshall 122 Oakwood Hospital and Medical Center Dearborn 123 Oakwood Annapolis Hospital Wayne 124 Oakwood Healthcare Center – Canton Canton 125 Oakwood Heritage Hospital Taylor 126 Oakwood Imaging Center – Canton Canton 127 Oakwood Imaging Center – Midwest Dearborn 128 Oakwood Imaging Center West Dearborn 129 Oakwood Outpatient Imaging Dearborn 130 Oakwood Southshore Medical Center Trenton 131 Orchard View Medical Center Washington Township 132 Otsego Memorial Hospital Gaylord 133 Paul Oliver Memorial Hospital Frankfort 134 POH Medical Center – Oxford Oxford 135 Portage Health System Hancock X 136 Port Huron Hospital Port Huron 137 Premier MRI CT Pontiac 138 Providence Hospital and Medical Center Southfield X 139 Providence Medical Center – Providence Park Novi 140 Providence Farmington Farmington Hills 141 Providence Mission Health Medical Center Livonia 142 Regional Medical Imaging Flint 143 Regional Medical Imaging Grand Blanc 144 Regional Medical Imaging PC Fenton 145 Romeo Plank Diagnostic Center – St. John Macomb 146 Scheurer Hospital Pigeon 147 Schoolcraft Memorial Hospital Manistique 148 Shelby Macomb Diagnostic Center Shelby Township 149 Sheridan Community Hospital Sheridan 150 Sinai – Grace Hospital Detroit 151 South Haven Community Hospital South Haven 152 Southgate CT, PLC Southgate 153 Southwest Michigan Imaging Center Kalamazoo 154 Sparrow Health System – St Lawrence Lansing 155 Sparrow Ramblewood Imaging East Lansing 156 Sparrow Ionia Hospital Ionia 157 Sparrow Hospital Lansing X Q-METRIC Overuse of Imaging, ALARA Policy Page 4 Facilities with Survey Name of Facility City Data 158 Spectrum Health – Blodgett Hospital Grand Rapids X 159 Spectrum Health United Memorial United Greenville X 160 Spectrum Health United Memorial Kelsey Lakeview X 161 Spectrum Health Gerber Memorial Freemont X 162 Spectrum Health Zeeland Community Hospital Zeeland X 163 Spectrum Health Reed City Hospital Reed City X 164 Spectrum Health West Pavilion Wyoming X 165 Spectrum Health Evergreen Imaging Center Grand Rapids X 166 Spectrum Health South Pavilion Grand Rapids X 167 Spectrum Health – Butterworth Hospital Grand Rapids X 168 St. Francis Hospital Escanaba 169 St. Mary's Health Care Grand Rapids X 170 St. Mary’s of Michigan Saginaw 171 St. Mary’s of Michigan Towne Centre Saginaw 172 St. Mary Mercy – Livonia Livonia 173 St. Mary’s Southwest Bryon Center 174 Sturgis Hospital Inc. Sturgis 175 St. John Hospital & Medical Center Detroit X 176 St John Providence River District Hospital East China 177 St. John Macomb Hospital - Department of Radiology Warren 178 St. John Macomb Township Imaging Macomb 179 St. John Providence Macomb Oakland – Oakland Center Madison Heights 180 St. Joseph Health System – Tawas Tawas X 181 St. Joseph Mercy Hospital (Ann Arbor) Ann Arbor X 182 Saint Joseph Mercy Canton Health Center Canton X 183 St Joseph Mercy – Brighton (Woodland) Brighton X 184 St. Joseph Mercy Livingston Hospital Howell X 185 St. Joseph Mercy Oakland Hospital Pontiac X 186 St. Joseph Mercy Oakland, Diagnostic Center West Bloomfield West Bloomfield X 187 St. Joseph Mercy Saline Hospital Saline X 188 St. Joseph Mercy, Port Huron Port Huron X 189 Three Rivers Health Three Rivers 190 University of Michigan Health System Ann Arbor X 191 University of Michigan Livonia Center for Specialty Care Livonia X 192 West Branch Regional Medical Center West Branch X 193 West Side Medical Mall Bay City 194 West Shore Medical Center Manistee Q-METRIC Overuse of Imaging, ALARA Policy Page 5 .