1_AttachmentJ-17CASCIPHospital.pdf

Provider ID Hospital Name Address City State ZIP Code

050002 St Rose Hospital 27200 Calaroga Ave Hayward CA 94545 050006 St Joseph Hospital 2700 Dolbeer Street Eureka CA 95501 050007 Peninsula Medical Center 1501 Trousdale Drive Burlingame CA 94010 050009 Queen Of The Valley 1000 Trancas St Napa CA 94558 050014 Sutter Amador Hospital 810 Court Street Jackson CA 95642 050018 Pacific Alliance Medical Center 531 W College St Los Angeles CA 90012 050022 Riverside Community Hospital 4445 Magnolia Avenue Riverside CA 92501 050028 Mad River Community Hospital 3800 Janes Rd Arcata CA 95521 050030 Oroville Hospital 2767 Olive Highway Oroville CA 95965 050038 Santa Clara Valley Medical Center 751 South Bascom Avenue San Jose CA 95128 050045 El Centro Regional Medical Center 1415 Ross Avenue El Centro CA 92243 050054 San Gorgonio Memorial Hospital 600 North Highland Springs Avenue Banning CA 92220 050055 St Luke'S Hospital 3555 Cesar Chavez Street San Francisco CA 94110 050056 Antelope Valley Hospital Med Center 1600 W Ave J Lancaster CA 93534 050057 Kaweah Delta District Hospital 400 W Mineral King Ave Visalia CA 93291 050058 Glendale Mem Hospital & Hlth Center 1420 S Central Ave Glendale CA 91204 050060 Community Regional Medical Center 2823 Fresno Street Fresno CA 93715 050063 Hollywood Presbyterian Medical Center 1300 N Vermont Ave Los Angeles CA 90028 050078 Little Company Of Mary--San Pedro 1300 W 7th St San Pedro CA 90732 050079 Doctors Medical Center-San Pablo/Pinole 2000 Vale Rd San Pablo CA 94806 050089 Community Hospital Of San Bernardino 1805 Medical Center Drive San Bernardino CA 92411 050091 Community And Mission Hospital Of Hunting2623 E Slausen Ave Huntington Park CA 90255

CA Hospitals Targeted for Improvement Based on Surgical Care Improvement Plan (SCIP) Quality Measures "SCIP Infection-1" and "SCIP-Infection 3." "SCIP-Infection 1" measures "prophylactic antibiotic received within 1 hour prior to surgical incision." "SCIP-Infection 3" measures "prophylactic antibiotic discontinued within 24 hours after surgery time ends."

NOTE: For more information about CMS' quality measures for hospitals, please visit the Hospital Compare tool at http://www.hospitalcompare.hhs.gov.

The QIO may recruit up to 15% of the total number of providers they will work with from among providers not included in the J-17. The QIO must submit the criteria used to select these providers in their proposal to CMS. In no case may the total number of providers exceed the maximum number of providers as specified in Table B nor may the number of providers not identified in the J-17 exceed 15% of the total number of the providers the QIO recruits to work with.

050099 San Antonio Community Hospital 999 San Bernardino Rd Upland CA 91786 050112 Santa Monica - Ucla Med Ctr & Orthopaedic 1250 16th Street Santa Monica CA 90404 050121 Hanford Community Medical Center 450 Greenfield Ave Hanford CA 93230 050122 Dameron Hospital 525 West Acacia Street Stockton CA 95203 050124 Verdugo Hills Hospital 1812 Verdugo Blvd Glendale CA 91209 050125 Regional Medical Center Of San Jose 225 N Jackson Ave San Jose CA 95116 050126 Valley Presbyterian Hospital 15107 Vanowen St Van Nuys CA 91406 050129 St Bernardine Medical Center 2101 N Waterman Ave San Bernardino CA 92404 050132 San Gabriel Valley Medical Center 438 W Las Tunas Drive San Gabriel CA 91778 050137 Kaiser Foundation Hospital 13652 Cantara St Panorama City CA 91402 050138 Kaiser Foundation Hospital 4867 Sunset Blvd Los Angeles CA 90027 050139 Kaiser Foundation Hospital 9400 E Rosecrans Ave Bellflower CA 90706 050140 Kaiser Foundation Hospital Fontana 9961 Sierra Ave Fontana CA 92335 050158 Encino-Tarzana Regional Medical Ctr 16237 Ventura Blvd Encino CA 91436 050167 San Joaquin General Hospital 500 W Hospital Road French Camp CA 95231 050173 Anaheim General Hospital 3350 W Ball Rd Anaheim CA 92804 050174 Santa Rosa Memorial Hospital 1165 Montgomery Dr Santa Rosa CA 95405 050179 Emanuel Medical Center Inc 825 Delbon Ave Turlock CA 95382 050180 John Muir Medical Center - Walnut Creek Ca 1601 Ygnacio Valley Rd Walnut Creek CA 94598 050189 George L Mee Memorial Hospital 300 Canal Street King City CA 93930 050193 South Coast Medical Center 31872 Coast Hwy Laguna Beach CA 92677 050196 Central Valley General Hospital 1025 N Douty St Hanford CA 93230 050204 Lancaster Community Hospital 43830 N 10th St W Lancaster CA 93534 050205 East Valley Hospital Medical Center 150 West Route 66 Glendora CA 91740 050219 Coast Plaza Doctors Hospital 13100 S Studebaker Rd Norwalk CA 90650 050226 Anaheim Memorial Hospital 1111 W La Palma Ave Anaheim CA 92801 050231 Pomona Valley Hospital Medical Center 1798 N Garey Ave Pomona CA 91767 050236 Simi Valley Hospital & Health Care Services 2975 N Sycamore Dr Simi Valley CA 93065 050238 Methodist Hospital Of Southern Ca 300 W Huntington Dr Arcadia CA 91006 050239 Glendale Adventist Medical Center 1509 E Wilson Ave Glendale CA 91206 050242 Dominican Hospital 1555 Soquel Drive Santa Cruz CA 95065 050243 Desert Regional Medical Center 1150 North Indian Canyon Drive Palm Springs CA 92262 050261 Sierra View District Hospital 465 W Putnam Ave Porterville CA 93257 050262 Ucla Medical Center 10833 Le Conte Ave Bh 427, Chs Los Angeles CA 90095 050272 Redlands Community Hospital 350 Terracina Blvd Redlands CA 92373 050279 Hi-Desert Medical Center 6601 White Feather Road Joshua Tree CA 92252 050281 Alhambra Hospital And Medical Center 100 S Raymond Ave Alhambra CA 91801

050292 Riverside County Regional Medical Center 26520 Cactus Avenue Moreno Valley CA 92555 050295 Mercy Hospital 2215 Truxtun Avenue Bakersfield CA 93301 050296 Hazel Hawkins Memorial Hospital 900 Sunset Drive Hollister CA 95023 050298 Barstow Community Hospital 555 South Seventh Avenue Barstow CA 92311 050315 Kern Medical Center 1830 Flower Street Bakersfield CA 93305 050320 Alameda County Medical Center 1411 E 31st St Oakland CA 94602 050329 Corona Regional Medical Center 800 South Main Street Corona CA 92882 050350 Beverly Hospital 309 W Beverly Blvd Montebello CA 90640 050352 Barton Memorial Hospital 2170 South Avenue South Lake Tahoe CA 96158 050357 Goleta Valley Cottage Hospital 351 S Patterson Ave Santa Barbara CA 93111 050359 Tulare District Hospital 869 Cherry Ave Tulare CA 93274 050369 Citrus Valley Medical Center-Qv Campus 1115 S Sunset Ave West Covina CA 91790 050373 Lac+Usc Medical Center 1200 N State St Los Angeles CA 90033 050382 Citrus Valley Medical Center-Ic Campus 210 W San Bernardino Road Covina CA 91723 050385 Palm Drive Hospital 501 Petaluma Ave Sebastopol CA 95472 050390 Hemet Valley Medical Center 1117 E Devonshire Hemet CA 92543 050394 Community Memorial Hospital San Buenaven147 North Brent St Ventura CA 93003 050396 Santa Barbara Cottage Hospital Pueblo At Bath St Santa Barbara CA 93105 050407 Chinese Hospital 845 Jackson St San Francisco CA 94133 050411 Kaiser Foundation Hospital 25825 South Vermont Avenue Harbor City CA 90710 050423 Palo Verde Hospital 250 North First Street Blythe CA 92225 050438 Huntington Memorial Hospital 100 W California Blvd Pasadena CA 91109 050441 Stanford Hospital 300 Pasteur Drive Stanford CA 94305 050448 Ridgecrest Regional Hospital 1081 North China Lake Blvd Ridgecrest CA 93555 050455 San Joaquin Community Hospital 2615 Chester Avenue Bakersfield CA 93301 050457 St Mary'S Medical Center 450 Stanyan St San Francisco CA 94117 050468 Memorial Hospital Of Gardena 1145 W Redondo Beach Blvd Gardena CA 90247 050470 Selma Community Hospital 1141 Rose Ave Selma CA 93662 050476 Sutter Lakeside Hospital 5176 Hill Road East Lakeport CA 95453 050485 Long Beach Memorial Medical Center 2801 Atlantic Ave Long Beach CA 90806 050502 Saint Vincent Medical Center 2131 W 3rd St Los Angeles CA 90057 050503 Scripps Memorial Hospital - Encinitas 354 Santa Fe Drive Encinitas CA 92024 050515 Kaiser Foundation Hospital - San Diego 4647 Zion Ave San Diego CA 92120 050517 Victor Valley Community Hospital 15248 11th St Victorville CA 92392 050523 Sutter Delta Medical Center 3901 Lone Tree Way Antioch CA 94509 050549 Los Robles Hospital & Medical Center 215 W Janss Rd Thousand Oaks CA 91360 050561 Kaiser Foundation Hospital - West La 6041 Cadillac Ave Los Angeles CA 90034

050570 Fountain Valley Regional Hospital 17100 Euclid Street Fountain Valley CA 92708 050575 Tri-City Regional Medical Center 21530 S Pioneer Blvd Hawaiian Gardens CA 90716 050578 Martin Luther King, Jr - Harbor Hospital 12021 S Wilmington Ave Los Angeles CA 90059 050586 Chino Valley Medical Center 5451 Walnut Ave Chino CA 91710 050588 San Dimas Community Hospital 1350 W Covina Blvd San Dimas CA 91773 050597 Foothill Presbyterian Hospital 250 S Grand Ave Glendora CA 91740 050608 Delano Regional Medical Center 1401 Garces Highway Delano CA 93215 050609 Kaiser Foundation Hospital Anaheim 441 N Lakeview Avenue Anaheim CA 92807 050624 Henry Mayo Newhall Memorial Hospital 23845 W Mcbean Pkwy Valencia CA 91355 050641 East Los Angeles Doctors Hospital 4060 Whittier Blvd Los Angeles CA 90023 050677 Kaiser Foundation Hospital 5601 De Soto Woodland Hills CA 91367 050678 Orange Coast Memorial Medical Center 9920 Talbert Avenue Fountain Valley CA 92708 050680 Northbay Vacavalley Hospital 1000 Nut Tree Road Vacaville CA 95688 050684 Menifee Valley Medical Center 28400 Mccall Blvd Sun City CA 92585 050688 Saint Louise Regional Hospital 9400 No Name Uno Gilroy CA 95020 050694 Moreno Valley Community Hospital 27300 Iris Avenue Moreno Valley CA 92555 050696 Usc University Hospital 1500 San Pablo St Los Angeles CA 90033 050701 Southwest Healthcare System 25500 Medical Center Drive Murrieta CA 92562 050704 Mission Community Hospital - Panorama 14850 Roscoe Blvd Panorama City CA 91402 050723 Kaiser Foundation Hospital 1011 Baldwin Park Blvd Baldwin Park CA 91706 050726 Stanislaus Surgical Hospital 1421 Oakdale Road Modesto CA 95355 050727 Community Hospital Of Long Beach 1720 Termino Avenue Long Beach CA 90804 050736 Monterey Park Hospital 900 South Atlantic Monterey Park CA 91754 050737 Garfield Medical Center 525 North Garfield Avenue Monterey Park CA 91754 050739 Centinela Freeman Regional Medical Center 555 East Hardy Street Inglewood CA 90301 050740 Centinela Freeman Regional Medical Center 4650 Lincoln Blvd Marina Del Rey CA 90291 050744 Western Medical Center Hosp Anaheim 1025 S Anaheim Blvd Anaheim CA 92805 050746 Western Medical Center Santa Ana 1001 North Tustin Avenue Santa Ana CA 92705 050747 Coastal Communities Hospital 2701 South Bristol Street Santa Ana CA 92704 050749 Thousand Oaks Surgical Hospital 401 Rolling Oaks Drive Thousand Oaks CA 91361 050752 Brotman Medical Center 3828 Delmas Terrace Culver City CA 90231 051316 Fairchild Medical Center 444 Bruce Street Yreka CA 96097 051320 Banner Lassen Medical Center 1800 Spring Ridge Drive Susanville CA 96130