1_AttachmentJ-17NCSCIPHospital.pdf

Provider ID Hospital Name Address City State ZIP Code

340017 Margaret R Pardee Memorial Hospital 800 N Justice Street Hendersonville NC 28791 340027 Lenoir Memorial Hospital 100 Airport Road Kinston NC 28503 340036 Franklin Regional Medical Center 100 Hospital Drive Louisburg NC 27549 340041 Caldwell Memorial Hospital 321 Mulberry Street Sw Lenoir NC 28645 340042 Onslow Memorial Hospital 317 Western Boulevard Jacksonville NC 28546 340055 Valdese General Hospital Inc 720 Malcolm Blvd Valdese NC 28690 340064 Wilkes Regional Medical Center 1370 West D St North Wilkesboro NC 28659 340071 Betsy Johnson Regional Hospital 800 Tilghman Dr Dunn NC 28334 340072 Ashe Memorial Hospital 200 Hospital Ave Jefferson NC 28640 340075 Grace Hospital Inc 2201 South Sterling Street Morganton NC 28655 340084 Anson Community Hospital 500 Morven Road Wadesboro NC 28170 340087 The Mcdowell Hospital 430 Rankin Drive Marion NC 28752 340090 Johnston Memorial Hospital 509 Bright Leaf Blvd Smithfield NC 27577 340106 Sandhills Regional Medical Center 1000 West Hamlet Avenue Hamlet NC 28345 340109 Albemarle Hospital Authority 1144 N Road St Elizabeth City NC 27909 340132 Maria Parham Medical Center 566 Ruin Creek Road Henderson NC 27536 340145 Lincoln Medical Center 200 Gamble Drive Lincolnton NC 28092 340173 Wakemed, Cary Hospital 1900 Kildaire Farm Road Cary NC 27518 341318 Chowan Hospital 211 Virginia Rd Edenton NC 27932

NC 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.