(1) In which medical and health services are provided;

(2) That, except for a freestanding medical facility established as a result of a conversion of a licensed general hospital under § 19-120(o)(3) of this title, is physically separate from a hospital or hospital grounds;

(3) That is an administrative part of a hospital, as defined in § 19-301 of this title; and

(4) That meets the requirements for provider-based status under the certification for an affiliated hospital as set forth by the Centers for Medicare and Medicaid Services in 42 C.F.R. § 413.65.