Medicare Advantage Applications - Part C

Medicare Advantage Applications - Part C and regulations under 42 CFR 422 subpart K

Combined HSD 12-04-2008.xls

Medicare Advantage Applications - Part C

OMB: 0938-0935

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HSD- 1 County Projected Enrollment:








County Served (state/county code) Specialty Code Specialty or Required Medicare Service # of Available Medicare Providers by County Medicare Provider Breakdown Total # of Providers Total # of PCPs Accepting New Patients Total # of PCPs Accepting Only Established Patients Other Counties Served


Direct w/MAO Downstream Arrangement

001 General Practice







002 Family Practice







003 Internal Medicine







004 Geriatrics







005 Mid -Level Practitioners







006 Obstetrics/Gynecology







007 Cardiology







008 Chiropractic







009 Dermatology







010 Endocrinology







011 ENT







012 Gastroenterology







013 General Surgery







014 Nephrology







015 Neurology







016 Oncology







017 Ophthalmology







018 Oral Surgery







019 Orthopedics







020 Podiatry







021 Psychiatry







022 Pulmonology







023 Radiology







024 Rheumatology







025 Urology







026 Vascular Surgery







027 Acute Inpatient Hospitals







028 Diagnostic & Terapeeutic Radiology (Excluding Mammogram)







029 DME/Prosthetic Devices







030 Home Health







031 Lab Services







032 IP - Mental Illness







033 OP- Mental Illness







034 Mammography







035 OP - Renal Dialysis







036 Skilled Nursing Facility







037 Surgical Services - OP or Ambulatory







038 Therapy - Occupational/Physical







039 Therapy - Speech







040 Heart Transplant Facilities







041 Heart & Lung Transplant Facilities







042 Intestinal Transplant Facilities







043 Kidney Transplant Facilities







044 Liver Transplant Facilities







045 Lung Transplant Facilities







046 Pancreas Transplant Facilities














































File Typeapplication/vnd.ms-excel
AuthorCMS
Last Modified ByCMS
File Modified2008-12-05
File Created2007-10-30

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