CMS-10237 CMS-10237_MA_Facility_Table_2013

Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application regulations under 42 CFR 422 subpart K & 417.400

CMS-10237_MA_Facility_Table_2013

Part C Medicare Advantage Applications and 1876 Cost Plan Expansion Application (CY 2012)

OMB: 0938-0935

Document [pdf]
Download: pdf | pdf
SSA State/County
Code

Facility or Service
Type

Specialty Code

Medicare
National Provider
Certification Number
Identifier (NPI) Number
(MCN)

# of Staffed, MedicareCertified Beds

Facility Name

Provider Service
Street Address

Provider Service City

Provider Service
State

Provider Service Zip
Code


File Typeapplication/pdf
File TitleHSD Table Templates
AuthorCGI Federal
File Modified2011-10-18
File Created2011-10-18

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