Download:
pdf |
pdfSSA State/County
Code
Name of Physician or
National Provider
Mid-Level Practitioner Identifier (NPI) Number
Specialty
Specialty Code
Contract Type
Provider Street
Address
Provider City
Provider State
Provider Zip Code
Provider Previously
Listed? (Y or N)
Contracted Hospital
Where Privileged
Hospital NPI Number
If PCP, Accepts New
Patients? (Y or N)
Name of Medical
Group Affiliation or
"DC"
Employment Status
Uses CMS MA
Contract Amendment
(Y or N)
| File Type | application/pdf |
| File Title | HSD Table Templates |
| Author | CGI Federal |
| File Modified | 2012-09-13 |
| File Created | 2012-09-13 |