CMS-10237 Medicare Advantage Facility HSD Table

Medicare Advantage Application - Part C and 1876 Cost Plan Expansion Application Regulations under 42 CFR 422 (Subpart K) & 417.400 (CMS-10237)

CY2017 CMS MA Facility HSD Table 30 Day

Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application

OMB: 0938-0935

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CY 2017 MA Facility HSD Table

SSA State/County
Code

Facility or Service
Type

Specialty Code

CMS Certification
Number

National Provider
Identifier (NPI) Number

# of Staffed, MedicareCertified Beds

Facility Name

Provider Service
Street Address

Provider Service City

Provider Service
State

Provider Service Zip Uses CMS MA Contract
Code
Amendment (Y or N)


File Typeapplication/pdf
File TitleHSD Table Templates
AuthorCGI Federal
File Modified2015-09-18
File Created2015-09-18

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