CMS-10237 CY 2018 Medicare Advantage Provider HSD Table

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

CY2018 CMS MA Provider HSD Table 10-20-16

Part C Medicare Advantage Application and 1876 Cost Plan Expansion Application

OMB: 0938-0935

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-0935 can be found here:

Document [pdf]

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2018 CMS MA Provider HSD Table

SSA State/County
Code

Name of Physician or
Mid-Level Practitioner

National Provider
Identifier (NPI)
Number

Specialty

OMB Control Number: 0938-0935 (Expires: TBD)

Specialty Code

Contract Type

Provider Street
Address

Provider City

Provider State

Provider Zip Code

If PCP, Accepts New
Patients? (Y or N)

Name of Medical
Group Affiliation or
"DC"

Uses CMS MA Contract
Amendment (Y or N)

File Type	application/pdf
File Title	HSD Table Templates
Author	CGI Federal
File Modified	2016-10-20
File Created	2016-10-13