Download:
pdf |
pdfCY 2018 Provider HSD Table
SSA State/County
Code
Name of Physician or
Mid-Level Practitioner
National Provider
Identifier (NPI)
Number
Specialty
OMB Control Number: 0938-New (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 | 2017-07-21 |
| File Created | 2016-10-13 |