report record number
provider control type code
provider number
national provider identifier
report status code
fiscal year begin date
fiscal year end date
hcris process date
initial report switch
last report switch
transmittal number
fiscal intermediary number
automated desk review vendor code
fiscal intermediary create date
utilization code
notice of program reimbursment date
special indicator
fiscal intermediary receipt date
Hospital Street Address           S200001 00100 00100
Hospital City                     S200001 00200 00100
Hospital PO Box                   S200001 00100 00200
Hospital State                    S200001 00200 00200
IPF Provider Number               S200001 00400 00200
Provider's actual MSA or CBSA             S200001 00300 00300
Hospital County                   S200001 00200 00400
Land                                 A700001 00100 00100
Land Improvements                    A700001 00200 00100
Buildings and Fixtures               A700001 00300 00100
Fixed Equipment                      A700001 00500 00100
Land                                 A700001 00100 00200
Land Improvements                    A700001 00200 00200
Buildings and Fixtures               A700001 00300 00200
Fixed Equipment                      A700001 00500 00200
Land                                 A700001 00100 00500
Land Improvements                    A700001 00200 00500
Buildings and Fixtures               A700001 00300 00500
Fixed Equipment                      A700001 00500 00500
Investment Income-New Movable Equip       A800000 00200 00200
E20F180 00100 00100
E30A182 00100 00100
E30B182 00100 00100
E30A183 00100 00100
E30C183 00100 00100
E30A184 00100 00100
E30E186 00100 00100
e_B_hos10_c1_1
e_B_ipf10_c1_1
e_B_snf10_c1_1
G200000 00100 00100
G300000 00100 00100
H310181 00500 00500
H310181 00600 00500
H310181 00600 00700
H310181 00700 00700
S300001   01400   01400 S300001 01400 01400
Total                                 S300001 00700 00200
Total Hospital                        S300001 00700 00300
Total Hospital                        S300001 00700 00400
Total Adults & Peds                     S300001 00700 00600
HMO                                     S300001 00200 00700
S300001 00300 00700
S300001 00400 00700
Hospital Adlts & Ped Swing Bed SNF      S300001 00500 00700
Total Adults & Peds                     S300001 00700 00700
Physician-Part A                          S300002 00400 00200
Physician-Part B                          S300002 00500 00200
Non-Physician Part B                      S300002 00600 00200
Physician-Part A                          S300002 00400 00400
Physician-Part B                          S300002 00500 00400
Non-Physician Part B                      S300002 00600 00400
Physician-Part A                         S300002 00400 00500
Physician-Part B                         S300002 00500 00500
Non-Physician Part B                     S300002 00600 00500
Physician-Part A                         S300002 00400 00600
Physician-Part B                         S300002 00500 00600
Non-Physician Part B                     S300002 00600 00600
Excluded Area Salaries                  S300003 00200 00200
Subtotal Other Wages and Related Csts   S300003 00400 00200
Subtotal Wage Related Csts              S300003 00500 00200
Total                                   S300003 00600 00200
Excluded Area Salaries                  S300003 00200 00400
Subtotal Other Wages and Related Csts   S300003 00400 00400
Subtotal Wage Related Csts              S300003 00500 00400
Total                                   S300003 00600 00400
Excluded Area Salaries                  S300003 00200 00500
Subtotal Other Wages and Related Csts   S300003 00400 00500
Total                                   S300003 00600 00500
Excluded Area Salaries                  S300003 00200 00600
Subtotal Other Wages and Related Csts   S300003 00400 00600
Subtotal Wage Related Csts              S300003 00500 00600
Total                                   S300003 00600 00600
end of cost reporting period               S500000 00100 00100
receives Dialysis                          S500000 00200 00100
including setup                            S500000 00300 00100
furnished                                  S500000 00500 00100
Number of stations                         S500000 00600 00100
end of cost reporting period               S500000 00100 00200
Patient receives Dialysis                  S500000 00200 00200
including setup                            S500000 00300 00200
furnished                                  S500000 00500 00200
Number of stations                      S500000 00600 00200