********************************************* * * * A T T E N T I O N * * * * THESE POS RECORD SPECIFICATIONS WERE * * PRODUCED FROM OUR DICTIONARY AT THE * * SAME TIME AS THE POS DATA FILE THAT * * YOU REQUESTED. YOU MAY WISH TO CHECK * * THESE SPECIFICATIONS TO SEE IF ANY * * CHANGES HAVE OCCURED SINCE YOUR RECEIPT * * OF ANY PRIOR DOCUMENTATION. * * * * FILE CREATION DATE = 10/06/2020 * * * ********************************************* Provider Category Subtype Code 2 1 2 VARCHAR2 Description: Identifies the subtype of the provider, within the primary category. Used in reporting to show the breakdown of provider categories, mainly for hospitals and SNFs. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=Federally Qualified Health Center P Provider Category Code 2 3 4 VARCHAR2 Description: Identifies the type of provider participating in the Medicare/Medicaid program. SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 21=Federally Qualified Health Center CHOW Count 2 5 6 NUMBER Description: Number of times this provider has undergone a change of ownership. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT CHOW Date 8 7 14 DATE Description: Effective date of the most recent change of ownership for this provider. SAS Name: CHOW_DT COBOL Name: CHOW-DT Address: City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Acceptable POC 1 43 43 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies. SAS Name: ACPTBL_POC_SW COBOL Name: ACPTBL-POC-SW Compliance: Status 1 44 44 VARCHAR2 Description: Compliance status of a provider at the time of certification survey. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE SSA County Code 3 45 47 VARCHAR2 Description: Social Security Administration geographic code indicating the county where the provider is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD Cross Ref Provider Number 10 48 57 CHAR Description: Cross reference provider number SAS Name: CROSS_REF_PROVIDER_NUMBER COBOL Name: CROSS-REF-PROVIDER-NUMBER Certification Date 8 58 65 DATE Description: Equal to the exit date of the initial visit of the Health survey for certifications completed after July 28, 2012. For certifications prior to that date, the certification date is equal to the exit date of the initial visit of the Health survey or LSC survey, whichever is later. SAS Name: CRTFCTN_DT COBOL Name: CRTFCTN-DT Eligibility Indicator 1 66 66 VARCHAR2 Description: Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs. SAS Name: ELGBLTY_SW COBOL Name: ELGBLTY-SW Facility Name 50 67 116 VARCHAR2 Description: Name of the provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Medicare Administrative Contractor (MAC) or 5 117 121 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_CD COBOL Name: INTRMDRY-CARR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01111=Noridian (CA) 01112=Noridian (NF) 01120=AETNA (HAWAII) 01182=Noridian (SF) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01211=Noridian (AS, GU, HI) 01212=Noridian (AS, GU, HI) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01311=Noridian (NV) 01312=Noridian (NV) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 01911=Noridian (AS, GU, HI, NV) 02050=OCCIDENTAL (CALIFORNIA) 02101=Noridian AK 02102=Noridian AK 02201=Noridian ID 02202=Noridian ID 02301=Noridian OR 02302=Noridian OR 02401=Noridian WA 02402=Noridian WA 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04211=NOVITAS (NEW MEXICO) 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06001=NGS (WI) 06004=National Govt Serv HHH 06101=NGS (IL) 06102=NGS (IL) 06201=NGS (MN) 06202=NGS (MN) 06301=NGS (WI) 06302=NGS (WI) 07101=Novitas AR 07102=Novitas AR 07201=Novitas LA 07202=Novitas LA 07301=Novitas MS 07302=Novitas MS 08101=WPS IN 08102=WPS IN 08201=WPS MI 08202=WPS MI 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 10111=PALMETTO GBA (Part A) (AL) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10211=PALMETTO GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA GBA (TN) 10311=PALMETTO GBA (TN) 10490=TRAVELERS (VIRGINIA) 10492=TRAVELERS - VIRGINIA SPECIAL PROJECT 11004=PALMETTO HHH C 11201=PALMETTO GBA (SC) 11202=PALMETTO GBA (SC) 11260=GENERAL AMERICAN 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=Novitas DE 12102=Novitas DE 12201=Novitas DC 12202=Novitas DC 12301=Novitas MD 12302=Novitas MD 12401=Novitas NJ 12402=Novitas NJ 12501=Novitas PA 12502=Novitas PA 12901=Novitas Solutions DC, DE, MD, PA 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NGS (UN) 13292=NGS (QN) 14004=NATIONAL HERITAGE (HHA - A) 14014=NGS (HHA) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14111=NGS (ME) 14112=NGS (ME) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14211=NGS (MA) 14212=NGS (MA) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14311=NGS (NH) 14312=NGS (NH) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14411=NGS (RI) 14412=NGS (RI) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 14511=NGS (VT) 14512=NGS (VT) 15004=CGS Administrators HHH 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=WISCONSIN PHYSICIANS SERVICE 57400=COOPERATIVA (PUERTO RICO) Medicaid Vendor Number 15 122 136 VARCHAR2 Description: Number which may be assigned to a provider by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Original Participation Date 8 137 144 DATE Description: Date a provider is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior CHOW Date 8 145 152 DATE Description: Effective date of the previous change of ownership for this provider. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Prior Medicare Administrative Contractor (MAC) or 5 153 157 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the previous Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_PRIOR_CD COBOL Name: INTRMDRY-CARR-PRIOR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01111=Noridian (CA) 01112=Noridian (NF) 01120=AETNA (HAWAII) 01182=Noridian (SF) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01211=Noridian (AS, GU, HI) 01212=Noridian (AS, GU, HI) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01311=Noridian (NV) 01312=Noridian (NV) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 01911=Noridian (AS, GU, HI, NV) 02050=OCCIDENTAL (CALIFORNIA) 02101=Noridian AK 02102=Noridian AK 02201=Noridian ID 02202=Noridian ID 02301=Noridian OR 02302=Noridian OR 02401=Noridian WA 02402=Noridian WA 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04211=NOVITAS (NEW MEXICO) 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06001=NGS (WI) 06004=National Govt Serv HHH 06101=NGS (IL) 06102=NGS (IL) 06201=NGS (MN) 06202=NGS (MN) 06301=NGS (WI) 06302=NGS (WI) 07101=Novitas AR 07102=Novitas AR 07201=Novitas LA 07202=Novitas LA 07301=Novitas MS 07302=Novitas MS 08101=WPS IN 08102=WPS IN 08201=WPS MI 08202=WPS MI 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 10111=PALMETTO GBA (Part A) (AL) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10211=PALMETTO GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA GBA (TN) 10311=PALMETTO GBA (TN) 10490=TRAVELERS (VIRGINIA) 10492=TRAVELERS - VIRGINIA SPECIAL PROJECT 11004=PALMETTO HHH C 11201=PALMETTO GBA (SC) 11202=PALMETTO GBA (SC) 11260=GENERAL AMERICAN 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=Novitas DE 12102=Novitas DE 12201=Novitas DC 12202=Novitas DC 12301=Novitas MD 12302=Novitas MD 12401=Novitas NJ 12402=Novitas NJ 12501=Novitas PA 12502=Novitas PA 12901=Novitas Solutions DC, DE, MD, PA 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NGS (UN) 13292=NGS (QN) 14004=NATIONAL HERITAGE (HHA - A) 14014=NGS (HHA) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14111=NGS (ME) 14112=NGS (ME) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14211=NGS (MA) 14212=NGS (MA) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14311=NGS (NH) 14312=NGS (NH) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14411=NGS (RI) 14412=NGS (RI) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 14511=NGS (VT) 14512=NGS (VT) 15004=CGS Administrators HHH 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=WISCONSIN PHYSICIANS SERVICE 57400=COOPERATIVA (PUERTO RICO) CCN 10 158 167 VARCHAR2 Description: Six or ten position identification number that is assigned to a certified provider. This is the CMS Certification Number. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Region Code 2 168 169 VARCHAR2 Description: Indicates the CMS Regional Office responsible for the certification of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=Boston 02=New York 03=Philadelphia 04=Atlanta 05=Chicago 06=Dallas 07=Kansas City 08=Denver 09=San Francisco 10=Seattle Skeleton Record Indicator 1 170 170 VARCHAR2 Description: Indicates if the record is a skeleton record. Only a limited set of data is available for this provider; no survey data exists. Only provider categories 01,17,19,21and 22 can have skeleton providers. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 Description: Two-character state abbreviation. SAS Name: STATE_CD COBOL Name: STATE-CD VALUES: AK=ALASKA AL=ALABAMA AR=ARKANSAS AS=AMERICAN SAMOA AZ=ARIZONA CA=CALIFORNIA CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=INTERNATIONAL GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA KS=KANSAS KY=KENTUCKY LA=LOUISIANA MA=MASSACHUSETTS MD=MARYLAND ME=MAINE MI=MICHIGAN MN=MINNESOTA MO=MISSOURI MP=SAIPAN MS=MISSISSIPPI MT=MONTANA MX=MEXICO NC=NORTH CAROLINA ND=NORTH DAKOTA NE=NEBRASKA NH=NEW HAMPSHIRE NJ=NEW JERSEY NM=NEW MEXICO NV=NEVADA NY=NEW YORK OH=OHIO OK=OKLAHOMA OR=OREGON PA=PENNSYLVANIA PR=PUERTO RICO RI=RHODE ISLAND SC=SOUTH CAROLINA SD=SOUTH DAKOTA TN=TENNESSEE TX=TEXAS UT=UTAH VA=VIRGINIA VI=VIRGIN ISLANDS VT=VERMONT WA=WASHINGTON WI=WISCONSIN WV=WEST VIRGINIA WY=WYOMING SSA State Code 2 173 174 VARCHAR2 Description: Social Security Administration geographic code indicating the state where the provider is located. SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=INTERNATIONAL State Region Code 3 175 177 VARCHAR2 Description: Identifies the region within a state where the provider is located. SAS Name: STATE_RGN_CD COBOL Name: STATE-RGN-CD VALUES: AK/001=ALASKA AK/LAB=LABORATORIES AK/NPH=NON-PARTICIPATING HOSPITAL AL/001=ALABAMA AL/LAB=LABORATORIES AL/NPH=NON-PARTICIPATING HOSPITAL AR/001=ARKANSAS AR/LAB=LABORATORIES AR/NPH=NON-PARTICIPATING HOSPITAL AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AS/NPH=NON-PARTICIPATING HOSPITAL AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/NPH=NON-PARTICIPATING HOSPITAL AZ/TUC=TUCSON CA/001=CALIFORNIA CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/EB=East Bay CA/FR=FRESNO CA/L1=L.A. WEST CA/L2=L.A. NORTH CA/L3=L.A. CENTRAL CA/L4=L.A. EAST CA/L5=SAN GABRIEL CA/LA1=LA Region 1 CA/LA2=LA Region 2 CA/LA3=LA Region 3 CA/LA4=LA Acute/Ancillary CA/LA5=LA HHA/Hospice CA/LA6=LA ICF/DD/CLinics CA/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/NPH=NON-PARTICIPATING HOSPITAL CA/ORG=ORANGE CA/RIV=RIVERSIDE CA/S1=SACRAMENTO CA/S3=CHICO CA/SD=SAN DIEGO CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CN/NPH=NON-PARTICIPATING HOSPITAL CO/001=COLORADO CO/LAB=LABORATORIES CO/NPH=NON-PARTICIPATING HOSPITAL CT/001=CONNECTICUT CT/LAB=LABORATORIES CT/NPH=NON-PARTICIPATING HOSPITAL DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DC/NPH=NON-PARTICIPATING HOSPITAL DE/001=DELAWARE DE/LAB=LABORATORIES DE/NPH=NON-PARTICIPATING HOSPITAL FL/001=FLORIDA FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/NPH=NON-PARTICIPATING HOSPITAL FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FM/NPH=NON-PARTICIPATING HOSPITAL FN/001=INTERNATIONAL FN/LAB=LABORATORIES FN/NPH=NON-PARTICIPATING HOSPITAL GA/001=GEORGIA GA/GAA=GEORGIA ALL GA/GAC=GEORGIA CENTRAL GA/GAE=GEORGIA EASTERN GA/GAN=GEORGIA NORTH GA/GAS=GEORGIA SOUTH GA/GAW=GEORGIA WESTERN GA/LAB=LABORATORIES GA/NPH=NON-PARTICIPATING HOSPITAL GU/001=GUAM GU/LAB=LABORATORIES GU/NPH=NON-PARTICIPATING HOSPITAL HI/001=HAWAII HI/LAB=LABORATORIES HI/NPH=NON-PARTICIPATING HOSPITAL IA/001=IOWA IA/LAB=LABORATORIES IA/NPH=NON-PARTICIPATING HOSPITAL ID/001=IDAHO ID/LAB=LABORATORIES ID/NPH=NON-PARTICIPATING HOSPITAL IL/001=ILLINOIS IL/LAB=LABORATORIES IL/NPH=NON-PARTICIPATING HOSPITAL IN/001=INDIANA IN/LAB=LABORATORIES IN/NPH=NON-PARTICIPATING HOSPITAL KS/001=KANSAS KS/KCK=KANSAS CITY KS/KDH=KDHE KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS KS/NPH=NON-PARTICIPATING HOSPITAL KS/NW=NORTH WEST KANSAS KS/SC=SOUTH CENTRAL KANSAS KS/SE=SOUTH EAST KANSAS KS/SW=SOUTH WEST KANSAS KS/WST=WEST KY/2C1=HOPKINSVILLE KY/2C2=LOUISVILLE KY/2C3=LONDON KY/2C4=LEXINGTON KY/LAB=LABORATORIES KY/NPH=NON-PARTICIPATING HOSPITAL LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA LA/NPH=NON-PARTICIPATING HOSPITAL MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MA/NPH=NON-PARTICIPATING HOSPITAL MD/001=MARYLAND MD/LAB=LABORATORIES MD/NPH=NON-PARTICIPATING HOSPITAL ME/001=MAINE ME/LAB=LABORATORIES ME/NPH=NON-PARTICIPATING HOSPITAL MH/001=MARSHALL ISLANDS MH/NPH=NON-PARTICIPATING HOSPITAL MI/001=MICHIGAN MI/LAB=LABORATORIES MI/NPH=NON-PARTICIPATING HOSPITAL MN/001=MINNESOTA MN/LAB=LABORATORIES MN/NPH=NON-PARTICIPATING HOSPITAL MO/001=MISSOURI MO/01=REGION01 MO/02=REGION02 MO/03=REGION 03 MO/04=REGION 04 MO/05=REGION 05 MO/06=REGION 06 MO/07=REGION 07 MO/1NH=REGION 1 NH MO/2NH=REGION 2 NH MO/3NH=REGION 3 NH MO/4NH=REGION 4 NH MO/5NH=REGION 5 NH MO/6NH=REGION 6 NH MO/7NH=REGION 7 NH MO/LAB=LABORATORIES MO/MO=STATEWIDE MO/NPH=NON-PARTICIPATING HOSPITAL MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MP/NPH=NON-PARTICIPATING HOSPITAL MS/001=MISSISSIPPI MS/LAB=LABORATORIES MS/NPH=NON-PARTICIPATING HOSPITAL MT/001=MONTANA MT/LAB=LABORATORIES MT/NPH=NON-PARTICIPATING HOSPITAL MX/001=MEXICO MX/LAB=LABORATORY MX/NPH=NON-PARTICIPATING HOSPITAL NC/001=NORTH CAROLINA NC/LAB=LABORATORIES NC/NCC=NORTH CAROLINA CENTRAL NC/NCE=NORTH CAROLINA EAST NC/NCN=NORTH CAROLINA NORTH NC/NCS=NORTH CAROLINA SOUTH NC/NCW=NORTH CAROLINA WEST NC/NPH=NON-PARTICIPATING HOSPITAL ND/001=NORTH DAKOTA ND/LAB=LABORATORIES ND/NPH=NON-PARTICIPATING HOSPITAL NE/001=NEBRASKA NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NE/NPH=NON-PARTICIPATING HOSPITAL NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NH/NPH=NON-PARTICIPATING HOSPITAL NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NJ/NPH=NON-PARTICIPATING HOSPITAL NM/001=NEW MEXICO NM/LAB=LABORATORIES NM/NPH=NON-PARTICIPATING HOSPITAL NV/001=NEVADA NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS NV/NPH=NON-PARTICIPATING HOSPITAL NY/001=BUFFALO NY/002=ROCHESTER NY/003=SYRACUSE NY/004=ALBANY NY/005=NEW ROCHELLE NY/006=NEW YORK CITY NY/007=SUFFOLK/NASSAU COUNTY NY/LAB=LABORATORIES NY/NPH=NON-PARTICIPATING HOSPITAL OH/001=OHIO OH/LAB=LABORATORIES OH/NPH=NON-PARTICIPATING HOSPITAL OK/001=OKLAHOMA OK/LAB=LABORATORIES OK/NPH=NON-PARTICIPATING HOSPITAL OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES OR/NPH=NON-PARTICIPATING HOSPITAL PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PA/NPH=NON-PARTICIPATING HOSPITAL PR/001=PUERTO RICO PR/LAB=LABORATORIES PR/NPH=NON-PARTICIPATING HOSPITAL PW/001=PALAU PW/NPH=NON-PARTICIPATING HOSPITAL RI/001=RHODE ISLAND RI/LAB=LABORATORIES RI/NPH=NON-PARTICIPATING HOSPITAL SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SC/NPH=NON-PARTICIPATING HOSPITAL SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES SD/NPH=NON-PARTICIPATING HOSPITAL TN/001=TENNESSEE TN/LAB=LABORATORIES TN/NPH=NON-PARTICIPATING HOSPITAL TN/TNC=TENNESSEE COOKEVILLE TN/TNE=TENNESSEE EASTERN TN/TNM=TENNESSEE MIDDLE TN/TNW=TENNESSEE WESTERN TX/001=TEXAS TX/L01=AMARILLO-LTC TX/L02=ABILENE-LTC TX/L03=ARLINGTON-LTC TX/L04=TYLER-LTC TX/L05=TEMPLE-LTC TX/L06=HOUSTON-LTC TX/L07=SAN ANTONIO-LTC TX/LAB=LABORATORIES TX/NPH=NON-PARTICIPATING HOSPITAL TX/TX1=LUBBOCK TX/TX2=ARLINGTON TX/TX3=SAN ANTONIO TX/TX4=HOUSTON TX/TX5=TYLER TX/TX6=AUSTIN UT/001=UTAH UT/LAB=LABORATORIES UT/NPH=NON-PARTICIPATING HOSPITAL VA/001=VIRGINIA VA/LAB=LABORATORIES VA/NPH=NON-PARTICIPATING HOSPITAL VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VI/NPH=NON-PARTICIPATING HOSPITAL VT/001=VERMONT VT/LAB=LABORATORIES VT/NPH=NON-PARTICIPATING HOSPITAL WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A WA/D1B=District 1, Unit B WA/D1C=District 1, Unit C WA/D1D=District 1, Unit D WA/D2=SPOKANE & SE WA/D2A=District 2, Unit A WA/D2B=District 2, Unit B WA/D2C=District 2, Unit C WA/D2D=District 2, Unit D WA/D2E=District 2, Unit E WA/D2F=District 2, Unit F WA/D2G=District 2, Unit G WA/D2H=District 2, Unit H WA/D3=NW WASHINGTON WA/D3A=District 3, Unit A WA/D3B=District 3, Unit B WA/D3C=District 3, Unit C WA/D3D=District 3, Unit D WA/D3E=District 3, Unit E WA/D4A=GREATER SEATTLE AREA WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WA/NPH=NON-PARTICIPATING HOSPITAL WI/001=WISCONSIN WI/LAB=LABORATORIES WI/NPH=NON-PARTICIPATING HOSPITAL WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WV/NPH=NON-PARTICIPATING HOSPITAL WY/001=WYOMING WY/LAB=LABORATORIES WY/NPH=NON-PARTICIPATING HOSPITAL Address: Street 50 178 227 VARCHAR2 Description: Street address where the provider is located. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 228 237 VARCHAR2 Description: Telephone number of the provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 2 238 239 VARCHAR2 Description: Indicates the current termination status for the provider. SAS Name: PGM_TRMNTN_CD COBOL Name: PGM-TRMNTN-CD VALUES: 00=ACTIVE PROVIDER 01=VOLUNTARY-MERGER, CLOSURE 02=VOLUNTARY-DISSATISFACTION WITH REIMBURSEMENT 03=VOLUNTARY-RISK OF INVOLUNTARY TERMINATION 04=VOLUNTARY-OTHER REASON FOR WITHDRAWAL 05=INVOLUNTARY-FAILURE TO MEET HEALTH/SAFETY REQ 06=INVOLUNTARY-FAILURE TO MEET AGREEMENT 07=OTHER-PROVIDER STATUS CHANGE 08=NONPAYMENT OF FEES - CLIA Only 09=REV/UNSUCCESSFUL PARTICIPATION IN PT - CLIA Only 10=REV/OTHER REASON - CLIA Only 11=INCOMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only 13=MULTIPLE TO SINGLE SITE CERTIFICATE - CLIA Only 14=SHARED LABORATORY - CLIA Only 15=FAILURE TO RENEW WAIVER PPM CERTIFICATE - CLIA Only 16=DUPLICATE CLIA NUMBER - CLIA Only 17=MAIL RETURNED NO FORWARD ADDRESS CERT ENDED - CLIA Only 20=NOTIFICATION BANKRUPTCY - CLIA Only 33=ACCREDITATION NOT CONFIRMED - CLIA Only 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE - CLIA Only Termination or Expiration Date 8 240 247 DATE Description: Date the provider was terminated. For CLIA providers, date the laboratory's certificate was terminated or the expiration date of the current CLIA certificate. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action Code 1 248 248 VARCHAR2 Description: Identifies the reason for the certification. Type of action from the official survey record, CMS 1539 form. SAS Name: CRTFCTN_ACTN_TYPE_CD COBOL Name: CRTFCTN-ACTN-TYPE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 8=FULL SURVEY AFTER COMPLAINT Ownership Type Code 2 249 250 VARCHAR2 Description: Indicates the ownership type of the provider. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=RELIGIOUS AFFILIATION 02=PRIVATE 03=OTHER 04=PROPRIETARY 05=GOVERNMENT - STATE/COUNTY 06=GOVERNMENT - COMBINATION GOVT & VOLUNTARY Address: ZIP Code 5 251 255 VARCHAR2 Description: Five-digit ZIP code for a provider's physical address. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 256 257 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 04=ARIZONA 05=ARKANSAS 06=CALIFORNIA 08=COLORADO 09=CONNECTICUT 10=DELAWARE 11=DISTRICT OF COLUMBIA 12=FLORIDA 13=GEORGIA 15=HAWAII 16=IDAHO 17=ILLINOIS 18=INDIANA 19=IOWA 20=KANSAS 21=KENTUCKY 22=LOUISIANA 23=MAINE 24=MARYLAND 25=MASSACHUSETTS 26=MICHIGAN 27=MINNESOTA 28=MISSISSIPPI 29=MISSOURI 30=MONTANA 31=NEBRASKA 32=NEVADA 33=NEW HAMPSHIRE 34=NEW JERSEY 35=NEW MEXICO 36=NEW YORK 37=NORTH CAROLINA 38=NORTH DAKOTA 39=OHIO 40=OKLAHOMA 41=OREGON 42=PENNSYLVANIA 43=PUERTO RICO 44=RHODE ISLAND 45=SOUTH CAROLINA 46=SOUTH DAKOTA 47=TENNESSEE 48=TEXAS 49=UTAH 50=VERMONT 51=VIRGINIA 53=WASHINGTON 54=WEST VIRGINIA 55=WISCONSIN 56=WYOMING 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN/MARIANA IS. 78=VIRGIN ISLANDS FIPS County Code 3 258 260 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 261 261 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND COBOL Name: CBSA-URBN-RRL-IND CBSA Code 5 262 266 VARCHAR2 Description: CBSA (Core Based Statistical Area) geographic entities defined by the U.S. Office of Management and Budget (OMB) on June 6, 2003 for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. CBSA collectively refers to MSA. SAS Name: CBSA_CD COBOL Name: CBSA-CD FQHC Approved RHC Provider Num 10 468 477 CHAR Description: FQHC approved provider number SAS Name: FQHC_APPROVED_RHC_PROVIDER_NUM COBOL Name: FQHC-APPROVED-RHC-PROVIDER-NUM FQHC Federally Funded Indicator 1 478 478 VARCHAR2 Description: Indicates whether this facility receives federal funds. SAS Name: FED_FUNDD_FQHC_SW COBOL Name: FED-FUNDD-FQHC-SW Part of RHC Indicator 1 638 638 VARCHAR2 Description: Indicates if the facility is part of a Medicare approved Rural Health Clinic. SAS Name: FQHC_APRVD_RHC_SW COBOL Name: FQHC-APRVD-RHC-SW Related Provider Number 10 686 695 CHAR Description: Related provider number SAS Name: RELATED_PROVIDER_NUMBER COBOL Name: RELATED-PROVIDER-NUMBER