********************************************* * * * 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 = 01/01/2014 * * * ********************************************* DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Short Term 02=Long Term 03=Religious Non-Medical Health Care Institutions 04=Psychiatric 05=Rehabilitation 06=Childrens Hospitals 07=Distinct Part Psychiatric Hospital 11=Critical Access Hospitals 20=Transplant Hospitals 22=Medicaid Only Short-Term Hospitals 23=Medicaid Only Childrens Hospitals 24=Medicaid Only Children's Psychiatric 25=Medicaid Only Psychiatric Hospitals 26=Medicaid Only Rehabilitation Hospitals 27=Medicaid Only Long-Term Hospitals 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: 01=Hospital 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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) 00030=BLUE CROSS (ARIZONA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00250=BLUE CROSS (MONTANA) 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 00460=BLUE CROSS (WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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) 00030=BLUE CROSS (ARIZONA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA GBA (TN) 10490=TRAVELERS (VIRGINIA) 10492=TRAVELERS - VIRGINIA SPECIAL PROJECT 11004=PALMETTO HHH C 11201=PALMETTO GBA (SC) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS KS/NW=NORTH WEST KANSAS KS/SC=SOUTH CENTRAL KANSAS KS/SE=SOUTH EAST KANSAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE KS/SW=SOUTH WEST KANSAS KS/WST=WEST KY/2C1=HOPKINSVILLE KY/2C2=LOUISVILLE KY/2C3=LONDON KY/2C4=LEXINGTON KY/LAB=LABORATORIES 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES TX/TX1=LUBBOCK TX/TX2=ARLINGTON TX/TX3=SAN ANTONIO TX/TX4=HOUSTON TX/TX5=TYLER TX/TX6=AUSTIN UT/001=UTAH * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE UT/LAB=LABORATORIES VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=CHURCH 02=PRIVATE (NOT FOR PROFIT) 03=OTHER (SPECIFY) 04=PRIVATE (FOR PROFIT) 05=FEDERAL 06=STATE 07=LOCAL 08=HOSPITAL DISTRICT OR AUTHORITY 09=PHYSICIAN OWNERSHIP 10=TRIBAL 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Accreditation Effective Date 8 262 269 DATE Description: Effective date of the period of accreditation associated with this certification. SAS Name: ACRDTN_EFCTV_DT COBOL Name: ACRDTN-EFCTV-DT Accreditation Expiration Date 8 270 277 DATE Description: Expiration date of the period of accreditation associated with this certification. SAS Name: ACRDTN_EXPRTN_DT COBOL Name: ACRDTN-EXPRTN-DT Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Affiliated Resident Program: Allopathic 1 279 279 VARCHAR2 Description: Indicates if the provider has an affiliated allopathic resident program. SAS Name: RSDNT_PGM_ALPTHC_SW COBOL Name: RSDNT-PGM-ALPTHC-SW Affiliated Resident Program: Dental 1 280 280 VARCHAR2 Description: Indicates if the provider has an affiliated dental resident program. SAS Name: RSDNT_PGM_DNTL_SW COBOL Name: RSDNT-PGM-DNTL-SW Affiliated Resident Program: Osteopathic 1 281 281 VARCHAR2 Description: Indicates if the provider has an affiliated osteopathic resident program. SAS Name: RSDNT_PGM_OSTPTHC_SW COBOL Name: RSDNT-PGM-OSTPTHC-SW Affiliated Resident Program: Other 1 282 282 VARCHAR2 Description: Indicates if the provider has any other affiliated resident program. SAS Name: RSDNT_PGM_OTHR_SW COBOL Name: RSDNT-PGM-OTHR-SW Gnrl Fac Type Cd 2 283 284 CHAR Description: General Fac Type Cd SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD Phrmcy Srvc Cd 1 286 286 CHAR Description: Pharmacy Service Cd SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD Phrmcy Srvc Desc 49 287 335 CHAR Description: Pharmacy Service Desc SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC Ovrrd Bed Cnt Sw 1 346 346 CHAR Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT COBOL Name: BED-CNT CLIA ID Number 1 10 403 412 CHAR Description: CLIA ID number 1 SAS Name: CLIA_ID_NUMBER_1 COBOL Name: CLIA-ID-NUMBER-1 CLIA ID Number 2 10 413 422 CHAR Description: CLIA ID number 2 SAS Name: CLIA_ID_NUMBER_2 COBOL Name: CLIA-ID-NUMBER-2 CLIA ID Number 3 10 423 432 CHAR Description: CLIA ID number 3 SAS Name: CLIA_ID_NUMBER_3 COBOL Name: CLIA-ID-NUMBER-3 CLIA ID Number 4 10 433 442 CHAR Description: CLIA ID number 4 SAS Name: CLIA_ID_NUMBER_4 COBOL Name: CLIA-ID-NUMBER-4 CLIA ID Number 5 10 443 452 CHAR Description: CLIA ID number 5 SAS Name: CLIA_ID_NUMBER_5 COBOL Name: CLIA-ID-NUMBER-5 Rn 24 Hr Wvr Sw 1 453 453 CHAR Description: RN 24 Hour Waiver Switch SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Compliance: Scope of Service Waiver 1 458 458 VARCHAR2 Description: Indicates if a waiver of the scope of services requirement has been recommended for a provider. SAS Name: SCOPE_OF_SRVC_WVR_SW COBOL Name: SCOPE-OF-SRVC-WVR-SW Compliance: Technical Personnel Waiver 1 459 459 VARCHAR2 Description: Indicates if a waiver of the technical personnel requirement has been recommended for a provider. SAS Name: TCHNCL_PRSNEL_WVR_SW COBOL Name: TCHNCL-PRSNEL-WVR-SW Current Survey Ever Swing Bed Indicator 1 460 460 VARCHAR2 Description: Indicates if this provider was a swing bed hospital at any time during this certification. SAS Name: SRVY_EVER_SB_SW COBOL Name: SRVY-EVER-SB-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Fax Phone Number 10 484 493 VARCHAR2 Description: 10-digit fax phone number of the primary contact or the operator of the provider. SAS Name: FAX_PHNE_NUM COBOL Name: FAX-PHNE-NUM Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Medical School Affiliation Code 1 523 523 VARCHAR2 Description: Type of affiliation that a hospital has with a medical school. SAS Name: MDCL_SCHL_AFLTN_CD COBOL Name: MDCL-SCHL-AFLTN-CD VALUES: 1=MAJOR 2=LIMITED 3=GRADUATE 4=NO AFFILIATION Medicare or Medicaid Participating Provider Indicator 1 534 534 VARCHAR2 Description: Indicates if a provider is participating in the Medicaid or Medicare or both programs. SAS Name: MDCD_MDCR_PRTCPTG_PRVDR_SW COBOL Name: MDCD-MDCR-PRTCPTG-PRVDR-SW Non-Participating Hospital Meets 1861(e) Indicator 1 580 580 VARCHAR2 Description: Indicates if an non-participating emergency hospital meets the definition of 'hospital' contained in Section 1861(e) of the Social Security Act. SAS Name: MEET_1861_SW COBOL Name: MEET-1861-SW Non-Participating Hospital Type Code 1 581 581 VARCHAR2 Description: Indicates if a non-participating hospital is classified as a federal hospital or an emergency non-federal hospital. SAS Name: NPP_TYPE_CD COBOL Name: NPP-TYPE-CD VALUES: E=Non-Participating Emergency Hospital F=Non-Participating Federal Hospital Nurse to Bed Ratio Override Indicator 1 582 582 VARCHAR2 Description: Indicates if the regional office has approved a significant nurse-to-bed ratio change from the previous certification. SAS Name: OVRRD_NRS_BED_SW COBOL Name: OVRRD-NRS-BED-SW Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Psychiatric Unit Bed Count 3 601 603 NUMBER Description: Number of beds in a Prospective Payment System (PPS) -exempt psychiatric unit of a hospital. SAS Name: PSYCH_UNIT_BED_CNT COBOL Name: PSYCH-UNIT-BED-CNT Psychiatric Unit Effective Date 8 604 611 DATE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Date a psychiatric unit of a hospital became exempt from the Prospective Payment System (PPS). SAS Name: PSYCH_UNIT_EFCTV_DT COBOL Name: PSYCH-UNIT-EFCTV-DT Psychiatric Unit Indicator 1 612 612 VARCHAR2 Description: Indicates if a hospital has a Prospective Payment System (PPS) -exempt psychiatric unit. SAS Name: PSYCH_UNIT_SW COBOL Name: PSYCH-UNIT-SW Psychiatric Unit Termination Code 1 613 613 VARCHAR2 Description: Indicates the reason that a psychiatric unit of a hospital is no longer exempt from Prospective Payment System (PPS). SAS Name: PSYCH_UNIT_TRMNTN_CD COBOL Name: PSYCH-UNIT-TRMNTN-CD VALUES: 0=ACTIVE 1=VOLUNTARY-MERGER OR CLOSURE 2=VOLUNTARY-DISSATISFIED WITH REIMBURSEMENT 3=RISK OF INVOLUNTARY TERMINATION 4=VOLUNTARY-OTHER 5=FAILURE TO MEET HEALTH/SAFETY 6=FAILURE TO MEET AGREEMENT 7=PROVIDER STATUS CHANGE Psychiatric Unit Termination Date 8 614 621 DATE Description: Date a psychiatric unit of a hospital is no longer exempt from the Prospective Payment System (PPS). SAS Name: PSYCH_UNIT_TRMNTN_DT COBOL Name: PSYCH-UNIT-TRMNTN-DT Rehabilitation Unit Bed Count 3 622 624 NUMBER Description: Number of beds in a Prospective Payment System (PPS) -exempt rehabilitation unit of a hospital. SAS Name: REHAB_UNIT_BED_CNT COBOL Name: REHAB-UNIT-BED-CNT Rehabilitation Unit Effective Date 8 625 632 DATE Description: Date a rehabilitation unit of a hospital became exempt from the Prospective Payment System (PPS). SAS Name: REHAB_UNIT_EFCTV_DT COBOL Name: REHAB-UNIT-EFCTV-DT Rehabilitation Unit Indicator 1 633 633 VARCHAR2 Description: Indicates if a hospital has a Prospective Payment System (PPS) -exempt rehabilitation unit. SAS Name: REHAB_UNIT_SW COBOL Name: REHAB-UNIT-SW Rehabilitation Unit Termination Code 1 634 634 VARCHAR2 Description: Indicates the reason that a rehabilitation unit hospital is no longer exempt from Prospective Payment System (PPS). SAS Name: REHAB_UNIT_TRMNTN_CD COBOL Name: REHAB-UNIT-TRMNTN-CD VALUES: 0=ACTIVE 1=VOLUNTARY-MERGER OR CLOSURE 2=VOLUNTARY-DISSATISFIED WITH REIMBURSEMENT 3=RISK OF INVOLUNTARY TERMINATION 4=VOLUNTARY-OTHER 5=FAILURE TO MEET HEALTH/SAFETY 6=FAILURE TO MEET AGREEMENT 7=PROVIDER STATUS CHANGE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Rehabilitation Unit Termination Date 8 635 642 DATE Description: Date a rehabilitation unit of a hospital is no longer exempt from the Prospective Payment System (PPS). SAS Name: REHAB_UNIT_TRMNTN_DT COBOL Name: REHAB-UNIT-TRMNTN-DT Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Acute Renal Dialysis Code 1 653 653 VARCHAR2 Description: Indicates how acute renal dialysis services are provided. SAS Name: ACUTE_RNL_DLYS_SRVC_CD COBOL Name: ACUTE-RNL-DLYS-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Acute Renal Dialysis Description 49 654 702 VARCHAR2 Description: Indicates how acute renal dialysis services are provided. SAS Name: ACUTE_RNL_DLYS_SRVC_DESC COBOL Name: ACUTE-RNL-DLYS-SRVC-DESC Services: Adult Inpatient Psychiatric Code 1 703 703 VARCHAR2 Description: Indicates how adult inpatient psychiatric services are provided. SAS Name: PSYCH_SRVC_CD COBOL Name: PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Adult Inpatient Psychiatric Description 49 704 752 VARCHAR2 Description: Indicates how adult inpatient psychiatric services are provided. SAS Name: PSYCH_SRVC_DESC COBOL Name: PSYCH-SRVC-DESC Services: Alcohol and/or Drug Code 1 754 754 VARCHAR2 Description: Indicates how alcohol and/or drug services are provided. SAS Name: ALCHL_DRUG_SRVC_CD COBOL Name: ALCHL-DRUG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Alcohol and/or Drug Description 49 755 803 VARCHAR2 Description: Indicates how alcohol and/or drug services are provided. SAS Name: ALCHL_DRUG_SRVC_DESC COBOL Name: ALCHL-DRUG-SRVC-DESC Services: Anesthesia Code 1 804 804 VARCHAR2 Description: Indicates how anesthesia services are provided. SAS Name: ANSTHSA_SRVC_CD COBOL Name: ANSTHSA-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Anesthesia Description 49 805 853 VARCHAR2 Description: Indicates how anesthesia services are provided. SAS Name: ANSTHSA_SRVC_DESC COBOL Name: ANSTHSA-SRVC-DESC Services: Audiology Code 1 855 855 VARCHAR2 Description: Indicates how audiology services are provided. SAS Name: AUDLGY_SRVC_CD COBOL Name: AUDLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Audiology Description 49 856 904 VARCHAR2 Description: Indicates how audiology services are provided. SAS Name: AUDLGY_SRVC_DESC COBOL Name: AUDLGY-SRVC-DESC Services: Burn Care Unit Code 1 908 908 VARCHAR2 Description: Indicates how burn care unit services are provided. SAS Name: BURN_CARE_UNIT_SRVC_CD COBOL Name: BURN-CARE-UNIT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Burn Care Unit Description 49 909 957 VARCHAR2 Description: Indicates how burn care unit services are provided. SAS Name: BURN_CARE_UNIT_SRVC_DESC COBOL Name: BURN-CARE-UNIT-SRVC-DESC Services: Cardiac Catheterization Lab Code 1 958 958 VARCHAR2 Description: Indicates how cardiac catheterization lab services are provided. SAS Name: CRDC_CTHRTZTN_LAB_SRVC_CD COBOL Name: CRDC-CTHRTZTN-LAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Cardiac Catheterization Lab Description 49 959 1007 VARCHAR2 Description: Indicates how cardiac catheterization lab services are provided. SAS Name: CRDC_CTHRTZTN_LAB_SRVC_DESC COBOL Name: CRDC-CTHRTZTN-LAB-SRVC-DESC Services: Cardiac Thoracic Surgery Code 1 1008 1008 VARCHAR2 Description: Indicates how cardiac thoracic surgery services are provided. SAS Name: OPEN_HRT_SRGRY_SRVC_CD COBOL Name: OPEN-HRT-SRGRY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Cardiac Thoracic Surgery Description 49 1009 1057 VARCHAR2 Description: Indicates how cardiac thoracic surgery services are provided. SAS Name: OPEN_HRT_SRGRY_SRVC_DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: OPEN-HRT-SRGRY-SRVC-DESC Services: CARF Inpatient Rehabilitation Code 1 1058 1058 VARCHAR2 Description: Indicates how Commission on Accreditation of Rehabilitation Facilities inpatient rehabilitation services are provided. SAS Name: CARF_IP_REHAB_SRVC_CD COBOL Name: CARF-IP-REHAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: CARF Inpatient Rehabilitation Description 49 1059 1107 VARCHAR2 Description: Indicates how Commission on Accreditation of Rehabilitation Facilities inpatient rehabilitation services are provided. SAS Name: CARF_IP_REHAB_SRVC_DESC COBOL Name: CARF-IP-REHAB-SRVC-DESC Services: Chemotherapy Code 1 1108 1108 VARCHAR2 Description: Indicates how chemotherapy services are provided. SAS Name: CHMTHRPY_SRVC_CD COBOL Name: CHMTHRPY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Chemotherapy Description 49 1109 1157 VARCHAR2 Description: Indicates how chemotherapy services are provided. SAS Name: CHMTHRPY_SRVC_DESC COBOL Name: CHMTHRPY-SRVC-DESC Services: Chiropractic Code 1 1158 1158 VARCHAR2 Description: Indicates how chiropractic services are provided. SAS Name: CHRPRCTIC_SRVC_CD COBOL Name: CHRPRCTIC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Chiropractic Description 49 1159 1207 VARCHAR2 Description: Indicates how chiropractic services are provided. SAS Name: CHRPRCTIC_SRVC_DESC COBOL Name: CHRPRCTIC-SRVC-DESC Services: Clinical Laboratory Code 1 1211 1211 VARCHAR2 Description: Indicates how clinical laboratory services are provided. SAS Name: CL_SRVC_CD COBOL Name: CL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Clinical Laboratory Description 49 1212 1260 VARCHAR2 Description: Indicates how clinical laboratory services are provided. SAS Name: CL_SRVC_DESC COBOL Name: CL-SRVC-DESC Services: Coronary Care Unit Code 1 1261 1261 VARCHAR2 Description: Indicates how Coronary Care Unit services are provided. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: CRNRY_CARE_UNIT_SRVC_CD COBOL Name: CRNRY-CARE-UNIT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Coronary Care Unit Description 49 1262 1310 VARCHAR2 Description: Indicates how Coronary Care Unit services are provided. SAS Name: CRNRY_CARE_UNIT_SRVC_DESC COBOL Name: CRNRY-CARE-UNIT-SRVC-DESC Services: CT Scan Code 1 1312 1312 VARCHAR2 Description: Indicates how CT scan services are provided. SAS Name: CT_SCAN_SRVC_CD COBOL Name: CT-SCAN-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: CT Scan Description 49 1313 1361 VARCHAR2 Description: Indicates how CT scan services are provided. SAS Name: CT_SCAN_SRVC_DESC COBOL Name: CT-SCAN-SRVC-DESC Services: Dental Code 1 1362 1362 VARCHAR2 Description: Indicates how dental services are provided. SAS Name: DNTL_SRVC_CD COBOL Name: DNTL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Dental Description 49 1363 1411 VARCHAR2 Description: Indicates how dental services are provided. SAS Name: DNTL_SRVC_DESC COBOL Name: DNTL-SRVC-DESC Services: Designated Trauma Center Code 1 1415 1415 VARCHAR2 Description: Indicates how designated trauma center services are provided. SAS Name: SHCK_TRMA_SRVC_CD COBOL Name: SHCK-TRMA-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Designated Trauma Center Description 49 1416 1464 VARCHAR2 Description: Indicates how designated trauma center services are provided. SAS Name: SHCK_TRMA_SRVC_DESC COBOL Name: SHCK-TRMA-SRVC-DESC Services: Diagnostic Radiology Code 1 1465 1465 VARCHAR2 Description: Indicates how diagnostic radiology services are provided. SAS Name: DGNSTC_RDLGY_SRVC_CD COBOL Name: DGNSTC-RDLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Diagnostic Radiology Description 49 1466 1514 VARCHAR2 Description: Indicates how diagnostic radiology services are provided. SAS Name: DGNSTC_RDLGY_SRVC_DESC COBOL Name: DGNSTC-RDLGY-SRVC-DESC Services: Dietary Code 1 1515 1515 VARCHAR2 Description: Indicates how dietary services are provided. SAS Name: DTRY_SRVC_CD COBOL Name: DTRY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Dietary Description 49 1516 1564 VARCHAR2 Description: Indicates how dietary services are provided. SAS Name: DTRY_SRVC_DESC COBOL Name: DTRY-SRVC-DESC Services: Emergency Department Code 1 1568 1568 VARCHAR2 Description: Indicates how dedicated emergency department services are provided. SAS Name: DCTD_ER_SRVC_CD COBOL Name: DCTD-ER-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Emergency Department Description 49 1569 1617 VARCHAR2 Description: Indicates how dedicated emergency department services are provided. SAS Name: DCTD_ER_SRVC_DESC COBOL Name: DCTD-ER-SRVC-DESC Services: Emergency Psychiatric Code 1 1618 1618 VARCHAR2 Description: Indicates how emergency psychiatric services are provided. SAS Name: EMER_PSYCH_SRVC_CD COBOL Name: EMER-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Emergency Psychiatric Description 49 1619 1667 VARCHAR2 Description: Indicates how emergency psychiatric services are provided. SAS Name: EMER_PSYCH_SRVC_DESC COBOL Name: EMER-PSYCH-SRVC-DESC Services: ESWL Code 1 1668 1668 VARCHAR2 Description: Indicates how extracorporeal shockwave lithotripter services are provided. SAS Name: XTRCRPRL_SHCK_LTHTRPTR_SRVC_CD COBOL Name: XTRCRPRL-SHCK-LTHTRPTR-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: ESWL Description 49 1669 1717 VARCHAR2 Description: Indicates how extracorporeal shockwave lithotripter * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 29 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE services are provided. SAS Name: XTRCRPRL_SHCK_LTHTRP_SRVC_DESC COBOL Name: XTRCRPRL-SHCK-LTHTRP-SRVC-DESC Services: Forensic Psychiatric Code 1 1718 1718 VARCHAR2 Description: Indicates how forensic psychiatric services are provided. SAS Name: FRNSC_PSYCH_SRVC_CD COBOL Name: FRNSC-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Forensic Psychiatric Description 49 1719 1767 VARCHAR2 Description: Indicates how forensic psychiatric services are provided. SAS Name: FRNSC_PSYCH_SRVC_DESC COBOL Name: FRNSC-PSYCH-SRVC-DESC Services: Geriatric Psychiatric Code 1 1768 1768 VARCHAR2 Description: Indicates how geriatric psychiatric services are provided. SAS Name: GRTRC_PSYCH_SRVC_CD COBOL Name: GRTRC-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Geriatric Psychiatric Description 49 1769 1817 VARCHAR2 Description: Indicates how geriatric psychiatric services are provided. SAS Name: GRTRC_PSYCH_SRVC_DESC COBOL Name: GRTRC-PSYCH-SRVC-DESC Services: Gerontological Specialty Code 1 1818 1818 VARCHAR2 Description: Indicates how gerontological specialty services are provided. SAS Name: GRNTLGCL_SPCLTY_SRVC_CD COBOL Name: GRNTLGCL-SPCLTY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Gerontological Specialty Description 49 1819 1867 VARCHAR2 Description: Indicates how gerontological specialty services are provided. SAS Name: GRNTLGCL_SPCLTY_SRVC_DESC COBOL Name: GRNTLGCL-SPCLTY-SRVC-DESC Services: Inpatient Surgical Code 1 1872 1872 VARCHAR2 Description: Indicates how inpatient surgical services are provided. SAS Name: IP_SRGCL_SRVC_CD COBOL Name: IP-SRGCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Inpatient Surgical Description 49 1873 1921 VARCHAR2 Description: Indicates how inpatient surgical services are provided. SAS Name: IP_SRGCL_SRVC_DESC COBOL Name: IP-SRGCL-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 30 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Medical Surgical ICU Code 1 1925 1925 VARCHAR2 Description: Indicates how medical surgical intensive care unit services are provided. SAS Name: ICU_SRVC_CD COBOL Name: ICU-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Medical Surgical ICU Description 49 1926 1974 VARCHAR2 Description: Indicates how medical surgical intensive care unit services are provided. SAS Name: ICU_SRVC_DESC COBOL Name: ICU-SRVC-DESC Services: Medicare Certified Transplant Center Code 1 1975 1975 VARCHAR2 Description: Indicates how Medicare certified transplant center services are provided. SAS Name: MDCR_TRNSPLNT_CNTR_SRVC_CD COBOL Name: MDCR-TRNSPLNT-CNTR-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Medicare Certified Transplant Center 49 1976 2024 VARCHAR2 Description Description: Indicates how Medicare certified transplant center services are provided. SAS Name: MDCR_TRNSPLNT_CNTR_SRVC_DESC COBOL Name: MDCR-TRNSPLNT-CNTR-SRVC-DESC Services: MRI Code 1 2028 2028 VARCHAR2 Description: Indicates how magnetic resonance imaging services are provided. SAS Name: MGNTC_RSNC_IMG_SRVC_CD COBOL Name: MGNTC-RSNC-IMG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: MRI Description 49 2029 2077 VARCHAR2 Description: Indicates how magnetic resonance imaging services are provided. SAS Name: MGNTC_RSNC_IMG_SRVC_DESC COBOL Name: MGNTC-RSNC-IMG-SRVC-DESC Services: Neonatal ICU Code 1 2078 2078 VARCHAR2 Description: Indicates how neonatal intensive care unit services are provided. SAS Name: NEONTL_ICU_SRVC_CD COBOL Name: NEONTL-ICU-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Neonatal ICU Description 49 2079 2127 VARCHAR2 Description: Indicates how neonatal intensive care unit services are provided. SAS Name: NEONTL_ICU_SRVC_DESC COBOL Name: NEONTL-ICU-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 31 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Neonatal Nursery Code 1 2128 2128 VARCHAR2 Description: Indicates how neonatal nursery services are provided. SAS Name: NEONTL_NRSRY_SRVC_CD COBOL Name: NEONTL-NRSRY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Neonatal Nursery Description 49 2129 2177 VARCHAR2 Description: Indicates how neonatal nursery services are provided. SAS Name: NEONTL_NRSRY_SRVC_DESC COBOL Name: NEONTL-NRSRY-SRVC-DESC Services: Neurosurgical Code 1 2178 2178 VARCHAR2 Description: Indicates how neurosurgical services are provided. SAS Name: NRSRGCL_SRVC_CD COBOL Name: NRSRGCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Neurosurgical Description 49 2179 2227 VARCHAR2 Description: Indicates how neurosurgical services are provided. SAS Name: NRSRGCL_SRVC_DESC COBOL Name: NRSRGCL-SRVC-DESC Services: Non-Medicare Organ Transplant Code 1 2228 2228 VARCHAR2 Description: Indicates how non-Medicare certified organ transplant services are provided. SAS Name: ORGN_TRNSPLNT_SRVC_CD COBOL Name: ORGN-TRNSPLNT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Non-Medicare Organ Transplant Description 49 2229 2277 VARCHAR2 Description: Indicates how non-Medicare certified organ transplant services are provided. SAS Name: ORGN_TRNSPLNT_SRVC_DESC COBOL Name: ORGN-TRNSPLNT-SRVC-DESC Services: Nuclear Medicine Code 1 2278 2278 VARCHAR2 Description: Indicates how nuclear medicine services are provided. SAS Name: NUCLR_MDCN_SRVC_CD COBOL Name: NUCLR-MDCN-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Nuclear Medicine Description 49 2279 2327 VARCHAR2 Description: Indicates how nuclear medicine services are provided. SAS Name: NUCLR_MDCN_SRVC_DESC COBOL Name: NUCLR-MDCN-SRVC-DESC Services: Obstetrics Code 1 2336 2336 VARCHAR2 Description: Indicates how obstetrics services are provided. SAS Name: OB_SRVC_CD COBOL Name: OB-SRVC-CD VALUES: 0=NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 32 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Obstetrics Description 49 2337 2385 VARCHAR2 Description: Indicates how obstetrics services are provided. SAS Name: OB_SRVC_DESC COBOL Name: OB-SRVC-DESC Services: Ophthalmic Surgery Code 1 2386 2386 VARCHAR2 Description: Indicates how ophthalmic surgery services are provided. SAS Name: OPTHLMC_SRGY_SRVC_CD COBOL Name: OPTHLMC-SRGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Ophthalmic Surgery Description 49 2387 2435 VARCHAR2 Description: Indicates how ophthalmic surgery services are provided. SAS Name: OPTHLMC_SRGY_SRVC_DESC COBOL Name: OPTHLMC-SRGY-SRVC-DESC Services: Optometric Code 1 2436 2436 VARCHAR2 Description: Indicates how optometric services are provided. SAS Name: OPTMTRC_SRVC_CD COBOL Name: OPTMTRC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Optometric Description 49 2437 2485 VARCHAR2 Description: Indicates how optometric services are provided. SAS Name: OPTMTRC_SRVC_DESC COBOL Name: OPTMTRC-SRVC-DESC Services: OR Code 1 2486 2486 VARCHAR2 Description: Indicates how operating room services are provided. SAS Name: OPRTG_ROOM_SRVC_CD COBOL Name: OPRTG-ROOM-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: OR Description 49 2487 2535 VARCHAR2 Description: Indicates how operating room services are provided. SAS Name: OPRTG_ROOM_SRVC_DESC COBOL Name: OPRTG-ROOM-SRVC-DESC Services: Orthopedic Surgery Code 1 2536 2536 VARCHAR2 Description: Indicates how orthopedic surgery services are provided. SAS Name: ORTHPDC_SRGY_SRVC_CD COBOL Name: ORTHPDC-SRGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Orthopedic Surgery Description 49 2537 2585 VARCHAR2 Description: Indicates how orthopedic surgery services are provided. SAS Name: ORTHPDC_SRGY_SRVC_DESC COBOL Name: ORTHPDC-SRGY-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 33 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Ot Srvc Cd 1 2592 2592 CHAR Description: OT Service Cd SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD Ot Srvc Desc 49 2593 2641 CHAR Description: OT Service Desc SAS Name: OT_SRVC_DESC COBOL Name: OT-SRVC-DESC Services: Outpatient Code 1 2646 2646 VARCHAR2 Description: Indicates how outpatient services are provided. SAS Name: OP_SRVC_CD COBOL Name: OP-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Outpatient Description 49 2647 2695 VARCHAR2 Description: Indicates how outpatient services are provided. SAS Name: OP_SRVC_DESC COBOL Name: OP-SRVC-DESC Services: Outpatient Psychiatric Code 1 2696 2696 VARCHAR2 Description: Indicates how outpatient psychiatric services are provided. SAS Name: OP_PSYCH_SRVC_CD COBOL Name: OP-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Outpatient Psychiatric Description 49 2697 2745 VARCHAR2 Description: Indicates how outpatient psychiatric services are provided. SAS Name: OP_PSYCH_SRVC_DESC COBOL Name: OP-PSYCH-SRVC-DESC Services: Outpatient Rehabilitation Code 1 2746 2746 VARCHAR2 Description: Indicates how outpatient rehabilitation services are provided. SAS Name: OP_REHAB_SRVC_CD COBOL Name: OP-REHAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Outpatient Rehabilitation Description 49 2747 2795 VARCHAR2 Description: Indicates how outpatient rehabilitation services are provided. SAS Name: OP_REHAB_SRVC_DESC COBOL Name: OP-REHAB-SRVC-DESC Services: Outpatient Surgery Code 1 2796 2796 VARCHAR2 Description: Indicates how outpatient surgery services are provided. SAS Name: OP_SRGRY_UNIT_SRVC_CD COBOL Name: OP-SRGRY-UNIT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 34 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Outpatient Surgery Description 49 2797 2845 VARCHAR2 Description: Indicates how outpatient surgery services are provided. SAS Name: OP_SRGRY_UNIT_SRVC_DESC COBOL Name: OP-SRGRY-UNIT-SRVC-DESC Services: Pediatric Code 1 2846 2846 VARCHAR2 Description: Indicates how pediatric services are provided. SAS Name: PED_SRVC_CD COBOL Name: PED-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Pediatric Description 49 2847 2895 VARCHAR2 Description: Indicates how pediatric services are provided. SAS Name: PED_SRVC_DESC COBOL Name: PED-SRVC-DESC Services: Pediatric ICU Code 1 2896 2896 VARCHAR2 Description: Indicates how pediatric ICU services are provided. SAS Name: PED_ICU_SRVC_CD COBOL Name: PED-ICU-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Pediatric ICU Description 49 2897 2945 VARCHAR2 Description: Indicates how pediatric ICU services are provided. SAS Name: PED_ICU_SRVC_DESC COBOL Name: PED-ICU-SRVC-DESC Services: PET Scan Code 1 2946 2946 VARCHAR2 Description: Indicates how Positron Emissions Tomography scan services are provided. SAS Name: PET_SCAN_SRVC_CD COBOL Name: PET-SCAN-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: PET Scan Description 49 2947 2995 VARCHAR2 Description: Indicates how Positron Emissions Tomography scan services are provided. SAS Name: PET_SCAN_SRVC_DESC COBOL Name: PET-SCAN-SRVC-DESC Services: Postoperative Recovery Room Code 1 3012 3012 VARCHAR2 Description: Indicates how postoperative recovery room services are provided. SAS Name: PSTOPRTV_RCVRY_SRVC_CD COBOL Name: PSTOPRTV-RCVRY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Postoperative Recovery Room Description 49 3013 3061 VARCHAR2 Description: Indicates how postoperative recovery room services are provided. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 35 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PSTOPRTV_RCVRY_SRVC_DESC COBOL Name: PSTOPRTV-RCVRY-SRVC-DESC Services: Psychiatric Child and/or Adolescent Code 1 3062 3062 VARCHAR2 Description: Indicates how child and/or adolescent psychiatric services are provided. SAS Name: CHLD_ADLSCNT_PSYCH_SRVC_CD COBOL Name: CHLD-ADLSCNT-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Psychiatric Child and/or Adolescent 49 3063 3111 VARCHAR2 Description Description: Indicates how child and/or adolescent psychiatric services are provided. SAS Name: CHLD_ADLSCNT_PSYCH_SRVC_DESC COBOL Name: CHLD-ADLSCNT-PSYCH-SRVC-DESC Pt Srvc Cd 1 3118 3118 CHAR Description: PT Service Cd SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD Pt Srvc Desc 49 3119 3167 CHAR Description: PT Service Desc SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Services: Reconstructive Surgery Code 1 3171 3171 VARCHAR2 Description: Indicates how reconstructive surgery services are provided. SAS Name: RCNSTRCTN_SRGY_SRVC_CD COBOL Name: RCNSTRCTN-SRGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Reconstructive Surgery Description 49 3172 3220 VARCHAR2 Description: Indicates how reconstructive surgery services are provided. SAS Name: RCNSTRCTN_SRGY_SRVC_DESC COBOL Name: RCNSTRCTN-SRGY-SRVC-DESC Services: Respiratory Care Code 1 3224 3224 VARCHAR2 Description: Indicates how respiratory care services are provided. SAS Name: RSPRTRY_CARE_SRVC_CD COBOL Name: RSPRTRY-CARE-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Respiratory Care Description 49 3225 3273 VARCHAR2 Description: Indicates how respiratory care services are provided. SAS Name: RSPRTRY_CARE_SRVC_DESC COBOL Name: RSPRTRY-CARE-SRVC-DESC Services: Social Code 1 3278 3278 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_CD COBOL Name: SCL-SRVC-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 36 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Social Description 49 3279 3327 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_DESC COBOL Name: SCL-SRVC-DESC Spch Pthlgy Srvc Cd 1 3334 3334 CHAR Description: Speech Pathology Service Cd SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD Spch Pthlgy Srvc Desc 49 3335 3383 CHAR Description: Speech Pathology Service Desc SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Services: Surgical ICU Code 1 3388 3388 VARCHAR2 Description: Indicates how surgical intensive care unit services are provided. SAS Name: SRGCL_ICU_SRVC_CD COBOL Name: SRGCL-ICU-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Surgical ICU Description 49 3389 3437 VARCHAR2 Description: Indicates how surgical intensive care unit services are provided. SAS Name: SRGCL_ICU_SRVC_DESC COBOL Name: SRGCL-ICU-SRVC-DESC Services: Therapeutic Radiology Code 1 3447 3447 VARCHAR2 Description: Indicates how therapeutic radiology services are provided. SAS Name: THRPTC_RDLGY_SRVC_CD COBOL Name: THRPTC-RDLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Therapeutic Radiology Description 49 3448 3496 VARCHAR2 Description: Indicates how therapeutic radiology services are provided. SAS Name: THRPTC_RDLGY_SRVC_DESC COBOL Name: THRPTC-RDLGY-SRVC-DESC Services: Urgent Care Center Code 1 3500 3500 VARCHAR2 Description: Indicates how urgent care center services are provided. SAS Name: URGNT_CARE_SRVC_CD COBOL Name: URGNT-CARE-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services: Urgent Care Center Description 49 3501 3549 VARCHAR2 Description: Indicates how urgent care center services are provided. SAS Name: URGNT_CARE_SRVC_DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 37 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: URGNT-CARE-SRVC-DESC Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Staff Count: CRNA 8 3639 3646 NUMBER Description: Number of full-time equivalent Certified Registered Nurse Anesthetists employed by a provider. SAS Name: CRNA_CNT COBOL Name: CRNA-CNT Dietn Cnt 8 3671 3678 NUMBER Description: Dietician Count SAS Name: DIETN_CNT COBOL Name: DIETN-CNT Lpn Lvn Cnt 8 3783 3790 NUMBER Description: LPN LVN Count SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Mdcl Scl Workr Cnt 8 3847 3854 NUMBER Description: Medical Social Worker Count SAS Name: MDCL_SCL_WORKR_CNT COBOL Name: MDCL-SCL-WORKR-CNT Staff Count: Medical Technologist 8 3863 3870 NUMBER Description: Number of full-time equivalent medical technologists employed by a provider. SAS Name: MDCL_TCHNLGST_CNT COBOL Name: MDCL-TCHNLGST-CNT Staff Count: Nuclear Medicine Technician 8 3919 3926 NUMBER Description: Number of full-time equivalent nuclear medicine technicians employed by a provider. SAS Name: NUCLR_MDCN_TCHNCN_CNT COBOL Name: NUCLR-MDCN-TCHNCN-CNT Nrs Prctnr Cnt 8 3951 3958 NUMBER Description: Nurse Practitioner Count SAS Name: NRS_PRCTNR_CNT COBOL Name: NRS-PRCTNR-CNT Ocptnl Thrpst Cnt 8 3983 3990 NUMBER Description: Occupational Therapist Count SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Physn Cnt 8 4215 4222 NUMBER Description: Physician Count SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Physn Astnt Cnt 8 4231 4238 NUMBER Description: Phsycian Assistant Count SAS Name: PHYSN_ASTNT_CNT COBOL Name: PHYSN-ASTNT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 38 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Physician Resident 8 4263 4270 NUMBER Description: Number of full-time equivalent physician - residents employed by a provider. SAS Name: RSDNT_PHYSN_CNT COBOL Name: RSDNT-PHYSN-CNT Staff Count: Psychologist 8 4295 4302 NUMBER Description: Number of full-time equivalent psychologists employed by a provider. SAS Name: PSYCHLGST_CNT COBOL Name: PSYCHLGST-CNT Phys Thrpst Cnt 8 4311 4318 NUMBER Description: Physical Therapist Count SAS Name: PHYS_THRPST_CNT COBOL Name: PHYS-THRPST-CNT Staff Count: Radiology Technician 8 4399 4406 NUMBER Description: Number of full-time equivalent radiology technicians employed by a provider. SAS Name: RDLGY_TCHNCN_CNT COBOL Name: RDLGY-TCHNCN-CNT Reg Phrmcst Cnt 8 4407 4414 NUMBER Description: Reg Pharmacist Count SAS Name: REG_PHRMCST_CNT COBOL Name: REG-PHRMCST-CNT Staff Count: Respiratory Therapist 8 4415 4422 NUMBER Description: Number of full-time equivalent respiratory therapists employed by a provider. SAS Name: INHLTN_THRPST_CNT COBOL Name: INHLTN-THRPST-CNT Rn Cnt 8 4423 4430 NUMBER Description: RN Count SAS Name: RN_CNT COBOL Name: RN-CNT Spch Pthlgst Audlgst Cnt 8 4559 4566 NUMBER Description: Speech Pathologist Audiologist Count SAS Name: SPCH_PTHLGST_AUDLGST_CNT COBOL Name: SPCH-PTHLGST-AUDLGST-CNT Swing Bed Indicator 1 4620 4620 VARCHAR2 Description: Indicates if a hospital provides swing bed services (beds can be used for either hospital or long term care services). SAS Name: SB_SW COBOL Name: SB-SW Swing Bed Size Code 1 4621 4621 VARCHAR2 Description: Indicates the size of a hospital providing swing bed services (beds can be used for either hospital or long term care services). SAS Name: SB_SIZE_CD COBOL Name: SB-SIZE-CD VALUES: 1=49 OR FEWER BEDS 2=50 TO 99 BEDS Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 39 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 03=Title 18/19 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: 02=Skilled Nursing Facility/Nursing Facility (Dually Certified) 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A WA/D1B=District 1, Unit B * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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/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 WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOR PROFIT - INDIVIDUAL 02=FOR PROFIT - PARTNERSHIP 03=FOR PROFIT - CORPORATION 04=NONPROFIT - CHURCH RELATED 05=NONPROFIT - CORPORATION 06=NONPROFIT - OTHER 07=GOVERNMENT - STATE 08=GOVERNMENT - COUNTY 09=GOVERNMENT - CITY 10=GOVERNMENT - CITY/COUNTY 11=GOVERNMENT - HOSPITAL DISTRICT 12=GOVERNMENT - FEDERAL 13=FOR PROFIT - LIMITED LIABILITY CORPORATION 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 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 Ovrrd Bed Cnt Sw 1 346 346 CHAR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Count: Medicaid NF 4 355 358 NUMBER Description: Number of Medicaid-certified Nursing Facility beds. SAS Name: MDCD_NF_BED_CNT COBOL Name: MDCD-NF-BED-CNT Bed Count: Medicare SNF 4 359 362 NUMBER Description: Number of Medicare-certified Skilled Nursing Facility beds. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Bed Count: Medicare/Medicaid SNF 4 363 366 NUMBER Description: Number of dually certified (Medicare/Medicaid) beds in a Skilled Nursing Facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Bed Count: Special Care - AIDS 3 367 369 NUMBER Description: Number of beds in a special care unit dedicated for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Bed Count: Special Care - Alzheimers 3 370 372 NUMBER Description: Number of beds in a special care unit dedicated for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Bed Count: Special Care - Dialysis 3 373 375 NUMBER Description: Number of beds in a special care unit dedicated for residents who require dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Bed Count: Special Care - Disabled Children 3 376 378 NUMBER Description: Number of beds in a special care unit dedicated for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Bed Count: Special Care - Head Trauma 3 379 381 NUMBER Description: Number of beds in a special care unit dedicated for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Bed Count: Special Care - Hospice 3 382 384 NUMBER Description: Number of beds in a special care unit dedicated for residents who require hospice care. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Bed Count: Special Care - Huntingtons Disease 3 385 387 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of beds in a special care unit dedicated for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Bed Count: Special Care - Specialized Rehab 3 388 390 NUMBER Description: Number of beds in a special care unit dedicated for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Bed Count: Special Care - Ventilator 3 391 393 NUMBER Description: Number of beds in a special care unit dedicated for residents requiring a ventilator and/or respiratory care. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT COBOL Name: BED-CNT Rn 24 Hr Wvr Sw 1 453 453 CHAR Description: RN 24 Hour Waiver Switch SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7-Day RN Waiver Indicator 1 454 454 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse staffing requirements has been recommended for a Skilled Nursing Facility. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Bed Per Room Wvr Sw 1 455 455 CHAR Description: Bed Per Room Waiver Switch SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Room Size Wvr Sw 1 457 457 CHAR Description: Room Size Waiver Switch SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Experimental Research Conducted Indicator 1 483 483 VARCHAR2 Description: Indicates if a facility conducts experimental research. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD LTC Cross Ref Provider Number 10 513 522 CHAR Description: LTC cross ref provider number SAS Name: LTC_CRS_RFRNC_PRVDR_NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: LTC-CRS-RFRNC-PRVDR-NUM Mlt Fac Org Name 38 541 578 CHAR Description: Multi Fac Org Name SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Mlt Ownd Fac Org Sw 1 579 579 CHAR Description: Multi Owned Fac Org Switch SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Organized Family Group Indicator 1 585 585 VARCHAR2 Description: Indicates if the facility has an organized group of family members of residents. SAS Name: ORGNZ_FMLY_MBR_GRP_SW COBOL Name: ORGNZ-FMLY-MBR-GRP-SW Organized Resident Group Indicator 1 586 586 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Blood Administration Off-Site Residents 1 905 905 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Services: Blood Administration On-Site Nonresidents 1 906 906 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Services: Blood Administration On-Site Residents 1 907 907 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Services: Clinical Laboratory - Off-Site Residents 1 1208 1208 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided off-site to residents. SAS Name: CL_SRVC_OFSITE_RSDNT_SW COBOL Name: CL-SRVC-OFSITE-RSDNT-SW Services: Clinical Laboratory - On-Site Nonresidents 1 1209 1209 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Indicator Description: Indicates if clinical laboratory services are provided on-site to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Services: Clinical Laboratory - On-Site Residents 1 1210 1210 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to residents. SAS Name: CL_SRVC_ONST_RSDNT_SW COBOL Name: CL-SRVC-ONST-RSDNT-SW Services: Dental Off-Site Residents Indicator 1 1412 1412 VARCHAR2 Description: Indicates if dental services are provided off-site to residents. SAS Name: DNTL_SRVC_OFSITE_RSDNT_SW COBOL Name: DNTL-SRVC-OFSITE-RSDNT-SW Services: Dental On-Site Nonresidents Indicator 1 1413 1413 VARCHAR2 Description: Indicates if dental services are provided on-site to nonresidents. SAS Name: DNTL_SRVC_ONST_NRSDNT_SW COBOL Name: DNTL-SRVC-ONST-NRSDNT-SW Services: Dental On-Site Residents Indicator 1 1414 1414 VARCHAR2 Description: Indicates if dental services are provided on-site to residents. SAS Name: DNTL_SRVC_ONST_RSDNT_SW COBOL Name: DNTL-SRVC-ONST-RSDNT-SW Services: Dietary Off-Site Residents Indicator 1 1565 1565 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Services: Dietary On-Site Nonresidents Indicator 1 1566 1566 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Services: Dietary On-Site Residents Indicator 1 1567 1567 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Services: Housekeeping Off-Site Residents Indicator 1 1869 1869 VARCHAR2 Description: Indicates if housekeeping services are provided off-site to residents. SAS Name: HSEKPNG_SRVC_OFSITE_RSDNT_SW COBOL Name: HSEKPNG-SRVC-OFSITE-RSDNT-SW Services: Housekeeping On-Site Nonresidents Indicator 1 1870 1870 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to nonresidents. SAS Name: HSEKPNG_SRVC_ONST_NRSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-NRSDNT-SW Services: Housekeeping On-Site Residents Indicator 1 1871 1871 VARCHAR2 Description: Indicates if housekeeping services are provided on-site * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE to residents. SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Services: Mental Health Off-Site Residents Indicator 1 2025 2025 VARCHAR2 Description: Indicates if mental health services are provided off-site to residents. SAS Name: MENTL_HLTH_OFSITE_RSDNT_SW COBOL Name: MENTL-HLTH-OFSITE-RSDNT-SW Services: Mental Health On-Site Nonresidents 1 2026 2026 VARCHAR2 Indicator Description: Indicates if mental health services are provided on-site to nonresidents. SAS Name: MENTL_HLTH_ONST_NRSDNT_SW COBOL Name: MENTL-HLTH-ONST-NRSDNT-SW Services: Mental Health On-Site Residents Indicator 1 2027 2027 VARCHAR2 Description: Indicates if mental health services are provided on-site to residents. SAS Name: MENTL_HLTH_ONST_RSDNT_SW COBOL Name: MENTL-HLTH-ONST-RSDNT-SW Services: Nursing Off-Site Residents Indicator 1 2332 2332 VARCHAR2 Description: Indicates if nursing services are provided off-site to residents. SAS Name: NRSNG_SRVC_OFSITE_RSDNT_SW COBOL Name: NRSNG-SRVC-OFSITE-RSDNT-SW Services: Nursing On-Site Nonresidents Indicator 1 2333 2333 VARCHAR2 Description: Indicates if nursing services are provided on-site to nonresidents. SAS Name: NRSNG_SRVC_ONST_NRSDNT_SW COBOL Name: NRSNG-SRVC-ONST-NRSDNT-SW Services: Nursing On-Site Residents Indicator 1 2334 2334 VARCHAR2 Description: Indicates if nursing services are provided on-site to residents. SAS Name: NRSNG_SRVC_ONST_RSDNT_SW COBOL Name: NRSNG-SRVC-ONST-RSDNT-SW Services: OT Off-Site Residents Indicator 1 2642 2642 VARCHAR2 Description: Indicates if occupational therapy services are provided off-site to residents. SAS Name: OT_SRVC_OFSITE_RSDNT_SW COBOL Name: OT-SRVC-OFSITE-RSDNT-SW Services: OT On-Site Nonresidents Indicator 1 2643 2643 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to nonresidents. SAS Name: OT_SRVC_ONST_NRSDNT_SW COBOL Name: OT-SRVC-ONST-NRSDNT-SW Services: OT On-Site Residents Indicator 1 2644 2644 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to residents. SAS Name: OT_SRVC_ONST_RSDNT_SW COBOL Name: OT-SRVC-ONST-RSDNT-SW Services: Pharmacy Off-Site Residents Indicator 1 2996 2996 VARCHAR2 Description: Indicates if pharmacy services are provided off-site to residents. SAS Name: PHRMCY_SRVC_OFSITE_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PHRMCY-SRVC-OFSITE-RSDNT-SW Services: Pharmacy On-Site Nonresidents Indicator 1 2997 2997 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to nonresidents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Services: Pharmacy On-Site Residents Indicator 1 2998 2998 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to residents. SAS Name: PHRMCY_SRVC_ONST_RSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-RSDNT-SW Services: Physician Extender Off-Site Residents 1 3003 3003 VARCHAR2 Indicator Description: Indicates if physician extender services are provided off-site to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Services: Physician Extender On-Site Nonresidents 1 3004 3004 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to nonresidents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Services: Physician Extender On-Site Residents 1 3005 3005 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to residents. SAS Name: PHYSN_EXT_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-RSDNT-SW Services: Physician Off-Site Residents Indicator 1 3006 3006 VARCHAR2 Description: Indicates if physician services are provided off-site to residents. SAS Name: PHYSN_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-SRVC-OFSITE-RSDNT-SW Services: Physician On-Site Nonresidents Indicator 1 3007 3007 VARCHAR2 Description: Indicates if physician services are provided on-site to nonresidents. SAS Name: PHYSN_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-SRVC-ONST-NRSDNT-SW Services: Physician On-Site Residents Indicator 1 3008 3008 VARCHAR2 Description: Indicates if physician services are provided on-site to residents. SAS Name: PHYSN_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-SRVC-ONST-RSDNT-SW Services: Podiatry Off-Site Residents Indicator 1 3009 3009 VARCHAR2 Description: Indicates if podiatry services are provided off-site to residents. SAS Name: PDTRY_SRVC_OFSITE_RSDNT_SW COBOL Name: PDTRY-SRVC-OFSITE-RSDNT-SW Services: Podiatry On-Site Nonresidents Indicator 1 3010 3010 VARCHAR2 Description: Indicates if podiatry services are provided on-site to nonresidents. SAS Name: PDTRY_SRVC_ONST_NRSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PDTRY-SRVC-ONST-NRSDNT-SW Services: Podiatry On-Site Residents Indicator 1 3011 3011 VARCHAR2 Description: Indicates if podiatry services are provided on-site to residents. SAS Name: PDTRY_SRVC_ONST_RSDNT_SW COBOL Name: PDTRY-SRVC-ONST-RSDNT-SW Services: PT Off-Site Residents Indicator 1 3168 3168 VARCHAR2 Description: Indicates if physical therapy services are provided off-site to residents. SAS Name: PT_OFSITE_RSDNT_SW COBOL Name: PT-OFSITE-RSDNT-SW Services: PT On-Site Nonresidents Indicator 1 3169 3169 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to nonresidents. SAS Name: PT_ONST_NRSDNT_SW COBOL Name: PT-ONST-NRSDNT-SW Services: PT On-Site Residents Indicator 1 3170 3170 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to residents. SAS Name: PT_ONST_RSDNT_SW COBOL Name: PT-ONST-RSDNT-SW Services: Social Work Off-Site Residents Indicator 1 3328 3328 VARCHAR2 Description: Indicates if social work services are provided off-site to residents. SAS Name: SCL_WORK_SRVC_OFSITE_RSDNT_SW COBOL Name: SCL-WORK-SRVC-OFSITE-RSDNT-SW Services: Social Work On-Site Nonresidents Indicator 1 3329 3329 VARCHAR2 Description: Indicates if social work services are provided on-site to nonresidents. SAS Name: SCL_WORK_SRVC_ONST_NRSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-NRSDNT-SW Services: Social Work On-Site Residents Indicator 1 3330 3330 VARCHAR2 Description: Indicates if social work services are provided on-site to residents. SAS Name: SCL_WORK_SRVC_ONST_RSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-RSDNT-SW Services: Speech Pathology Off-Site Residents 1 3384 3384 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided off-site to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Services: Speech Pathology On-Site Nonresidents 1 3385 3385 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to nonresidents. SAS Name: SPCH_PTHLGY_ONST_NRSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-NRSDNT-SW Services: Speech Pathology On-Site Residents 1 3386 3386 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to residents. SAS Name: SPCH_PTHLGY_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: SPCH-PTHLGY-ONST-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3438 3438 VARCHAR2 Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3439 3439 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3440 3440 VARCHAR2 On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3441 3441 VARCHAR2 Off-Site Residents Indicator Description: Indicates if other therapeutic social services are provided off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3442 3442 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if other therapeutic social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3443 3443 VARCHAR2 On-Site Residents Indicator Description: Indicates if other therapeutic social services are provided on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3444 3444 VARCHAR2 Professional - Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by qualified activities professionals. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3445 3445 VARCHAR2 Professional - On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by qualified activities professionals. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Services: Therapeutic - Qualified Activities 1 3446 3446 VARCHAR2 Professional - On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by qualified activities professionals. SAS Name: ACTVTY_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: ACTVTY-ONST-RSDNT-SW Services: Therapeutic Recreational Specialty Off-Site 1 3497 3497 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided off-site to residents. SAS Name: THRPTC_RCRTNL_OFSITE_RSDNT_SW COBOL Name: THRPTC-RCRTNL-OFSITE-RSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3498 3498 VARCHAR2 Nonresidents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to nonresidents. SAS Name: THRPTC_RCRTNL_ONST_NRSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-NRSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3499 3499 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to residents. SAS Name: THRPTC_RCRTNL_ONST_RSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-RSDNT-SW Services: Vocational Off-Site Residents Indicator 1 3551 3551 VARCHAR2 Description: Indicates if vocational services are provided off-site to residents. SAS Name: VCTNL_SRVC_OFSITE_RSDNT_SW COBOL Name: VCTNL-SRVC-OFSITE-RSDNT-SW Services: Vocational On-Site Nonresidents Indicator 1 3552 3552 VARCHAR2 Description: Indicates if vocational services are provided on-site to nonresidents. SAS Name: VCTNL_SRVC_ONST_NRSDNT_SW COBOL Name: VCTNL-SRVC-ONST-NRSDNT-SW Services: Vocational On-Site Residents Indicator 1 3553 3553 VARCHAR2 Description: Indicates if vocational services are provided on-site to residents. SAS Name: VCTNL_SRVC_ONST_RSDNT_SW COBOL Name: VCTNL-SRVC-ONST-RSDNT-SW Services: X-ray Off-Site Residents Indicator 1 3554 3554 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided off-site to residents. SAS Name: DGNSTC_XRAY_OFSITE_RSDNT_SW COBOL Name: DGNSTC-XRAY-OFSITE-RSDNT-SW Services: X-ray On-Site Nonresidents Indicator 1 3555 3555 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to nonresidents. SAS Name: DGNSTC_XRAY_ONST_NRSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-NRSDNT-SW Services: X-ray On-Site Residents Indicator 1 3556 3556 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to residents. SAS Name: DGNSTC_XRAY_ONST_RSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-RSDNT-SW Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 29 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Administrative Staff - Contract 8 3559 3566 NUMBER Description: Number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Staff Count: Administrative Staff - Full-Time 8 3567 3574 NUMBER Description: Number of full-time equivalent administrative staff employed on a full-time basis by a facility. SAS Name: PROFNL_ADMIN_FLTM_CNT COBOL Name: PROFNL-ADMIN-FLTM-CNT Staff Count: Administrative Staff - Part-Time 8 3575 3582 NUMBER Description: Number of full-time equivalent administrative staff employed on a part-time basis by a facility. SAS Name: PROFNL_ADMIN_PRTM_CNT COBOL Name: PROFNL-ADMIN-PRTM-CNT Staff Count: Certified Nurse Aide - Contract 8 3599 3606 NUMBER Description: Number of full-time equivalent certified nurse aides under contract to a facility. SAS Name: NRS_AIDE_CNTRCT_CNT COBOL Name: NRS-AIDE-CNTRCT-CNT Staff Count: Certified Nurse Aide - Full-Time 8 3607 3614 NUMBER Description: Number of full-time equivalent certified nurse aides employed full-time by a facility. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Staff Count: Certified Nurse Aide - Part-Time 8 3615 3622 NUMBER Description: Number of full-time equivalent certified nurse aides employed part-time by a facility. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Staff Count: Dentist - Contract 8 3647 3654 NUMBER Description: Number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Staff Count: Dentist - Full-Time 8 3655 3662 NUMBER Description: Number of full-time equivalent dentists employed full time by a facility. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Staff Count: Dentist - Part-Time 8 3663 3670 NUMBER Description: Number of full-time equivalent dentists employed part time by a facility. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Staff Count: Dietitian - Contract 8 3679 3686 NUMBER Description: Number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Staff Count: Dietitian - Full-Time 8 3687 3694 NUMBER Description: Number of full-time equivalent dietitians employed full * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 30 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE time by a facility. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Staff Count: Dietitian - Part-Time 8 3695 3702 NUMBER Description: Number of full-time equivalent dietitians employed part time by a facility. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Staff Count: Food Service Worker - Contract 8 3711 3718 NUMBER Description: Number of full-time equivalent food service personnel under contract to a facility. SAS Name: FOOD_SRVC_CNTRCT_CNT COBOL Name: FOOD-SRVC-CNTRCT-CNT Staff Count: Food Service Worker - Full-Time 8 3719 3726 NUMBER Description: Number of full-time equivalent food service personnel employed full-time by a facility. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Staff Count: Food Service Worker - Part-Time 8 3727 3734 NUMBER Description: Number of full-time equivalent food service personnel employed part-time by a facility. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Staff Count: Housekeeping - Contract 8 3759 3766 NUMBER Description: Number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Staff Count: Housekeeping - Full-Time 8 3767 3774 NUMBER Description: Number of full-time equivalent housekeeping personnel employed full-time by a facility. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Staff Count: Housekeeping - Part-Time 8 3775 3782 NUMBER Description: Number of full-time equivalent housekeeping personnel employed part-time by a facility. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT Staff Count: LPN/LVN - Contract 8 3791 3798 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses under contract to a facility. SAS Name: LPN_LVN_CNTRCT_CNT COBOL Name: LPN-LVN-CNTRCT-CNT Staff Count: LPN/LVN - Full-Time 8 3799 3806 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed full-time by a facility. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT Staff Count: LPN/LVN - Part-Time 8 3807 3814 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed part-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 31 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Staff Count: Medical Director - Contract 8 3823 3830 NUMBER Description: Number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Staff Count: Medical Director - Full-Time 8 3831 3838 NUMBER Description: Number of full-time equivalent medical directors employed full-time by a facility. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Staff Count: Medical Director - Part-Time 8 3839 3846 NUMBER Description: Number of full-time equivalent medical directors employed part-time by a facility. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Staff Count: Medication Aide/Technician - Contract 8 3871 3878 NUMBER Description: Number of full-time equivalent medication aides/ technicians under contract to a facility. SAS Name: MDCTN_AIDE_CNTRCT_CNT COBOL Name: MDCTN-AIDE-CNTRCT-CNT Staff Count: Medication Aide/Technician - Full-Time 8 3879 3886 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed full-time by a facility. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Staff Count: Medication Aide/Technician - Part-Time 8 3887 3894 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed part-time by a facility. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Staff Count: Mental Health Services - Contract 8 3895 3902 NUMBER Description: Number of full-time equivalent mental health services personnel under contract to a facility. SAS Name: MENTL_HLTH_SRVC_CNTRCT_CNT COBOL Name: MENTL-HLTH-SRVC-CNTRCT-CNT Staff Count: Mental Health Services - Full-Time 8 3903 3910 NUMBER Description: Number of full-time equivalent mental health services personnel employed full-time by a facility. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Staff Count: Mental Health Services - Part-Time 8 3911 3918 NUMBER Description: Number of full-time equivalent mental health services personnel employed part-time by a facility. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Staff Count: Nurse Aide in Training - Contract 8 3927 3934 NUMBER Description: Number of full-time equivalent nurse aides in training under contract to a facility. SAS Name: NAT_CNTRCT_CNT COBOL Name: NAT-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 32 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Nurse Aide in Training - Full-Time 8 3935 3942 NUMBER Description: Number of full-time equivalent nurse aides in training employed full-time by a facility. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Staff Count: Nurse Aide in Training - Part-Time 8 3943 3950 NUMBER Description: Number of full-time equivalent nurse aides in training employed part-time by a facility. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Staff Count: Nurse With Administrative Duties - 8 3959 3966 NUMBER Contract Description: Number of full-time equivalent nurses with administrative duties under contract to a facility. SAS Name: NRS_ADMINV_CNTRCT_CNT COBOL Name: NRS-ADMINV-CNTRCT-CNT Staff Count: Nurse With Administrative Duties - 8 3967 3974 NUMBER Full-Time Description: Number of full-time equivalent nurses with administrative duties employed full-time by a facility. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Staff Count: Nurse With Administrative Duties - 8 3975 3982 NUMBER Part-Time Description: Number of full-time equivalent nurses with administrative duties employed part-time by a facility. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Ocptnl Thrpst Cntrct Cnt 8 3991 3998 NUMBER Description: Occupational Therapist Contractor Count SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Ocptnl Thrpst Fltm Cnt 8 3999 4006 NUMBER Description: Occupational Therapist Fulltime Count SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Staff Count: OT - Part-Time 8 4007 4014 NUMBER Description: Number of full-time equivalent occupational therapists employed part-time by a facility. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Staff Count: OT Aide - Contract 8 4015 4022 NUMBER Description: Number of full-time equivalent occupational therapy aides under contract to a facility. SAS Name: OT_AIDE_CNTRCT_CNT COBOL Name: OT-AIDE-CNTRCT-CNT Staff Count: OT Aide - Full-Time 8 4023 4030 NUMBER Description: Number of full-time equivalent occupational therapy aides employed full-time by a facility. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Staff Count: OT Aide - Part-Time 8 4031 4038 NUMBER Description: Number of full-time equivalent occupational therapy aides * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 33 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE employed part-time by a facility. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Staff Count: OT Assistant - Contract 8 4039 4046 NUMBER Description: Number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_CNTRCT_CNT COBOL Name: OT-ASTNT-CNTRCT-CNT Staff Count: OT Assistant - Full-Time 8 4047 4054 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed full-time by a facility. SAS Name: OT_ASTNT_FLTM_CNT COBOL Name: OT-ASTNT-FLTM-CNT Staff Count: OT Assistant - Part-Time 8 4055 4062 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed part-time by a facility. SAS Name: OT_ASTNT_PRTM_CNT COBOL Name: OT-ASTNT-PRTM-CNT Staff Count: Other Activities - Contract 8 4071 4078 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services under contract to a facility. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Staff Count: Other Activities - Full-Time 8 4079 4086 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Staff Count: Other Activities - Part-Time 8 4087 4094 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Staff Count: Other Physician - Contract 8 4095 4102 NUMBER Description: Number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Staff Count: Other Physician - Full-Time 8 4103 4110 NUMBER Description: Number of full-time equivalent other physicians employed full-time by a facility. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Staff Count: Other Physician - Part-Time 8 4111 4118 NUMBER Description: Number of full-time equivalent other physicians employed part-time by a facility. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Staff Count: Other Social Services - Contract 8 4119 4126 NUMBER Description: Number of full-time equivalent other social services * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 34 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE staff under contract to a facility. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Staff Count: Other Social Services - Full-Time 8 4127 4134 NUMBER Description: Number of full-time equivalent other social services staff employed full time by a facility. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Staff Count: Other Social Services - Part-Time 8 4135 4142 NUMBER Description: Number of full-time equivalent other social services staff employed part time by a facility. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Staff Count: Other Staff - Contract 8 4143 4150 NUMBER Description: Number of full-time equivalent staff not included in any other categories under contract to the facility. SAS Name: STF_OTHR_CNTRCT_CNT COBOL Name: STF-OTHR-CNTRCT-CNT Staff Count: Other Staff - Full-Time 8 4151 4158 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed full-time by the facility. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Staff Count: Other Staff - Part-Time 8 4159 4166 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed part-time by the facility. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT Staff Count: Pharmacist - Contract 8 4167 4174 NUMBER Description: Number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Staff Count: Pharmacist - Full-Time 8 4175 4182 NUMBER Description: Number of full-time equivalent pharmacists employed full-time by a facility. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Staff Count: Pharmacist - Part-Time 8 4183 4190 NUMBER Description: Number of full-time equivalent pharmacists employed part-time by a facility. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Staff Count: Physical Therapist - Contract 8 4191 4198 NUMBER Description: Number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Staff Count: Physical Therapist - Full-Time 8 4199 4206 NUMBER Description: Number of full-time equivalent physical therapists employed full-time by a facility. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 35 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Physical Therapist - Part-Time 8 4207 4214 NUMBER Description: Number of full-time equivalent physical therapists employed part-time by a facility. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Staff Count: Physician Extender - Contract 8 4239 4246 NUMBER Description: Number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Staff Count: Physician Extender - Full-Time 8 4247 4254 NUMBER Description: Number of full-time equivalent physician extenders employed full-time by the facility. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Staff Count: Physician Extender - Part-Time 8 4255 4262 NUMBER Description: Number of full-time equivalent physician extenders employed part-time by the facility. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Staff Count: Podiatrist - Contract 8 4271 4278 NUMBER Description: Number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Staff Count: Podiatrist - Full-Time 8 4279 4286 NUMBER Description: Number of full-time equivalent podiatrists employed full-time by a facility. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Staff Count: Podiatrist - Part-Time 8 4287 4294 NUMBER Description: Number of full-time equivalent podiatrists employed part-time by a facility. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Staff Count: PT Aide - Contract 8 4327 4334 NUMBER Description: Number of full-time equivalent physical therapy aides under contract to a facility. SAS Name: PT_AIDE_CNTRCT_CNT COBOL Name: PT-AIDE-CNTRCT-CNT Staff Count: PT Aide - Full-Time 8 4335 4342 NUMBER Description: Number of full-time equivalent physical therapy aides employed full-time by a facility. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Staff Count: PT Aide - Part-Time 8 4343 4350 NUMBER Description: Number of full-time equivalent physical therapy aides employed part-time by a facility. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Staff Count: PT Assistant - Contract 8 4351 4358 NUMBER Description: Number of full-time equivalent physical therapy * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 36 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE assistants under contract to a facility. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Staff Count: PT Assistant - Full-Time 8 4359 4366 NUMBER Description: Number of full-time equivalent physical therapy assistants employed full-time by a facility. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Staff Count: PT Assistant - Part-Time 8 4367 4374 NUMBER Description: Number of full-time equivalent physical therapy assistants employed part-time by a facility. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Staff Count: Qualified Activities Professional - 8 4375 4382 NUMBER Contract Description: Number of full-time equivalent qualified activities professionals providing therapeutic services under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Staff Count: Qualified Activities Professional - 8 4383 4390 NUMBER Full-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Staff Count: Qualified Activities Professional - 8 4391 4398 NUMBER Part-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Staff Count: RN - Contract 8 4431 4438 NUMBER Description: Number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Staff Count: RN - Full-Time 8 4439 4446 NUMBER Description: Number of full-time equivalent registered nurses employed full-time by a facility. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Staff Count: RN - Part-Time 8 4447 4454 NUMBER Description: Number of full-time equivalent registered nurses employed part-time by a facility. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Staff Count: RN Director of Nursing - Contract 8 4463 4470 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing under contract to a facility. SAS Name: RN_DRCTR_CNTRCT_CNT COBOL Name: RN-DRCTR-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 37 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: RN Director of Nursing - Full-Time 8 4471 4478 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed full-time by a facility. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT Staff Count: RN Director of Nursing - Part-Time 8 4479 4486 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed part-time by a facility. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Staff Count: Social Worker - Contract 8 4495 4502 NUMBER Description: Number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Staff Count: Social Worker - Full-Time 8 4503 4510 NUMBER Description: Number of full-time equivalent social workers employed full-time by a facility. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Staff Count: Social Worker - Part-Time 8 4511 4518 NUMBER Description: Number of full-time equivalent social workers employed part-time by a facility. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Staff Count: Speech Pathologist - Contract 8 4527 4534 NUMBER Description: Number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Spch Pthlgst Fltm Cnt 8 4535 4542 NUMBER Description: Speech Pathologist Fulltime Count SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Staff Count: Speech Pathologist - Part-Time 8 4543 4550 NUMBER Description: Number of full-time equivalent speech pathologists employed part-time by a facility. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4567 4574 NUMBER Contract Description: Number of full-time equivalent therapeutic recreation specialist staff under contract to a facility. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Staff Count: Therapeutic Recreational Specialist - 8 4575 4582 NUMBER Full-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4583 4590 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 38 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Part-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 03=Title 18/19 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: 03=Skilled Nursing Facility/Nursing Facility (Distinct Part) 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A WA/D1B=District 1, Unit B * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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/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 WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOR PROFIT - INDIVIDUAL 02=FOR PROFIT - PARTNERSHIP 03=FOR PROFIT - CORPORATION 04=NONPROFIT - CHURCH RELATED 05=NONPROFIT - CORPORATION 06=NONPROFIT - OTHER 07=GOVERNMENT - STATE 08=GOVERNMENT - COUNTY 09=GOVERNMENT - CITY 10=GOVERNMENT - CITY/COUNTY 11=GOVERNMENT - HOSPITAL DISTRICT 12=GOVERNMENT - FEDERAL 13=FOR PROFIT - LIMITED LIABILITY CORPORATION 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 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 Ovrrd Bed Cnt Sw 1 346 346 CHAR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Count: Medicaid NF 4 355 358 NUMBER Description: Number of Medicaid-certified Nursing Facility beds. SAS Name: MDCD_NF_BED_CNT COBOL Name: MDCD-NF-BED-CNT Bed Count: Medicare SNF 4 359 362 NUMBER Description: Number of Medicare-certified Skilled Nursing Facility beds. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Bed Count: Medicare/Medicaid SNF 4 363 366 NUMBER Description: Number of dually certified (Medicare/Medicaid) beds in a Skilled Nursing Facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Bed Count: Special Care - AIDS 3 367 369 NUMBER Description: Number of beds in a special care unit dedicated for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Bed Count: Special Care - Alzheimers 3 370 372 NUMBER Description: Number of beds in a special care unit dedicated for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Bed Count: Special Care - Dialysis 3 373 375 NUMBER Description: Number of beds in a special care unit dedicated for residents who require dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Bed Count: Special Care - Disabled Children 3 376 378 NUMBER Description: Number of beds in a special care unit dedicated for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Bed Count: Special Care - Head Trauma 3 379 381 NUMBER Description: Number of beds in a special care unit dedicated for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Bed Count: Special Care - Hospice 3 382 384 NUMBER Description: Number of beds in a special care unit dedicated for residents who require hospice care. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Bed Count: Special Care - Huntingtons Disease 3 385 387 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of beds in a special care unit dedicated for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Bed Count: Special Care - Specialized Rehab 3 388 390 NUMBER Description: Number of beds in a special care unit dedicated for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Bed Count: Special Care - Ventilator 3 391 393 NUMBER Description: Number of beds in a special care unit dedicated for residents requiring a ventilator and/or respiratory care. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT COBOL Name: BED-CNT Rn 24 Hr Wvr Sw 1 453 453 CHAR Description: RN 24 Hour Waiver Switch SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7-Day RN Waiver Indicator 1 454 454 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse staffing requirements has been recommended for a Skilled Nursing Facility. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Bed Per Room Wvr Sw 1 455 455 CHAR Description: Bed Per Room Waiver Switch SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Room Size Wvr Sw 1 457 457 CHAR Description: Room Size Waiver Switch SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Experimental Research Conducted Indicator 1 483 483 VARCHAR2 Description: Indicates if a facility conducts experimental research. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD LTC Cross Ref Provider Number 10 513 522 CHAR Description: LTC cross ref provider number SAS Name: LTC_CRS_RFRNC_PRVDR_NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: LTC-CRS-RFRNC-PRVDR-NUM Mlt Fac Org Name 38 541 578 CHAR Description: Multi Fac Org Name SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Mlt Ownd Fac Org Sw 1 579 579 CHAR Description: Multi Owned Fac Org Switch SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Organized Family Group Indicator 1 585 585 VARCHAR2 Description: Indicates if the facility has an organized group of family members of residents. SAS Name: ORGNZ_FMLY_MBR_GRP_SW COBOL Name: ORGNZ-FMLY-MBR-GRP-SW Organized Resident Group Indicator 1 586 586 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Blood Administration Off-Site Residents 1 905 905 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Services: Blood Administration On-Site Nonresidents 1 906 906 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Services: Blood Administration On-Site Residents 1 907 907 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Services: Clinical Laboratory - Off-Site Residents 1 1208 1208 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided off-site to residents. SAS Name: CL_SRVC_OFSITE_RSDNT_SW COBOL Name: CL-SRVC-OFSITE-RSDNT-SW Services: Clinical Laboratory - On-Site Nonresidents 1 1209 1209 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Indicator Description: Indicates if clinical laboratory services are provided on-site to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Services: Clinical Laboratory - On-Site Residents 1 1210 1210 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to residents. SAS Name: CL_SRVC_ONST_RSDNT_SW COBOL Name: CL-SRVC-ONST-RSDNT-SW Services: Dental Off-Site Residents Indicator 1 1412 1412 VARCHAR2 Description: Indicates if dental services are provided off-site to residents. SAS Name: DNTL_SRVC_OFSITE_RSDNT_SW COBOL Name: DNTL-SRVC-OFSITE-RSDNT-SW Services: Dental On-Site Nonresidents Indicator 1 1413 1413 VARCHAR2 Description: Indicates if dental services are provided on-site to nonresidents. SAS Name: DNTL_SRVC_ONST_NRSDNT_SW COBOL Name: DNTL-SRVC-ONST-NRSDNT-SW Services: Dental On-Site Residents Indicator 1 1414 1414 VARCHAR2 Description: Indicates if dental services are provided on-site to residents. SAS Name: DNTL_SRVC_ONST_RSDNT_SW COBOL Name: DNTL-SRVC-ONST-RSDNT-SW Services: Dietary Off-Site Residents Indicator 1 1565 1565 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Services: Dietary On-Site Nonresidents Indicator 1 1566 1566 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Services: Dietary On-Site Residents Indicator 1 1567 1567 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Services: Housekeeping Off-Site Residents Indicator 1 1869 1869 VARCHAR2 Description: Indicates if housekeeping services are provided off-site to residents. SAS Name: HSEKPNG_SRVC_OFSITE_RSDNT_SW COBOL Name: HSEKPNG-SRVC-OFSITE-RSDNT-SW Services: Housekeeping On-Site Nonresidents Indicator 1 1870 1870 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to nonresidents. SAS Name: HSEKPNG_SRVC_ONST_NRSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-NRSDNT-SW Services: Housekeeping On-Site Residents Indicator 1 1871 1871 VARCHAR2 Description: Indicates if housekeeping services are provided on-site * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE to residents. SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Services: Mental Health Off-Site Residents Indicator 1 2025 2025 VARCHAR2 Description: Indicates if mental health services are provided off-site to residents. SAS Name: MENTL_HLTH_OFSITE_RSDNT_SW COBOL Name: MENTL-HLTH-OFSITE-RSDNT-SW Services: Mental Health On-Site Nonresidents 1 2026 2026 VARCHAR2 Indicator Description: Indicates if mental health services are provided on-site to nonresidents. SAS Name: MENTL_HLTH_ONST_NRSDNT_SW COBOL Name: MENTL-HLTH-ONST-NRSDNT-SW Services: Mental Health On-Site Residents Indicator 1 2027 2027 VARCHAR2 Description: Indicates if mental health services are provided on-site to residents. SAS Name: MENTL_HLTH_ONST_RSDNT_SW COBOL Name: MENTL-HLTH-ONST-RSDNT-SW Services: Nursing Off-Site Residents Indicator 1 2332 2332 VARCHAR2 Description: Indicates if nursing services are provided off-site to residents. SAS Name: NRSNG_SRVC_OFSITE_RSDNT_SW COBOL Name: NRSNG-SRVC-OFSITE-RSDNT-SW Services: Nursing On-Site Nonresidents Indicator 1 2333 2333 VARCHAR2 Description: Indicates if nursing services are provided on-site to nonresidents. SAS Name: NRSNG_SRVC_ONST_NRSDNT_SW COBOL Name: NRSNG-SRVC-ONST-NRSDNT-SW Services: Nursing On-Site Residents Indicator 1 2334 2334 VARCHAR2 Description: Indicates if nursing services are provided on-site to residents. SAS Name: NRSNG_SRVC_ONST_RSDNT_SW COBOL Name: NRSNG-SRVC-ONST-RSDNT-SW Services: OT Off-Site Residents Indicator 1 2642 2642 VARCHAR2 Description: Indicates if occupational therapy services are provided off-site to residents. SAS Name: OT_SRVC_OFSITE_RSDNT_SW COBOL Name: OT-SRVC-OFSITE-RSDNT-SW Services: OT On-Site Nonresidents Indicator 1 2643 2643 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to nonresidents. SAS Name: OT_SRVC_ONST_NRSDNT_SW COBOL Name: OT-SRVC-ONST-NRSDNT-SW Services: OT On-Site Residents Indicator 1 2644 2644 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to residents. SAS Name: OT_SRVC_ONST_RSDNT_SW COBOL Name: OT-SRVC-ONST-RSDNT-SW Services: Pharmacy Off-Site Residents Indicator 1 2996 2996 VARCHAR2 Description: Indicates if pharmacy services are provided off-site to residents. SAS Name: PHRMCY_SRVC_OFSITE_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PHRMCY-SRVC-OFSITE-RSDNT-SW Services: Pharmacy On-Site Nonresidents Indicator 1 2997 2997 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to nonresidents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Services: Pharmacy On-Site Residents Indicator 1 2998 2998 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to residents. SAS Name: PHRMCY_SRVC_ONST_RSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-RSDNT-SW Services: Physician Extender Off-Site Residents 1 3003 3003 VARCHAR2 Indicator Description: Indicates if physician extender services are provided off-site to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Services: Physician Extender On-Site Nonresidents 1 3004 3004 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to nonresidents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Services: Physician Extender On-Site Residents 1 3005 3005 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to residents. SAS Name: PHYSN_EXT_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-RSDNT-SW Services: Physician Off-Site Residents Indicator 1 3006 3006 VARCHAR2 Description: Indicates if physician services are provided off-site to residents. SAS Name: PHYSN_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-SRVC-OFSITE-RSDNT-SW Services: Physician On-Site Nonresidents Indicator 1 3007 3007 VARCHAR2 Description: Indicates if physician services are provided on-site to nonresidents. SAS Name: PHYSN_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-SRVC-ONST-NRSDNT-SW Services: Physician On-Site Residents Indicator 1 3008 3008 VARCHAR2 Description: Indicates if physician services are provided on-site to residents. SAS Name: PHYSN_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-SRVC-ONST-RSDNT-SW Services: Podiatry Off-Site Residents Indicator 1 3009 3009 VARCHAR2 Description: Indicates if podiatry services are provided off-site to residents. SAS Name: PDTRY_SRVC_OFSITE_RSDNT_SW COBOL Name: PDTRY-SRVC-OFSITE-RSDNT-SW Services: Podiatry On-Site Nonresidents Indicator 1 3010 3010 VARCHAR2 Description: Indicates if podiatry services are provided on-site to nonresidents. SAS Name: PDTRY_SRVC_ONST_NRSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PDTRY-SRVC-ONST-NRSDNT-SW Services: Podiatry On-Site Residents Indicator 1 3011 3011 VARCHAR2 Description: Indicates if podiatry services are provided on-site to residents. SAS Name: PDTRY_SRVC_ONST_RSDNT_SW COBOL Name: PDTRY-SRVC-ONST-RSDNT-SW Services: PT Off-Site Residents Indicator 1 3168 3168 VARCHAR2 Description: Indicates if physical therapy services are provided off-site to residents. SAS Name: PT_OFSITE_RSDNT_SW COBOL Name: PT-OFSITE-RSDNT-SW Services: PT On-Site Nonresidents Indicator 1 3169 3169 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to nonresidents. SAS Name: PT_ONST_NRSDNT_SW COBOL Name: PT-ONST-NRSDNT-SW Services: PT On-Site Residents Indicator 1 3170 3170 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to residents. SAS Name: PT_ONST_RSDNT_SW COBOL Name: PT-ONST-RSDNT-SW Services: Social Work Off-Site Residents Indicator 1 3328 3328 VARCHAR2 Description: Indicates if social work services are provided off-site to residents. SAS Name: SCL_WORK_SRVC_OFSITE_RSDNT_SW COBOL Name: SCL-WORK-SRVC-OFSITE-RSDNT-SW Services: Social Work On-Site Nonresidents Indicator 1 3329 3329 VARCHAR2 Description: Indicates if social work services are provided on-site to nonresidents. SAS Name: SCL_WORK_SRVC_ONST_NRSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-NRSDNT-SW Services: Social Work On-Site Residents Indicator 1 3330 3330 VARCHAR2 Description: Indicates if social work services are provided on-site to residents. SAS Name: SCL_WORK_SRVC_ONST_RSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-RSDNT-SW Services: Speech Pathology Off-Site Residents 1 3384 3384 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided off-site to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Services: Speech Pathology On-Site Nonresidents 1 3385 3385 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to nonresidents. SAS Name: SPCH_PTHLGY_ONST_NRSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-NRSDNT-SW Services: Speech Pathology On-Site Residents 1 3386 3386 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to residents. SAS Name: SPCH_PTHLGY_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: SPCH-PTHLGY-ONST-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3438 3438 VARCHAR2 Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3439 3439 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3440 3440 VARCHAR2 On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3441 3441 VARCHAR2 Off-Site Residents Indicator Description: Indicates if other therapeutic social services are provided off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3442 3442 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if other therapeutic social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3443 3443 VARCHAR2 On-Site Residents Indicator Description: Indicates if other therapeutic social services are provided on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3444 3444 VARCHAR2 Professional - Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by qualified activities professionals. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3445 3445 VARCHAR2 Professional - On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by qualified activities professionals. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Services: Therapeutic - Qualified Activities 1 3446 3446 VARCHAR2 Professional - On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by qualified activities professionals. SAS Name: ACTVTY_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: ACTVTY-ONST-RSDNT-SW Services: Therapeutic Recreational Specialty Off-Site 1 3497 3497 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided off-site to residents. SAS Name: THRPTC_RCRTNL_OFSITE_RSDNT_SW COBOL Name: THRPTC-RCRTNL-OFSITE-RSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3498 3498 VARCHAR2 Nonresidents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to nonresidents. SAS Name: THRPTC_RCRTNL_ONST_NRSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-NRSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3499 3499 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to residents. SAS Name: THRPTC_RCRTNL_ONST_RSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-RSDNT-SW Services: Vocational Off-Site Residents Indicator 1 3551 3551 VARCHAR2 Description: Indicates if vocational services are provided off-site to residents. SAS Name: VCTNL_SRVC_OFSITE_RSDNT_SW COBOL Name: VCTNL-SRVC-OFSITE-RSDNT-SW Services: Vocational On-Site Nonresidents Indicator 1 3552 3552 VARCHAR2 Description: Indicates if vocational services are provided on-site to nonresidents. SAS Name: VCTNL_SRVC_ONST_NRSDNT_SW COBOL Name: VCTNL-SRVC-ONST-NRSDNT-SW Services: Vocational On-Site Residents Indicator 1 3553 3553 VARCHAR2 Description: Indicates if vocational services are provided on-site to residents. SAS Name: VCTNL_SRVC_ONST_RSDNT_SW COBOL Name: VCTNL-SRVC-ONST-RSDNT-SW Services: X-ray Off-Site Residents Indicator 1 3554 3554 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided off-site to residents. SAS Name: DGNSTC_XRAY_OFSITE_RSDNT_SW COBOL Name: DGNSTC-XRAY-OFSITE-RSDNT-SW Services: X-ray On-Site Nonresidents Indicator 1 3555 3555 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to nonresidents. SAS Name: DGNSTC_XRAY_ONST_NRSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-NRSDNT-SW Services: X-ray On-Site Residents Indicator 1 3556 3556 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to residents. SAS Name: DGNSTC_XRAY_ONST_RSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-RSDNT-SW Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 29 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Administrative Staff - Contract 8 3559 3566 NUMBER Description: Number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Staff Count: Administrative Staff - Full-Time 8 3567 3574 NUMBER Description: Number of full-time equivalent administrative staff employed on a full-time basis by a facility. SAS Name: PROFNL_ADMIN_FLTM_CNT COBOL Name: PROFNL-ADMIN-FLTM-CNT Staff Count: Administrative Staff - Part-Time 8 3575 3582 NUMBER Description: Number of full-time equivalent administrative staff employed on a part-time basis by a facility. SAS Name: PROFNL_ADMIN_PRTM_CNT COBOL Name: PROFNL-ADMIN-PRTM-CNT Staff Count: Certified Nurse Aide - Contract 8 3599 3606 NUMBER Description: Number of full-time equivalent certified nurse aides under contract to a facility. SAS Name: NRS_AIDE_CNTRCT_CNT COBOL Name: NRS-AIDE-CNTRCT-CNT Staff Count: Certified Nurse Aide - Full-Time 8 3607 3614 NUMBER Description: Number of full-time equivalent certified nurse aides employed full-time by a facility. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Staff Count: Certified Nurse Aide - Part-Time 8 3615 3622 NUMBER Description: Number of full-time equivalent certified nurse aides employed part-time by a facility. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Staff Count: Dentist - Contract 8 3647 3654 NUMBER Description: Number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Staff Count: Dentist - Full-Time 8 3655 3662 NUMBER Description: Number of full-time equivalent dentists employed full time by a facility. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Staff Count: Dentist - Part-Time 8 3663 3670 NUMBER Description: Number of full-time equivalent dentists employed part time by a facility. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Staff Count: Dietitian - Contract 8 3679 3686 NUMBER Description: Number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Staff Count: Dietitian - Full-Time 8 3687 3694 NUMBER Description: Number of full-time equivalent dietitians employed full * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 30 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE time by a facility. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Staff Count: Dietitian - Part-Time 8 3695 3702 NUMBER Description: Number of full-time equivalent dietitians employed part time by a facility. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Staff Count: Food Service Worker - Contract 8 3711 3718 NUMBER Description: Number of full-time equivalent food service personnel under contract to a facility. SAS Name: FOOD_SRVC_CNTRCT_CNT COBOL Name: FOOD-SRVC-CNTRCT-CNT Staff Count: Food Service Worker - Full-Time 8 3719 3726 NUMBER Description: Number of full-time equivalent food service personnel employed full-time by a facility. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Staff Count: Food Service Worker - Part-Time 8 3727 3734 NUMBER Description: Number of full-time equivalent food service personnel employed part-time by a facility. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Staff Count: Housekeeping - Contract 8 3759 3766 NUMBER Description: Number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Staff Count: Housekeeping - Full-Time 8 3767 3774 NUMBER Description: Number of full-time equivalent housekeeping personnel employed full-time by a facility. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Staff Count: Housekeeping - Part-Time 8 3775 3782 NUMBER Description: Number of full-time equivalent housekeeping personnel employed part-time by a facility. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT Staff Count: LPN/LVN - Contract 8 3791 3798 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses under contract to a facility. SAS Name: LPN_LVN_CNTRCT_CNT COBOL Name: LPN-LVN-CNTRCT-CNT Staff Count: LPN/LVN - Full-Time 8 3799 3806 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed full-time by a facility. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT Staff Count: LPN/LVN - Part-Time 8 3807 3814 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed part-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 31 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Staff Count: Medical Director - Contract 8 3823 3830 NUMBER Description: Number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Staff Count: Medical Director - Full-Time 8 3831 3838 NUMBER Description: Number of full-time equivalent medical directors employed full-time by a facility. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Staff Count: Medical Director - Part-Time 8 3839 3846 NUMBER Description: Number of full-time equivalent medical directors employed part-time by a facility. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Staff Count: Medication Aide/Technician - Contract 8 3871 3878 NUMBER Description: Number of full-time equivalent medication aides/ technicians under contract to a facility. SAS Name: MDCTN_AIDE_CNTRCT_CNT COBOL Name: MDCTN-AIDE-CNTRCT-CNT Staff Count: Medication Aide/Technician - Full-Time 8 3879 3886 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed full-time by a facility. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Staff Count: Medication Aide/Technician - Part-Time 8 3887 3894 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed part-time by a facility. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Staff Count: Mental Health Services - Contract 8 3895 3902 NUMBER Description: Number of full-time equivalent mental health services personnel under contract to a facility. SAS Name: MENTL_HLTH_SRVC_CNTRCT_CNT COBOL Name: MENTL-HLTH-SRVC-CNTRCT-CNT Staff Count: Mental Health Services - Full-Time 8 3903 3910 NUMBER Description: Number of full-time equivalent mental health services personnel employed full-time by a facility. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Staff Count: Mental Health Services - Part-Time 8 3911 3918 NUMBER Description: Number of full-time equivalent mental health services personnel employed part-time by a facility. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Staff Count: Nurse Aide in Training - Contract 8 3927 3934 NUMBER Description: Number of full-time equivalent nurse aides in training under contract to a facility. SAS Name: NAT_CNTRCT_CNT COBOL Name: NAT-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 32 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Nurse Aide in Training - Full-Time 8 3935 3942 NUMBER Description: Number of full-time equivalent nurse aides in training employed full-time by a facility. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Staff Count: Nurse Aide in Training - Part-Time 8 3943 3950 NUMBER Description: Number of full-time equivalent nurse aides in training employed part-time by a facility. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Staff Count: Nurse With Administrative Duties - 8 3959 3966 NUMBER Contract Description: Number of full-time equivalent nurses with administrative duties under contract to a facility. SAS Name: NRS_ADMINV_CNTRCT_CNT COBOL Name: NRS-ADMINV-CNTRCT-CNT Staff Count: Nurse With Administrative Duties - 8 3967 3974 NUMBER Full-Time Description: Number of full-time equivalent nurses with administrative duties employed full-time by a facility. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Staff Count: Nurse With Administrative Duties - 8 3975 3982 NUMBER Part-Time Description: Number of full-time equivalent nurses with administrative duties employed part-time by a facility. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Ocptnl Thrpst Cntrct Cnt 8 3991 3998 NUMBER Description: Occupational Therapist Contractor Count SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Ocptnl Thrpst Fltm Cnt 8 3999 4006 NUMBER Description: Occupational Therapist Fulltime Count SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Staff Count: OT - Part-Time 8 4007 4014 NUMBER Description: Number of full-time equivalent occupational therapists employed part-time by a facility. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Staff Count: OT Aide - Contract 8 4015 4022 NUMBER Description: Number of full-time equivalent occupational therapy aides under contract to a facility. SAS Name: OT_AIDE_CNTRCT_CNT COBOL Name: OT-AIDE-CNTRCT-CNT Staff Count: OT Aide - Full-Time 8 4023 4030 NUMBER Description: Number of full-time equivalent occupational therapy aides employed full-time by a facility. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Staff Count: OT Aide - Part-Time 8 4031 4038 NUMBER Description: Number of full-time equivalent occupational therapy aides * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 33 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE employed part-time by a facility. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Staff Count: OT Assistant - Contract 8 4039 4046 NUMBER Description: Number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_CNTRCT_CNT COBOL Name: OT-ASTNT-CNTRCT-CNT Staff Count: OT Assistant - Full-Time 8 4047 4054 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed full-time by a facility. SAS Name: OT_ASTNT_FLTM_CNT COBOL Name: OT-ASTNT-FLTM-CNT Staff Count: OT Assistant - Part-Time 8 4055 4062 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed part-time by a facility. SAS Name: OT_ASTNT_PRTM_CNT COBOL Name: OT-ASTNT-PRTM-CNT Staff Count: Other Activities - Contract 8 4071 4078 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services under contract to a facility. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Staff Count: Other Activities - Full-Time 8 4079 4086 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Staff Count: Other Activities - Part-Time 8 4087 4094 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Staff Count: Other Physician - Contract 8 4095 4102 NUMBER Description: Number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Staff Count: Other Physician - Full-Time 8 4103 4110 NUMBER Description: Number of full-time equivalent other physicians employed full-time by a facility. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Staff Count: Other Physician - Part-Time 8 4111 4118 NUMBER Description: Number of full-time equivalent other physicians employed part-time by a facility. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Staff Count: Other Social Services - Contract 8 4119 4126 NUMBER Description: Number of full-time equivalent other social services * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 34 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE staff under contract to a facility. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Staff Count: Other Social Services - Full-Time 8 4127 4134 NUMBER Description: Number of full-time equivalent other social services staff employed full time by a facility. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Staff Count: Other Social Services - Part-Time 8 4135 4142 NUMBER Description: Number of full-time equivalent other social services staff employed part time by a facility. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Staff Count: Other Staff - Contract 8 4143 4150 NUMBER Description: Number of full-time equivalent staff not included in any other categories under contract to the facility. SAS Name: STF_OTHR_CNTRCT_CNT COBOL Name: STF-OTHR-CNTRCT-CNT Staff Count: Other Staff - Full-Time 8 4151 4158 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed full-time by the facility. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Staff Count: Other Staff - Part-Time 8 4159 4166 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed part-time by the facility. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT Staff Count: Pharmacist - Contract 8 4167 4174 NUMBER Description: Number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Staff Count: Pharmacist - Full-Time 8 4175 4182 NUMBER Description: Number of full-time equivalent pharmacists employed full-time by a facility. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Staff Count: Pharmacist - Part-Time 8 4183 4190 NUMBER Description: Number of full-time equivalent pharmacists employed part-time by a facility. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Staff Count: Physical Therapist - Contract 8 4191 4198 NUMBER Description: Number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Staff Count: Physical Therapist - Full-Time 8 4199 4206 NUMBER Description: Number of full-time equivalent physical therapists employed full-time by a facility. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 35 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Physical Therapist - Part-Time 8 4207 4214 NUMBER Description: Number of full-time equivalent physical therapists employed part-time by a facility. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Staff Count: Physician Extender - Contract 8 4239 4246 NUMBER Description: Number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Staff Count: Physician Extender - Full-Time 8 4247 4254 NUMBER Description: Number of full-time equivalent physician extenders employed full-time by the facility. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Staff Count: Physician Extender - Part-Time 8 4255 4262 NUMBER Description: Number of full-time equivalent physician extenders employed part-time by the facility. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Staff Count: Podiatrist - Contract 8 4271 4278 NUMBER Description: Number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Staff Count: Podiatrist - Full-Time 8 4279 4286 NUMBER Description: Number of full-time equivalent podiatrists employed full-time by a facility. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Staff Count: Podiatrist - Part-Time 8 4287 4294 NUMBER Description: Number of full-time equivalent podiatrists employed part-time by a facility. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Staff Count: PT Aide - Contract 8 4327 4334 NUMBER Description: Number of full-time equivalent physical therapy aides under contract to a facility. SAS Name: PT_AIDE_CNTRCT_CNT COBOL Name: PT-AIDE-CNTRCT-CNT Staff Count: PT Aide - Full-Time 8 4335 4342 NUMBER Description: Number of full-time equivalent physical therapy aides employed full-time by a facility. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Staff Count: PT Aide - Part-Time 8 4343 4350 NUMBER Description: Number of full-time equivalent physical therapy aides employed part-time by a facility. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Staff Count: PT Assistant - Contract 8 4351 4358 NUMBER Description: Number of full-time equivalent physical therapy * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 36 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE assistants under contract to a facility. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Staff Count: PT Assistant - Full-Time 8 4359 4366 NUMBER Description: Number of full-time equivalent physical therapy assistants employed full-time by a facility. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Staff Count: PT Assistant - Part-Time 8 4367 4374 NUMBER Description: Number of full-time equivalent physical therapy assistants employed part-time by a facility. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Staff Count: Qualified Activities Professional - 8 4375 4382 NUMBER Contract Description: Number of full-time equivalent qualified activities professionals providing therapeutic services under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Staff Count: Qualified Activities Professional - 8 4383 4390 NUMBER Full-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Staff Count: Qualified Activities Professional - 8 4391 4398 NUMBER Part-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Staff Count: RN - Contract 8 4431 4438 NUMBER Description: Number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Staff Count: RN - Full-Time 8 4439 4446 NUMBER Description: Number of full-time equivalent registered nurses employed full-time by a facility. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Staff Count: RN - Part-Time 8 4447 4454 NUMBER Description: Number of full-time equivalent registered nurses employed part-time by a facility. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Staff Count: RN Director of Nursing - Contract 8 4463 4470 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing under contract to a facility. SAS Name: RN_DRCTR_CNTRCT_CNT COBOL Name: RN-DRCTR-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 37 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: RN Director of Nursing - Full-Time 8 4471 4478 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed full-time by a facility. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT Staff Count: RN Director of Nursing - Part-Time 8 4479 4486 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed part-time by a facility. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Staff Count: Social Worker - Contract 8 4495 4502 NUMBER Description: Number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Staff Count: Social Worker - Full-Time 8 4503 4510 NUMBER Description: Number of full-time equivalent social workers employed full-time by a facility. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Staff Count: Social Worker - Part-Time 8 4511 4518 NUMBER Description: Number of full-time equivalent social workers employed part-time by a facility. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Staff Count: Speech Pathologist - Contract 8 4527 4534 NUMBER Description: Number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Spch Pthlgst Fltm Cnt 8 4535 4542 NUMBER Description: Speech Pathologist Fulltime Count SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Staff Count: Speech Pathologist - Part-Time 8 4543 4550 NUMBER Description: Number of full-time equivalent speech pathologists employed part-time by a facility. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4567 4574 NUMBER Contract Description: Number of full-time equivalent therapeutic recreation specialist staff under contract to a facility. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Staff Count: Therapeutic Recreational Specialist - 8 4575 4582 NUMBER Full-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4583 4590 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 38 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Part-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Title 18 Only 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: 04=Skilled Nursing Facility 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOR PROFIT - INDIVIDUAL 02=FOR PROFIT - PARTNERSHIP 03=FOR PROFIT - CORPORATION 04=NONPROFIT - CHURCH RELATED 05=NONPROFIT - CORPORATION 06=NONPROFIT - OTHER 07=GOVERNMENT - STATE 08=GOVERNMENT - COUNTY 09=GOVERNMENT - CITY 10=GOVERNMENT - CITY/COUNTY 11=GOVERNMENT - HOSPITAL DISTRICT 12=GOVERNMENT - FEDERAL 13=FOR PROFIT - LIMITED LIABILITY CORPORATION 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 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 Ovrrd Bed Cnt Sw 1 346 346 CHAR Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Count: Medicaid NF 4 355 358 NUMBER Description: Number of Medicaid-certified Nursing Facility beds. SAS Name: MDCD_NF_BED_CNT COBOL Name: MDCD-NF-BED-CNT Bed Count: Medicare SNF 4 359 362 NUMBER Description: Number of Medicare-certified Skilled Nursing Facility beds. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Bed Count: Medicare/Medicaid SNF 4 363 366 NUMBER Description: Number of dually certified (Medicare/Medicaid) beds in a Skilled Nursing Facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Bed Count: Special Care - AIDS 3 367 369 NUMBER Description: Number of beds in a special care unit dedicated for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Bed Count: Special Care - Alzheimers 3 370 372 NUMBER Description: Number of beds in a special care unit dedicated for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Bed Count: Special Care - Dialysis 3 373 375 NUMBER Description: Number of beds in a special care unit dedicated for residents who require dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Bed Count: Special Care - Disabled Children 3 376 378 NUMBER Description: Number of beds in a special care unit dedicated for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Bed Count: Special Care - Head Trauma 3 379 381 NUMBER Description: Number of beds in a special care unit dedicated for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Bed Count: Special Care - Hospice 3 382 384 NUMBER Description: Number of beds in a special care unit dedicated for residents who require hospice care. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Bed Count: Special Care - Huntingtons Disease 3 385 387 NUMBER Description: Number of beds in a special care unit dedicated for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Bed Count: Special Care - Specialized Rehab 3 388 390 NUMBER Description: Number of beds in a special care unit dedicated for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Bed Count: Special Care - Ventilator 3 391 393 NUMBER Description: Number of beds in a special care unit dedicated for residents requiring a ventilator and/or respiratory care. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: BED-CNT Rn 24 Hr Wvr Sw 1 453 453 CHAR Description: RN 24 Hour Waiver Switch SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7-Day RN Waiver Indicator 1 454 454 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse staffing requirements has been recommended for a Skilled Nursing Facility. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Bed Per Room Wvr Sw 1 455 455 CHAR Description: Bed Per Room Waiver Switch SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Room Size Wvr Sw 1 457 457 CHAR Description: Room Size Waiver Switch SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Experimental Research Conducted Indicator 1 483 483 VARCHAR2 Description: Indicates if a facility conducts experimental research. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD LTC Cross Ref Provider Number 10 513 522 CHAR Description: LTC cross ref provider number SAS Name: LTC_CRS_RFRNC_PRVDR_NUM COBOL Name: LTC-CRS-RFRNC-PRVDR-NUM Mlt Fac Org Name 38 541 578 CHAR Description: Multi Fac Org Name SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Mlt Ownd Fac Org Sw 1 579 579 CHAR Description: Multi Owned Fac Org Switch SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Organized Family Group Indicator 1 585 585 VARCHAR2 Description: Indicates if the facility has an organized group of family members of residents. SAS Name: ORGNZ_FMLY_MBR_GRP_SW COBOL Name: ORGNZ-FMLY-MBR-GRP-SW Organized Resident Group Indicator 1 586 586 VARCHAR2 Description: Indicates if the facility has an organized residents group. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Blood Administration Off-Site Residents 1 905 905 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Services: Blood Administration On-Site Nonresidents 1 906 906 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Services: Blood Administration On-Site Residents 1 907 907 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Services: Clinical Laboratory - Off-Site Residents 1 1208 1208 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided off-site to residents. SAS Name: CL_SRVC_OFSITE_RSDNT_SW COBOL Name: CL-SRVC-OFSITE-RSDNT-SW Services: Clinical Laboratory - On-Site Nonresidents 1 1209 1209 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Services: Clinical Laboratory - On-Site Residents 1 1210 1210 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to residents. SAS Name: CL_SRVC_ONST_RSDNT_SW COBOL Name: CL-SRVC-ONST-RSDNT-SW Services: Dental Off-Site Residents Indicator 1 1412 1412 VARCHAR2 Description: Indicates if dental services are provided off-site to residents. SAS Name: DNTL_SRVC_OFSITE_RSDNT_SW COBOL Name: DNTL-SRVC-OFSITE-RSDNT-SW Services: Dental On-Site Nonresidents Indicator 1 1413 1413 VARCHAR2 Description: Indicates if dental services are provided on-site to nonresidents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: DNTL_SRVC_ONST_NRSDNT_SW COBOL Name: DNTL-SRVC-ONST-NRSDNT-SW Services: Dental On-Site Residents Indicator 1 1414 1414 VARCHAR2 Description: Indicates if dental services are provided on-site to residents. SAS Name: DNTL_SRVC_ONST_RSDNT_SW COBOL Name: DNTL-SRVC-ONST-RSDNT-SW Services: Dietary Off-Site Residents Indicator 1 1565 1565 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Services: Dietary On-Site Nonresidents Indicator 1 1566 1566 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Services: Dietary On-Site Residents Indicator 1 1567 1567 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Services: Housekeeping Off-Site Residents Indicator 1 1869 1869 VARCHAR2 Description: Indicates if housekeeping services are provided off-site to residents. SAS Name: HSEKPNG_SRVC_OFSITE_RSDNT_SW COBOL Name: HSEKPNG-SRVC-OFSITE-RSDNT-SW Services: Housekeeping On-Site Nonresidents Indicator 1 1870 1870 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to nonresidents. SAS Name: HSEKPNG_SRVC_ONST_NRSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-NRSDNT-SW Services: Housekeeping On-Site Residents Indicator 1 1871 1871 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to residents. SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Services: Mental Health Off-Site Residents Indicator 1 2025 2025 VARCHAR2 Description: Indicates if mental health services are provided off-site to residents. SAS Name: MENTL_HLTH_OFSITE_RSDNT_SW COBOL Name: MENTL-HLTH-OFSITE-RSDNT-SW Services: Mental Health On-Site Nonresidents 1 2026 2026 VARCHAR2 Indicator Description: Indicates if mental health services are provided on-site to nonresidents. SAS Name: MENTL_HLTH_ONST_NRSDNT_SW COBOL Name: MENTL-HLTH-ONST-NRSDNT-SW Services: Mental Health On-Site Residents Indicator 1 2027 2027 VARCHAR2 Description: Indicates if mental health services are provided on-site to residents. SAS Name: MENTL_HLTH_ONST_RSDNT_SW COBOL Name: MENTL-HLTH-ONST-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Nursing Off-Site Residents Indicator 1 2332 2332 VARCHAR2 Description: Indicates if nursing services are provided off-site to residents. SAS Name: NRSNG_SRVC_OFSITE_RSDNT_SW COBOL Name: NRSNG-SRVC-OFSITE-RSDNT-SW Services: Nursing On-Site Nonresidents Indicator 1 2333 2333 VARCHAR2 Description: Indicates if nursing services are provided on-site to nonresidents. SAS Name: NRSNG_SRVC_ONST_NRSDNT_SW COBOL Name: NRSNG-SRVC-ONST-NRSDNT-SW Services: Nursing On-Site Residents Indicator 1 2334 2334 VARCHAR2 Description: Indicates if nursing services are provided on-site to residents. SAS Name: NRSNG_SRVC_ONST_RSDNT_SW COBOL Name: NRSNG-SRVC-ONST-RSDNT-SW Services: OT Off-Site Residents Indicator 1 2642 2642 VARCHAR2 Description: Indicates if occupational therapy services are provided off-site to residents. SAS Name: OT_SRVC_OFSITE_RSDNT_SW COBOL Name: OT-SRVC-OFSITE-RSDNT-SW Services: OT On-Site Nonresidents Indicator 1 2643 2643 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to nonresidents. SAS Name: OT_SRVC_ONST_NRSDNT_SW COBOL Name: OT-SRVC-ONST-NRSDNT-SW Services: OT On-Site Residents Indicator 1 2644 2644 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to residents. SAS Name: OT_SRVC_ONST_RSDNT_SW COBOL Name: OT-SRVC-ONST-RSDNT-SW Services: Pharmacy Off-Site Residents Indicator 1 2996 2996 VARCHAR2 Description: Indicates if pharmacy services are provided off-site to residents. SAS Name: PHRMCY_SRVC_OFSITE_RSDNT_SW COBOL Name: PHRMCY-SRVC-OFSITE-RSDNT-SW Services: Pharmacy On-Site Nonresidents Indicator 1 2997 2997 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to nonresidents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Services: Pharmacy On-Site Residents Indicator 1 2998 2998 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to residents. SAS Name: PHRMCY_SRVC_ONST_RSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-RSDNT-SW Services: Physician Extender Off-Site Residents 1 3003 3003 VARCHAR2 Indicator Description: Indicates if physician extender services are provided off-site to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Services: Physician Extender On-Site Nonresidents 1 3004 3004 VARCHAR2 Indicator Description: Indicates if physician extender services are provided * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE on-site to nonresidents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Services: Physician Extender On-Site Residents 1 3005 3005 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to residents. SAS Name: PHYSN_EXT_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-RSDNT-SW Services: Physician Off-Site Residents Indicator 1 3006 3006 VARCHAR2 Description: Indicates if physician services are provided off-site to residents. SAS Name: PHYSN_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-SRVC-OFSITE-RSDNT-SW Services: Physician On-Site Nonresidents Indicator 1 3007 3007 VARCHAR2 Description: Indicates if physician services are provided on-site to nonresidents. SAS Name: PHYSN_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-SRVC-ONST-NRSDNT-SW Services: Physician On-Site Residents Indicator 1 3008 3008 VARCHAR2 Description: Indicates if physician services are provided on-site to residents. SAS Name: PHYSN_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-SRVC-ONST-RSDNT-SW Services: Podiatry Off-Site Residents Indicator 1 3009 3009 VARCHAR2 Description: Indicates if podiatry services are provided off-site to residents. SAS Name: PDTRY_SRVC_OFSITE_RSDNT_SW COBOL Name: PDTRY-SRVC-OFSITE-RSDNT-SW Services: Podiatry On-Site Nonresidents Indicator 1 3010 3010 VARCHAR2 Description: Indicates if podiatry services are provided on-site to nonresidents. SAS Name: PDTRY_SRVC_ONST_NRSDNT_SW COBOL Name: PDTRY-SRVC-ONST-NRSDNT-SW Services: Podiatry On-Site Residents Indicator 1 3011 3011 VARCHAR2 Description: Indicates if podiatry services are provided on-site to residents. SAS Name: PDTRY_SRVC_ONST_RSDNT_SW COBOL Name: PDTRY-SRVC-ONST-RSDNT-SW Services: PT Off-Site Residents Indicator 1 3168 3168 VARCHAR2 Description: Indicates if physical therapy services are provided off-site to residents. SAS Name: PT_OFSITE_RSDNT_SW COBOL Name: PT-OFSITE-RSDNT-SW Services: PT On-Site Nonresidents Indicator 1 3169 3169 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to nonresidents. SAS Name: PT_ONST_NRSDNT_SW COBOL Name: PT-ONST-NRSDNT-SW Services: PT On-Site Residents Indicator 1 3170 3170 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to residents. SAS Name: PT_ONST_RSDNT_SW COBOL Name: PT-ONST-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Social Work Off-Site Residents Indicator 1 3328 3328 VARCHAR2 Description: Indicates if social work services are provided off-site to residents. SAS Name: SCL_WORK_SRVC_OFSITE_RSDNT_SW COBOL Name: SCL-WORK-SRVC-OFSITE-RSDNT-SW Services: Social Work On-Site Nonresidents Indicator 1 3329 3329 VARCHAR2 Description: Indicates if social work services are provided on-site to nonresidents. SAS Name: SCL_WORK_SRVC_ONST_NRSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-NRSDNT-SW Services: Social Work On-Site Residents Indicator 1 3330 3330 VARCHAR2 Description: Indicates if social work services are provided on-site to residents. SAS Name: SCL_WORK_SRVC_ONST_RSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-RSDNT-SW Services: Speech Pathology Off-Site Residents 1 3384 3384 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided off-site to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Services: Speech Pathology On-Site Nonresidents 1 3385 3385 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to nonresidents. SAS Name: SPCH_PTHLGY_ONST_NRSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-NRSDNT-SW Services: Speech Pathology On-Site Residents 1 3386 3386 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to residents. SAS Name: SPCH_PTHLGY_ONST_RSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3438 3438 VARCHAR2 Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3439 3439 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3440 3440 VARCHAR2 On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3441 3441 VARCHAR2 Off-Site Residents Indicator Description: Indicates if other therapeutic social services are * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE provided off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3442 3442 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if other therapeutic social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3443 3443 VARCHAR2 On-Site Residents Indicator Description: Indicates if other therapeutic social services are provided on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3444 3444 VARCHAR2 Professional - Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by qualified activities professionals. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3445 3445 VARCHAR2 Professional - On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by qualified activities professionals. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Services: Therapeutic - Qualified Activities 1 3446 3446 VARCHAR2 Professional - On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by qualified activities professionals. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Services: Therapeutic Recreational Specialty Off-Site 1 3497 3497 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided off-site to residents. SAS Name: THRPTC_RCRTNL_OFSITE_RSDNT_SW COBOL Name: THRPTC-RCRTNL-OFSITE-RSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3498 3498 VARCHAR2 Nonresidents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to nonresidents. SAS Name: THRPTC_RCRTNL_ONST_NRSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-NRSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3499 3499 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to residents. SAS Name: THRPTC_RCRTNL_ONST_RSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-RSDNT-SW Services: Vocational Off-Site Residents Indicator 1 3551 3551 VARCHAR2 Description: Indicates if vocational services are provided off-site to residents. SAS Name: VCTNL_SRVC_OFSITE_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: VCTNL-SRVC-OFSITE-RSDNT-SW Services: Vocational On-Site Nonresidents Indicator 1 3552 3552 VARCHAR2 Description: Indicates if vocational services are provided on-site to nonresidents. SAS Name: VCTNL_SRVC_ONST_NRSDNT_SW COBOL Name: VCTNL-SRVC-ONST-NRSDNT-SW Services: Vocational On-Site Residents Indicator 1 3553 3553 VARCHAR2 Description: Indicates if vocational services are provided on-site to residents. SAS Name: VCTNL_SRVC_ONST_RSDNT_SW COBOL Name: VCTNL-SRVC-ONST-RSDNT-SW Services: X-ray Off-Site Residents Indicator 1 3554 3554 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided off-site to residents. SAS Name: DGNSTC_XRAY_OFSITE_RSDNT_SW COBOL Name: DGNSTC-XRAY-OFSITE-RSDNT-SW Services: X-ray On-Site Nonresidents Indicator 1 3555 3555 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to nonresidents. SAS Name: DGNSTC_XRAY_ONST_NRSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-NRSDNT-SW Services: X-ray On-Site Residents Indicator 1 3556 3556 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to residents. SAS Name: DGNSTC_XRAY_ONST_RSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-RSDNT-SW Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Staff Count: Administrative Staff - Contract 8 3559 3566 NUMBER Description: Number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Staff Count: Administrative Staff - Full-Time 8 3567 3574 NUMBER Description: Number of full-time equivalent administrative staff employed on a full-time basis by a facility. SAS Name: PROFNL_ADMIN_FLTM_CNT COBOL Name: PROFNL-ADMIN-FLTM-CNT Staff Count: Administrative Staff - Part-Time 8 3575 3582 NUMBER Description: Number of full-time equivalent administrative staff employed on a part-time basis by a facility. SAS Name: PROFNL_ADMIN_PRTM_CNT COBOL Name: PROFNL-ADMIN-PRTM-CNT Staff Count: Certified Nurse Aide - Contract 8 3599 3606 NUMBER Description: Number of full-time equivalent certified nurse aides under contract to a facility. SAS Name: NRS_AIDE_CNTRCT_CNT COBOL Name: NRS-AIDE-CNTRCT-CNT Staff Count: Certified Nurse Aide - Full-Time 8 3607 3614 NUMBER Description: Number of full-time equivalent certified nurse aides employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 29 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Staff Count: Certified Nurse Aide - Part-Time 8 3615 3622 NUMBER Description: Number of full-time equivalent certified nurse aides employed part-time by a facility. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Staff Count: Dentist - Contract 8 3647 3654 NUMBER Description: Number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Staff Count: Dentist - Full-Time 8 3655 3662 NUMBER Description: Number of full-time equivalent dentists employed full time by a facility. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Staff Count: Dentist - Part-Time 8 3663 3670 NUMBER Description: Number of full-time equivalent dentists employed part time by a facility. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Staff Count: Dietitian - Contract 8 3679 3686 NUMBER Description: Number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Staff Count: Dietitian - Full-Time 8 3687 3694 NUMBER Description: Number of full-time equivalent dietitians employed full time by a facility. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Staff Count: Dietitian - Part-Time 8 3695 3702 NUMBER Description: Number of full-time equivalent dietitians employed part time by a facility. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Staff Count: Food Service Worker - Contract 8 3711 3718 NUMBER Description: Number of full-time equivalent food service personnel under contract to a facility. SAS Name: FOOD_SRVC_CNTRCT_CNT COBOL Name: FOOD-SRVC-CNTRCT-CNT Staff Count: Food Service Worker - Full-Time 8 3719 3726 NUMBER Description: Number of full-time equivalent food service personnel employed full-time by a facility. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Staff Count: Food Service Worker - Part-Time 8 3727 3734 NUMBER Description: Number of full-time equivalent food service personnel employed part-time by a facility. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Staff Count: Housekeeping - Contract 8 3759 3766 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 30 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Staff Count: Housekeeping - Full-Time 8 3767 3774 NUMBER Description: Number of full-time equivalent housekeeping personnel employed full-time by a facility. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Staff Count: Housekeeping - Part-Time 8 3775 3782 NUMBER Description: Number of full-time equivalent housekeeping personnel employed part-time by a facility. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT Staff Count: LPN/LVN - Contract 8 3791 3798 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses under contract to a facility. SAS Name: LPN_LVN_CNTRCT_CNT COBOL Name: LPN-LVN-CNTRCT-CNT Staff Count: LPN/LVN - Full-Time 8 3799 3806 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed full-time by a facility. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT Staff Count: LPN/LVN - Part-Time 8 3807 3814 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed part-time by a facility. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Staff Count: Medical Director - Contract 8 3823 3830 NUMBER Description: Number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Staff Count: Medical Director - Full-Time 8 3831 3838 NUMBER Description: Number of full-time equivalent medical directors employed full-time by a facility. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Staff Count: Medical Director - Part-Time 8 3839 3846 NUMBER Description: Number of full-time equivalent medical directors employed part-time by a facility. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Staff Count: Medication Aide/Technician - Contract 8 3871 3878 NUMBER Description: Number of full-time equivalent medication aides/ technicians under contract to a facility. SAS Name: MDCTN_AIDE_CNTRCT_CNT COBOL Name: MDCTN-AIDE-CNTRCT-CNT Staff Count: Medication Aide/Technician - Full-Time 8 3879 3886 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 31 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Staff Count: Medication Aide/Technician - Part-Time 8 3887 3894 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed part-time by a facility. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Staff Count: Mental Health Services - Contract 8 3895 3902 NUMBER Description: Number of full-time equivalent mental health services personnel under contract to a facility. SAS Name: MENTL_HLTH_SRVC_CNTRCT_CNT COBOL Name: MENTL-HLTH-SRVC-CNTRCT-CNT Staff Count: Mental Health Services - Full-Time 8 3903 3910 NUMBER Description: Number of full-time equivalent mental health services personnel employed full-time by a facility. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Staff Count: Mental Health Services - Part-Time 8 3911 3918 NUMBER Description: Number of full-time equivalent mental health services personnel employed part-time by a facility. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Staff Count: Nurse Aide in Training - Contract 8 3927 3934 NUMBER Description: Number of full-time equivalent nurse aides in training under contract to a facility. SAS Name: NAT_CNTRCT_CNT COBOL Name: NAT-CNTRCT-CNT Staff Count: Nurse Aide in Training - Full-Time 8 3935 3942 NUMBER Description: Number of full-time equivalent nurse aides in training employed full-time by a facility. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Staff Count: Nurse Aide in Training - Part-Time 8 3943 3950 NUMBER Description: Number of full-time equivalent nurse aides in training employed part-time by a facility. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Staff Count: Nurse With Administrative Duties - 8 3959 3966 NUMBER Contract Description: Number of full-time equivalent nurses with administrative duties under contract to a facility. SAS Name: NRS_ADMINV_CNTRCT_CNT COBOL Name: NRS-ADMINV-CNTRCT-CNT Staff Count: Nurse With Administrative Duties - 8 3967 3974 NUMBER Full-Time Description: Number of full-time equivalent nurses with administrative duties employed full-time by a facility. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Staff Count: Nurse With Administrative Duties - 8 3975 3982 NUMBER Part-Time Description: Number of full-time equivalent nurses with administrative duties employed part-time by a facility. SAS Name: NRS_ADMINV_PRTM_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 32 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NRS-ADMINV-PRTM-CNT Ocptnl Thrpst Cntrct Cnt 8 3991 3998 NUMBER Description: Occupational Therapist Contractor Count SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Ocptnl Thrpst Fltm Cnt 8 3999 4006 NUMBER Description: Occupational Therapist Fulltime Count SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Staff Count: OT - Part-Time 8 4007 4014 NUMBER Description: Number of full-time equivalent occupational therapists employed part-time by a facility. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Staff Count: OT Aide - Contract 8 4015 4022 NUMBER Description: Number of full-time equivalent occupational therapy aides under contract to a facility. SAS Name: OT_AIDE_CNTRCT_CNT COBOL Name: OT-AIDE-CNTRCT-CNT Staff Count: OT Aide - Full-Time 8 4023 4030 NUMBER Description: Number of full-time equivalent occupational therapy aides employed full-time by a facility. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Staff Count: OT Aide - Part-Time 8 4031 4038 NUMBER Description: Number of full-time equivalent occupational therapy aides employed part-time by a facility. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Staff Count: OT Assistant - Contract 8 4039 4046 NUMBER Description: Number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_CNTRCT_CNT COBOL Name: OT-ASTNT-CNTRCT-CNT Staff Count: OT Assistant - Full-Time 8 4047 4054 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed full-time by a facility. SAS Name: OT_ASTNT_FLTM_CNT COBOL Name: OT-ASTNT-FLTM-CNT Staff Count: OT Assistant - Part-Time 8 4055 4062 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed part-time by a facility. SAS Name: OT_ASTNT_PRTM_CNT COBOL Name: OT-ASTNT-PRTM-CNT Staff Count: Other Activities - Contract 8 4071 4078 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services under contract to a facility. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Staff Count: Other Activities - Full-Time 8 4079 4086 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed full time by a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 33 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE facility. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Staff Count: Other Activities - Part-Time 8 4087 4094 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Staff Count: Other Physician - Contract 8 4095 4102 NUMBER Description: Number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Staff Count: Other Physician - Full-Time 8 4103 4110 NUMBER Description: Number of full-time equivalent other physicians employed full-time by a facility. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Staff Count: Other Physician - Part-Time 8 4111 4118 NUMBER Description: Number of full-time equivalent other physicians employed part-time by a facility. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Staff Count: Other Social Services - Contract 8 4119 4126 NUMBER Description: Number of full-time equivalent other social services staff under contract to a facility. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Staff Count: Other Social Services - Full-Time 8 4127 4134 NUMBER Description: Number of full-time equivalent other social services staff employed full time by a facility. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Staff Count: Other Social Services - Part-Time 8 4135 4142 NUMBER Description: Number of full-time equivalent other social services staff employed part time by a facility. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Staff Count: Other Staff - Contract 8 4143 4150 NUMBER Description: Number of full-time equivalent staff not included in any other categories under contract to the facility. SAS Name: STF_OTHR_CNTRCT_CNT COBOL Name: STF-OTHR-CNTRCT-CNT Staff Count: Other Staff - Full-Time 8 4151 4158 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed full-time by the facility. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Staff Count: Other Staff - Part-Time 8 4159 4166 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed part-time by the facility. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 34 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Pharmacist - Contract 8 4167 4174 NUMBER Description: Number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Staff Count: Pharmacist - Full-Time 8 4175 4182 NUMBER Description: Number of full-time equivalent pharmacists employed full-time by a facility. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Staff Count: Pharmacist - Part-Time 8 4183 4190 NUMBER Description: Number of full-time equivalent pharmacists employed part-time by a facility. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Staff Count: Physical Therapist - Contract 8 4191 4198 NUMBER Description: Number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Staff Count: Physical Therapist - Full-Time 8 4199 4206 NUMBER Description: Number of full-time equivalent physical therapists employed full-time by a facility. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT Staff Count: Physical Therapist - Part-Time 8 4207 4214 NUMBER Description: Number of full-time equivalent physical therapists employed part-time by a facility. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Staff Count: Physician Extender - Contract 8 4239 4246 NUMBER Description: Number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Staff Count: Physician Extender - Full-Time 8 4247 4254 NUMBER Description: Number of full-time equivalent physician extenders employed full-time by the facility. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Staff Count: Physician Extender - Part-Time 8 4255 4262 NUMBER Description: Number of full-time equivalent physician extenders employed part-time by the facility. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Staff Count: Podiatrist - Contract 8 4271 4278 NUMBER Description: Number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Staff Count: Podiatrist - Full-Time 8 4279 4286 NUMBER Description: Number of full-time equivalent podiatrists employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 35 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Staff Count: Podiatrist - Part-Time 8 4287 4294 NUMBER Description: Number of full-time equivalent podiatrists employed part-time by a facility. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Staff Count: PT Aide - Contract 8 4327 4334 NUMBER Description: Number of full-time equivalent physical therapy aides under contract to a facility. SAS Name: PT_AIDE_CNTRCT_CNT COBOL Name: PT-AIDE-CNTRCT-CNT Staff Count: PT Aide - Full-Time 8 4335 4342 NUMBER Description: Number of full-time equivalent physical therapy aides employed full-time by a facility. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Staff Count: PT Aide - Part-Time 8 4343 4350 NUMBER Description: Number of full-time equivalent physical therapy aides employed part-time by a facility. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Staff Count: PT Assistant - Contract 8 4351 4358 NUMBER Description: Number of full-time equivalent physical therapy assistants under contract to a facility. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Staff Count: PT Assistant - Full-Time 8 4359 4366 NUMBER Description: Number of full-time equivalent physical therapy assistants employed full-time by a facility. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Staff Count: PT Assistant - Part-Time 8 4367 4374 NUMBER Description: Number of full-time equivalent physical therapy assistants employed part-time by a facility. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Staff Count: Qualified Activities Professional - 8 4375 4382 NUMBER Contract Description: Number of full-time equivalent qualified activities professionals providing therapeutic services under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Staff Count: Qualified Activities Professional - 8 4383 4390 NUMBER Full-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Staff Count: Qualified Activities Professional - 8 4391 4398 NUMBER Part-Time Description: Number of full-time equivalent qualified activities * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 36 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE professionals providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Staff Count: RN - Contract 8 4431 4438 NUMBER Description: Number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Staff Count: RN - Full-Time 8 4439 4446 NUMBER Description: Number of full-time equivalent registered nurses employed full-time by a facility. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Staff Count: RN - Part-Time 8 4447 4454 NUMBER Description: Number of full-time equivalent registered nurses employed part-time by a facility. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Staff Count: RN Director of Nursing - Contract 8 4463 4470 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing under contract to a facility. SAS Name: RN_DRCTR_CNTRCT_CNT COBOL Name: RN-DRCTR-CNTRCT-CNT Staff Count: RN Director of Nursing - Full-Time 8 4471 4478 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed full-time by a facility. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT Staff Count: RN Director of Nursing - Part-Time 8 4479 4486 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed part-time by a facility. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Staff Count: Social Worker - Contract 8 4495 4502 NUMBER Description: Number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Staff Count: Social Worker - Full-Time 8 4503 4510 NUMBER Description: Number of full-time equivalent social workers employed full-time by a facility. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Staff Count: Social Worker - Part-Time 8 4511 4518 NUMBER Description: Number of full-time equivalent social workers employed part-time by a facility. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Staff Count: Speech Pathologist - Contract 8 4527 4534 NUMBER Description: Number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 37 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Spch Pthlgst Fltm Cnt 8 4535 4542 NUMBER Description: Speech Pathologist Fulltime Count SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Staff Count: Speech Pathologist - Part-Time 8 4543 4550 NUMBER Description: Number of full-time equivalent speech pathologists employed part-time by a facility. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4567 4574 NUMBER Contract Description: Number of full-time equivalent therapeutic recreation specialist staff under contract to a facility. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Staff Count: Therapeutic Recreational Specialist - 8 4575 4582 NUMBER Full-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4583 4590 NUMBER Part-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Home Health Agency 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: 05=Home Health Agency 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=VOLUNTARY NON PROFIT - RELIGIOUS AFFILIATION 02=VOLUNTARY NON-PROFIT - PRIVATE 03=VOLUNTARY NON-PROFIT - OTHER 04=PROPRIETARY 05=GOVERNMENT - STATE/COUNTY 06=GOVERNMENT - COMBINATION GOVT & VOLUNTARY 07=GOVERNMENT - LOCAL 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Gnrl Fac Type Cd 2 283 284 CHAR Description: General Fac Type Cd SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD Lab Srvc Cd 1 285 285 CHAR Description: Lab Service Cd SAS Name: LAB_SRVC_CD COBOL Name: LAB-SRVC-CD Phrmcy Srvc Cd 1 286 286 CHAR Description: Pharmacy Service Cd SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD Phrmcy Srvc Desc 49 287 335 CHAR Description: Pharmacy Service Desc SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC Branch Count 3 398 400 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of branches operated by the home health agency. SAS Name: BRNCH_CNT COBOL Name: BRNCH-CNT Branch Operation Indicator 1 401 401 VARCHAR2 Description: Indicates if the home health agency operates any branches. SAS Name: BRNCH_OPRTN_SW COBOL Name: BRNCH-OPRTN-SW CHOW Indicator 1 402 402 VARCHAR2 Description: Indicates if the home health agency has undergone a change of ownership since the last survey. SAS Name: CHOW_SW COBOL Name: CHOW-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD HHA Qualified For OPT Indicator 1 509 509 VARCHAR2 Description: Indicates if a home health agency is qualified to provide outpatient physical therapy/speech services. SAS Name: HHA_QLFYD_OPT_SPCH_SW COBOL Name: HHA-QLFYD-OPT-SPCH-SW Home Health Aide Training Program Code 1 510 510 VARCHAR2 Description: Indicates how the agency provides home health aide training and competency evaluation programs. SAS Name: HH_AIDE_TRNG_PGM_CD COBOL Name: HH-AIDE-TRNG-PGM-CD VALUES: 1=HOME HEALTH AIDE TRAINING 2=HOME HEALTH AIDE COMPETENCY EVALUATION PROG. 3=HOME HEALTH AIDE TRAINING/COMPETENCY PROGRAMS 4=NEITHER Hospice Indicator 1 511 511 VARCHAR2 Description: Indicates if the home health agency also participates in the Medicare program as a hospice. SAS Name: MDCR_HOSPC_SW COBOL Name: MDCR-HOSPC-SW Medicare Hospice Provider Num 10 524 533 CHAR Description: Medicare hospice provider number SAS Name: MDCR_HSPC_PRVDR_NUM COBOL Name: MDCR-HSPC-PRVDR-NUM Medicare Medicaid Prvdr Number 6 535 540 CHAR Description: Medicare/Medicaid provider number SAS Name: MDCD_CARE_VEND_NUM COBOL Name: MDCD-CARE-VEND-NUM Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Hh Aide Srvc Cd 1 753 753 CHAR Description: HH Aide Service Cd SAS Name: HH_AIDE_SRVC_CD COBOL Name: HH-AIDE-SRVC-CD Services: Appliance and Equipment Code 1 854 854 VARCHAR2 Description: Indicates how appliance and equipment services are provided by a home health agency. SAS Name: APLNC_EQUIP_SRVC_CD COBOL Name: APLNC-EQUIP-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services: Interns and Residents Code 1 1922 1922 VARCHAR2 Description: Indicates how intern and resident services are provided by a home health agency. SAS Name: INTRN_RSDNT_SRVC_CD COBOL Name: INTRN-RSDNT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Mdcl Scl Srvc Cd 1 1923 1923 CHAR Description: Medical Social Service Cd SAS Name: MDCL_SCL_SRVC_CD COBOL Name: MDCL-SCL-SRVC-CD Nrsng Srvc Cd 1 2331 2331 CHAR Description: Nursing Service Cd SAS Name: NRSNG_SRVC_CD COBOL Name: NRSNG-SRVC-CD Services: Nutritional Guidance Code 1 2335 2335 VARCHAR2 Description: Indicates how nutritional guidance services are provided by a home health agency. SAS Name: NTRTNL_GDNC_SRVC_CD COBOL Name: NTRTNL-GDNC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Ot Srvc Cd 1 2592 2592 CHAR Description: OT Service Cd SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD Ot Srvc Desc 49 2593 2641 CHAR Description: OT Service Desc SAS Name: OT_SRVC_DESC COBOL Name: OT-SRVC-DESC Othr Srvc Cd 1 2645 2645 CHAR Description: Other Services Cd SAS Name: OTHR_SRVC_CD COBOL Name: OTHR-SRVC-CD Pt Srvc Cd 1 3118 3118 CHAR Description: PT Service Cd SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Pt Srvc Desc 49 3119 3167 CHAR Description: PT Service Desc SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Services: Speech Therapy Code 1 3387 3387 VARCHAR2 Description: Indicates how speech therapy services are provided by the home health agency. SAS Name: SPCH_THRPY_SRVC_CD COBOL Name: SPCH-THRPY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services: Vocational Guidance Code 1 3550 3550 VARCHAR2 Description: Indicates how vocational guidance services are provided by the home health agency. SAS Name: VCTNL_GDNC_SRVC_CD COBOL Name: VCTNL-GDNC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Dietn Cnt 8 3671 3678 NUMBER Description: Dietician Count SAS Name: DIETN_CNT COBOL Name: DIETN-CNT Staff Count: Home Health Aide 8 3735 3742 NUMBER Description: Number of full-time equivalent home health aides employed by a home health agency. SAS Name: HH_AIDE_CNT COBOL Name: HH-AIDE-CNT Lpn Lvn Cnt 8 3783 3790 NUMBER Description: LPN LVN Count SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Ocptnl Thrpst Cnt 8 3983 3990 NUMBER Description: Occupational Therapist Count SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Phys Thrpst Stf Cnt 8 4303 4310 NUMBER Description: Physical Therapist Staff Count SAS Name: PHYS_THRPST_STF_CNT COBOL Name: PHYS-THRPST-STF-CNT Reg Phrmcst Cnt 8 4407 4414 NUMBER Description: Reg Pharmacist Count * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: REG_PHRMCST_CNT COBOL Name: REG-PHRMCST-CNT Rn Cnt 8 4423 4430 NUMBER Description: RN Count SAS Name: RN_CNT COBOL Name: RN-CNT Scl Workr Cnt 8 4487 4494 NUMBER Description: Social Worker Count SAS Name: SCL_WORKR_CNT COBOL Name: SCL-WORKR-CNT Spch Pthlgst Audlgst Cnt 8 4559 4566 NUMBER Description: Speech Pathologist Audiologist Count SAS Name: SPCH_PTHLGST_AUDLGST_CNT COBOL Name: SPCH-PTHLGST-AUDLGST-CNT Subunit Count 3 4609 4611 NUMBER Description: Number of subunits operated by the home health agency. SAS Name: SBUNIT_CNT COBOL Name: SBUNIT-CNT Subunit Indicator 1 4612 4612 VARCHAR2 Description: Indicates if the home health agency is a subunit of another agency. SAS Name: SBUNIT_SW COBOL Name: SBUNIT-SW Subunit Operation Indicator 1 4613 4613 VARCHAR2 Description: Indicates if the home health agency operates any subunits. SAS Name: SBUNIT_OPRTN_SW COBOL Name: SBUNIT-OPRTN-SW Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Psychiatric Residential Treatment 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: 06=Psychiatric Residential Treatment Facility 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=PRIVATE NON PROFIT 02=PROPRIETARY 03=RELIGIOUS AFFILIATION 04=VOL. NON-PROF. - RELIGIOUS AFF. 05=FOR PROFIT 06=NOT FOR PROFIT 07=CORPORATION 08=STATE 09=LOCAL GOVERNMENT 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 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 Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT COBOL Name: BED-CNT Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=X-Ray 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: 07=Portable X-Ray Supplier 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=INDIVIDUAL 02=PARTNERSHIP 03=CORPORATION 04=OTHER THAN PRIVATE 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 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 Director Qualification Code 1 461 461 VARCHAR2 Description: Indicates the highest degree held by the director of a supplier of portable X-ray services. SAS Name: DRCTR_QUALN_CD COBOL Name: DRCTR-QUALN-CD VALUES: 1=PHYSICIAN 2=PHD/SCD 3=MS/MA 4=BS/BA 5=OTHER Director Qualification Description 19 462 480 VARCHAR2 Description: Indicates the highest degree held by the director of a supplier of portable X-ray services. SAS Name: DRCTR_QUALN_DESC COBOL Name: DRCTR-QUALN-DESC Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Technologist Count: 24-Month Radiologic School 8 4622 4629 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of full-time equivalent technologists who are graduates of a 24-month approved school of radiologic technology. SAS Name: TCHNLGST_2_YR_RDLGC_CNT COBOL Name: TCHNLGST-2-YR-RDLGC-CNT Technologist Count: Associate Degree 8 4630 4637 NUMBER Description: Number of full-time equivalent technologists with an Associate degree in radiologic technology. SAS Name: TCHNLGST_ASCT_DGR_CNT COBOL Name: TCHNLGST-ASCT-DGR-CNT Technologist Count: BS or BA Degree 8 4638 4645 NUMBER Description: Number of full-time equivalent technologists with a Bachelor of Science or Bachelor of Arts degree in radiologic technology. SAS Name: TCHNLGST_BS_BA_DGR_CNT COBOL Name: TCHNLGST-BS-BA-DGR-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=OPT or Speech Pathology 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: 08=Outpatient Physical Therapy/Speech Pathology 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A WA/D1B=District 1, Unit B * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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/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 WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=VOLUNTARY NON PROFIT OTHER THAN CHURCH 02=VOLUNTARY NON PROFIT CHURCH 03=STATE GOVERNMENT 04=LOCAL GOVERNMENT 05=COMBINATION GOVERNMENT & VOLUNTARY 06=PROPRIETARY 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Gnrl Fac Type Cd 2 283 284 CHAR Description: General Fac Type Cd SAS Name: GNRL_FAC_TYPE_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: GNRL-FAC-TYPE-CD Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Ot Srvc Cd 1 2592 2592 CHAR Description: OT Service Cd SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD Pt Srvc Cd 1 3118 3118 CHAR Description: PT Service Cd SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD Spch Pthlgy Srvc Cd 1 3334 3334 CHAR Description: Speech Pathology Service Cd SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD Spch Pthlgy Srvc Desc 49 3335 3383 CHAR Description: Speech Pathology Service Desc SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Ocptnl Thrpst Cnt 8 3983 3990 NUMBER Description: Occupational Therapist Count SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Ocptnl Thrpst Cntrct Cnt 8 3991 3998 NUMBER Description: Occupational Therapist Contractor Count SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Ocptnl Thrpst Fltm Cnt 8 3999 4006 NUMBER Description: Occupational Therapist Fulltime Count SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Phys Thrpst Stf Cnt 8 4303 4310 NUMBER Description: Physical Therapist Staff Count SAS Name: PHYS_THRPST_STF_CNT COBOL Name: PHYS-THRPST-STF-CNT Phys Thrpst Cnt 8 4311 4318 NUMBER Description: Physical Therapist Count SAS Name: PHYS_THRPST_CNT COBOL Name: PHYS-THRPST-CNT Staff Count: PT - Arrangement 8 4319 4326 NUMBER Description: Total number of full-time equivalent physical therapists at the outpatient physical therapy facility. SAS Name: PHYS_THRPST_ARNGMT_CNT COBOL Name: PHYS-THRPST-ARNGMT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Speech Pathologist - Arrangement 8 4519 4526 NUMBER Description: Number of full-time equivalent speech pathologists under arrangement to the outpatient physical therapy facility. SAS Name: SPCH_PTHLGST_ARNGMT_CNT COBOL Name: SPCH-PTHLGST-ARNGMT-CNT Spch Pthlgst Fltm Cnt 8 4535 4542 NUMBER Description: Speech Pathologist Fulltime Count SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Staff Count: Speech Pathologist - Total 8 4551 4558 NUMBER Description: Total number of full-time equivalent speech pathologists at the outpatient physical therapy facility. SAS Name: SPCH_PTHLGST_CNT COBOL Name: SPCH-PTHLGST-CNT Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=End Stage Renal Disease 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: 09=End Stage Renal Disease Facility 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOR PROFIT 02=NOT FOR PROFIT 03=PUBLIC 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 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 ESRD Network Number 2 481 482 VARCHAR2 Description: Number of the network to which the end-stage renal disease facility is assigned. SAS Name: ESRD_NTWRK_NUM COBOL Name: ESRD-NTWRK-NUM VALUES: 01=CONN-MAINE-MASS-NEW HAMP-RHODE ISLAND-VERMONT 02=NEW YORK 03=NEW JERSEY, PUERTO RICO AND VIRGIN ISLAND 04=DELAWARE AND PENNSYLVANIA 05=DIST OF COLUM-MARYLAND-VIRGINIA-WEST VIRGINIA 06=GEORGIA, SOUTH CAROLINA AND NORTH CAROLINA 07=FLORIDA 08=ALABAMA, MISSISSIPPI AND TENNESSEE 09=INDIANA, KENTUCKY AND OHIO 10=ILLINOIS 11=MICH-MINN-NORTH DAKOTA-SOUTH DAKOTA-WISCONSIN 12=IOWA, KANSAS, MISSOURI AND NEBRASKA 13=ARKANSAS, LOUISIANA AND OKLAHOMA 14=TEXAS 15=ARIZONA-COLO-NEVADA-NEW MEXI-UTAH AND WYOMING 16=ALASKA, IDAHO, MONTANA, OREGON AND WASHINGTON 17=COUNTIES IN NORTHERN CALIF, HAWAII, AS, GUAM 18=COUNTIES IN SOUTHERN CALIFORNIA Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Mlt Fac Org Name 38 541 578 CHAR Description: Multi Fac Org Name SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Mlt Ownd Fac Org Sw 1 579 579 CHAR Description: Multi Owned Fac Org Switch SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Dietn Cnt 8 3671 3678 NUMBER Description: Dietician Count SAS Name: DIETN_CNT COBOL Name: DIETN-CNT Rn Cnt 8 4423 4430 NUMBER Description: RN Count SAS Name: RN_CNT COBOL Name: RN-CNT Scl Workr Cnt 8 4487 4494 NUMBER Description: Social Worker Count SAS Name: SCL_WORKR_CNT COBOL Name: SCL-WORKR-CNT Total Approved Stations 3 4646 4648 NUMBER Description: Total number of approved dialysis stations in an end-stage renal disease facility. SAS Name: DLYS_STN_CNT COBOL Name: DLYS-STN-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 02=Title 19 Only 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: 10=Nursing Facility 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOR PROFIT - INDIVIDUAL 02=FOR PROFIT - PARTNERSHIP 03=FOR PROFIT - CORPORATION 04=NONPROFIT - CHURCH RELATED 05=NONPROFIT - CORPORATION 06=NONPROFIT - OTHER 07=GOVERNMENT - STATE 08=GOVERNMENT - COUNTY 09=GOVERNMENT - CITY 10=GOVERNMENT - CITY/COUNTY 11=GOVERNMENT - HOSPITAL DISTRICT 12=GOVERNMENT - FEDERAL 13=FOR PROFIT - LIMITED LIABILITY CORPORATION 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 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 Ovrrd Bed Cnt Sw 1 346 346 CHAR Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Count: Medicaid NF 4 355 358 NUMBER Description: Number of Medicaid-certified Nursing Facility beds. SAS Name: MDCD_NF_BED_CNT COBOL Name: MDCD-NF-BED-CNT Bed Count: Medicare SNF 4 359 362 NUMBER Description: Number of Medicare-certified Skilled Nursing Facility beds. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Bed Count: Medicare/Medicaid SNF 4 363 366 NUMBER Description: Number of dually certified (Medicare/Medicaid) beds in a Skilled Nursing Facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Bed Count: Special Care - AIDS 3 367 369 NUMBER Description: Number of beds in a special care unit dedicated for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Bed Count: Special Care - Alzheimers 3 370 372 NUMBER Description: Number of beds in a special care unit dedicated for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Bed Count: Special Care - Dialysis 3 373 375 NUMBER Description: Number of beds in a special care unit dedicated for residents who require dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Bed Count: Special Care - Disabled Children 3 376 378 NUMBER Description: Number of beds in a special care unit dedicated for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Bed Count: Special Care - Head Trauma 3 379 381 NUMBER Description: Number of beds in a special care unit dedicated for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Bed Count: Special Care - Hospice 3 382 384 NUMBER Description: Number of beds in a special care unit dedicated for residents who require hospice care. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Bed Count: Special Care - Huntingtons Disease 3 385 387 NUMBER Description: Number of beds in a special care unit dedicated for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Bed Count: Special Care - Specialized Rehab 3 388 390 NUMBER Description: Number of beds in a special care unit dedicated for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Bed Count: Special Care - Ventilator 3 391 393 NUMBER Description: Number of beds in a special care unit dedicated for residents requiring a ventilator and/or respiratory care. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: BED-CNT Rn 24 Hr Wvr Sw 1 453 453 CHAR Description: RN 24 Hour Waiver Switch SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7-Day RN Waiver Indicator 1 454 454 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse staffing requirements has been recommended for a Skilled Nursing Facility. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Bed Per Room Wvr Sw 1 455 455 CHAR Description: Bed Per Room Waiver Switch SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Room Size Wvr Sw 1 457 457 CHAR Description: Room Size Waiver Switch SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Experimental Research Conducted Indicator 1 483 483 VARCHAR2 Description: Indicates if a facility conducts experimental research. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD LTC Cross Ref Provider Number 10 513 522 CHAR Description: LTC cross ref provider number SAS Name: LTC_CRS_RFRNC_PRVDR_NUM COBOL Name: LTC-CRS-RFRNC-PRVDR-NUM Mlt Fac Org Name 38 541 578 CHAR Description: Multi Fac Org Name SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Mlt Ownd Fac Org Sw 1 579 579 CHAR Description: Multi Owned Fac Org Switch SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Organized Family Group Indicator 1 585 585 VARCHAR2 Description: Indicates if the facility has an organized group of family members of residents. SAS Name: ORGNZ_FMLY_MBR_GRP_SW COBOL Name: ORGNZ-FMLY-MBR-GRP-SW Organized Resident Group Indicator 1 586 586 VARCHAR2 Description: Indicates if the facility has an organized residents group. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Blood Administration Off-Site Residents 1 905 905 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Services: Blood Administration On-Site Nonresidents 1 906 906 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Services: Blood Administration On-Site Residents 1 907 907 VARCHAR2 Indicator Description: Indicates if blood administration and storage services are provided on-site to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Services: Clinical Laboratory - Off-Site Residents 1 1208 1208 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided off-site to residents. SAS Name: CL_SRVC_OFSITE_RSDNT_SW COBOL Name: CL-SRVC-OFSITE-RSDNT-SW Services: Clinical Laboratory - On-Site Nonresidents 1 1209 1209 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Services: Clinical Laboratory - On-Site Residents 1 1210 1210 VARCHAR2 Indicator Description: Indicates if clinical laboratory services are provided on-site to residents. SAS Name: CL_SRVC_ONST_RSDNT_SW COBOL Name: CL-SRVC-ONST-RSDNT-SW Services: Dental Off-Site Residents Indicator 1 1412 1412 VARCHAR2 Description: Indicates if dental services are provided off-site to residents. SAS Name: DNTL_SRVC_OFSITE_RSDNT_SW COBOL Name: DNTL-SRVC-OFSITE-RSDNT-SW Services: Dental On-Site Nonresidents Indicator 1 1413 1413 VARCHAR2 Description: Indicates if dental services are provided on-site to nonresidents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: DNTL_SRVC_ONST_NRSDNT_SW COBOL Name: DNTL-SRVC-ONST-NRSDNT-SW Services: Dental On-Site Residents Indicator 1 1414 1414 VARCHAR2 Description: Indicates if dental services are provided on-site to residents. SAS Name: DNTL_SRVC_ONST_RSDNT_SW COBOL Name: DNTL-SRVC-ONST-RSDNT-SW Services: Dietary Off-Site Residents Indicator 1 1565 1565 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Services: Dietary On-Site Nonresidents Indicator 1 1566 1566 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Services: Dietary On-Site Residents Indicator 1 1567 1567 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Services: Housekeeping Off-Site Residents Indicator 1 1869 1869 VARCHAR2 Description: Indicates if housekeeping services are provided off-site to residents. SAS Name: HSEKPNG_SRVC_OFSITE_RSDNT_SW COBOL Name: HSEKPNG-SRVC-OFSITE-RSDNT-SW Services: Housekeeping On-Site Nonresidents Indicator 1 1870 1870 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to nonresidents. SAS Name: HSEKPNG_SRVC_ONST_NRSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-NRSDNT-SW Services: Housekeeping On-Site Residents Indicator 1 1871 1871 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to residents. SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Services: Mental Health Off-Site Residents Indicator 1 2025 2025 VARCHAR2 Description: Indicates if mental health services are provided off-site to residents. SAS Name: MENTL_HLTH_OFSITE_RSDNT_SW COBOL Name: MENTL-HLTH-OFSITE-RSDNT-SW Services: Mental Health On-Site Nonresidents 1 2026 2026 VARCHAR2 Indicator Description: Indicates if mental health services are provided on-site to nonresidents. SAS Name: MENTL_HLTH_ONST_NRSDNT_SW COBOL Name: MENTL-HLTH-ONST-NRSDNT-SW Services: Mental Health On-Site Residents Indicator 1 2027 2027 VARCHAR2 Description: Indicates if mental health services are provided on-site to residents. SAS Name: MENTL_HLTH_ONST_RSDNT_SW COBOL Name: MENTL-HLTH-ONST-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 24 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Nursing Off-Site Residents Indicator 1 2332 2332 VARCHAR2 Description: Indicates if nursing services are provided off-site to residents. SAS Name: NRSNG_SRVC_OFSITE_RSDNT_SW COBOL Name: NRSNG-SRVC-OFSITE-RSDNT-SW Services: Nursing On-Site Nonresidents Indicator 1 2333 2333 VARCHAR2 Description: Indicates if nursing services are provided on-site to nonresidents. SAS Name: NRSNG_SRVC_ONST_NRSDNT_SW COBOL Name: NRSNG-SRVC-ONST-NRSDNT-SW Services: Nursing On-Site Residents Indicator 1 2334 2334 VARCHAR2 Description: Indicates if nursing services are provided on-site to residents. SAS Name: NRSNG_SRVC_ONST_RSDNT_SW COBOL Name: NRSNG-SRVC-ONST-RSDNT-SW Services: OT Off-Site Residents Indicator 1 2642 2642 VARCHAR2 Description: Indicates if occupational therapy services are provided off-site to residents. SAS Name: OT_SRVC_OFSITE_RSDNT_SW COBOL Name: OT-SRVC-OFSITE-RSDNT-SW Services: OT On-Site Nonresidents Indicator 1 2643 2643 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to nonresidents. SAS Name: OT_SRVC_ONST_NRSDNT_SW COBOL Name: OT-SRVC-ONST-NRSDNT-SW Services: OT On-Site Residents Indicator 1 2644 2644 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to residents. SAS Name: OT_SRVC_ONST_RSDNT_SW COBOL Name: OT-SRVC-ONST-RSDNT-SW Services: Pharmacy Off-Site Residents Indicator 1 2996 2996 VARCHAR2 Description: Indicates if pharmacy services are provided off-site to residents. SAS Name: PHRMCY_SRVC_OFSITE_RSDNT_SW COBOL Name: PHRMCY-SRVC-OFSITE-RSDNT-SW Services: Pharmacy On-Site Nonresidents Indicator 1 2997 2997 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to nonresidents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Services: Pharmacy On-Site Residents Indicator 1 2998 2998 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to residents. SAS Name: PHRMCY_SRVC_ONST_RSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-RSDNT-SW Services: Physician Extender Off-Site Residents 1 3003 3003 VARCHAR2 Indicator Description: Indicates if physician extender services are provided off-site to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Services: Physician Extender On-Site Nonresidents 1 3004 3004 VARCHAR2 Indicator Description: Indicates if physician extender services are provided * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 25 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE on-site to nonresidents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Services: Physician Extender On-Site Residents 1 3005 3005 VARCHAR2 Indicator Description: Indicates if physician extender services are provided on-site to residents. SAS Name: PHYSN_EXT_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-RSDNT-SW Services: Physician Off-Site Residents Indicator 1 3006 3006 VARCHAR2 Description: Indicates if physician services are provided off-site to residents. SAS Name: PHYSN_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-SRVC-OFSITE-RSDNT-SW Services: Physician On-Site Nonresidents Indicator 1 3007 3007 VARCHAR2 Description: Indicates if physician services are provided on-site to nonresidents. SAS Name: PHYSN_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-SRVC-ONST-NRSDNT-SW Services: Physician On-Site Residents Indicator 1 3008 3008 VARCHAR2 Description: Indicates if physician services are provided on-site to residents. SAS Name: PHYSN_SRVC_ONST_RSDNT_SW COBOL Name: PHYSN-SRVC-ONST-RSDNT-SW Services: Podiatry Off-Site Residents Indicator 1 3009 3009 VARCHAR2 Description: Indicates if podiatry services are provided off-site to residents. SAS Name: PDTRY_SRVC_OFSITE_RSDNT_SW COBOL Name: PDTRY-SRVC-OFSITE-RSDNT-SW Services: Podiatry On-Site Nonresidents Indicator 1 3010 3010 VARCHAR2 Description: Indicates if podiatry services are provided on-site to nonresidents. SAS Name: PDTRY_SRVC_ONST_NRSDNT_SW COBOL Name: PDTRY-SRVC-ONST-NRSDNT-SW Services: Podiatry On-Site Residents Indicator 1 3011 3011 VARCHAR2 Description: Indicates if podiatry services are provided on-site to residents. SAS Name: PDTRY_SRVC_ONST_RSDNT_SW COBOL Name: PDTRY-SRVC-ONST-RSDNT-SW Services: PT Off-Site Residents Indicator 1 3168 3168 VARCHAR2 Description: Indicates if physical therapy services are provided off-site to residents. SAS Name: PT_OFSITE_RSDNT_SW COBOL Name: PT-OFSITE-RSDNT-SW Services: PT On-Site Nonresidents Indicator 1 3169 3169 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to nonresidents. SAS Name: PT_ONST_NRSDNT_SW COBOL Name: PT-ONST-NRSDNT-SW Services: PT On-Site Residents Indicator 1 3170 3170 VARCHAR2 Description: Indicates if physical therapy services are provided on-site to residents. SAS Name: PT_ONST_RSDNT_SW COBOL Name: PT-ONST-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 26 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services: Social Work Off-Site Residents Indicator 1 3328 3328 VARCHAR2 Description: Indicates if social work services are provided off-site to residents. SAS Name: SCL_WORK_SRVC_OFSITE_RSDNT_SW COBOL Name: SCL-WORK-SRVC-OFSITE-RSDNT-SW Services: Social Work On-Site Nonresidents Indicator 1 3329 3329 VARCHAR2 Description: Indicates if social work services are provided on-site to nonresidents. SAS Name: SCL_WORK_SRVC_ONST_NRSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-NRSDNT-SW Services: Social Work On-Site Residents Indicator 1 3330 3330 VARCHAR2 Description: Indicates if social work services are provided on-site to residents. SAS Name: SCL_WORK_SRVC_ONST_RSDNT_SW COBOL Name: SCL-WORK-SRVC-ONST-RSDNT-SW Services: Speech Pathology Off-Site Residents 1 3384 3384 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided off-site to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Services: Speech Pathology On-Site Nonresidents 1 3385 3385 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to nonresidents. SAS Name: SPCH_PTHLGY_ONST_NRSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-NRSDNT-SW Services: Speech Pathology On-Site Residents 1 3386 3386 VARCHAR2 Indicator Description: Indicates if speech/language pathology services are provided on-site to residents. SAS Name: SPCH_PTHLGY_ONST_RSDNT_SW COBOL Name: SPCH-PTHLGY-ONST-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3438 3438 VARCHAR2 Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3439 3439 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Activities Staff - 1 3440 3440 VARCHAR2 On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by other activities staff. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3441 3441 VARCHAR2 Off-Site Residents Indicator Description: Indicates if other therapeutic social services are * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 27 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE provided off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3442 3442 VARCHAR2 On-Site Nonresidents Indicator Description: Indicates if other therapeutic social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Services: Therapeutic - Other Social Services Staff - 1 3443 3443 VARCHAR2 On-Site Residents Indicator Description: Indicates if other therapeutic social services are provided on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3444 3444 VARCHAR2 Professional - Off-Site Residents Indicator Description: Indicates if therapeutic services are provided off-site to residents by qualified activities professionals. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Services: Therapeutic - Qualified Activities 1 3445 3445 VARCHAR2 Professional - On-Site Nonresidents Indicator Description: Indicates if therapeutic services are provided on-site to nonresidents by qualified activities professionals. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Services: Therapeutic - Qualified Activities 1 3446 3446 VARCHAR2 Professional - On-Site Residents Indicator Description: Indicates if therapeutic services are provided on-site to residents by qualified activities professionals. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Services: Therapeutic Recreational Specialty Off-Site 1 3497 3497 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided off-site to residents. SAS Name: THRPTC_RCRTNL_OFSITE_RSDNT_SW COBOL Name: THRPTC-RCRTNL-OFSITE-RSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3498 3498 VARCHAR2 Nonresidents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to nonresidents. SAS Name: THRPTC_RCRTNL_ONST_NRSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-NRSDNT-SW Services: Therapeutic Recreational Specialty On-Site 1 3499 3499 VARCHAR2 Residents Indicator Description: Indicates if therapeutic recreation specialist services are provided on-site to residents. SAS Name: THRPTC_RCRTNL_ONST_RSDNT_SW COBOL Name: THRPTC-RCRTNL-ONST-RSDNT-SW Services: Vocational Off-Site Residents Indicator 1 3551 3551 VARCHAR2 Description: Indicates if vocational services are provided off-site to residents. SAS Name: VCTNL_SRVC_OFSITE_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 28 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: VCTNL-SRVC-OFSITE-RSDNT-SW Services: Vocational On-Site Nonresidents Indicator 1 3552 3552 VARCHAR2 Description: Indicates if vocational services are provided on-site to nonresidents. SAS Name: VCTNL_SRVC_ONST_NRSDNT_SW COBOL Name: VCTNL-SRVC-ONST-NRSDNT-SW Services: Vocational On-Site Residents Indicator 1 3553 3553 VARCHAR2 Description: Indicates if vocational services are provided on-site to residents. SAS Name: VCTNL_SRVC_ONST_RSDNT_SW COBOL Name: VCTNL-SRVC-ONST-RSDNT-SW Services: X-ray Off-Site Residents Indicator 1 3554 3554 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided off-site to residents. SAS Name: DGNSTC_XRAY_OFSITE_RSDNT_SW COBOL Name: DGNSTC-XRAY-OFSITE-RSDNT-SW Services: X-ray On-Site Nonresidents Indicator 1 3555 3555 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to nonresidents. SAS Name: DGNSTC_XRAY_ONST_NRSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-NRSDNT-SW Services: X-ray On-Site Residents Indicator 1 3556 3556 VARCHAR2 Description: Indicates if diagnostic X-ray services are provided on-site to residents. SAS Name: DGNSTC_XRAY_ONST_RSDNT_SW COBOL Name: DGNSTC-XRAY-ONST-RSDNT-SW Ovrrd Stfg Sw 1 3558 3558 CHAR Description: Override Staffing Switch SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Staff Count: Administrative Staff - Contract 8 3559 3566 NUMBER Description: Number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Staff Count: Administrative Staff - Full-Time 8 3567 3574 NUMBER Description: Number of full-time equivalent administrative staff employed on a full-time basis by a facility. SAS Name: PROFNL_ADMIN_FLTM_CNT COBOL Name: PROFNL-ADMIN-FLTM-CNT Staff Count: Administrative Staff - Part-Time 8 3575 3582 NUMBER Description: Number of full-time equivalent administrative staff employed on a part-time basis by a facility. SAS Name: PROFNL_ADMIN_PRTM_CNT COBOL Name: PROFNL-ADMIN-PRTM-CNT Staff Count: Certified Nurse Aide - Contract 8 3599 3606 NUMBER Description: Number of full-time equivalent certified nurse aides under contract to a facility. SAS Name: NRS_AIDE_CNTRCT_CNT COBOL Name: NRS-AIDE-CNTRCT-CNT Staff Count: Certified Nurse Aide - Full-Time 8 3607 3614 NUMBER Description: Number of full-time equivalent certified nurse aides employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 29 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Staff Count: Certified Nurse Aide - Part-Time 8 3615 3622 NUMBER Description: Number of full-time equivalent certified nurse aides employed part-time by a facility. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Staff Count: Dentist - Contract 8 3647 3654 NUMBER Description: Number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Staff Count: Dentist - Full-Time 8 3655 3662 NUMBER Description: Number of full-time equivalent dentists employed full time by a facility. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Staff Count: Dentist - Part-Time 8 3663 3670 NUMBER Description: Number of full-time equivalent dentists employed part time by a facility. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Staff Count: Dietitian - Contract 8 3679 3686 NUMBER Description: Number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Staff Count: Dietitian - Full-Time 8 3687 3694 NUMBER Description: Number of full-time equivalent dietitians employed full time by a facility. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Staff Count: Dietitian - Part-Time 8 3695 3702 NUMBER Description: Number of full-time equivalent dietitians employed part time by a facility. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Staff Count: Food Service Worker - Contract 8 3711 3718 NUMBER Description: Number of full-time equivalent food service personnel under contract to a facility. SAS Name: FOOD_SRVC_CNTRCT_CNT COBOL Name: FOOD-SRVC-CNTRCT-CNT Staff Count: Food Service Worker - Full-Time 8 3719 3726 NUMBER Description: Number of full-time equivalent food service personnel employed full-time by a facility. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Staff Count: Food Service Worker - Part-Time 8 3727 3734 NUMBER Description: Number of full-time equivalent food service personnel employed part-time by a facility. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Staff Count: Housekeeping - Contract 8 3759 3766 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 30 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Staff Count: Housekeeping - Full-Time 8 3767 3774 NUMBER Description: Number of full-time equivalent housekeeping personnel employed full-time by a facility. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Staff Count: Housekeeping - Part-Time 8 3775 3782 NUMBER Description: Number of full-time equivalent housekeeping personnel employed part-time by a facility. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT Staff Count: LPN/LVN - Contract 8 3791 3798 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses under contract to a facility. SAS Name: LPN_LVN_CNTRCT_CNT COBOL Name: LPN-LVN-CNTRCT-CNT Staff Count: LPN/LVN - Full-Time 8 3799 3806 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed full-time by a facility. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT Staff Count: LPN/LVN - Part-Time 8 3807 3814 NUMBER Description: Number of full-time equivalent licensed practical/vocational nurses employed part-time by a facility. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Staff Count: Medical Director - Contract 8 3823 3830 NUMBER Description: Number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Staff Count: Medical Director - Full-Time 8 3831 3838 NUMBER Description: Number of full-time equivalent medical directors employed full-time by a facility. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Staff Count: Medical Director - Part-Time 8 3839 3846 NUMBER Description: Number of full-time equivalent medical directors employed part-time by a facility. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Staff Count: Medication Aide/Technician - Contract 8 3871 3878 NUMBER Description: Number of full-time equivalent medication aides/ technicians under contract to a facility. SAS Name: MDCTN_AIDE_CNTRCT_CNT COBOL Name: MDCTN-AIDE-CNTRCT-CNT Staff Count: Medication Aide/Technician - Full-Time 8 3879 3886 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 31 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Staff Count: Medication Aide/Technician - Part-Time 8 3887 3894 NUMBER Description: Number of full-time equivalent medication aides/ technicians employed part-time by a facility. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Staff Count: Mental Health Services - Contract 8 3895 3902 NUMBER Description: Number of full-time equivalent mental health services personnel under contract to a facility. SAS Name: MENTL_HLTH_SRVC_CNTRCT_CNT COBOL Name: MENTL-HLTH-SRVC-CNTRCT-CNT Staff Count: Mental Health Services - Full-Time 8 3903 3910 NUMBER Description: Number of full-time equivalent mental health services personnel employed full-time by a facility. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Staff Count: Mental Health Services - Part-Time 8 3911 3918 NUMBER Description: Number of full-time equivalent mental health services personnel employed part-time by a facility. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Staff Count: Nurse Aide in Training - Contract 8 3927 3934 NUMBER Description: Number of full-time equivalent nurse aides in training under contract to a facility. SAS Name: NAT_CNTRCT_CNT COBOL Name: NAT-CNTRCT-CNT Staff Count: Nurse Aide in Training - Full-Time 8 3935 3942 NUMBER Description: Number of full-time equivalent nurse aides in training employed full-time by a facility. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Staff Count: Nurse Aide in Training - Part-Time 8 3943 3950 NUMBER Description: Number of full-time equivalent nurse aides in training employed part-time by a facility. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Staff Count: Nurse With Administrative Duties - 8 3959 3966 NUMBER Contract Description: Number of full-time equivalent nurses with administrative duties under contract to a facility. SAS Name: NRS_ADMINV_CNTRCT_CNT COBOL Name: NRS-ADMINV-CNTRCT-CNT Staff Count: Nurse With Administrative Duties - 8 3967 3974 NUMBER Full-Time Description: Number of full-time equivalent nurses with administrative duties employed full-time by a facility. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Staff Count: Nurse With Administrative Duties - 8 3975 3982 NUMBER Part-Time Description: Number of full-time equivalent nurses with administrative duties employed part-time by a facility. SAS Name: NRS_ADMINV_PRTM_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 32 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NRS-ADMINV-PRTM-CNT Ocptnl Thrpst Cntrct Cnt 8 3991 3998 NUMBER Description: Occupational Therapist Contractor Count SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Ocptnl Thrpst Fltm Cnt 8 3999 4006 NUMBER Description: Occupational Therapist Fulltime Count SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Staff Count: OT - Part-Time 8 4007 4014 NUMBER Description: Number of full-time equivalent occupational therapists employed part-time by a facility. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Staff Count: OT Aide - Contract 8 4015 4022 NUMBER Description: Number of full-time equivalent occupational therapy aides under contract to a facility. SAS Name: OT_AIDE_CNTRCT_CNT COBOL Name: OT-AIDE-CNTRCT-CNT Staff Count: OT Aide - Full-Time 8 4023 4030 NUMBER Description: Number of full-time equivalent occupational therapy aides employed full-time by a facility. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Staff Count: OT Aide - Part-Time 8 4031 4038 NUMBER Description: Number of full-time equivalent occupational therapy aides employed part-time by a facility. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Staff Count: OT Assistant - Contract 8 4039 4046 NUMBER Description: Number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_CNTRCT_CNT COBOL Name: OT-ASTNT-CNTRCT-CNT Staff Count: OT Assistant - Full-Time 8 4047 4054 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed full-time by a facility. SAS Name: OT_ASTNT_FLTM_CNT COBOL Name: OT-ASTNT-FLTM-CNT Staff Count: OT Assistant - Part-Time 8 4055 4062 NUMBER Description: Number of full-time equivalent occupational therapy assistants employed part-time by a facility. SAS Name: OT_ASTNT_PRTM_CNT COBOL Name: OT-ASTNT-PRTM-CNT Staff Count: Other Activities - Contract 8 4071 4078 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services under contract to a facility. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Staff Count: Other Activities - Full-Time 8 4079 4086 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed full time by a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 33 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE facility. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Staff Count: Other Activities - Part-Time 8 4087 4094 NUMBER Description: Number of full-time equivalent other activities staff providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Staff Count: Other Physician - Contract 8 4095 4102 NUMBER Description: Number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Staff Count: Other Physician - Full-Time 8 4103 4110 NUMBER Description: Number of full-time equivalent other physicians employed full-time by a facility. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Staff Count: Other Physician - Part-Time 8 4111 4118 NUMBER Description: Number of full-time equivalent other physicians employed part-time by a facility. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Staff Count: Other Social Services - Contract 8 4119 4126 NUMBER Description: Number of full-time equivalent other social services staff under contract to a facility. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Staff Count: Other Social Services - Full-Time 8 4127 4134 NUMBER Description: Number of full-time equivalent other social services staff employed full time by a facility. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Staff Count: Other Social Services - Part-Time 8 4135 4142 NUMBER Description: Number of full-time equivalent other social services staff employed part time by a facility. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Staff Count: Other Staff - Contract 8 4143 4150 NUMBER Description: Number of full-time equivalent staff not included in any other categories under contract to the facility. SAS Name: STF_OTHR_CNTRCT_CNT COBOL Name: STF-OTHR-CNTRCT-CNT Staff Count: Other Staff - Full-Time 8 4151 4158 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed full-time by the facility. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Staff Count: Other Staff - Part-Time 8 4159 4166 NUMBER Description: Number of full-time equivalent persons not included in any other categories employed part-time by the facility. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 34 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Staff Count: Pharmacist - Contract 8 4167 4174 NUMBER Description: Number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Staff Count: Pharmacist - Full-Time 8 4175 4182 NUMBER Description: Number of full-time equivalent pharmacists employed full-time by a facility. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Staff Count: Pharmacist - Part-Time 8 4183 4190 NUMBER Description: Number of full-time equivalent pharmacists employed part-time by a facility. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Staff Count: Physical Therapist - Contract 8 4191 4198 NUMBER Description: Number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Staff Count: Physical Therapist - Full-Time 8 4199 4206 NUMBER Description: Number of full-time equivalent physical therapists employed full-time by a facility. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT Staff Count: Physical Therapist - Part-Time 8 4207 4214 NUMBER Description: Number of full-time equivalent physical therapists employed part-time by a facility. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Staff Count: Physician Extender - Contract 8 4239 4246 NUMBER Description: Number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Staff Count: Physician Extender - Full-Time 8 4247 4254 NUMBER Description: Number of full-time equivalent physician extenders employed full-time by the facility. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Staff Count: Physician Extender - Part-Time 8 4255 4262 NUMBER Description: Number of full-time equivalent physician extenders employed part-time by the facility. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Staff Count: Podiatrist - Contract 8 4271 4278 NUMBER Description: Number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Staff Count: Podiatrist - Full-Time 8 4279 4286 NUMBER Description: Number of full-time equivalent podiatrists employed full-time by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 35 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Staff Count: Podiatrist - Part-Time 8 4287 4294 NUMBER Description: Number of full-time equivalent podiatrists employed part-time by a facility. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Staff Count: PT Aide - Contract 8 4327 4334 NUMBER Description: Number of full-time equivalent physical therapy aides under contract to a facility. SAS Name: PT_AIDE_CNTRCT_CNT COBOL Name: PT-AIDE-CNTRCT-CNT Staff Count: PT Aide - Full-Time 8 4335 4342 NUMBER Description: Number of full-time equivalent physical therapy aides employed full-time by a facility. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Staff Count: PT Aide - Part-Time 8 4343 4350 NUMBER Description: Number of full-time equivalent physical therapy aides employed part-time by a facility. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Staff Count: PT Assistant - Contract 8 4351 4358 NUMBER Description: Number of full-time equivalent physical therapy assistants under contract to a facility. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Staff Count: PT Assistant - Full-Time 8 4359 4366 NUMBER Description: Number of full-time equivalent physical therapy assistants employed full-time by a facility. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Staff Count: PT Assistant - Part-Time 8 4367 4374 NUMBER Description: Number of full-time equivalent physical therapy assistants employed part-time by a facility. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Staff Count: Qualified Activities Professional - 8 4375 4382 NUMBER Contract Description: Number of full-time equivalent qualified activities professionals providing therapeutic services under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Staff Count: Qualified Activities Professional - 8 4383 4390 NUMBER Full-Time Description: Number of full-time equivalent qualified activities professionals providing therapeutic services employed full time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Staff Count: Qualified Activities Professional - 8 4391 4398 NUMBER Part-Time Description: Number of full-time equivalent qualified activities * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 36 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE professionals providing therapeutic services employed part time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Staff Count: RN - Contract 8 4431 4438 NUMBER Description: Number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Staff Count: RN - Full-Time 8 4439 4446 NUMBER Description: Number of full-time equivalent registered nurses employed full-time by a facility. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Staff Count: RN - Part-Time 8 4447 4454 NUMBER Description: Number of full-time equivalent registered nurses employed part-time by a facility. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Staff Count: RN Director of Nursing - Contract 8 4463 4470 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing under contract to a facility. SAS Name: RN_DRCTR_CNTRCT_CNT COBOL Name: RN-DRCTR-CNTRCT-CNT Staff Count: RN Director of Nursing - Full-Time 8 4471 4478 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed full-time by a facility. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT Staff Count: RN Director of Nursing - Part-Time 8 4479 4486 NUMBER Description: Number of full-time equivalent registered nurse directors of nursing employed part-time by a facility. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Staff Count: Social Worker - Contract 8 4495 4502 NUMBER Description: Number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Staff Count: Social Worker - Full-Time 8 4503 4510 NUMBER Description: Number of full-time equivalent social workers employed full-time by a facility. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Staff Count: Social Worker - Part-Time 8 4511 4518 NUMBER Description: Number of full-time equivalent social workers employed part-time by a facility. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Staff Count: Speech Pathologist - Contract 8 4527 4534 NUMBER Description: Number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 37 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Spch Pthlgst Fltm Cnt 8 4535 4542 NUMBER Description: Speech Pathologist Fulltime Count SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Staff Count: Speech Pathologist - Part-Time 8 4543 4550 NUMBER Description: Number of full-time equivalent speech pathologists employed part-time by a facility. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4567 4574 NUMBER Contract Description: Number of full-time equivalent therapeutic recreation specialist staff under contract to a facility. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Staff Count: Therapeutic Recreational Specialist - 8 4575 4582 NUMBER Full-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Staff Count: Therapeutic Recreational Specialist - 8 4583 4590 NUMBER Part-Time Description: Number of full-time equivalent therapeutic recreation specialist staff employed full-time by a facility. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 02=Title 19 Only 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: 11=Intermediate Care Facility/Individuals with Intellectual Disabilities 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12101=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 LA/001=LOUISIANA LA/LA1=NEW ORLEANS LA/LA2=MANDEVILLE LA/LA3=LAFAYETTE LA/LA4=MONROE LA/LA5=SHREVEPORT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA/LA6=ALEXANDRIA LA/LAB=LABORATORIES LA/LB1=CLIA NEW ORLEANS LA/LB5=CLIA SHREVEPORT LA/LB6=CLIA ALEXANDRIA MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES WA/001=ALL OTHERS (NON-LTC FAC) WA/D1=SPOKANE & YAKIMA AREAS WA/D1A=District 1, Unit A WA/D1B=District 1, Unit B * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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/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 WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=PRIVATE NON PROFIT 02=PRIVATE PROPRIETARY 03=STATE 04=CITY/TOWN 05=COUNTY 06=CITY/COUNTY 07=OTHER 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 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 Ovrrd Bed Cnt Sw 1 346 346 CHAR Description: Override Bed Count Switch SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Crtfd Bed Cnt 4 347 350 NUMBER Description: Certified Bed Count * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Bed Count: Certified - Total 4 351 354 NUMBER Description: Number of certified beds in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). SAS Name: ICFIID_BED_CNT COBOL Name: ICFIID-BED-CNT Bed Cnt 4 394 397 NUMBER Description: Bed Count SAS Name: BED_CNT COBOL Name: BED-CNT Bed Per Room Wvr Sw 1 455 455 CHAR Description: Bed Per Room Waiver Switch SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Room Size Wvr Sw 1 457 457 CHAR Description: Room Size Waiver Switch SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Pgm Prtcptn Cd 1 599 599 CHAR Description: Program Participation Cd SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD Provider Based Facility Indicator 1 600 600 VARCHAR2 Description: Indicates if an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) facility is provider-based, a distinct part of a Hospital, Skilled Nursing Facility or Nursing Facility. Related CCN is found in the Provider Auxiliary Facility Table. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Staff Count: Direct Care 8 3703 3710 NUMBER Description: Number of full-time equivalent direct care personnel employed by an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). SAS Name: DRCT_CARE_PRSNEL_CNT COBOL Name: DRCT-CARE-PRSNEL-CNT Lpn Lvn Cnt 8 3783 3790 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Intermediate Care Facility/Individuals with Intellectual Disabilities, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: LPN LVN Count SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Rn Cnt 8 4423 4430 NUMBER Description: RN Count SAS Name: RN_CNT COBOL Name: RN-CNT Emplee Cnt 9 4591 4599 NUMBER Description: Employee Count SAS Name: EMPLEE_CNT COBOL Name: EMPLEE-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Rural Health Clinics 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: 12=Rural Health Clinic 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 03=STATE GOVERNMENT 04=LOCAL GOVERNMENT 05=FEDERAL GOVERNMENT 1A=FOR PROFIT INDIVIDUAL 1B=FOR PROFIT CORPORATION 1C=FOR PROFIT PARTNERSHIP 2A=NON PROFIT INDIVIDUAL 2B=NON PROFIT CORPORATION 2C=NON PROFIT PARTNERSHIP 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Parent Provider Number 10 587 596 CHAR Description: Parent provider number SAS Name: PRNT_PRVDR_NUM COBOL Name: PRNT-PRVDR-NUM Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PRSNEL-OTHR-CNT Nrs Prctnr Cnt 8 3951 3958 NUMBER Description: Nurse Practitioner Count SAS Name: NRS_PRCTNR_CNT COBOL Name: NRS-PRCTNR-CNT Physn Cnt 8 4215 4222 NUMBER Description: Physician Count SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Physn Astnt Cnt 8 4231 4238 NUMBER Description: Phsycian Assistant Count SAS Name: PHYSN_ASTNT_CNT COBOL Name: PHYSN-ASTNT-CNT Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Comprehensive Outpatient 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: 14=Comprehensive Outpatient Rehab Facility 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=PROPRIETARY 02=NON PROFIT CHURCH 03=NON PROFIT OTHER 04=GOVERNMENT 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Parent Provider Number 10 587 596 CHAR Description: Parent provider number SAS Name: PRNT_PRVDR_NUM COBOL Name: PRNT-PRVDR-NUM Participation Medicare OPT/SP Indicator 1 598 598 VARCHAR2 Description: Indicates if this comprehensive outpatient rehabilitation facility also participates in Medicare as a provider of outpatient physical therapy and/or speech pathology. SAS Name: MDCR_PRTCPTN_OP_PT_SPCH_SW COBOL Name: MDCR-PRTCPTN-OP-PT-SPCH-SW Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services: Nursing - Employee Indicator 1 2328 2328 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates if nursing services are provided by employees. SAS Name: NRSNG_SRVC_EMPLEE_SW COBOL Name: NRSNG-SRVC-EMPLEE-SW Services: Nursing - Independent Contractor Indicator 1 2329 2329 VARCHAR2 Description: Indicates if nursing services are provided by independent contractors. SAS Name: NRSNG_SRVC_CNTRCTR_SW COBOL Name: NRSNG-SRVC-CNTRCTR-SW Services: Nursing - Under Arrangement Indicator 1 2330 2330 VARCHAR2 Description: Indicates if nursing services are provided under arrangement. SAS Name: NRSNG_SRVC_ARNGMT_SW COBOL Name: NRSNG-SRVC-ARNGMT-SW Services: Orthotic / Prosthetic - Employee Indicator 1 2586 2586 VARCHAR2 Description: Indicates if orthotic prosthetic services are provided by employees. SAS Name: ORTHTC_PRSTHTC_EMPLEE_SW COBOL Name: ORTHTC-PRSTHTC-EMPLEE-SW Services: Orthotic / Prosthetic - Independent 1 2587 2587 VARCHAR2 Contractor Indicator Description: Indicates if orthotic prosthetic services are provided by independent contractors. SAS Name: ORTHTC_PRSTHTC_CNTRCTR_SW COBOL Name: ORTHTC-PRSTHTC-CNTRCTR-SW Services: Orthotic / Prosthetic - Under Arrangement 1 2588 2588 VARCHAR2 Indicator Description: Indicates if orthotic/prosthetic services are provided under arrangement. SAS Name: ORTHTC_PRSTHTC_ARNGMT_SW COBOL Name: ORTHTC-PRSTHTC-ARNGMT-SW Services: OT - Employee Indicator 1 2589 2589 VARCHAR2 Description: Indicates if occupational therapy services are provided by employees. SAS Name: OT_EMPLEE_SW COBOL Name: OT-EMPLEE-SW Services: OT - Independent Contractor Indicator 1 2590 2590 VARCHAR2 Description: Indicates if occupational therapy services are provided by independent contractors. SAS Name: OT_CNTRCTR_SW COBOL Name: OT-CNTRCTR-SW Services: OT - Under Arrangement Indicator 1 2591 2591 VARCHAR2 Description: Indicates if occupational therapy services are provided under arrangement. SAS Name: OT_ARNGMT_SW COBOL Name: OT-ARNGMT-SW Services: Physician - Employee Indicator 1 2999 2999 VARCHAR2 Description: Indicates if physician services are provided by employees. SAS Name: PHYSN_EMPLEE_SW COBOL Name: PHYSN-EMPLEE-SW Services: Physician - Independent Contractor 1 3000 3000 VARCHAR2 Indicator Description: Indicates if physician services are provided by independent contractors. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PHYSN_CNTRCTR_SW COBOL Name: PHYSN-CNTRCTR-SW Services: Physician - Under Arrangement Indicator 1 3001 3001 VARCHAR2 Description: Indicates if physician services are provided under arrangement. SAS Name: PHYSN_ARNGMT_SW COBOL Name: PHYSN-ARNGMT-SW Services: Psychological - Employee Indicator 1 3112 3112 VARCHAR2 Description: Indicates if psychological services are provided by employees. SAS Name: PSYCHLGCL_EMPLEE_SW COBOL Name: PSYCHLGCL-EMPLEE-SW Services: Psychological - Independent Contractor 1 3113 3113 VARCHAR2 Indicator Description: Indicates if psychological services are provided by independent contractors. SAS Name: PSYCHLGCL_CNTRCTR_SW COBOL Name: PSYCHLGCL-CNTRCTR-SW Services: Psychological - Under Arrangement Indicator 1 3114 3114 VARCHAR2 Description: Indicates if psychological services are provided under arrangement. SAS Name: PSYCHLGCL_ARNGMT_SW COBOL Name: PSYCHLGCL-ARNGMT-SW Services: PT - Employee Indicator 1 3115 3115 VARCHAR2 Description: Indicates if physical therapy services are provided by employees. SAS Name: PT_EMPLEE_SW COBOL Name: PT-EMPLEE-SW Services: PT - Independent Contractor Indicator 1 3116 3116 VARCHAR2 Description: Indicates if physical therapy services are provided by independent contractors. SAS Name: PT_CNTRCTR_SW COBOL Name: PT-CNTRCTR-SW Services: PT - Under Arrangement Indicator 1 3117 3117 VARCHAR2 Description: Indicates if physical therapy services are provided under arrangement. SAS Name: PT_ARNGMT_SW COBOL Name: PT-ARNGMT-SW Services: Respiratory Care - Employee Indicator 1 3221 3221 VARCHAR2 Description: Indicates if respiratory care services are provided by employees. SAS Name: RSPRTRY_CARE_EMPLEE_SW COBOL Name: RSPRTRY-CARE-EMPLEE-SW Services: Respiratory Care - Independent Contractor 1 3222 3222 VARCHAR2 Indicator Description: Indicates if respiratory care services are provided by independent contractors. SAS Name: RSPRTRY_CARE_CNTRCTR_SW COBOL Name: RSPRTRY-CARE-CNTRCTR-SW Services: Respiratory Care - Under Arrangement 1 3223 3223 VARCHAR2 Indicator Description: Indicates if respiratory care services are provided under arrangement. SAS Name: RSPRTRY_CARE_ARNGMT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: RSPRTRY-CARE-ARNGMT-SW Services: Social - Employee Indicator 1 3275 3275 VARCHAR2 Description: Indicates if social services are provided by employees. SAS Name: SCL_EMPLEE_SW COBOL Name: SCL-EMPLEE-SW Services: Social - Independent Contractor Indicator 1 3276 3276 VARCHAR2 Description: Indicates if social services are provided by independent contractors. SAS Name: SCL_CNTRCTR_SW COBOL Name: SCL-CNTRCTR-SW Services: Social - Under Arrangement Indicator 1 3277 3277 VARCHAR2 Description: Indicates if social services are provided under arrangement. SAS Name: SCL_ARNGMT_SW COBOL Name: SCL-ARNGMT-SW Services: Speech Pathology - Employee Indicator 1 3331 3331 VARCHAR2 Description: Indicates if speech pathology services are provided by employees. SAS Name: SPCH_PTHLGY_EMPLEE_SW COBOL Name: SPCH-PTHLGY-EMPLEE-SW Services: Speech Pathology - Independent Contractor 1 3332 3332 VARCHAR2 Indicator Description: Indicates if speech pathology services are provided by independent contractors. SAS Name: SPCH_PTHLGY_CNTRCTR_SW COBOL Name: SPCH-PTHLGY-CNTRCTR-SW Services: Speech Pathology - Under Arrangement 1 3333 3333 VARCHAR2 Indicator Description: Indicates if speech pathology services are provided under arrangement. SAS Name: SPCH_PTHLGY_ARNGMT_SW COBOL Name: SPCH-PTHLGY-ARNGMT-SW Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Ambulatory Surgical Center 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: 15=Ambulatory Surgical 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=PROPRIETARY 02=NON PROFIT 03=GOVERNMENT 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Lab Srvc Cd 1 285 285 CHAR Description: Lab Service Cd SAS Name: LAB_SRVC_CD COBOL Name: LAB-SRVC-CD Phrmcy Srvc Cd 1 286 286 CHAR Description: Pharmacy Service Cd SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD Phrmcy Srvc Desc 49 287 335 CHAR Description: Pharmacy Service Desc SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC Ancillary Services: Radiology Code 1 336 336 VARCHAR2 Description: Indicates how radiology services are provided. SAS Name: RDLGY_SRVC_CD COBOL Name: RDLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION ASC Begin Service Date 8 337 344 DATE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Date an ambulatory surgical center began providing health care services. SAS Name: ASC_BGN_SRVC_DT COBOL Name: ASC-BGN-SRVC-DT ASC Free Standing Indicator 1 345 345 VARCHAR2 Description: Indicates if the ambulatory surgical center is freestanding. SAS Name: FREESTNDNG_ASC_SW COBOL Name: FREESTNDNG-ASC-SW Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Operating Room Count 2 583 584 NUMBER Description: Number of operating rooms in an ambulatory surgical center. SAS Name: OPRTG_ROOM_CNT COBOL Name: OPRTG-ROOM-CNT Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Surgical Specialty: Ear/Nose/Throat Indicator 1 4614 4614 VARCHAR2 Description: Indicates if ear, nose and throat surgery is offered by an ambulatory surgical center. SAS Name: OTLRYNGLGY_SRGRY_SW COBOL Name: OTLRYNGLGY-SRGRY-SW Surgical Specialty: Obstetrics / Gynecology Indicator 1 4615 4615 VARCHAR2 Description: Indicates if obstetrics/gynecology surgery is offered by an ambulatory surgical center. SAS Name: OB_GYN_SRGRY_SW COBOL Name: OB-GYN-SRGRY-SW Surgical Specialty: Ophthalmologic Indicator 1 4616 4616 VARCHAR2 Description: Indicates if ophthalmologic surgery is offered by an ambulatory surgical center. SAS Name: OPTHMLGY_SRGRY_SW COBOL Name: OPTHMLGY-SRGRY-SW Surgical Specialty: Orthopedic Indicator 1 4617 4617 VARCHAR2 Description: Indicates if orthopedic surgery is offered by an ambulatory surgical center. SAS Name: ORTHPDC_SRGRY_SW COBOL Name: ORTHPDC-SRGRY-SW Surgical Specialty: Plastic / Reconstructive 1 4618 4618 VARCHAR2 Indicator Description: Indicates if plastic and reconstructive surgery is offered by an ambulatory surgical center. SAS Name: PLSTC_SRGRY_SW COBOL Name: PLSTC-SRGRY-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Surgical Specialty: Podiatry Indicator 1 4619 4619 VARCHAR2 Description: Indicates if podiatric surgery is offered by an ambulatory surgical center. SAS Name: FT_SRGRY_SW COBOL Name: FT-SRGRY-SW Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Hospice 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: 16=Hospice 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=VOLUNTARY NON-PROFIT - CHURCH 02=VOLUNTARY NON-PROFIT - PRIVATE 03=VOLUNTARY NON-PROFIT - OTHER 04=PROPRIETARY - INDIVIDUAL 05=PROPRIETARY - PARTNERSHIP 06=PROPRIETARY - CORPORATION 07=PROPRIETARY - OTHER 08=GOVERNMENT - STATE 09=GOVERNMENT - COUNTY 10=GOVERNMENT - CITY 11=GOVERNMENT - CITY-COUNTY 12=COMBINATION GOVERNMENT & NONPROFIT 13=OTHER 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 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 Acrdtn Type Cd 1 278 278 CHAR Description: Accreditation Type Code SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD Gnrl Fac Type Cd 2 283 284 CHAR Description: General Fac Type Cd SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD Lsc Wvr Sw 1 456 456 CHAR Description: LSC Waiver Switch SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 20 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Hh Aide Srvc Cd 1 753 753 CHAR Description: HH Aide Service Cd SAS Name: HH_AIDE_SRVC_CD COBOL Name: HH-AIDE-SRVC-CD Services: Counseling Code 1 1311 1311 VARCHAR2 Description: Indicates how counseling services are provided by the hospice. SAS Name: CNSLNG_SRVC_CD COBOL Name: CNSLNG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services: Homemaker Code 1 1868 1868 VARCHAR2 Description: Indicates how homemaker services are provided by the hospice. SAS Name: HMMKR_SRVC_CD COBOL Name: HMMKR-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Mdcl Scl Srvc Cd 1 1923 1923 CHAR Description: Medical Social Service Cd SAS Name: MDCL_SCL_SRVC_CD COBOL Name: MDCL-SCL-SRVC-CD Services: Medical Supplies Code 1 1924 1924 VARCHAR2 Description: Indicates how medical supply services are provided by the hospice. SAS Name: MDCL_SUPLY_SRVC_CD COBOL Name: MDCL-SUPLY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Nrsng Srvc Cd 1 2331 2331 CHAR Description: Nursing Service Cd SAS Name: NRSNG_SRVC_CD COBOL Name: NRSNG-SRVC-CD Ot Srvc Cd 1 2592 2592 CHAR Description: OT Service Cd SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD Ot Srvc Desc 49 2593 2641 CHAR Description: OT Service Desc SAS Name: OT_SRVC_DESC COBOL Name: OT-SRVC-DESC Othr Srvc Cd 1 2645 2645 CHAR Description: Other Services Cd SAS Name: OTHR_SRVC_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 21 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: OTHR-SRVC-CD Services: Physician Code 1 3002 3002 VARCHAR2 Description: Indicates how physician services are provided by the hospice. SAS Name: PHYSN_SRVC_CD COBOL Name: PHYSN-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Pt Srvc Cd 1 3118 3118 CHAR Description: PT Service Cd SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD Pt Srvc Desc 49 3119 3167 CHAR Description: PT Service Desc SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Services: Short Term Inpatient Care Code 1 3274 3274 VARCHAR2 Description: Indicates how short term inpatient care services are provided by the hospice. SAS Name: SHRT_TERM_IP_SRVC_CD COBOL Name: SHRT-TERM-IP-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Spch Pthlgy Srvc Cd 1 3334 3334 CHAR Description: Speech Pathology Service Cd SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD Spch Pthlgy Srvc Desc 49 3335 3383 CHAR Description: Speech Pathology Service Desc SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Short Term Inpatient Acute/Respite Care Code 1 3557 3557 VARCHAR2 Description: Indicates the type of short-term inpatient care provided by the hospice. SAS Name: ACUTE_RESP_CARE_CD COBOL Name: ACUTE-RESP-CARE-CD VALUES: A=SHORT TERM INPATIENT ACUTE CARE PROV'D IN HSP B=SHORT TERM INPATIENT RESPITE CARE PROV IN HSP C=ST INPATIENT ACUTE & RESPITE CARE PROV IN HSP Staff Count: Aide - Volunteer 8 3583 3590 NUMBER Description: Number of full-time equivalent aides volunteering in a hospice. SAS Name: HH_AIDE_VLNTR_CNT COBOL Name: HH-AIDE-VLNTR-CNT Prsnel Othr Cnt 8 3591 3598 NUMBER Description: Personnel Other Count SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Staff Count: Counselor - Employee 8 3623 3630 NUMBER Description: Number of full-time equivalent counselors employed by the * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 22 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE hospice. SAS Name: CNSLR_EMPLEE_CNT COBOL Name: CNSLR-EMPLEE-CNT Staff Count: Counselor - Volunteer 8 3631 3638 NUMBER Description: Number of full-time equivalent counselors volunteering in a Hospice. SAS Name: CNSLR_VLNTR_CNT COBOL Name: CNSLR-VLNTR-CNT Staff Count: Homemaker - Employee 8 3743 3750 NUMBER Description: Number of full-time equivalent homemakers employed by the hospice. SAS Name: HMMKR_EMPLEE_CNT COBOL Name: HMMKR-EMPLEE-CNT Staff Count: Homemaker - Volunteer 8 3751 3758 NUMBER Description: Number of full-time equivalent homemaker volunteering in a hospice. SAS Name: HMMKR_VLNTR_CNT COBOL Name: HMMKR-VLNTR-CNT Lpn Lvn Cnt 8 3783 3790 NUMBER Description: LPN LVN Count SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Staff Count: LPN/LVN - Volunteer 8 3815 3822 NUMBER Description: Number of full-time equivalent licensed practical or vocational nurses volunteering in the hospice. SAS Name: LPN_LVN_VLNTR_CNT COBOL Name: LPN-LVN-VLNTR-CNT Mdcl Scl Workr Cnt 8 3847 3854 NUMBER Description: Medical Social Worker Count SAS Name: MDCL_SCL_WORKR_CNT COBOL Name: MDCL-SCL-WORKR-CNT Staff Count: Medical Social Worker - Volunteer 8 3855 3862 NUMBER Description: Number of full-time equivalent medical social workers volunteering in the hospice. SAS Name: MDCL_SCL_WORKR_VLNTR_CNT COBOL Name: MDCL-SCL-WORKR-VLNTR-CNT Staff Count: Other - Volunteer 8 4063 4070 NUMBER Description: Number of full-time equivalent others volunteering in the hospice. SAS Name: VLNTR_OTHR_CNT COBOL Name: VLNTR-OTHR-CNT Physn Cnt 8 4215 4222 NUMBER Description: Physician Count SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Staff Count: Physician - Volunteer 8 4223 4230 NUMBER Description: Number of full-time equivalent physicians volunteering in a hospice. SAS Name: PHYSN_VLNTR_CNT COBOL Name: PHYSN-VLNTR-CNT Rn Cnt 8 4423 4430 NUMBER Description: RN Count SAS Name: RN_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 23 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: RN-CNT Staff Count: RN - Volunteer 8 4455 4462 NUMBER Description: Number of full-time equivalent registered nurses volunteering in a hospice. SAS Name: RN_VLNTR_CNT COBOL Name: RN-VLNTR-CNT Emplee Cnt 9 4591 4599 NUMBER Description: Employee Count SAS Name: EMPLEE_CNT COBOL Name: EMPLEE-CNT Staff Count: Total - Volunteer 9 4600 4608 NUMBER Description: Number of full-time equivalent volunteers in the hospice. SAS Name: VLNTR_CNT COBOL Name: VLNTR-CNT Validation Survey Date 8 4649 4656 DATE Description: Date of the most recent validation survey of a deemed provider, performed by the state agency. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Organ Procurement 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: 17=Organ Procurement Organization 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 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 Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=Community Mental Health Center 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: 19=Community Mental 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=PROPRIETARY 02=CHURCH RELATED 03=NONPROFIT CORPORATION 04=OTHER NONPROFIT 05=STATE 06=LOCAL 07=FEDERAL 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 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 Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Related Provider Number 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 1 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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_RFRNC_PRVDR_NUM COBOL Name: CROSS-RFRNC-PRVDR-NUM 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 2 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 3 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 4 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 5 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 6 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 7 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00030=BLUE CROSS (ARIZONA) 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) 00250=BLUE CROSS (MONTANA) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 8 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 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) 00751=BLUE SHIELD (MONTANA) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 9 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01120=AETNA (HAWAII) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) 02302=NATIONAL HERITAGE (OREGON) 02401=NATIONAL HERITAGE (WASHINGTON) 02402=NATIONAL HERITAGE (WASHINGTON) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 10 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) 08101=PINNACLE (INDIANA) 08102=PINNACLE (INDIANA) 08201=PINNACLE (MICHIGAN) 08202=PINNACLE (MICHIGAN) 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) 10201=CAHABA GBA (GA) 10202=CAHABA GBA (GA) 10230=TRAVELERS (CONNECTICUT) 10240=TRAVELERS (MINNESOTA) 10250=TRAVELERS (MISSISSIPPI) 10301=CAHABA GBA (TN) 10302=CAHABA 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=HIGHMARK (DELAWARE) 12102=HIGHMARK (DELAWARE) 12201=HIGHMARK (DISTRICT OF COLUMBIA) 12202=HIGHMARK (DISTRICT OF COLUMBIA) 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 12901=HIGHMARK 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=NATIONAL GOVT SERVICES (NEW YORK - HEALTHNOW) 13292=NATIONAL GOVT SERVICES (NEW YORK - GHI) 14004=NATIONAL HERITAGE (HHA - A) 14101=NATIONAL HERITAGE (MAINE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 11 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14102=NATIONAL HERITAGE (MAINE) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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 31140=NATIONAL HERITAGE (CA) 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 31146=NATIONAL HERTAGE INSURANCE 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 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. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 12 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 13 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 14 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 AL/001=ALABAMA AL/LAB=LABORATORIES AR/001=ARKANSAS AR/LAB=LABORATORIES AS/001=AMERICAN SAMOA AS/LAB=LABORATORY AZ/AZ=PHOENIX AZ/LAB=ARIZONA LAB AZ/TUC=TUCSON CA/BAK=BAKERSFIELD CA/BER=SAN BERNARDINO CA/BK=BERKELEY CA/BK1=CONTRA COSTA 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/LAB=LABORATORIES CA/M1=LAB. SOUTH CA/M2=LAB. NORTH CA/ORG=ORANGE CO CA/RIV=RIVERSIDE CA/RWC=REDWOOD COAST CA/S1=SACRAMENTO CA/S2=SACTO SOUTH CA/S3=CHICO CA/SD=SAN DIEGO CA/SDS=SAN DIEGO SOUTH CA/SF=SAN FRANCISCO CA/SJ=SAN JOSE CA/SR=SANTA ROSA CA/VEN=VENTURA CN/001=CANADA CN/LAB=LABORATORY CO/001=COLORADO CO/LAB=LABORATORIES CT/001=CONNECTICUT CT/LAB=LABORATORIES DC/001=DISTRICT OF COLUMBIA DC/LAB=LABORATORIES DE/001=DELAWARE DE/LAB=LABORATORIES FL/FTM=FT. MYERS FL/GAI=GAINESVILLE FL/JAX=JACKSONVILLE FL/LAB=LABORATORIES FL/LAN=LANTANA FL/LAU=LAUDERHILL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 15 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=INTERNATIONAL FN/LAB=LABORATORIES 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 GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/LAB=LABORATORIES KS/LAW=LAWRENCE KS/NC=NORTH CENTRAL KANSAS KS/NE=NORTH EAST KANSAS 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 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 MA/001=MASSACHUSETTS MA/LAB=LABORATORIES MD/001=MARYLAND MD/LAB=LABORATORIES ME/001=MAINE ME/LAB=LABORATORIES MH/001=MARSHALL ISLANDS MI/001=MICHIGAN MI/LAB=LABORATORIES MN/001=MINNESOTA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 16 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE MN/LAB=LABORATORIES 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 MP/001=NORTHERN MARIANA ISLANDS MP/LAB=LABORATORIES MS/001=MISSISSIPPI MS/LAB=LABORATORIES MT/001=MONTANA MT/LAB=LABORATORIES MX/001=MEXICO MX/LAB=LABORATORY 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 ND/001=NORTH DAKOTA ND/LAB=LABORATORIES NE/1=NORTH CENTRAL NE/2=CENTRAL NE/3=NORTHEAST NE/4=SOUTHEAST NE/5=WESTERN NE/LAB=LABORATORIES NH/001=NEW HAMPSHIRE NH/LAB=LABORATORIES NJ/001=NEW JERSEY NJ/LAB=LABORATORIES NM/001=NEW MEXICO NM/LAB=LABORATORIES NV/CC=CARSON CITY NV/LAB=LABORATORIES NV/LV=LAS VEGAS 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 OH/001=OHIO OH/LAB=LABORATORIES OK/001=OKLAHOMA OK/LAB=LABORATORIES OR/001=OFFICE #1 OR/002=OFFICE #2 OR/003=OFFICE #3 OR/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 17 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES SC/001=SOUTH CAROLINA SC/LAB=LABORATORIES SD/001=SOUTH DAKOTA SD/LAB=LABORATORIES TN/LAB=LABORATORIES 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=BEAUMONT-LTC TX/L06=HOUSTON-LTC TX/L07=TEMPLE-LTC TX/L08=SAN ANTONIO-LTC TX/L09=SAN ANGELO-LTC TX/L10=EL PASO-LTC TX/L11=CORPUS CHRISTI-LTC TX/LAB=LABORATORIES 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 VA/001=VIRGINIA VA/LAB=LABORATORIES VI/001=VIRGIN ISLANDS VI/LAB=LABORATORIES VT/001=VERMONT VT/LAB=LABORATORIES 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 18 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2014 DATE: 01/01/2014 POS RECORD LAYOUT PAGE: 19 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Fiscal Year End Date (MMDD) 4 494 497 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD FQHC Approved RHC Provider Num 10 498 507 CHAR Description: FQHC approved provider number SAS Name: FQHC_APRVD_RHC_PRVDR_NUM COBOL Name: FQHC-APRVD-RHC-PRVDR-NUM FQHC Federally Funded Indicator 1 508 508 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 1 597 597 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 10 643 652 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM