********************************************* * * * 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 = 01/01/2013 * * * ********************************************* DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 01=Hospital Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01302=PALMETTO (NEVADA) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04901=MUTUAL LEGACY 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) 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 00260=BLUE CROSS (NEBRASKA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 13 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 14 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 15 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 16 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 05101=WPS (IOWA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 17 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 19 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 21 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 22 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA KS=KANSAS KY=KENTUCKY LA=LOUISIANA MA=MASSACHUSETTS MD=MARYLAND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 23 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 24 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WY=WYOMING SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 25 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 27 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 29 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 31 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 33 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Accreditation Effective Date 8 263 270 DATE Description: The effective date of the current period of accreditation by the Joint Commission on Accreditation of Health Care Organizations (JCAHO) or the American Osteopathic Association (AOA). SAS Name: ACRDTN_EFCTV_DT COBOL Name: ACRDTN-EFCTV-DT Accreditation Expiration Date 8 271 278 DATE Description: The expiration date of the current period of Accreditation by the Joint Committee on Accreditation of Health Care Organizations (JCAHO) or the American Osteopathic Association (AOA). SAS Name: ACRDTN_EXPRTN_DT COBOL Name: ACRDTN-EXPRTN-DT Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=NOT ACCREDITED 1=JC 2=AOA/HFAP 3=DNV Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Certified Registered Nurse Anesthetists (CRNA) 8 472 479 NUMBER Description: Number of full-time equivalent Certified Registered Nurse Anesthetists (CRNA) employed by a hospital. SAS Name: CRNA_CNT COBOL Name: CRNA-CNT Compliance: 24 Hour Registered Nurse 1 481 481 VARCHAR2 Description: Indicates if a waiver of the 24-hour registered nurse requirement has been recommended for a facility. SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Compliance: Scope of Service 1 486 486 VARCHAR2 Description: Indicates if a waiver of the scope of services requirement has been recommended for a hospital. SAS Name: SCOPE_OF_SRVC_WVR_SW COBOL Name: SCOPE-OF-SRVC-WVR-SW Compliance: Technical Personnel Waiver 1 487 487 VARCHAR2 Description: Indicates if a waiver of the technical personnel requirement has been recommended for a hospital. SAS Name: TCHNCL_PRSNEL_WVR_SW COBOL Name: TCHNCL-PRSNEL-WVR-SW Current Survey Ever Accredited 1 504 504 VARCHAR2 Description: Indicates if this provider was an accredited hospital anytime during the current survey. SAS Name: SRVY_EVER_ACRDTD_SW COBOL Name: SRVY-EVER-ACRDTD-SW Current Survey Ever Non-Accredited 1 505 505 VARCHAR2 Description: Indicates if this provider was a non-accredited hospital anytime during the current survey. SAS Name: SRVY_EVER_NACRDTD_SW COBOL Name: SRVY-EVER-NACRDTD-SW Current Survey Ever Swing Bed 1 506 506 VARCHAR2 Description: Indicates if this provider was a swing bed hospital anytime during the current survey. SAS Name: SRVY_EVER_SB_SW COBOL Name: SRVY-EVER-SB-SW Date of Validation Survey 8 515 522 DATE Description: Date a validation survey is performed by the state agency in a JCAHCO (Joint Commission on Accreditation of Health Care Organizations) or AOA (American Osteopathic Association) accredited hospital. SAS Name: VLDTN_SRVY_DT COBOL Name: VLDTN-SRVY-DT Dietitians 8 547 554 NUMBER Description: Number of full-time equivalent dietitians employed by a facility. SAS Name: DIETN_CNT COBOL Name: DIETN-CNT Fax Phone Number 10 601 610 VARCHAR2 Description: The 10-digit fax phone number of the primary contact or the operator of the laboratory. SAS Name: FAX_PHNE_NUM COBOL Name: FAX-PHNE-NUM Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Licensed Practical/Vocational Nurses 8 711 718 NUMBER Description: Number of full-time equivalent licensed practical or vocational nurses employed by a facility. SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Medical School Affiliation 1 815 815 VARCHAR2 Description: The type of affiliation that a hospital may have 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 Medical Social Workers 8 816 823 NUMBER Description: Number of full-time equivalent medical social workers employed by a hospital or hospice. SAS Name: MDCL_SCL_WORKR_CNT COBOL Name: MDCL-SCL-WORKR-CNT Medical Technologist Count 8 832 839 NUMBER Description: The count of medical technologists. SAS Name: MDCL_TCHNLGST_CNT COBOL Name: MDCL-TCHNLGST-CNT Medicare or Medicaid Participating Provider Switch 1 840 840 VARCHAR2 Description: This code indicates whether a provider is participating in the Medicaid or Medicare program. SAS Name: MDCD_MDCR_PRTCPTG_PRVDR_SW COBOL Name: MDCD-MDCR-PRTCPTG-PRVDR-SW Meets 1861 Definition 1 865 865 VARCHAR2 Description: Indicates if an emergency hospital meets the definition of 'hospital' contained in Section 1861 of the Social Security Act. SAS Name: MEET_1861_SW COBOL Name: MEET-1861-SW Nuclear Medicine Technician Count 8 929 936 NUMBER Description: The count of nuclear medicine technicians. SAS Name: NUCLR_MDCN_TCHNCN_CNT COBOL Name: NUCLR-MDCN-TCHNCN-CNT Nurse Practitioners 8 964 971 NUMBER Description: Number of full-time equivalent nurse practitioners in a rural health clinic. SAS Name: NRS_PRCTNR_CNT COBOL Name: NRS-PRCTNR-CNT Occupational Therapists 8 1020 1027 NUMBER Description: The number of full-time equivalent occupational therapists employed by a provider. SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Physical Therapists 8 1204 1211 NUMBER Description: The number of full-time equivalent physical therapists employed by an outpatient physical therapy provider or a home health agency provider. SAS Name: PHYS_THRPST_CNT COBOL Name: PHYS-THRPST-CNT Physician Assistants (PA) 8 1292 1299 NUMBER Description: The number of full-time equivalent physician assistants (PA) employed by a hospital or rural health clinic. SAS Name: PHYSN_ASTNT_CNT COBOL Name: PHYSN-ASTNT-CNT Physicians 8 1327 1334 NUMBER Description: The number of full-time equivalent physicians employed by a provider. SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Physicians (Residents) 8 1335 1342 NUMBER Description: The number of full-time equivalent residents (physicians) employed by a hospital. SAS Name: RSDNT_PHYSN_CNT COBOL Name: RSDNT-PHYSN-CNT Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 41 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Psychiatric Unit Bed Count 3 1401 1403 NUMBER Description: The number of beds in a PPS-exempt psychiatric unit of a hospital. SAS Name: PSYCH_UNIT_BED_CNT COBOL Name: PSYCH-UNIT-BED-CNT Psychiatric Unit Effective Date 8 1404 1411 DATE Description: The date a psychiatric unit became exempt from the Prospective Payment System (PPS). SAS Name: PSYCH_UNIT_EFCTV_DT COBOL Name: PSYCH-UNIT-EFCTV-DT Psychiatric Unit Switch 1 1412 1412 VARCHAR2 Description: Indicates if a hospital has a PPS-exempt psychiatric unit. SAS Name: PSYCH_UNIT_SW COBOL Name: PSYCH-UNIT-SW Psychiatric Unit Termination Code 1 1413 1413 VARCHAR2 Description: Indicates the reason that a psychiatric unit is no longer exempt from 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 1414 1421 DATE Description: The date a psychiatric unit is no longer exempt from the Prospective Payment System (PPS). SAS Name: PSYCH_UNIT_TRMNTN_DT COBOL Name: PSYCH-UNIT-TRMNTN-DT Psychologist Count 8 1422 1429 NUMBER Description: The count of psychologists. SAS Name: PSYCHLGST_CNT COBOL Name: PSYCHLGST-CNT Radiology Technician Count 8 1430 1437 NUMBER Description: The count of radiology technicians. SAS Name: RDLGY_TCHNCN_CNT COBOL Name: RDLGY-TCHNCN-CNT Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Regional Override # 3 (Nurse - Bed) 1 1440 1440 VARCHAR2 Description: This field is set to 'Y' when the regional office has to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 43 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_NRS_BED_SW COBOL Name: OVRRD-NRS-BED-SW Registered Nurses 8 1465 1472 NUMBER Description: The number of full-time equivalent registered professional nurses employed by a provider. SAS Name: RN_CNT COBOL Name: RN-CNT Registered Pharmacists 8 1481 1488 NUMBER Description: The number of full-time equivalent registered pharmacists employed by a provider. SAS Name: REG_PHRMCST_CNT COBOL Name: REG-PHRMCST-CNT Rehabilitation Unit Bed Count 3 1489 1491 NUMBER Description: The number of beds in a PPS-exempt rehabilitation unit of a hospital. SAS Name: REHAB_UNIT_BED_CNT COBOL Name: REHAB-UNIT-BED-CNT Rehabilitation Unit Effective Date 8 1492 1499 DATE Description: The date a rehabilitation unit became exempt from the Prospective Payment System (PPS). SAS Name: REHAB_UNIT_EFCTV_DT COBOL Name: REHAB-UNIT-EFCTV-DT Rehabilitation Unit Switch 1 1500 1500 VARCHAR2 Description: Indicates if a hospital has a PPS-exempt rehabilitation unit. SAS Name: REHAB_UNIT_SW COBOL Name: REHAB-UNIT-SW Rehabilitation Unit Termination Code 1 1501 1501 VARCHAR2 Description: This element indicates the reason for a hospital rehabilitation unit's termination of its exclusion status under 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 Rehabilitation Unit Termination Date 8 1502 1509 DATE Description: This element is the date the hospital's psychiatric unit is no longer excluded from Prospective Payment System (PPS). SAS Name: REHAB_UNIT_TRMNTN_DT COBOL Name: REHAB-UNIT-TRMNTN-DT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Resident Program Approved by ADA 1 1528 1528 VARCHAR2 Description: Indicates if the resident program at a hospital is approved by the American Dental Association (ADA). SAS Name: RSDNT_PGM_ADA_APRVD_SW COBOL Name: RSDNT-PGM-ADA-APRVD-SW Resident Program Approved by AMA 1 1529 1529 VARCHAR2 Description: Indicates if the resident program at a hospital is approved by the American Medical Association (AMA). SAS Name: RSDNT_PGM_AMA_APRVD_SW COBOL Name: RSDNT-PGM-AMA-APRVD-SW Resident Program Approved by AOA 1 1530 1530 VARCHAR2 Description: Indicates if the resident program at a hospital is approved by the American Osteopathic Association (AOA). SAS Name: RSDNT_PGM_AOA_APRVD_SW COBOL Name: RSDNT-PGM-AOA-APRVD-SW Resident Program Approved by Other 1 1531 1531 VARCHAR2 Description: Indicates if the resident program at a hospital is approved by other professional organizations. SAS Name: RSDNT_PGM_OTHR_APRVD_SW COBOL Name: RSDNT-PGM-OTHR-APRVD-SW Respiratory Therapists 8 1532 1539 NUMBER Description: NUMBER OF FULL-TIME EQUIVALENT RESPIRATORY THERAPISTS EMPLOYED BY A HOSPITAL. SAS Name: INHLTN_THRPST_CNT COBOL Name: INHLTN-THRPST-CNT Services Provided: Cardiac - Thoracic Surgery 1 1660 1660 VARCHAR2 Description: Indicates how open heart surgery facility services are provided by a hospital. 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 Provided: Postoperative Recovery Room 1 1661 1661 VARCHAR2 Description: Indicates how postoperative recovery room services are provided by a hospital. 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 Provided: Acute Renal Dialysis 1 1662 1662 VARCHAR2 Description: Indicates how acute renal dialysis services are provided in a hospital. 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 Provided: Acute Renal Dialysis Description 39 1663 1701 VARCHAR2 Description: Indicates how acute renal dialysis services are provided in a hospital. SAS Name: ACUTE_RNL_DLYS_SRVC_DESC COBOL Name: ACUTE-RNL-DLYS-SRVC-DESC Services Provided: Alcohol and or Drug Description 39 1702 1740 VARCHAR2 Description: Indicates how alcohol and/or drug services are provided by a hospital. SAS Name: ALCHL_DRUG_SRVC_DESC COBOL Name: ALCHL-DRUG-SRVC-DESC Services Provided: Alcohol and/or Drug 1 1741 1741 VARCHAR2 Description: Indicates how alcohol and/or drug services are provided by a hospital. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 47 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Anesthesia 1 1742 1742 VARCHAR2 Description: Indicates how anesthesia services are provided by a hospital. 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 Services Provided: Anesthesia Description 39 1743 1781 VARCHAR2 Description: Indicates how anesthesia services are provided by a hospital. SAS Name: ANSTHSA_SRVC_DESC COBOL Name: ANSTHSA-SRVC-DESC Services Provided: Audiology 1 1782 1782 VARCHAR2 Description: Indicates how audiology services are provided by a hospital. 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 Provided: Audiology Description 39 1783 1821 VARCHAR2 Description: Indicates how audiology services are provided by a hospital. SAS Name: AUDLGY_SRVC_DESC COBOL Name: AUDLGY-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 48 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Burn Care Unit 1 1822 1822 VARCHAR2 Description: Indicates how burn care unit services are provided by a hospital. 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 Provided: Burn Care Unit Description 39 1823 1861 VARCHAR2 Description: Indicates how burn care unit services are provided by a hospital. SAS Name: BURN_CARE_UNIT_SRVC_DESC COBOL Name: BURN-CARE-UNIT-SRVC-DESC Services Provided: Cardiac - Thoracic Surgery 39 1862 1900 VARCHAR2 Description Description: Indicates how open heart surgery facility services are provided by a hospital. SAS Name: OPEN_HRT_SRGRY_SRVC_DESC COBOL Name: OPEN-HRT-SRGRY-SRVC-DESC Services Provided: Cardiac Catheterization Lab 1 1901 1901 VARCHAR2 Description: Indicates how cardiac catheterization lab service is provided. SAS Name: CRDC_CTHTRZTN_LAB_SRVC_CD COBOL Name: CRDC-CTHTRZTN-LAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 49 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Cardiac Catheterization Lab 39 1902 1940 VARCHAR2 Description Description: Indicates how cardiac catheterization lab service is provided. SAS Name: CRDC_CTHTRZTN_LAB_SRVC_DESC COBOL Name: CRDC-CTHTRZTN-LAB-SRVC-DESC Services Provided: CARF Inpatient Rehabilitation Code 1 1941 1941 VARCHAR2 Description: Indicates how CARF inpatient rehabilitation service is 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 Provided: CARF Inpatient Rehabilitation 39 1942 1980 VARCHAR2 Description Description: Indicates how CARF inpatient rehabilitation service is provided. SAS Name: CARF_IP_REHAB_SRVC_DESC COBOL Name: CARF-IP-REHAB-SRVC-DESC Services Provided: Chemotherapy 1 1981 1981 VARCHAR2 Description: Indicates how chemotherapy service is provided. SAS Name: CHMTHRPY_SRVC_CD COBOL Name: CHMTHRPY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 50 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Chemotherapy Description 39 1982 2020 VARCHAR2 Description: Indicates how chemotherapy service is provided. SAS Name: CHMTHRPY_SRVC_DESC COBOL Name: CHMTHRPY-SRVC-DESC Services Provided: Child Adolescent Psychiatric 39 2021 2059 VARCHAR2 Description Description: Indicates how child adolescent psychiatric services are provided by a hospital. SAS Name: CHLD_ADLSCNT_PSYCH_SRVC_DESC COBOL Name: CHLD-ADLSCNT-PSYCH-SRVC-DESC Services Provided: Chiropractic 1 2060 2060 VARCHAR2 Description: Indicates how Chiropractic services are provided by a hospital. 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 Provided: Chiropractic Description 39 2061 2099 VARCHAR2 Description: Indicates how Chiropractic services are provided by a hospital. SAS Name: CHRPRCTIC_SRVC_DESC COBOL Name: CHRPRCTIC-SRVC-DESC Services Provided: Clinical Laboratory 1 2100 2100 VARCHAR2 Description: Indicates how clinical laboratory services are provided in a hospital. 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 Provided: Clinical Laboratory Description 39 2101 2139 VARCHAR2 Description: Indicates how clinical laboratory services are provided in a hospital. SAS Name: CL_SRVC_DESC COBOL Name: CL-SRVC-DESC Services Provided: CT Scanner 1 2140 2140 VARCHAR2 Description: Indicates how CT scanner services are provided by a hospital. 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 Provided: CT Scanner Description 39 2141 2179 VARCHAR2 Description: Indicates how CT scanner services are provided by a hospital. SAS Name: CT_SCAN_SRVC_DESC COBOL Name: CT-SCAN-SRVC-DESC Services Provided: Dental 1 2180 2180 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 52 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Dental Description 39 2181 2219 VARCHAR2 Description: Indicates how dental services are provided. SAS Name: DNTL_SRVC_DESC COBOL Name: DNTL-SRVC-DESC Services Provided: Diagnostic Radiology Description 39 2220 2258 VARCHAR2 Description: Indicates how diagnostic radiology services are provided by a hospital. SAS Name: DGNSTC_RDLGY_SRVC_DESC COBOL Name: DGNSTC-RDLGY-SRVC-DESC Services Provided: Dietary 1 2259 2259 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 Provided: Dietary Description 39 2260 2298 VARCHAR2 Description: Indicates how dietary services are provided. SAS Name: DTRY_SRVC_DESC COBOL Name: DTRY-SRVC-DESC Services Provided: Emergency Dept (Dedicated) 39 2299 2337 VARCHAR2 Description Description: Indicates how dedicated emergency department services are provided by a hospital. SAS Name: DCTD_ER_SRVC_DESC COBOL Name: DCTD-ER-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 53 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Emergency Dept(Dedicated) 1 2338 2338 VARCHAR2 Description: Indicates how dedicated emergency department services are provided by a hospital. 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 Provided: Extracorporeal Shock Wave 1 2339 2339 VARCHAR2 Description: Indicates how extracorporeal shockwave lithotripter services are provided in a hospital. 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 Provided: Extracorporeal Shock Wave 39 2340 2378 VARCHAR2 Description Description: Indicates how extracorporeal shockwave lithotripter services are provided in a hospital. SAS Name: XTRCRPRL_SHCK_LTHTRPTR_SRVCDSC COBOL Name: XTRCRPRL-SHCK-LTHTRPTR-SRVCDSC Services Provided: Gerontological Specialty 1 2379 2379 VARCHAR2 Description: Indicates how gerontological specialty service is provided in a hospital. SAS Name: GRNTLGCL_SPCLTY_SRVC_CD COBOL Name: GRNTLGCL-SPCLTY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 54 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Gerontological Specialty 39 2380 2418 VARCHAR2 Description Description: Indicates how gerontological specialty service is provided in a hospital. SAS Name: GRNTLGCL_SPCLTY_SRVC_DESC COBOL Name: GRNTLGCL-SPCLTY-SRVC-DESC Services Provided: ICU Cardiac (non-surgical) 1 2419 2419 VARCHAR2 Description: Indicates how Coronary Care Unit services are provided by a hospital. 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 Provided: ICU Cardiac (non-surgical) 39 2420 2458 VARCHAR2 Description Description: Indicates how Coronary Care Unit services are provided by a hospital. SAS Name: CRNRY_CARE_UNIT_SRVC_DESC COBOL Name: CRNRY-CARE-UNIT-SRVC-DESC Services Provided: ICU Medical/Surgical 1 2459 2459 VARCHAR2 Description: A code representive the way that services are provided to the Intensive Care Unit. SAS Name: ICU_SRVC_CD COBOL Name: ICU-SRVC-CD VALUES: 0=NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 55 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 Provided: ICU Medical/Surgical Description 44 2460 2503 VARCHAR2 Description: A code representive the way that services are provided to the Intensive Care Unit. SAS Name: ICU_SRVC_DESC COBOL Name: ICU-SRVC-DESC Services Provided: ICU Neonatal 1 2504 2504 VARCHAR2 Description: Indicates how neonatal ICU service is provided in a hospital. 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 Provided: ICU Pediatric 1 2505 2505 VARCHAR2 Description: Indicates how pediatric ICU service is provided in hospital. 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 Provided: ICU Surgical 1 2506 2506 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 56 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates how surgical ICU services are provided in a hospital. 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 Provided: Inpatient Surgical 1 2507 2507 VARCHAR2 Description: Indicates how inpatient surgical services are provided by a hospital. 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 Provided: Inpatient Surgical Description 39 2508 2546 VARCHAR2 Description: Indicates how inpatient surgical services are provided by a hospital. SAS Name: IP_SRGCL_SRVC_DESC COBOL Name: IP-SRGCL-SRVC-DESC Services Provided: Magnetic Resonance Imaging 1 2547 2547 VARCHAR2 Description: Indicates how magnetic resonance imaging service is provided in a hospital. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 57 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Magnetic Resonance Imaging 39 2548 2586 VARCHAR2 Description Description: Indicates how magnetic resonance imaging service is provided in a hospital. SAS Name: MGNTC_RSNC_IMG_SRVC_DESC COBOL Name: MGNTC-RSNC-IMG-SRVC-DESC Services Provided: Neonatal ICU Description 39 2587 2625 VARCHAR2 Description: Indicates how forensic psychiatric service is provided in a hospital. SAS Name: NEONTL_ICU_SRVC_DESC COBOL Name: NEONTL-ICU-SRVC-DESC Services Provided: Neonatal Nursery 1 2626 2626 VARCHAR2 Description: Indicates how neonatal nursery services are provided by a hospital. 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 Provided: Neonatal Nursery Description 39 2627 2665 VARCHAR2 Description: Indicates how neonatal nursery services are provided by a hospital. SAS Name: NEONTL_NRSRY_SRVC_DESC COBOL Name: NEONTL-NRSRY-SRVC-DESC Services Provided: Neurosurgical Description 39 2666 2704 VARCHAR2 Description: Indicates how neurosurgical services are provided in a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 58 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE hospital. SAS Name: NRSRGCL_SRVC_DESC COBOL Name: NRSRGCL-SRVC-DESC Services Provided: Neurosurgical Services 1 2705 2705 VARCHAR2 Description: Indicates how neurosurgical services are provided in a hospital. 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 Provided: Nuclear Medicine 1 2706 2706 VARCHAR2 Description: Indicates how nuclear medicine services are provided by a hospital. 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 Provided: Nuclear Medicine Description 39 2707 2745 VARCHAR2 Description: Indicates how nuclear medicine services are provided by a hospital. SAS Name: NUCLR_MDCN_SRVC_DESC COBOL Name: NUCLR-MDCN-SRVC-DESC Services Provided: Obstetrics 1 2746 2746 VARCHAR2 Description: Indicates how obstetrics services are provided by a hospital. SAS Name: OB_SRVC_CD COBOL Name: OB-SRVC-CD VALUES: 0=NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 59 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 Provided: Obstetrics Description 39 2747 2785 VARCHAR2 Description: Indicates how obstetrics services are provided by a hospital. SAS Name: OB_SRVC_DESC COBOL Name: OB-SRVC-DESC Services Provided: Occupational Therapy 1 2786 2786 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Occupational Therapy Description 39 2787 2825 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_DESC COBOL Name: OT-SRVC-DESC Services Provided: Operating Room Description 39 2826 2864 VARCHAR2 Description: Indicates how operating room services are provided by a hospital. SAS Name: OPRTG_ROOM_SRVC_DESC COBOL Name: OPRTG-ROOM-SRVC-DESC Services Provided: Operating Rooms 1 2865 2865 VARCHAR2 Description: Indicates how operating room services are provided by a hospital. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 60 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Provided: Ophthalmic Surgery 1 2866 2866 VARCHAR2 Description: Indicates how ophthalmic surgery services are provided by a hospital. 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 Provided: Ophthalmic Surgery Description 39 2867 2905 VARCHAR2 Description: Indicates how ophthalmic surgery services are provided by a hospital. SAS Name: OPTHLMC_SRGY_SRVC_DESC COBOL Name: OPTHLMC-SRGY-SRVC-DESC Services Provided: Optometric 1 2906 2906 VARCHAR2 Description: Indicates how optometric services are provided by a hospital. SAS Name: OPTMTRC_SRVC_CD COBOL Name: OPTMTRC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 61 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Optometric Description 44 2907 2950 VARCHAR2 Description: Indicates how optometric services are provided by a hospital. SAS Name: OPTMTRC_SRVC_DESC COBOL Name: OPTMTRC-SRVC-DESC Services Provided: Organ Transplant (Not Medicare 1 2951 2951 VARCHAR2 Certified) Description: Indicates how organ transplant services are provided by a hospital. 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 Provided: Organ Transplant (Not Medicare 39 2952 2990 VARCHAR2 Certified) Description Description: Indicates how organ transplant services are provided by a hospital. SAS Name: ORGN_TRNSPLNT_SRVC_DESC COBOL Name: ORGN-TRNSPLNT-SRVC-DESC Services Provided: Orthopedic Surgery 1 2991 2991 VARCHAR2 Description: Indicates how orthopedic surgery service is provided in a hospital. SAS Name: ORTHPDC_SRGY_SRVC_CD COBOL Name: ORTHPDC-SRGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 62 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Orthopedic Surgery Description 39 2992 3030 VARCHAR2 Description: Indicates how orthopedic surgery service is provided in a hospital. SAS Name: ORTHPDC_SRGY_SRVC_DESC COBOL Name: ORTHPDC-SRGY-SRVC-DESC Services Provided: Outpatient 1 3031 3031 VARCHAR2 Description: Indicates how outpatient services are provided by a hospital. 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 Provided: Outpatient Description 39 3032 3070 VARCHAR2 Description: Indicates how outpatient services are provided by a hospital. SAS Name: OP_SRVC_DESC COBOL Name: OP-SRVC-DESC Services Provided: Outpatient Surgery 1 3071 3071 VARCHAR2 Description: Indicates how outpatient surgery unit services are provided by a hospital. SAS Name: OP_SRGRY_UNIT_SRVC_CD COBOL Name: OP-SRGRY-UNIT-SRVC-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 63 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 Provided: Outpatient Surgery Description 39 3072 3110 VARCHAR2 Description: Indicates how outpatient surgery unit services are provided by a hospital. SAS Name: OP_SRGRY_UNIT_SRVC_DESC COBOL Name: OP-SRGRY-UNIT-SRVC-DESC Services Provided: Pediatric 1 3111 3111 VARCHAR2 Description: Indicates how pediatric services are provided by a hospital. 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 Provided: Pediatric Description 39 3112 3150 VARCHAR2 Description: Indicates how pediatric services are provided by a hospital. SAS Name: PED_SRVC_DESC COBOL Name: PED-SRVC-DESC Services Provided: Pediatric ICU Description 39 3151 3189 VARCHAR2 Description: Indicates how pediatric ICU service is provided in hospital. SAS Name: PED_ICU_SRVC_DESC COBOL Name: PED-ICU-SRVC-DESC Services Provided: PET Scan Services 1 3190 3190 VARCHAR2 Description: Indicates how Positron Emissions Tomography (PET) scanner services are provided by a hospital. 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 Provided: PET Scanner Description 39 3191 3229 VARCHAR2 Description: Indicates how Positron Emissions Tomography (PET) scanner services are provided by a hospital. SAS Name: PET_SCAN_SRVC_DESC COBOL Name: PET-SCAN-SRVC-DESC Services Provided: Pharmacy 1 3230 3230 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Pharmacy Description 39 3231 3269 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC Services Provided: Physical Therapy 1 3270 3270 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_CD COBOL Name: PT-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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 65 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Physical Therapy Description 39 3271 3309 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Services Provided: Postoperative Recovery Room 39 3310 3348 VARCHAR2 Description Description: Indicates how postoperative recovery room services are provided by a hospital. SAS Name: PSTOPRTV_RCVRY_SRVC_DESC COBOL Name: PSTOPRTV-RCVRY-SRVC-DESC Services Provided: Psychiatric - Adult Inpatient 1 3349 3349 VARCHAR2 Description: Indicates how psychiatric services are provided by a hospital. 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 Provided: Psychiatric - Adult Inpatient 39 3350 3388 VARCHAR2 Description Description: Indicates how psychiatric services are provided by a hospital. SAS Name: PSYCH_SRVC_DESC COBOL Name: PSYCH-SRVC-DESC Services Provided: Psychiatric - Emergency 1 3389 3389 VARCHAR2 Description: Indicates how emergency psychiatric services are provided * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 66 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE by a hospital. 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 Provided: Psychiatric - Forensic 1 3390 3390 VARCHAR2 Description: Indicates how forensic psychiatric service is provided by a hospital. 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 Provided: Psychiatric - Geriatric 1 3391 3391 VARCHAR2 Description: Indicates how geriatric psychiatric service is provided by a hospital. 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 Provided: Psychiatric - Outpatient 1 3392 3392 VARCHAR2 Description: Indicates how outpatient psychiatric service is provided in a hospital. SAS Name: OP_PSYCH_SRVC_CD COBOL Name: OP-PSYCH-SRVC-CD VALUES: 0=NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 67 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 Provided: Psychiatric Child/Adolescent 1 3393 3393 VARCHAR2 Description: Indicates how child adolescent psychiatric services are provided by a hospital. 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 Provided: Psychiatric Emergency Description 39 3394 3432 VARCHAR2 Description: Indicates how emergency psychiatric services are provided by a hospital. SAS Name: EMER_PSYCH_SRVC_DESC COBOL Name: EMER-PSYCH-SRVC-DESC Services Provided: Psychiatric Forensic Description 39 3433 3471 VARCHAR2 Description: Indicates how forensic psychiatric service is provided by a hospital. SAS Name: FRNSC_PSYCH_SRVC_DESC COBOL Name: FRNSC-PSYCH-SRVC-DESC Services Provided: Psychiatric Geriatric Description 39 3472 3510 VARCHAR2 Description: Indicates how geriatric psychiatric service is provided by a hospital. SAS Name: GRTRC_PSYCH_SRVC_DESC COBOL Name: GRTRC-PSYCH-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 68 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Psychiatric Outpatient Description 39 3511 3549 VARCHAR2 Description: Indicates how outpatient psychiatric service is provided in a hospital. SAS Name: OP_PSYCH_SRVC_DESC COBOL Name: OP-PSYCH-SRVC-DESC Services Provided: Radiology (Diagnostic) 1 3550 3550 VARCHAR2 Description: Indicates how diagnostic radiology services are provided by a hospital. 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 Services Provided: Radiology (Therapeutic) 1 3551 3551 VARCHAR2 Description: Indicates how therapeutic radiology services are provided by a hospital. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 69 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Radiology Therapeutic Description 39 3552 3590 VARCHAR2 Description: Indicates how therapeutic radiology services are provided by a hospital. SAS Name: THRPTC_RDLGY_SRVC_DESC COBOL Name: THRPTC-RDLGY-SRVC-DESC Services Provided: Reconstruction Surgery Description 39 3591 3629 VARCHAR2 Description: Indicates how reconstruction surgery services are provided by a hospital. SAS Name: RCNSTRCTN_SRGY_SRVC_DESC COBOL Name: RCNSTRCTN-SRGY-SRVC-DESC Services Provided: Reconstructive Surgery 1 3630 3630 VARCHAR2 Description: Indicates how reconstruction surgery services are provided by a hospital. 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 Provided: Rehabilitation Outpatient 1 3631 3631 VARCHAR2 Description: Indicates how outpatient rehabilitation service is provided in a hospital. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 70 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Provided: Rehabilitation Outpatient 39 3632 3670 VARCHAR2 Description Description: Indicates how outpatient rehabilitation service is provided in a hospital. SAS Name: OP_REHAB_SRVC_DESC COBOL Name: OP-REHAB-SRVC-DESC Services Provided: Respiratory Care 1 3671 3671 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 Provided: Respiratory Care Description 44 3672 3715 VARCHAR2 Description: Indicates how respiratory care services are provided. SAS Name: RSPRTRY_CARE_SRVC_DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 71 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: RSPRTRY-CARE-SRVC-DESC Services Provided: Social 1 3716 3716 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_CD COBOL Name: SCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Social Description 39 3717 3755 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_DESC COBOL Name: SCL-SRVC-DESC Services Provided: Speech Pathology 1 3756 3756 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY STAFF AND UNDER ARRANGEMENT Services Provided: Speech Pathology Description 39 3757 3795 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Services Provided: Surgical ICU Description 39 3796 3834 VARCHAR2 Description: Indicates how surgical ICU services are provided in a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 72 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE hospital. SAS Name: SRGCL_ICU_SRVC_DESC COBOL Name: SRGCL-ICU-SRVC-DESC Services Provided: Transplant Center (Medicare 1 3835 3835 VARCHAR2 Certified) Description: Indicates how Medicare transplant center service is provided by a hospital. 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 Provided: Transplant Center (Medicare 39 3836 3874 VARCHAR2 Certified) Description Description: Indicates how Medicare transplant center service is provided by a hospital. SAS Name: MDCR_TRNSPLNT_CNTR_SRVC_DESC COBOL Name: MDCR-TRNSPLNT-CNTR-SRVC-DESC Services Provided: Trauma Center (Designated) 1 3875 3875 VARCHAR2 Description: Indicates how shock trauma services are provided by a hospital. 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 Provided: Trauma Center (Designated) 39 3876 3914 VARCHAR2 Description * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 73 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates how shock trauma services are provided by a hospital. SAS Name: SHCK_TRMA_SRVC_DESC COBOL Name: SHCK-TRMA-SRVC-DESC Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Urgent Care Center Services 1 3915 3915 VARCHAR2 Description: Indicates how urgent care center services are provided by a hospital. 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 Provided: Urgent Care Description 39 3916 3954 VARCHAR2 Description: Indicates how urgent care center services are provided by a hospital. SAS Name: URGNT_CARE_SRVC_DESC COBOL Name: URGNT-CARE-SRVC-DESC Speech Pathologist or Audiologist 8 4050 4057 NUMBER Description: The number of full-time equivalent speech pathologists or audiologists employed by a provider. SAS Name: SPCH_PTHLGST_AUDLGST_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: SPCH-PTHLGST-AUDLGST-CNT Swing Bed Size Code 1 4083 4083 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 Swing Bed Switch 1 4084 4084 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 Type of Facility 2 4168 4169 VARCHAR2 Description: Indicates the category which represents the type of facility. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=SHORT - TERM 02=LONG - TERM 03=RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTION 04=PSYCHIATRIC 05=REHABILITATION 06=CHILDRENS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 07=DISTINCT PART PSYCHIATRIC HOSPITAL 11=CRITICAL ACCESS HOSPITALS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospital, CATEGORY = "01" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Type of Non-Participating Provider 1 4170 4170 VARCHAR2 Description: Indicates whether a non-participating hospital is federal or other than federal. SAS Name: NPP_TYPE_CD COBOL Name: NPP-TYPE-CD VALUES: E=EMERGENCY HOSPITAL NON-FEDERAL F=EMERGENCY HOSPITAL FEDERAL * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 02=Skilled Nursing Facility/Nursing Facility (Dually Certified) Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: The Certification date is equal to the exit date of the initial visit of the Health survey or LSC survey, whichever is later. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: CRTFCTN_DT COBOL Name: CRTFCTN-DT Eligibility Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00454=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 13101=NATIONAL GOVT SERVICES (CONNECTICUT) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 10 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 57400=COOPERATIVA (PUERTO RICO) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. SAS Name: INTRMDRY_CARR_PRIOR_CD COBOL Name: INTRMDRY-CARR-PRIOR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 13 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 16 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 19 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 21 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 22 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 23 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 24 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN State Region Code 3 176 178 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 25 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: For selected states, identifies the particular region within the 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 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 27 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 29 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 31 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 34 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 35 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Activity Professional Contract Count 8 280 287 NUMBER Description: The number of full-time equivalent activity professionals under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Activity Professional Full-Time Count 8 288 295 NUMBER Description: The number of full-time equivalent activity professionals employed full-time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Activity Professional Part-Time Count 8 296 303 NUMBER Description: The number of full-time equivalent activity professionals employed part-time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Activity Staff Other Contract Count 8 304 311 NUMBER Description: Number of contract staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Activity Staff Other Full-Time Count 8 312 319 NUMBER Description: Number of full-time staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Activity Staff Other Part-Time Count 8 320 327 NUMBER Description: Number of part-time staff hours provided by other activity staff. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Administrator - Contract 8 329 336 NUMBER Description: The number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Administrator - Full-Time 8 337 344 NUMBER Description: The 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 Administrator - Part-Time 8 345 352 NUMBER Description: The 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 Beds - Medicare SNF 4 374 377 NUMBER Description: Number of Medicare-certified SNF (Skilled Nursing Facility) beds in a facility. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Beds - Nursing Facility 4 378 381 NUMBER Description: Number of medicaid certified nursing facility beds in a facility. SAS Name: MDCD_SNF_BED_CNT COBOL Name: MDCD-SNF-BED-CNT Beds - SNF / NF 4 382 385 NUMBER Description: Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Certification Nurse Aides - Contract 8 448 455 NUMBER Description: The 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 Certification Nurse Aides - Full-Time 8 456 463 NUMBER Description: The number of full-time equivalent certified nurse aides * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 38 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE employed by a facility on a full-time basis. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Certification Nurse Aides - Part-Time 8 464 471 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a part-time basis. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Compliance: 24 Hour Registered Nurse 1 481 481 VARCHAR2 Description: Indicates if a waiver of the 24-hour registered nurse requirement has been recommended for a facility. SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7 Day Registered Nurse 1 482 482 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse requirements has been recommended for a SNF or NF. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Compliance: Beds Per Room Waiver 1 483 483 VARCHAR2 Description: Indicates if a waiver of the beds per room requirement has been recommended for a facility. SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Compliance: Patient Room Size 1 485 485 VARCHAR2 Description: Indicates if a waiver of patient room size has been recommended for a facility. SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Dentists - Contract 8 523 530 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 39 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Dentists - Full-Time 8 531 538 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a full-time basis. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Dentists - Part-Time 8 539 546 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a part-time basis. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Dietitians - Contract 8 555 562 NUMBER Description: The number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Dietitians - Full-Time 8 563 570 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a full-time basis. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Dietitians - Part-Time 8 571 578 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a part-time basis. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Experimental Research Conducted 1 590 590 VARCHAR2 Description: Indicates if a facility uses residents to develop and test clinical treatments. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Food Service - Contract 8 617 624 NUMBER Description: The 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 Food Service - Full-Time 8 625 632 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a full-time basis. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Food Service - Part-Time 8 633 640 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a part-time basis. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Housekeeping - Contract 8 677 684 NUMBER Description: The number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Housekeeping - Full-Time 8 685 692 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Housekeeping - Part-Time 8 693 700 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a part-time basis. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT LPN/LVN - Contract 8 719 726 NUMBER Description: The 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 LPN/LVN - Full-Time 8 727 734 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full-time basis. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT LPN/LVN - Part-Time 8 735 742 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part-time basis. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Medical Director - Contract 8 791 798 NUMBER Description: The number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Medical Director - Full-Time 8 799 806 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 42 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent medical directors employed by a facility on a full-time basis. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Medical Director - Part-Time 8 807 814 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a part-time basis. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Medication Aides / Techs - Contract 8 841 848 NUMBER Description: The 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 Medication Aides / Techs - Full-Time 8 849 856 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a full-time basis. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Medication Aides / Techs - Part-Time 8 857 864 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a part-time basis. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Mental Health Services - Contract 8 866 873 NUMBER Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 43 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Mental Health Services - Full-Time 8 874 881 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a full-time basis. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Mental Health Services - Part-Time 8 882 889 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a part-time basis. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Multi-Facility Organization Name 38 890 927 VARCHAR2 Description: The name of the multi-facility organization that owns the facility. SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Multi-Facility Organization Owned 1 928 928 VARCHAR2 Description: Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities. SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Nurse Aides in Training - Contract 8 940 947 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 Nurse Aides in Training - Full-Time 8 948 955 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a full-time basis. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Nurse Aides in Training - Part-Time 8 956 963 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a part-time basis. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Nurses With Administrative Duties - Contract 8 972 979 NUMBER Description: The 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 Nurses With Administrative Duties - Full-Time 8 980 987 NUMBER Description: The number of full-time equivalent nurses with administrative duties employed by a facility on a full-time basis. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Nurses With Administrative Duties - Part-Time 8 988 995 NUMBER Description: Number of full-time equivalent nurses with administrative duties employed by a facility on a part-time basis. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Occupational Therapist - Contract 8 996 1003 NUMBER Description: The number of full-time equivalent occupational therapists under contract to a facility. SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Occupational Therapist - Full-Time 8 1004 1011 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a full-time basis. SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 45 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Occupational Therapist - Part-Time 8 1012 1019 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a part-time basis. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Occupational Therapy Aide - Contract 8 1028 1035 NUMBER Description: The 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 Occupational Therapy Aide - Full-Time 8 1036 1043 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a full-time basis. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Occupational Therapy Aide - Part-Time 8 1044 1051 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a part-time basis. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Occupational Therapy Assistant - Contract 8 1052 1059 NUMBER Description: The number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_AIDE_CNTRCT_CNT COBOL Name: OT-ASTNT-AIDE-CNTRCT-CNT Occupational Therapy Assistant - Full-Time 8 1060 1067 NUMBER Description: The number of full-time equivalent occupational therapy * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 46 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE assistants employed by a facility on a full-time basis. SAS Name: OT_ASTNT_AIDE_FLTM_CNT COBOL Name: OT-ASTNT-AIDE-FLTM-CNT Occupational Therapy Assistant - Part-Time 8 1068 1075 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a part-time basis. SAS Name: OT_ASTNT_AIDE_PRTM_CNT COBOL Name: OT-ASTNT-AIDE-PRTM-CNT Organized Family Group 1 1078 1078 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 1 1079 1079 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Other - Contract 8 1081 1088 NUMBER Description: The 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 Other - Full-Time 8 1089 1096 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 47 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Other - Part-Time 8 1097 1104 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT Other Physician Contract 8 1113 1120 NUMBER Description: The number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Other Physician Full-Time 8 1121 1128 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a full-time basis. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Other Physician Part-Time 8 1129 1136 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a part-time basis. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Other Social Service Staff - Contract 8 1137 1144 NUMBER Description: Number of contract staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Other Social Service Staff - Full-Time 8 1145 1152 NUMBER Description: Number of full-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Other Social Service Staff - Part-Time 8 1153 1160 NUMBER Description: Number of part-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Pharmacists - Contract 8 1172 1179 NUMBER Description: The number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Pharmacists - Full-Time 8 1180 1187 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a full-time basis. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Pharmacists - Part-Time 8 1188 1195 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a part-time basis. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Physical Therapists - Contract 8 1212 1219 NUMBER Description: The number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Physical Therapists - Full-Time 8 1220 1227 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a full-time basis. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT Physical Therapists - Part-Time 8 1228 1235 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a part-time basis. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Physical Therapy Aide - Contract 8 1244 1251 NUMBER Description: The 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 Physical Therapy Aide - Full-Time 8 1252 1259 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a full-time basis. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Physical Therapy Aide - Part-Time 8 1260 1267 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a part-time basis. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Physical Therapy Assistant - Contract 8 1268 1275 NUMBER Description: Number of contract staff hours for physical therapy assistants. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Physical Therapy Assistant - Full-Time 8 1276 1283 NUMBER Description: Number of full-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Physical Therapy Assistant - Part-Time 8 1284 1291 NUMBER Description: Number of part-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Physician Extender - Contract 8 1300 1307 NUMBER Description: The number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 51 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Physician Extender Full-Time Count (F37B) 8 1308 1315 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a full-time basis. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Physician Extender Part-Time Count (F37C) 8 1316 1323 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a part-time basis. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Physician Extender Service Offsite To Resident Switch 1 1324 1324 VARCHAR2 (F37A3) Description: Indicates if physician extender services are provided offsite to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Physician Extender Service Onsite To Non-Resident 1 1325 1325 VARCHAR2 Switch (F37A2) Description: Indicates if physician extender services are provided onsite to non-residents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 52 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Physician Extender Service Onsite To Resident Switch 1 1326 1326 VARCHAR2 (F37A1) 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 Podiatrists - Contract 8 1351 1358 NUMBER Description: The number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Podiatrists - Full-Time 8 1359 1366 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a full-time basis. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Podiatrists - Part-Time 8 1367 1374 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 53 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent podiatrists employed by a facility on a part-time basis. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Provider Based Facility 1 1400 1400 VARCHAR2 Description: Indicates if a long term care facility is provider based. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurse - Contract 8 1441 1448 NUMBER Description: The number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Registered Nurse - Full-Time 8 1449 1456 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a full-time basis. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Registered Nurse - Part-Time 8 1457 1464 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a part-time basis. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM RN Director of Nursing - Contract 8 1540 1547 NUMBER Description: The 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 RN Director of Nursing - Full-Time 8 1548 1555 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a full-time basis. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT RN Director of Nursing - Part-Time 8 1556 1563 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a part-time basis. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Service: Activities-Offsite-Residents Switch 1 1564 1564 VARCHAR2 Description: Indicates if activity services are provided off-site to residents. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Service: Activities-Onsite-Nonresidents Switch 1 1565 1565 VARCHAR2 Description: Indicates if activity services are provided on-site to nonresidents. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Service: Activities-Onsite-Residents Switch 1 1566 1566 VARCHAR2 Description: Indicates if activity services are provided on-site to residents. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Service: Blood Administered-Offsite-Resident 1 1568 1568 VARCHAR2 Description: Indicates if administration and storage of blood services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Service: Blood Administered-Onsite-Nonresident 1 1569 1569 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Service: Blood Administered-Onsite-Resident 1 1570 1570 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Service: Clinical Laboratory-Offsite-Resident 1 1571 1571 VARCHAR2 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 Service: Clinical Laboratory-Onsite-Nonresident 1 1572 1572 VARCHAR2 Description: Indicates if clinical laboratory services are provided onsite to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Service: Clinical Laboratory-Onsite-Resident 1 1573 1573 VARCHAR2 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 Service: Dental On-Site Nonresidents 1 1575 1575 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 Service: Dental Off-Site Residents 1 1576 1576 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 Service: Dental On-Site Residents 1 1577 1577 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 Service: Dietary On-Site Nonresidents 1 1578 1578 VARCHAR2 Description: Indicates if dietary services are provided on-site to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 57 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Service: Dietary Off-Site Residents 1 1579 1579 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Service: Dietary On-Site Residents 1 1580 1580 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Service: Housekeeping On-Site to Nonresidents 1 1584 1584 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 Service: Housekeeping Off-Site to Residents 1 1585 1585 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 Service: Housekeeping On-Site to Residents 1 1586 1586 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to residents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 58 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Service: Mental Health Off-Site to Residents 1 1591 1591 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 Service: Mental Health On-Site to Residents 1 1592 1592 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 Service: Mental Health On-site to Nonresidents 1 1593 1593 VARCHAR2 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 Service: Nursing On-Site to Nonresidents 1 1595 1595 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 Service: Nursing Off-Site to Residents 1 1598 1598 VARCHAR2 Description: Indicates if nursing services are provided off-site to residents. SAS Name: NRSNG_SRVC_OFSITE_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 59 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NRSNG-SRVC-OFSITE-RSDNT-SW Service: Nursing On-Site to Residents 1 1599 1599 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 Service: Occupational Therapy On-Site to 1 1601 1601 VARCHAR2 Nonresidents 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 Service: Occupational Therapy Off-Site to Residents 1 1604 1604 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 Service: Occupational Therapy On-Site to Residents 1 1605 1605 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 Service: Other Activities-Offsite-Residents Switch 1 1609 1609 VARCHAR2 Description: Field 3 - indicates other activity services provided by staff off-site to residents. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 60 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Other Activities-Onsite-Nonresidents Switch 1 1610 1610 VARCHAR2 Description: Field 2 - indicates other activity services provided by staff on-site to nonresidents. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Service: Other Activities-Onsite-Residents Switch 1 1611 1611 VARCHAR2 Description: Field 1 - indicates other activity services provided by staff on-site to residents. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Service: Other Off-Site to Residents 1 1612 1612 VARCHAR2 Description: Field 3 - indicates services provided by other social services staff off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Service: Other On-Site to Nonresidents 1 1613 1613 VARCHAR2 Description: Indicates if other social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Service: Other On-Site to Residents 1 1614 1614 VARCHAR2 Description: Field 1 - indicates services provided by social service staff on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Service: Pharmacy Off-Site to Residents 1 1615 1615 VARCHAR2 Description: Indicates if pharmacy services are provided off-site to residents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 61 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PHRMCY_SRVC_OFSITE_RSDNT_SW COBOL Name: PHRMCY-SRVC-OFSITE-RSDNT-SW Service: Pharmacy On-Site to Nonresidents 1 1616 1616 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to non residents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Service: Pharmacy On-Site to Residents 1 1617 1617 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 Service: Physical Therapy Off-Site to Residents 1 1620 1620 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 Service: Physical Therapy On-Site to Nonresidents 1 1621 1621 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 Service: Physical Therapy On-Site to Residents 1 1622 1622 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 Service: Physician Off-Site to Residents 1 1626 1626 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 Service: Physician On-Site to Nonresidents 1 1627 1627 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 Service: Physician On-Site to Residents 1 1628 1628 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 Service: Podiatry Off-Site to Residents 1 1629 1629 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 Service: Podiatry On-Site to Nonresidents 1 1630 1630 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 Service: Podiatry On-Site to Residents 1 1631 1631 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 Service: Social Work Off-Site to Residents 1 1641 1641 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 Service: Social Work On-Site to Nonresidents 1 1642 1642 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 Service: Social Work On-Site to Residents 1 1643 1643 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 Service: Speech Pathology Off-Site to Residents 1 1646 1646 VARCHAR2 Description: Indicates if speech/language pathology services are provided offsite to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Service: Speech Pathology On-Site to Nonresidents 1 1647 1647 VARCHAR2 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 Service: Speech Pathology On-Site to Residents 1 1648 1648 VARCHAR2 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 Service: Therapeutic Recreational Specialty Off-Site 1 1650 1650 VARCHAR2 to Residents Description: Indicates if therapeutic recreation specialist services * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 64 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE are provided off-site to residents. SAS Name: THRPTC_RCRTNL_OFSITE_RSDNT_SW COBOL Name: THRPTC-RCRTNL-OFSITE-RSDNT-SW Service: Therapeutic Recreational Specialty On-Site 1 1651 1651 VARCHAR2 to Non Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1652 1652 VARCHAR2 to Residents 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 Service: Vocational Off-Site to Residents 1 1654 1654 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 Service: Vocational On-Site to Nonresidents 1 1655 1655 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 Service: Vocational On-Site to Residents 1 1656 1656 VARCHAR2 Description: Indicates if vocational services are provided on-site to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 65 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE residents. SAS Name: VCTNL_SRVC_ONST_RSDNT_SW COBOL Name: VCTNL-SRVC-ONST-RSDNT-SW Service: X-ray Off-Site Residents 1 1657 1657 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 Service: X-ray On-Site Nonresidents 1 1658 1658 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 Service: X-ray On-Site Residents 1 1659 1659 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 Social Worker - Contract 8 3955 3962 NUMBER Description: The number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Social Worker - Full-Time 8 3963 3970 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a full-time basis. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 66 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Social Worker - Part-Time 8 3971 3978 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a part time basis. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Special Care Bed - Specialized Rehab 3 3987 3989 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Special Care Beds - AIDS 3 3990 3992 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Special Care Beds - Alzheimers 3 3993 3995 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Special Care Beds - Dialysis 3 3996 3998 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 67 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of beds in a unit identified and dedicated by the facility for residents needing dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Special Care Beds - Disabled Child 3 3999 4001 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Special Care Beds - Head Trauma 3 4002 4004 NUMBER Description: The number of beds in a unit identified and dedicated by the facilty for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Special Care Beds - Hospice 3 4005 4007 NUMBER Description: The number of beds in a unit identified and dedicated by a facility for residents needing hospice services. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Special Care Beds - Huntingtons 3 4008 4010 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Special Care Beds - Ventilator 3 4011 4013 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with ventilator/resipiratory care needs. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Speech Pathologist - Contract 8 4026 4033 NUMBER Description: The number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Speech Pathologist - Full-Time 8 4034 4041 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a full-time basis. SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Speech Pathologist - Part-Time 8 4042 4049 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a part-time basis. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Therapeutic Recreational Specialty - Contract 8 4109 4116 NUMBER Description: Number of contract staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Therapeutic Recreational Specialty - Full-Time 8 4117 4124 NUMBER Description: Number of full-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Therapeutic Recreational Specialty - Part-Time 8 4125 4132 NUMBER Description: Number of part-time staff hours provided by therapeutic * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 69 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE recreation specialist. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 03=Title 18/19 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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 Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 03=Skilled Nursing Facility/Nursing Facility (Distinct Part) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Status 1 44 44 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Certification Date 8 58 65 DATE Description: 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Eligibility Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Dually Certified), CATEGORY = "02" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 10 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 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=FOREIGN FN/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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/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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 19 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Activity Professional Contract Count 8 280 287 NUMBER Description: The number of full-time equivalent activity professionals under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Activity Professional Full-Time Count 8 288 295 NUMBER Description: The number of full-time equivalent activity professionals employed full-time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Activity Professional Part-Time Count 8 296 303 NUMBER Description: The number of full-time equivalent activity professionals employed part-time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Activity Staff Other Contract Count 8 304 311 NUMBER Description: Number of contract staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Activity Staff Other Full-Time Count 8 312 319 NUMBER Description: Number of full-time staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 24 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Activity Staff Other Part-Time Count 8 320 327 NUMBER Description: Number of part-time staff hours provided by other activity staff. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Administrator - Contract 8 329 336 NUMBER Description: The number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Administrator - Full-Time 8 337 344 NUMBER Description: The 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 Administrator - Part-Time 8 345 352 NUMBER Description: The number of full-time equivalent administrative staff employed on a part-time basis by a facility. SAS Name: PROFNL_ADMIN_PRTM_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: PROFNL-ADMIN-PRTM-CNT Beds - Medicare SNF 4 374 377 NUMBER Description: Number of Medicare-certified SNF (Skilled Nursing Facility) beds in a facility. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Beds - Nursing Facility 4 378 381 NUMBER Description: Number of medicaid certified nursing facility beds in a facility. SAS Name: MDCD_SNF_BED_CNT COBOL Name: MDCD-SNF-BED-CNT Beds - SNF / NF 4 382 385 NUMBER Description: Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 26 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: BED_CNT COBOL Name: BED-CNT Certification Nurse Aides - Contract 8 448 455 NUMBER Description: The 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 Certification Nurse Aides - Full-Time 8 456 463 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a full-time basis. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Certification Nurse Aides - Part-Time 8 464 471 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a part-time basis. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Compliance: 24 Hour Registered Nurse 1 481 481 VARCHAR2 Description: Indicates if a waiver of the 24-hour registered nurse requirement has been recommended for a facility. SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7 Day Registered Nurse 1 482 482 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse requirements has been recommended for a SNF or NF. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 28 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Beds Per Room Waiver 1 483 483 VARCHAR2 Description: Indicates if a waiver of the beds per room requirement has been recommended for a facility. SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Compliance: Patient Room Size 1 485 485 VARCHAR2 Description: Indicates if a waiver of patient room size has been recommended for a facility. SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Dentists - Contract 8 523 530 NUMBER Description: The number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Dentists - Full-Time 8 531 538 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a full-time basis. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Dentists - Part-Time 8 539 546 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a part-time basis. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Dietitians - Contract 8 555 562 NUMBER Description: The number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Dietitians - Full-Time 8 563 570 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a full-time basis. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Dietitians - Part-Time 8 571 578 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a part-time basis. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Experimental Research Conducted 1 590 590 VARCHAR2 Description: Indicates if a facility uses residents to develop and test clinical treatments. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Food Service - Contract 8 617 624 NUMBER Description: The 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 Food Service - Full-Time 8 625 632 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a full-time basis. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Food Service - Part-Time 8 633 640 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a part-time basis. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Housekeeping - Contract 8 677 684 NUMBER Description: The number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Housekeeping - Full-Time 8 685 692 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Housekeeping - Part-Time 8 693 700 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a part-time basis. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT LPN/LVN - Contract 8 719 726 NUMBER Description: The 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 LPN/LVN - Full-Time 8 727 734 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full-time basis. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT LPN/LVN - Part-Time 8 735 742 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part-time basis. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Medical Director - Contract 8 791 798 NUMBER Description: The number of full-time equivalent medical directors under contract to a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 32 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Medical Director - Full-Time 8 799 806 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a full-time basis. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Medical Director - Part-Time 8 807 814 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a part-time basis. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Medication Aides / Techs - Contract 8 841 848 NUMBER Description: The 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 Medication Aides / Techs - Full-Time 8 849 856 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a full-time basis. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Medication Aides / Techs - Part-Time 8 857 864 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a part-time basis. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Mental Health Services - Contract 8 866 873 NUMBER Description: The 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 Mental Health Services - Full-Time 8 874 881 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a full-time basis. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Mental Health Services - Part-Time 8 882 889 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a part-time basis. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Multi-Facility Organization Name 38 890 927 VARCHAR2 Description: The name of the multi-facility organization that owns the facility. SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Multi-Facility Organization Owned 1 928 928 VARCHAR2 Description: Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities. SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Nurse Aides in Training - Contract 8 940 947 NUMBER Description: Number of full-time equivalent nurse aides in training under contract to a facility. SAS Name: NAT_CNTRCT_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 34 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NAT-CNTRCT-CNT Nurse Aides in Training - Full-Time 8 948 955 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a full-time basis. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Nurse Aides in Training - Part-Time 8 956 963 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a part-time basis. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Nurses With Administrative Duties - Contract 8 972 979 NUMBER Description: The 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 Nurses With Administrative Duties - Full-Time 8 980 987 NUMBER Description: The number of full-time equivalent nurses with administrative duties employed by a facility on a full-time basis. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Nurses With Administrative Duties - Part-Time 8 988 995 NUMBER Description: Number of full-time equivalent nurses with administrative * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 35 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE duties employed by a facility on a part-time basis. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Occupational Therapist - Contract 8 996 1003 NUMBER Description: The number of full-time equivalent occupational therapists under contract to a facility. SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Occupational Therapist - Full-Time 8 1004 1011 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a full-time basis. SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Occupational Therapist - Part-Time 8 1012 1019 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a part-time basis. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Occupational Therapy Aide - Contract 8 1028 1035 NUMBER Description: The number of full-time equivalent occupational therapy aides under contract to a facility. SAS Name: OT_AIDE_CNTRCT_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 36 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: OT-AIDE-CNTRCT-CNT Occupational Therapy Aide - Full-Time 8 1036 1043 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a full-time basis. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Occupational Therapy Aide - Part-Time 8 1044 1051 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a part-time basis. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Occupational Therapy Assistant - Contract 8 1052 1059 NUMBER Description: The number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_AIDE_CNTRCT_CNT COBOL Name: OT-ASTNT-AIDE-CNTRCT-CNT Occupational Therapy Assistant - Full-Time 8 1060 1067 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a full-time basis. SAS Name: OT_ASTNT_AIDE_FLTM_CNT COBOL Name: OT-ASTNT-AIDE-FLTM-CNT Occupational Therapy Assistant - Part-Time 8 1068 1075 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a part-time basis. SAS Name: OT_ASTNT_AIDE_PRTM_CNT COBOL Name: OT-ASTNT-AIDE-PRTM-CNT Organized Family Group 1 1078 1078 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 1 1079 1079 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Other - Contract 8 1081 1088 NUMBER Description: The 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 Other - Full-Time 8 1089 1096 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Other - Part-Time 8 1097 1104 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT Other Physician Contract 8 1113 1120 NUMBER Description: The number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Other Physician Full-Time 8 1121 1128 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a full-time basis. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Other Physician Part-Time 8 1129 1136 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a part-time basis. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Other Social Service Staff - Contract 8 1137 1144 NUMBER Description: Number of contract staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Other Social Service Staff - Full-Time 8 1145 1152 NUMBER Description: Number of full-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Other Social Service Staff - Part-Time 8 1153 1160 NUMBER Description: Number of part-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Pharmacists - Contract 8 1172 1179 NUMBER Description: The number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Pharmacists - Full-Time 8 1180 1187 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a full-time basis. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Pharmacists - Part-Time 8 1188 1195 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a part-time basis. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT Physical Therapists - Contract 8 1212 1219 NUMBER Description: The number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Physical Therapists - Full-Time 8 1220 1227 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a full-time basis. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 40 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Physical Therapists - Part-Time 8 1228 1235 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a part-time basis. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Physical Therapy Aide - Contract 8 1244 1251 NUMBER Description: The 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 Physical Therapy Aide - Full-Time 8 1252 1259 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a full-time basis. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Physical Therapy Aide - Part-Time 8 1260 1267 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a part-time basis. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Physical Therapy Assistant - Contract 8 1268 1275 NUMBER Description: Number of contract staff hours for physical therapy assistants. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Physical Therapy Assistant - Full-Time 8 1276 1283 NUMBER Description: Number of full-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Physical Therapy Assistant - Part-Time 8 1284 1291 NUMBER Description: Number of part-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Physician Extender - Contract 8 1300 1307 NUMBER Description: The number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Physician Extender Full-Time Count (F37B) 8 1308 1315 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a full-time basis. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Physician Extender Part-Time Count (F37C) 8 1316 1323 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a part-time basis. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Physician Extender Service Offsite To Resident Switch 1 1324 1324 VARCHAR2 (F37A3) Description: Indicates if physician extender services are provided offsite to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Physician Extender Service Onsite To Non-Resident 1 1325 1325 VARCHAR2 Switch (F37A2) Description: Indicates if physician extender services are provided onsite to non-residents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Physician Extender Service Onsite To Resident Switch 1 1326 1326 VARCHAR2 (F37A1) 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 Podiatrists - Contract 8 1351 1358 NUMBER Description: The number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Podiatrists - Full-Time 8 1359 1366 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a full-time basis. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Podiatrists - Part-Time 8 1367 1374 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a part-time basis. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Provider Based Facility 1 1400 1400 VARCHAR2 Description: Indicates if a long term care facility is provider based. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurse - Contract 8 1441 1448 NUMBER Description: The number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Registered Nurse - Full-Time 8 1449 1456 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a full-time basis. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 44 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Registered Nurse - Part-Time 8 1457 1464 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a part-time basis. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM RN Director of Nursing - Contract 8 1540 1547 NUMBER Description: The 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 RN Director of Nursing - Full-Time 8 1548 1555 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a full-time basis. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT RN Director of Nursing - Part-Time 8 1556 1563 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a part-time basis. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 45 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Activities-Offsite-Residents Switch 1 1564 1564 VARCHAR2 Description: Indicates if activity services are provided off-site to residents. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Service: Activities-Onsite-Nonresidents Switch 1 1565 1565 VARCHAR2 Description: Indicates if activity services are provided on-site to nonresidents. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Service: Activities-Onsite-Residents Switch 1 1566 1566 VARCHAR2 Description: Indicates if activity services are provided on-site to residents. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Service: Blood Administered-Offsite-Resident 1 1568 1568 VARCHAR2 Description: Indicates if administration and storage of blood services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Service: Blood Administered-Onsite-Nonresident 1 1569 1569 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Service: Blood Administered-Onsite-Resident 1 1570 1570 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 46 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Clinical Laboratory-Offsite-Resident 1 1571 1571 VARCHAR2 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 Service: Clinical Laboratory-Onsite-Nonresident 1 1572 1572 VARCHAR2 Description: Indicates if clinical laboratory services are provided onsite to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Service: Clinical Laboratory-Onsite-Resident 1 1573 1573 VARCHAR2 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 Service: Dental On-Site Nonresidents 1 1575 1575 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 Service: Dental Off-Site Residents 1 1576 1576 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 Service: Dental On-Site Residents 1 1577 1577 VARCHAR2 Description: Indicates if dental services are provided on-site to residents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 47 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: DNTL_SRVC_ONST_RSDNT_SW COBOL Name: DNTL-SRVC-ONST-RSDNT-SW Service: Dietary On-Site Nonresidents 1 1578 1578 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Service: Dietary Off-Site Residents 1 1579 1579 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Service: Dietary On-Site Residents 1 1580 1580 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Service: Housekeeping On-Site to Nonresidents 1 1584 1584 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 Service: Housekeeping Off-Site to Residents 1 1585 1585 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 48 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Housekeeping On-Site to Residents 1 1586 1586 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 Service: Mental Health Off-Site to Residents 1 1591 1591 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 Service: Mental Health On-Site to Residents 1 1592 1592 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 Service: Mental Health On-site to Nonresidents 1 1593 1593 VARCHAR2 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 Service: Nursing On-Site to Nonresidents 1 1595 1595 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 Service: Nursing Off-Site to Residents 1 1598 1598 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 49 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Nursing On-Site to Residents 1 1599 1599 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 Service: Occupational Therapy On-Site to 1 1601 1601 VARCHAR2 Nonresidents 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 Service: Occupational Therapy Off-Site to Residents 1 1604 1604 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 Service: Occupational Therapy On-Site to Residents 1 1605 1605 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 Service: Other Activities-Offsite-Residents Switch 1 1609 1609 VARCHAR2 Description: Field 3 - indicates other activity services provided by staff off-site to residents. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Service: Other Activities-Onsite-Nonresidents Switch 1 1610 1610 VARCHAR2 Description: Field 2 - indicates other activity services provided by staff on-site to nonresidents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 50 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Service: Other Activities-Onsite-Residents Switch 1 1611 1611 VARCHAR2 Description: Field 1 - indicates other activity services provided by staff on-site to residents. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Service: Other Off-Site to Residents 1 1612 1612 VARCHAR2 Description: Field 3 - indicates services provided by other social services staff off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Service: Other On-Site to Nonresidents 1 1613 1613 VARCHAR2 Description: Indicates if other social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Service: Other On-Site to Residents 1 1614 1614 VARCHAR2 Description: Field 1 - indicates services provided by social service staff on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Service: Pharmacy Off-Site to Residents 1 1615 1615 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 Service: Pharmacy On-Site to Nonresidents 1 1616 1616 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to non residents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Service: Pharmacy On-Site to Residents 1 1617 1617 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 Service: Physical Therapy Off-Site to Residents 1 1620 1620 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 Service: Physical Therapy On-Site to Nonresidents 1 1621 1621 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 Service: Physical Therapy On-Site to Residents 1 1622 1622 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 Service: Physician Off-Site to Residents 1 1626 1626 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 Service: Physician On-Site to Nonresidents 1 1627 1627 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 Service: Physician On-Site to Residents 1 1628 1628 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 52 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Service: Podiatry Off-Site to Residents 1 1629 1629 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 Service: Podiatry On-Site to Nonresidents 1 1630 1630 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 Service: Podiatry On-Site to Residents 1 1631 1631 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 Service: Social Work Off-Site to Residents 1 1641 1641 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 Service: Social Work On-Site to Nonresidents 1 1642 1642 VARCHAR2 Description: Indicates if social work services are provided on-site to nonresidents. SAS Name: SCL_WORK_SRVC_ONST_NRSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 53 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: SCL-WORK-SRVC-ONST-NRSDNT-SW Service: Social Work On-Site to Residents 1 1643 1643 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 Service: Speech Pathology Off-Site to Residents 1 1646 1646 VARCHAR2 Description: Indicates if speech/language pathology services are provided offsite to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Service: Speech Pathology On-Site to Nonresidents 1 1647 1647 VARCHAR2 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 Service: Speech Pathology On-Site to Residents 1 1648 1648 VARCHAR2 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 Service: Therapeutic Recreational Specialty Off-Site 1 1650 1650 VARCHAR2 to Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1651 1651 VARCHAR2 to Non Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1652 1652 VARCHAR2 to Residents 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 Service: Vocational Off-Site to Residents 1 1654 1654 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 Service: Vocational On-Site to Nonresidents 1 1655 1655 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 Service: Vocational On-Site to Residents 1 1656 1656 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 Service: X-ray Off-Site Residents 1 1657 1657 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 55 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: X-ray On-Site Nonresidents 1 1658 1658 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 Service: X-ray On-Site Residents 1 1659 1659 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 Social Worker - Contract 8 3955 3962 NUMBER Description: The number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Social Worker - Full-Time 8 3963 3970 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a full-time basis. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Social Worker - Part-Time 8 3971 3978 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a part time basis. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Special Care Bed - Specialized Rehab 3 3987 3989 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Special Care Beds - AIDS 3 3990 3992 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Special Care Beds - Alzheimers 3 3993 3995 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Special Care Beds - Dialysis 3 3996 3998 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents needing dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Special Care Beds - Disabled Child 3 3999 4001 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Special Care Beds - Head Trauma 3 4002 4004 NUMBER Description: The number of beds in a unit identified and dedicated by the facilty for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Special Care Beds - Hospice 3 4005 4007 NUMBER Description: The number of beds in a unit identified and dedicated by a facility for residents needing hospice services. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 57 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Special Care Beds - Huntingtons 3 4008 4010 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Special Care Beds - Ventilator 3 4011 4013 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with ventilator/resipiratory care needs. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Speech Pathologist - Contract 8 4026 4033 NUMBER Description: The number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Speech Pathologist - Full-Time 8 4034 4041 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a full-time basis. SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Speech Pathologist - Part-Time 8 4042 4049 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a part-time basis. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Therapeutic Recreational Specialty - Contract 8 4109 4116 NUMBER Description: Number of contract staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Therapeutic Recreational Specialty - Full-Time 8 4117 4124 NUMBER Description: Number of full-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Therapeutic Recreational Specialty - Part-Time 8 4125 4132 NUMBER Description: Number of part-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 04=Skilled Nursing Facility * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Facility Name 50 67 116 VARCHAR2 Description: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 02050=OCCIDENTAL (CALIFORNIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 00824=NORIDIAN GVT SERVICES (CO) 00825=BLUE SHIELD (NORTH DAKOTA/WYOMING) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05535=EQICOR (NORTH CAROLINA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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 Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FN/001=FOREIGN 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (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=INCMPLETE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 08=GOVERNMENT - COUNTY 09=GOVERNMENT - CITY 10=GOVERNMENT - CITY/COUNTY 11=GOVERNMENT - HOSPITAL DISTRICT 12=GOVERNMENT - FEDERAL 13=FOR PROFIT - LIMITED LIABILITY CORPORATION ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Activity Professional Contract Count 8 280 287 NUMBER Description: The number of full-time equivalent activity professionals under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Activity Professional Full-Time Count 8 288 295 NUMBER Description: The number of full-time equivalent activity professionals employed full-time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Activity Professional Part-Time Count 8 296 303 NUMBER Description: The number of full-time equivalent activity professionals employed part-time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Activity Staff Other Contract Count 8 304 311 NUMBER Description: Number of contract staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Activity Staff Other Full-Time Count 8 312 319 NUMBER Description: Number of full-time staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Activity Staff Other Part-Time Count 8 320 327 NUMBER Description: Number of part-time staff hours provided by other activity staff. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Administrator - Contract 8 329 336 NUMBER Description: The number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Administrator - Full-Time 8 337 344 NUMBER Description: The number of full-time equivalent administrative staff employed on a full-time basis by a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility/Nursing Facility (Distinct Part), CATEGORY = "03" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PROFNL_ADMIN_FLTM_CNT COBOL Name: PROFNL-ADMIN-FLTM-CNT Administrator - Part-Time 8 345 352 NUMBER Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Beds - Medicare SNF 4 374 377 NUMBER Description: Number of Medicare-certified SNF (Skilled Nursing Facility) beds in a facility. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Beds - Nursing Facility 4 378 381 NUMBER Description: Number of medicaid certified nursing facility beds in a facility. SAS Name: MDCD_SNF_BED_CNT COBOL Name: MDCD-SNF-BED-CNT Beds - SNF / NF 4 382 385 NUMBER Description: Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Certification Nurse Aides - Contract 8 448 455 NUMBER Description: The 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 Certification Nurse Aides - Full-Time 8 456 463 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a full-time basis. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Certification Nurse Aides - Part-Time 8 464 471 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a part-time basis. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Compliance: 24 Hour Registered Nurse 1 481 481 VARCHAR2 Description: Indicates if a waiver of the 24-hour registered nurse requirement has been recommended for a facility. SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7 Day Registered Nurse 1 482 482 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse requirements has been recommended for a SNF or NF. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Compliance: Beds Per Room Waiver 1 483 483 VARCHAR2 Description: Indicates if a waiver of the beds per room requirement has been recommended for a facility. SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Patient Room Size 1 485 485 VARCHAR2 Description: Indicates if a waiver of patient room size has been recommended for a facility. SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Dentists - Contract 8 523 530 NUMBER Description: The number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Dentists - Full-Time 8 531 538 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a full-time basis. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Dentists - Part-Time 8 539 546 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a part-time basis. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Dietitians - Contract 8 555 562 NUMBER Description: The number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT Dietitians - Full-Time 8 563 570 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a full-time basis. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Dietitians - Part-Time 8 571 578 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a part-time basis. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT Experimental Research Conducted 1 590 590 VARCHAR2 Description: Indicates if a facility uses residents to develop and test clinical treatments. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Food Service - Contract 8 617 624 NUMBER Description: The 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 Food Service - Full-Time 8 625 632 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a full-time basis. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Food Service - Part-Time 8 633 640 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a part-time basis. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Housekeeping - Contract 8 677 684 NUMBER Description: The number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Housekeeping - Full-Time 8 685 692 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Housekeeping - Part-Time 8 693 700 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a part-time basis. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT LPN/LVN - Contract 8 719 726 NUMBER Description: The 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 LPN/LVN - Full-Time 8 727 734 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full-time basis. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT LPN/LVN - Part-Time 8 735 742 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part-time basis. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medical Director - Contract 8 791 798 NUMBER Description: The number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT Medical Director - Full-Time 8 799 806 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a full-time basis. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Medical Director - Part-Time 8 807 814 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a part-time basis. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT Medication Aides / Techs - Contract 8 841 848 NUMBER Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medication Aides / Techs - Full-Time 8 849 856 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a full-time basis. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Medication Aides / Techs - Part-Time 8 857 864 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a part-time basis. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Mental Health Services - Contract 8 866 873 NUMBER Description: The 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 Mental Health Services - Full-Time 8 874 881 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a full-time basis. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Mental Health Services - Part-Time 8 882 889 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a part-time basis. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Multi-Facility Organization Name 38 890 927 VARCHAR2 Description: The name of the multi-facility organization that owns the facility. SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Multi-Facility Organization Owned 1 928 928 VARCHAR2 Description: Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities. SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Nurse Aides in Training - Contract 8 940 947 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 Nurse Aides in Training - Full-Time 8 948 955 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a full-time basis. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Nurse Aides in Training - Part-Time 8 956 963 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a part-time basis. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Nurses With Administrative Duties - Contract 8 972 979 NUMBER Description: The 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 Nurses With Administrative Duties - Full-Time 8 980 987 NUMBER Description: The number of full-time equivalent nurses with administrative duties employed by a facility on a full-time basis. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Nurses With Administrative Duties - Part-Time 8 988 995 NUMBER Description: Number of full-time equivalent nurses with administrative duties employed by a facility on a part-time basis. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Occupational Therapist - Contract 8 996 1003 NUMBER Description: The number of full-time equivalent occupational therapists under contract to a facility. SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Occupational Therapist - Full-Time 8 1004 1011 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a full-time basis. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Occupational Therapist - Part-Time 8 1012 1019 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a part-time basis. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Occupational Therapy Aide - Contract 8 1028 1035 NUMBER Description: The 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 Occupational Therapy Aide - Full-Time 8 1036 1043 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a full-time basis. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Occupational Therapy Aide - Part-Time 8 1044 1051 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a part-time basis. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Occupational Therapy Assistant - Contract 8 1052 1059 NUMBER Description: The number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_AIDE_CNTRCT_CNT COBOL Name: OT-ASTNT-AIDE-CNTRCT-CNT Occupational Therapy Assistant - Full-Time 8 1060 1067 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a full-time basis. SAS Name: OT_ASTNT_AIDE_FLTM_CNT COBOL Name: OT-ASTNT-AIDE-FLTM-CNT Occupational Therapy Assistant - Part-Time 8 1068 1075 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a part-time basis. SAS Name: OT_ASTNT_AIDE_PRTM_CNT COBOL Name: OT-ASTNT-AIDE-PRTM-CNT Organized Family Group 1 1078 1078 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 1 1079 1079 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Other - Contract 8 1081 1088 NUMBER Description: The 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 Other - Full-Time 8 1089 1096 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Other - Part-Time 8 1097 1104 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT Other Physician Contract 8 1113 1120 NUMBER Description: The number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Other Physician Full-Time 8 1121 1128 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a full-time basis. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT Other Physician Part-Time 8 1129 1136 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a part-time basis. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Other Social Service Staff - Contract 8 1137 1144 NUMBER Description: Number of contract staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Other Social Service Staff - Full-Time 8 1145 1152 NUMBER Description: Number of full-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Other Social Service Staff - Part-Time 8 1153 1160 NUMBER Description: Number of part-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Pharmacists - Contract 8 1172 1179 NUMBER Description: The number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Pharmacists - Full-Time 8 1180 1187 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a full-time basis. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Pharmacists - Part-Time 8 1188 1195 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a part-time basis. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Physical Therapists - Contract 8 1212 1219 NUMBER Description: The number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Physical Therapists - Full-Time 8 1220 1227 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a full-time basis. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT Physical Therapists - Part-Time 8 1228 1235 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a part-time basis. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Physical Therapy Aide - Contract 8 1244 1251 NUMBER Description: The 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 Physical Therapy Aide - Full-Time 8 1252 1259 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a full-time basis. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Physical Therapy Aide - Part-Time 8 1260 1267 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a part-time basis. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Physical Therapy Assistant - Contract 8 1268 1275 NUMBER Description: Number of contract staff hours for physical therapy assistants. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Physical Therapy Assistant - Full-Time 8 1276 1283 NUMBER Description: Number of full-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Physical Therapy Assistant - Part-Time 8 1284 1291 NUMBER Description: Number of part-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Physician Extender - Contract 8 1300 1307 NUMBER Description: The number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Physician Extender Full-Time Count (F37B) 8 1308 1315 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent physician extenders employed by the facility on a full-time basis. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Physician Extender Part-Time Count (F37C) 8 1316 1323 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a part-time basis. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Physician Extender Service Offsite To Resident Switch 1 1324 1324 VARCHAR2 (F37A3) Description: Indicates if physician extender services are provided offsite to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Physician Extender Service Onsite To Non-Resident 1 1325 1325 VARCHAR2 Switch (F37A2) Description: Indicates if physician extender services are provided onsite to non-residents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Physician Extender Service Onsite To Resident Switch 1 1326 1326 VARCHAR2 (F37A1) Description: Indicates if physician extender services are provided on-site to residents. SAS Name: PHYSN_EXT_SRVC_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: PHYSN-EXT-SRVC-ONST-RSDNT-SW Podiatrists - Contract 8 1351 1358 NUMBER Description: The number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT Podiatrists - Full-Time 8 1359 1366 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a full-time basis. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Podiatrists - Part-Time 8 1367 1374 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a part-time basis. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Provider Based Facility 1 1400 1400 VARCHAR2 Description: Indicates if a long term care facility is provider based. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurse - Contract 8 1441 1448 NUMBER Description: The number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Registered Nurse - Full-Time 8 1449 1456 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a full-time basis. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 11 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Registered Nurse - Part-Time 8 1457 1464 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a part-time basis. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM RN Director of Nursing - Contract 8 1540 1547 NUMBER Description: The 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 RN Director of Nursing - Full-Time 8 1548 1555 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a full-time basis. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT RN Director of Nursing - Part-Time 8 1556 1563 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 12 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE part-time basis. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Service: Activities-Offsite-Residents Switch 1 1564 1564 VARCHAR2 Description: Indicates if activity services are provided off-site to residents. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Service: Activities-Onsite-Nonresidents Switch 1 1565 1565 VARCHAR2 Description: Indicates if activity services are provided on-site to nonresidents. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW Service: Activities-Onsite-Residents Switch 1 1566 1566 VARCHAR2 Description: Indicates if activity services are provided on-site to residents. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Service: Blood Administered-Offsite-Resident 1 1568 1568 VARCHAR2 Description: Indicates if administration and storage of blood services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Service: Blood Administered-Onsite-Nonresident 1 1569 1569 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Service: Blood Administered-Onsite-Resident 1 1570 1570 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Service: Clinical Laboratory-Offsite-Resident 1 1571 1571 VARCHAR2 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 Service: Clinical Laboratory-Onsite-Nonresident 1 1572 1572 VARCHAR2 Description: Indicates if clinical laboratory services are provided onsite to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Service: Clinical Laboratory-Onsite-Resident 1 1573 1573 VARCHAR2 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 Service: Dental On-Site Nonresidents 1 1575 1575 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 Service: Dental Off-Site Residents 1 1576 1576 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 14 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Dental On-Site Residents 1 1577 1577 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 Service: Dietary On-Site Nonresidents 1 1578 1578 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Service: Dietary Off-Site Residents 1 1579 1579 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Service: Dietary On-Site Residents 1 1580 1580 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Service: Housekeeping On-Site to Nonresidents 1 1584 1584 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 15 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Housekeeping Off-Site to Residents 1 1585 1585 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 Service: Housekeeping On-Site to Residents 1 1586 1586 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 Service: Mental Health Off-Site to Residents 1 1591 1591 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 Service: Mental Health On-Site to Residents 1 1592 1592 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 Service: Mental Health On-site to Nonresidents 1 1593 1593 VARCHAR2 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 Service: Nursing On-Site to Nonresidents 1 1595 1595 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 Service: Nursing Off-Site to Residents 1 1598 1598 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 Service: Nursing On-Site to Residents 1 1599 1599 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 Service: Occupational Therapy On-Site to 1 1601 1601 VARCHAR2 Nonresidents 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 Service: Occupational Therapy Off-Site to Residents 1 1604 1604 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 Service: Occupational Therapy On-Site to Residents 1 1605 1605 VARCHAR2 Description: Indicates if occupational therapy services are provided on-site to residents. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 17 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: OT_SRVC_ONST_RSDNT_SW COBOL Name: OT-SRVC-ONST-RSDNT-SW Service: Other Activities-Offsite-Residents Switch 1 1609 1609 VARCHAR2 Description: Field 3 - indicates other activity services provided by staff off-site to residents. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Service: Other Activities-Onsite-Nonresidents Switch 1 1610 1610 VARCHAR2 Description: Field 2 - indicates other activity services provided by staff on-site to nonresidents. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Service: Other Activities-Onsite-Residents Switch 1 1611 1611 VARCHAR2 Description: Field 1 - indicates other activity services provided by staff on-site to residents. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Service: Other Off-Site to Residents 1 1612 1612 VARCHAR2 Description: Field 3 - indicates services provided by other social services staff off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Service: Other On-Site to Nonresidents 1 1613 1613 VARCHAR2 Description: Indicates if other social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Service: Other On-Site to Residents 1 1614 1614 VARCHAR2 Description: Field 1 - indicates services provided by social service staff on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Service: Pharmacy Off-Site to Residents 1 1615 1615 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 Service: Pharmacy On-Site to Nonresidents 1 1616 1616 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to non residents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Service: Pharmacy On-Site to Residents 1 1617 1617 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 Service: Physical Therapy Off-Site to Residents 1 1620 1620 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 Service: Physical Therapy On-Site to Nonresidents 1 1621 1621 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 Service: Physical Therapy On-Site to Residents 1 1622 1622 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 Service: Physician Off-Site to Residents 1 1626 1626 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 Service: Physician On-Site to Nonresidents 1 1627 1627 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 Service: Physician On-Site to Residents 1 1628 1628 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 Service: Podiatry Off-Site to Residents 1 1629 1629 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 Service: Podiatry On-Site to Nonresidents 1 1630 1630 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 20 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Service: Podiatry On-Site to Residents 1 1631 1631 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 Service: Social Work Off-Site to Residents 1 1641 1641 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 Service: Social Work On-Site to Nonresidents 1 1642 1642 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 Service: Social Work On-Site to Residents 1 1643 1643 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 Service: Speech Pathology Off-Site to Residents 1 1646 1646 VARCHAR2 Description: Indicates if speech/language pathology services are provided offsite to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 21 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Speech Pathology On-Site to Nonresidents 1 1647 1647 VARCHAR2 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 Service: Speech Pathology On-Site to Residents 1 1648 1648 VARCHAR2 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 Service: Therapeutic Recreational Specialty Off-Site 1 1650 1650 VARCHAR2 to Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1651 1651 VARCHAR2 to Non Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1652 1652 VARCHAR2 to Residents 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 Service: Vocational Off-Site to Residents 1 1654 1654 VARCHAR2 Description: Indicates if vocational services are provided off-site to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 22 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE residents. SAS Name: VCTNL_SRVC_OFSITE_RSDNT_SW COBOL Name: VCTNL-SRVC-OFSITE-RSDNT-SW Service: Vocational On-Site to Nonresidents 1 1655 1655 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 Service: Vocational On-Site to Residents 1 1656 1656 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 Service: X-ray Off-Site Residents 1 1657 1657 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 Service: X-ray On-Site Nonresidents 1 1658 1658 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 Service: X-ray On-Site Residents 1 1659 1659 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 23 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Social Worker - Contract 8 3955 3962 NUMBER Description: The number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Social Worker - Full-Time 8 3963 3970 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a full-time basis. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Social Worker - Part-Time 8 3971 3978 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a part time basis. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Special Care Bed - Specialized Rehab 3 3987 3989 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Special Care Beds - AIDS 3 3990 3992 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Special Care Beds - Alzheimers 3 3993 3995 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Special Care Beds - Dialysis 3 3996 3998 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents needing dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Special Care Beds - Disabled Child 3 3999 4001 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Special Care Beds - Head Trauma 3 4002 4004 NUMBER Description: The number of beds in a unit identified and dedicated by the facilty for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Special Care Beds - Hospice 3 4005 4007 NUMBER Description: The number of beds in a unit identified and dedicated by a facility for residents needing hospice services. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 25 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Special Care Beds - Huntingtons 3 4008 4010 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Special Care Beds - Ventilator 3 4011 4013 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with ventilator/resipiratory care needs. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Speech Pathologist - Contract 8 4026 4033 NUMBER Description: The number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Speech Pathologist - Full-Time 8 4034 4041 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a full-time basis. SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Speech Pathologist - Part-Time 8 4042 4049 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a part-time basis. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Therapeutic Recreational Specialty - Contract 8 4109 4116 NUMBER Description: Number of contract staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Therapeutic Recreational Specialty - Full-Time 8 4117 4124 NUMBER Description: Number of full-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Therapeutic Recreational Specialty - Part-Time 8 4125 4132 NUMBER Description: Number of part-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 05=Home Health Agency Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 16360=NATIONWIDE (OHIO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00883=PALMETTO GBA PART B 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=BOSTON 02=NEW YORK 03=PHILADELPHIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04=ATLANTA 05=CHICAGO 06=DALLAS 07=KANSAS CITY 08=DENVER 09=SAN FRANCISCO 10=SEATTLE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The two-character state abbreviation. SAS Name: STATE_CD COBOL Name: STATE-CD VALUES: AK=ALASKA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04=PROPRIETARY 05=GOVERNMENT - STATE/COUNTY 06=GOVERNMENT - COMBINATION GOVT & VOLUNTARY 07=GOVERNMENT - LOCAL ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=JC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=CHAP 3=ACHC Aide Training / Competency Programs 1 369 369 VARCHAR2 Description: Indicates how the agency provides home health aide training and competency evaluation programs. SAS Name: HHA_TRNG_PGM_CD COBOL Name: HHA-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 Branch Operation Switch 1 394 394 VARCHAR2 Description: Indicates if the agency operates any branches. SAS Name: BRNCH_OPRTN_SW COBOL Name: BRNCH-OPRTN-SW Branches 3 395 397 NUMBER Description: The number of branches operated by the agency. SAS Name: BRNCH_CNT COBOL Name: BRNCH-CNT Change of Ownership Switch 1 480 480 VARCHAR2 Description: Indicates if a Home Health Agency (HHA) has undergone a change of ownership since the last survey. SAS Name: CHOW_SW COBOL Name: CHOW-SW Dietitians 8 547 554 NUMBER Description: Number of full-time equivalent dietitians employed by a facility. SAS Name: DIETN_CNT COBOL Name: DIETN-CNT Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD HHA Qualified For Outpatient Physical Therapy 1 642 642 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 Aides employed by an HHA 8 651 658 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 Hospice Switch 1 675 675 VARCHAR2 Description: Indicates if the Home Health Agency also participates in the Medicare program as a hospice. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: MDCR_HOSPC_SW COBOL Name: MDCR-HOSPC-SW Licensed Practical/Vocational Nurses 8 711 718 NUMBER Description: Number of full-time equivalent licensed practical or vocational nurses employed by a facility. SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT Occupational Therapists 8 1020 1027 NUMBER Description: The number of full-time equivalent occupational therapists employed by a provider. SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Physical Therapists on Staff 8 1236 1243 NUMBER Description: The number of full-time equivalent physical therapists employed by an outpatient physical therapy provider or a home health agency provider. SAS Name: PHYS_THRPST_STF_CNT COBOL Name: PHYS-THRPST-STF-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Registered Nurses 8 1465 1472 NUMBER Description: The number of full-time equivalent registered professional nurses employed by a provider. SAS Name: RN_CNT COBOL Name: RN-CNT Registered Pharmacists 8 1481 1488 NUMBER Description: The number of full-time equivalent registered pharmacists employed by a provider. SAS Name: REG_PHRMCST_CNT COBOL Name: REG-PHRMCST-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Service: Appliance and Equipment 1 1567 1567 VARCHAR2 Description: Indicates how appliance and equipment services are provided by a Home Health Agency (HHA). SAS Name: APLNC_EQUIP_SRVC_CD COBOL Name: APLNC-EQUIP-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Home Health Aide 1 1582 1582 VARCHAR2 Description: Indicates how home health aide services are provided. SAS Name: HH_AIDE_SRVC_CD COBOL Name: HH-AIDE-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Interns and Residents 1 1587 1587 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 Service: Laboratory 1 1588 1588 VARCHAR2 Description: Indicates how laboratory services are provided. SAS Name: LAB_SRVC_CD COBOL Name: LAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Medical Social 1 1589 1589 VARCHAR2 Description: Indicates how medical social services are provided. SAS Name: MDCL_SCL_SRVC_CD COBOL Name: MDCL-SCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Nursing 1 1594 1594 VARCHAR2 Description: Indicates how nursing services are provided. SAS Name: NRSNG_SRVC_CD COBOL Name: NRSNG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Nutritional Guidance 1 1600 1600 VARCHAR2 Description: Indicates how nutritional guidance services are provided. 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 Service: Other 1 1608 1608 VARCHAR2 Description: Indicates how other (non-specified) services are provided. SAS Name: OTHR_SRVC_CD COBOL Name: OTHR-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Speech Therapy 1 1649 1649 VARCHAR2 Description: Indicates how speech therapy services are provided. 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 Service: Vocational Guidance 1 1653 1653 VARCHAR2 Description: Indicates how vocational guidance services are provided. 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 Services Provided: Occupational Therapy 1 2786 2786 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Occupational Therapy Description 39 2787 2825 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: OT-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Pharmacy 1 3230 3230 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Pharmacy Description 39 3231 3269 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Services Provided: Physical Therapy 1 3270 3270 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Physical Therapy Description 39 3271 3309 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Social Workers 8 3979 3986 NUMBER Description: The number of full-time equivalent social workers employed by the agency. SAS Name: SCL_WORKR_CNT COBOL Name: SCL-WORKR-CNT Speech Pathologist or Audiologist 8 4050 4057 NUMBER Description: The number of full-time equivalent speech pathologists or audiologists employed by a provider. SAS Name: SPCH_PTHLGST_AUDLGST_CNT COBOL Name: SPCH-PTHLGST-AUDLGST-CNT Subunit Operation Switch 1 4077 4077 VARCHAR2 Description: Indicates if the agency operates any subunits. SAS Name: SBUNIT_OPRTN_SW COBOL Name: SBUNIT-OPRTN-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Subunit Switch 1 4078 4078 VARCHAR2 Description: Indicates if the agency is a subunit of another agency. SAS Name: SBUNIT_SW COBOL Name: SBUNIT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Subunits 3 4079 4081 NUMBER Description: The number of subunits operated by the agency. SAS Name: SBUNIT_CNT COBOL Name: SBUNIT-CNT Surety Bond Indicator 1 4082 4082 VARCHAR2 Description: Surety bond indicator. Valid values are 'N' or 'Y' or 'W'. SAS Name: SRTY_BOND_CD COBOL Name: SRTY-BOND-CD VALUES: N=NO W=WAIVER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Y=YES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Type of Facility 2 4168 4169 VARCHAR2 Description: Indicates the category which represents the type of facility. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=VISITING NURSE ASSOCIATION 02=COMBINATION GOVERNMENT VOLUNTARY 03=OFFICIAL HEALTH AGENCY 04=REHABILITATION FACILITY BASED PROGRAM 05=HOSPITAL BASED PROGRAM 06=SKILLED NURSING FACILITY BASED PROGRAM 07=OTHER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=Psychiatric Residential Treatment * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 06=Psychiatric Residential Treatment Facility * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Plan of Correction 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Status 1 44 44 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03602=NORIDIAN (WYOMING) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Region Code 2 169 170 VARCHAR2 Description: The regional location 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Skilled Nursing Facility, CATEGORY = "04" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=X-Ray Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 07=Portable X-Ray Supplier Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00231=BLUE CROSS (LOUISIANA) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00511=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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 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) 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 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The two-character state abbreviation. SAS Name: STATE_CD COBOL Name: STATE-CD VALUES: AK=ALASKA AL=ALABAMA AR=ARKANSAS AS=AMERICAN SAMOA AZ=ARIZONA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CA=CALIFORNIA CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE provider of services. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=INDIVIDUAL 02=PARTNERSHIP 03=CORPORATION 04=OTHER THAN PRIVATE ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: CBSA-URBN-RRL-IND Director Qualifications 1 587 587 VARCHAR2 Description: Indicates the qualifications of 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 Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Technologists - 2 Year Radiology 8 4085 4092 NUMBER Description: The number of full-time equivalent technologists employed by a portable x-ray provider who are graduates of a two-year approved school of radiologic technology. SAS Name: TCHNLGST_2_YR_RDLGC_CNT COBOL Name: TCHNLGST-2-YR-RDLGC-CNT Technologists - Associate Degree 8 4093 4100 NUMBER Description: The number of technologists with associate degrees in radiologic technology. SAS Name: TCHNLGST_ASCT_DGR_CNT COBOL Name: TCHNLGST-ASCT-DGR-CNT Technologists - BS/BA Degree 8 4101 4108 NUMBER Description: Number of technologists with Bachelor of Science (BS) or Bachelor of Arts (BA) degrees in radiologic technology. SAS Name: TCHNLGST_BS_BA_DGR_CNT COBOL Name: TCHNLGST-BS-BA-DGR-CNT Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=OPT or Speech Pathology * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 08=Outpatient Physical Therapy/Speech Pathology Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Status 1 44 44 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 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 Switch 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Facility Name 50 67 116 VARCHAR2 Description: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 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) 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 00460=BLUE CROSS (WYOMING) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Home Health Agency, CATEGORY = "05" (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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The two-character state abbreviation. SAS Name: STATE_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Home Health Agency, CATEGORY = "05" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 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=FOREIGN 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=AAAASF Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: FY-END-MO-DAY-CD Occupational Therapist - Contract 8 996 1003 NUMBER Description: The number of full-time equivalent occupational therapists under contract to a facility. SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Occupational Therapist - Full-Time 8 1004 1011 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a full-time basis. SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Occupational Therapists 8 1020 1027 NUMBER Description: The number of full-time equivalent occupational therapists employed by a provider. SAS Name: OCPTNL_THRPST_CNT COBOL Name: OCPTNL-THRPST-CNT Physical Therapist - Arrangement 8 1196 1203 NUMBER Description: The number of full-time equivalent physical therapists employed by arrangement in an outpatient physical therapy facility. SAS Name: PHYS_THRPST_ARNGMT_CNT COBOL Name: PHYS-THRPST-ARNGMT-CNT Physical Therapists 8 1204 1211 NUMBER Description: The number of full-time equivalent physical therapists employed by an outpatient physical therapy provider or a home health agency provider. SAS Name: PHYS_THRPST_CNT COBOL Name: PHYS-THRPST-CNT Physical Therapists on Staff 8 1236 1243 NUMBER Description: The number of full-time equivalent physical therapists employed by an outpatient physical therapy provider or a home health agency provider. SAS Name: PHYS_THRPST_STF_CNT COBOL Name: PHYS-THRPST-STF-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Services Provided: Occupational Therapy 1 2786 2786 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD VALUES: 0=Not Provided 1=Provided Services Provided: Physical Therapy 1 3270 3270 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD VALUES: 0=Not Provided 1=Provided Services Provided: Speech Pathology 1 3756 3756 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD VALUES: 0=Not Provided 1=Provided Services Provided: Speech Pathology Description 39 3757 3795 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Speech Pathologist - Full-Time 8 4034 4041 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a full-time basis. SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Speech Pathologist or Audiologist 8 4050 4057 NUMBER Description: The number of full-time equivalent speech pathologists or audiologists employed by a provider. SAS Name: SPCH_PTHLGST_AUDLGST_CNT COBOL Name: SPCH-PTHLGST-AUDLGST-CNT Speech Pathologists - Arrangement 8 4058 4065 NUMBER Description: The number of full-time equivalent speech pathologists employed by arrangement in an outpatient physical therapy facility. SAS Name: SPCH_PTHLGST_ARNGMT_CNT COBOL Name: SPCH-PTHLGST-ARNGMT-CNT Speech Pathologists - Total 8 4066 4073 NUMBER Description: The total number of full-time equivalent speech pathologists on staff and by arrangement in an outpatient physical therapy facility. SAS Name: SPCH_PTHLGST_CNT COBOL Name: SPCH-PTHLGST-CNT Type of Facility 2 4168 4169 VARCHAR2 Description: Indicates the category which represents the type of facility. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=HOSPITAL 02=SKILLED NURSING FACILITY 03=HOME HEALTH AGENCY 04=REHABILITATION AGENCY 05=PUBLIC CLINIC 06=PRIVATE CLINIC 07=PUBLIC HEALTH AGENCY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=End Stage Renal Disease * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 09=End Stage Renal Disease Facility * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 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 00460=BLUE CROSS (WYOMING) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 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) 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 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=SEATTLE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FN/001=FOREIGN 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 10 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Psychiatric Residential Treatment Facility, CATEGORY = "06" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=FOR PROFIT 02=NOT FOR PROFIT 03=PUBLIC ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 Dietitians 8 547 554 NUMBER Description: Number of full-time equivalent dietitians employed by a facility. SAS Name: DIETN_CNT COBOL Name: DIETN-CNT ESRD Network Number 2 588 589 VARCHAR2 Description: The number of the network to which the end-stage renal dialysis 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 Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Hospital Based Switch 1 676 676 VARCHAR2 Description: Hospital based indicator. SAS Name: HOSP_BSD_SW COBOL Name: HOSP-BSD-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Multi-Facility Organization Name 38 890 927 VARCHAR2 Description: The name of the multi-facility organization that owns the facility. SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Multi-Facility Organization Owned 1 928 928 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities. SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Number of Patients Tuesday 4th Shift 3 937 939 NUMBER Description: Number of patients Tuesday, fourth shift. SAS Name: SHIFT_4_TUE_PTNT_CNT COBOL Name: SHIFT-4-TUE-PTNT-CNT Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurses 8 1465 1472 NUMBER Description: The number of full-time equivalent registered professional nurses employed by a provider. SAS Name: RN_CNT COBOL Name: RN-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Social Workers 8 3979 3986 NUMBER Description: The number of full-time equivalent social workers employed by the agency. SAS Name: SCL_WORKR_CNT COBOL Name: SCL-WORKR-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Stations - Total 3 4074 4076 NUMBER Description: The total number of approved dialysis stations in an end-stage renal dialysis facility. SAS Name: DLYS_STN_CNT COBOL Name: DLYS-STN-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 02=Title 19 Only * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 10=Nursing Facility * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (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) 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) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL=FLORIDA FN=FOREIGN 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Portable X-Ray Supplier, CATEGORY = "07" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Activity Professional Contract Count 8 280 287 NUMBER Description: The number of full-time equivalent activity professionals under contract to a facility. SAS Name: ACTVTY_PROFNL_CNTRCT_CNT COBOL Name: ACTVTY-PROFNL-CNTRCT-CNT Activity Professional Full-Time Count 8 288 295 NUMBER Description: The number of full-time equivalent activity professionals employed full-time by a facility. SAS Name: ACTVTY_PROFNL_FLTM_CNT COBOL Name: ACTVTY-PROFNL-FLTM-CNT Activity Professional Part-Time Count 8 296 303 NUMBER Description: The number of full-time equivalent activity professionals employed part-time by a facility. SAS Name: ACTVTY_PROFNL_PRTM_CNT COBOL Name: ACTVTY-PROFNL-PRTM-CNT Activity Staff Other Contract Count 8 304 311 NUMBER Description: Number of contract staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_CNTRCT_CNT COBOL Name: ACTVTY-STF-OTHR-CNTRCT-CNT Activity Staff Other Full-Time Count 8 312 319 NUMBER Description: Number of full-time staff hours for other activities. SAS Name: ACTVTY_STF_OTHR_FLTM_CNT COBOL Name: ACTVTY-STF-OTHR-FLTM-CNT Activity Staff Other Part-Time Count 8 320 327 NUMBER Description: Number of part-time staff hours provided by other activity staff. SAS Name: ACTVTY_STF_OTHR_PRTM_CNT COBOL Name: ACTVTY-STF-OTHR-PRTM-CNT Administrator - Contract 8 329 336 NUMBER Description: The number of full-time equivalent administrative staff under contract to a facility. SAS Name: PROFNL_ADMIN_CNTRCT_CNT COBOL Name: PROFNL-ADMIN-CNTRCT-CNT Administrator - Full-Time 8 337 344 NUMBER Description: The 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 Administrator - Part-Time 8 345 352 NUMBER Description: The 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 Beds - Medicare SNF 4 374 377 NUMBER Description: Number of Medicare-certified SNF (Skilled Nursing Facility) beds in a facility. SAS Name: MDCR_SNF_BED_CNT COBOL Name: MDCR-SNF-BED-CNT Beds - Nursing Facility 4 378 381 NUMBER Description: Number of medicaid certified nursing facility beds in a facility. SAS Name: MDCD_SNF_BED_CNT COBOL Name: MDCD-SNF-BED-CNT Beds - SNF / NF 4 382 385 NUMBER Description: Number of beds certified for both Medicare and Medicaid skilled nursing care in a long term care facility. SAS Name: MDCR_MDCD_SNF_BED_CNT COBOL Name: MDCR-MDCD-SNF-BED-CNT Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Certification Nurse Aides - Contract 8 448 455 NUMBER Description: The 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 Certification Nurse Aides - Full-Time 8 456 463 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a full-time basis. SAS Name: NRS_AIDE_FLTM_CNT COBOL Name: NRS-AIDE-FLTM-CNT Certification Nurse Aides - Part-Time 8 464 471 NUMBER Description: The number of full-time equivalent certified nurse aides employed by a facility on a part-time basis. SAS Name: NRS_AIDE_PRTM_CNT COBOL Name: NRS-AIDE-PRTM-CNT Compliance: 24 Hour Registered Nurse 1 481 481 VARCHAR2 Description: Indicates if a waiver of the 24-hour registered nurse requirement has been recommended for a facility. SAS Name: RN_24_HR_WVR_SW COBOL Name: RN-24-HR-WVR-SW Compliance: 7 Day Registered Nurse 1 482 482 VARCHAR2 Description: Indicates if a waiver of the 7-day registered nurse requirements has been recommended for a SNF or NF. SAS Name: RN_7_DAY_WVR_SW COBOL Name: RN-7-DAY-WVR-SW Compliance: Beds Per Room Waiver 1 483 483 VARCHAR2 Description: Indicates if a waiver of the beds per room requirement has been recommended for a facility. SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Patient Room Size 1 485 485 VARCHAR2 Description: Indicates if a waiver of patient room size has been recommended for a facility. SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW Dentists - Contract 8 523 530 NUMBER Description: The number of full-time equivalent dentists under contract to a facility. SAS Name: DNTST_CNTRCT_CNT COBOL Name: DNTST-CNTRCT-CNT Dentists - Full-Time 8 531 538 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a full-time basis. SAS Name: DNTST_FLTM_CNT COBOL Name: DNTST-FLTM-CNT Dentists - Part-Time 8 539 546 NUMBER Description: The number of full-time equivalent dentists employed by a facility on a part-time basis. SAS Name: DNTST_PRTM_CNT COBOL Name: DNTST-PRTM-CNT Dietitians - Contract 8 555 562 NUMBER Description: The number of full-time equivalent dietitians under contract to a facility. SAS Name: DIETN_CNTRCT_CNT COBOL Name: DIETN-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Dietitians - Full-Time 8 563 570 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a full-time basis. SAS Name: DIETN_FLTM_CNT COBOL Name: DIETN-FLTM-CNT Dietitians - Part-Time 8 571 578 NUMBER Description: The number of full-time equivalent dietitians employed by a facility on a part-time basis. SAS Name: DIETN_PRTM_CNT COBOL Name: DIETN-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Experimental Research Conducted 1 590 590 VARCHAR2 Description: Indicates if a facility uses residents to develop and test clinical treatments. SAS Name: EXPRMT_RSRCH_CNDCTD_SW COBOL Name: EXPRMT-RSRCH-CNDCTD-SW Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Food Service - Contract 8 617 624 NUMBER Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Food Service - Full-Time 8 625 632 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a full-time basis. SAS Name: FOOD_SRVC_FLTM_CNT COBOL Name: FOOD-SRVC-FLTM-CNT Food Service - Part-Time 8 633 640 NUMBER Description: The number of full-time equivalent food service personnel employed by a facility on a part-time basis. SAS Name: FOOD_SRVC_PRTM_CNT COBOL Name: FOOD-SRVC-PRTM-CNT Housekeeping - Contract 8 677 684 NUMBER Description: The number of full-time equivalent housekeeping personnel under contract to a facility. SAS Name: HSEKPNG_CNTRCT_CNT COBOL Name: HSEKPNG-CNTRCT-CNT Housekeeping - Full-Time 8 685 692 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a full time basis. SAS Name: HSEKPNG_FLTM_CNT COBOL Name: HSEKPNG-FLTM-CNT Housekeeping - Part-Time 8 693 700 NUMBER Description: The number of full-time equivalent housekeeping personnel employed by a facility on a part-time basis. SAS Name: HSEKPNG_PRTM_CNT COBOL Name: HSEKPNG-PRTM-CNT LPN/LVN - Contract 8 719 726 NUMBER Description: The 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 LPN/LVN - Full-Time 8 727 734 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a full-time basis. SAS Name: LPN_LVN_FLTM_CNT COBOL Name: LPN-LVN-FLTM-CNT LPN/LVN - Part-Time 8 735 742 NUMBER Description: The number of full-time equivalent licensed practical/ vocational nurses employed by a facility on a part-time basis. SAS Name: LPN_LVN_PRTM_CNT COBOL Name: LPN-LVN-PRTM-CNT Medical Director - Contract 8 791 798 NUMBER Description: The number of full-time equivalent medical directors under contract to a facility. SAS Name: MDCL_DRCTR_CNTRCT_CNT COBOL Name: MDCL-DRCTR-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medical Director - Full-Time 8 799 806 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a full-time basis. SAS Name: MDCL_DRCTR_FLTM_CNT COBOL Name: MDCL-DRCTR-FLTM-CNT Medical Director - Part-Time 8 807 814 NUMBER Description: The number of full-time equivalent medical directors employed by a facility on a part-time basis. SAS Name: MDCL_DRCTR_PRTM_CNT COBOL Name: MDCL-DRCTR-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medication Aides / Techs - Contract 8 841 848 NUMBER Description: The 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 Medication Aides / Techs - Full-Time 8 849 856 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a full-time basis. SAS Name: MDCTN_AIDE_FLTM_CNT COBOL Name: MDCTN-AIDE-FLTM-CNT Medication Aides / Techs - Part-Time 8 857 864 NUMBER Description: The number of full-time equivalent medication aides/ technicians employed by a facility on a part-time basis. SAS Name: MDCTN_AIDE_PRTM_CNT COBOL Name: MDCTN-AIDE-PRTM-CNT Mental Health Services - Contract 8 866 873 NUMBER Description: The 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 Mental Health Services - Full-Time 8 874 881 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a full-time basis. SAS Name: MENTL_HLTH_SRVC_FLTM_CNT COBOL Name: MENTL-HLTH-SRVC-FLTM-CNT Mental Health Services - Part-Time 8 882 889 NUMBER Description: The number of full-time equivalent mental health services personnel employed by a facility on a part-time basis. SAS Name: MENTL_HLTH_SRVC_PRTM_CNT COBOL Name: MENTL-HLTH-SRVC-PRTM-CNT Multi-Facility Organization Name 38 890 927 VARCHAR2 Description: The name of the multi-facility organization that owns the facility. SAS Name: MLT_FAC_ORG_NAME COBOL Name: MLT-FAC-ORG-NAME Multi-Facility Organization Owned 1 928 928 VARCHAR2 Description: Indicates if a facility is owned by an organization that owns (or leases) two or more nursing facilities. SAS Name: MLT_OWND_FAC_ORG_SW COBOL Name: MLT-OWND-FAC-ORG-SW Nurse Aides in Training - Contract 8 940 947 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 Nurse Aides in Training - Full-Time 8 948 955 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a full-time basis. SAS Name: NAT_FLTM_CNT COBOL Name: NAT-FLTM-CNT Nurse Aides in Training - Part-Time 8 956 963 NUMBER Description: The number of full-time equivalent nurse aides in training employed by a facility on a part-time basis. SAS Name: NAT_PRTM_CNT COBOL Name: NAT-PRTM-CNT Nurses With Administrative Duties - Contract 8 972 979 NUMBER Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Nurses With Administrative Duties - Full-Time 8 980 987 NUMBER Description: The number of full-time equivalent nurses with administrative duties employed by a facility on a full-time basis. SAS Name: NRS_ADMINV_FLTM_CNT COBOL Name: NRS-ADMINV-FLTM-CNT Nurses With Administrative Duties - Part-Time 8 988 995 NUMBER Description: Number of full-time equivalent nurses with administrative * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE duties employed by a facility on a part-time basis. SAS Name: NRS_ADMINV_PRTM_CNT COBOL Name: NRS-ADMINV-PRTM-CNT Occupational Therapist - Contract 8 996 1003 NUMBER Description: The number of full-time equivalent occupational therapists under contract to a facility. SAS Name: OCPTNL_THRPST_CNTRCT_CNT COBOL Name: OCPTNL-THRPST-CNTRCT-CNT Occupational Therapist - Full-Time 8 1004 1011 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a full-time basis. SAS Name: OCPTNL_THRPST_FLTM_CNT COBOL Name: OCPTNL-THRPST-FLTM-CNT Occupational Therapist - Part-Time 8 1012 1019 NUMBER Description: The number of full-time equivalent occupational therapists employed by a facility on a part-time basis. SAS Name: OCPTNL_THRPST_PRTM_CNT COBOL Name: OCPTNL-THRPST-PRTM-CNT Occupational Therapy Aide - Contract 8 1028 1035 NUMBER Description: The 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 Occupational Therapy Aide - Full-Time 8 1036 1043 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a full-time basis. SAS Name: OT_AIDE_FLTM_CNT COBOL Name: OT-AIDE-FLTM-CNT Occupational Therapy Aide - Part-Time 8 1044 1051 NUMBER Description: The number of full-time equivalent occupational therapy aides employed by a facility on a part-time basis. SAS Name: OT_AIDE_PRTM_CNT COBOL Name: OT-AIDE-PRTM-CNT Occupational Therapy Assistant - Contract 8 1052 1059 NUMBER Description: The number of full-time equivalent occupational therapy assistants under contract to a facility. SAS Name: OT_ASTNT_AIDE_CNTRCT_CNT COBOL Name: OT-ASTNT-AIDE-CNTRCT-CNT Occupational Therapy Assistant - Full-Time 8 1060 1067 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a full-time basis. SAS Name: OT_ASTNT_AIDE_FLTM_CNT COBOL Name: OT-ASTNT-AIDE-FLTM-CNT Occupational Therapy Assistant - Part-Time 8 1068 1075 NUMBER Description: The number of full-time equivalent occupational therapy assistants employed by a facility on a part-time basis. SAS Name: OT_ASTNT_AIDE_PRTM_CNT COBOL Name: OT-ASTNT-AIDE-PRTM-CNT Organized Family Group 1 1078 1078 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 1 1079 1079 VARCHAR2 Description: Indicates if the facility has an organized residents group. SAS Name: ORGNZ_RSDNT_GRP_SW COBOL Name: ORGNZ-RSDNT-GRP-SW Other - Contract 8 1081 1088 NUMBER Description: The 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 Other - Full-Time 8 1089 1096 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a full-time basis. SAS Name: STF_OTHR_FLTM_CNT COBOL Name: STF-OTHR-FLTM-CNT Other - Part-Time 8 1097 1104 NUMBER Description: The number of full-time equivalent persons not included in any other categories employed by the facility on a part-time basis. SAS Name: STF_OTHR_PRTM_CNT COBOL Name: STF-OTHR-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Other Physician Contract 8 1113 1120 NUMBER Description: The number of full-time equivalent other physicians under contract to a facility. SAS Name: PHYSN_OTHR_CNTRCT_CNT COBOL Name: PHYSN-OTHR-CNTRCT-CNT Other Physician Full-Time 8 1121 1128 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a full-time basis. SAS Name: PHYSN_OTHR_FLTM_CNT COBOL Name: PHYSN-OTHR-FLTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Other Physician Part-Time 8 1129 1136 NUMBER Description: The number of full-time equivalent other physicians employed by a facility on a part-time basis. SAS Name: PHYSN_OTHR_PRTM_CNT COBOL Name: PHYSN-OTHR-PRTM-CNT Other Social Service Staff - Contract 8 1137 1144 NUMBER Description: Number of contract staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_CNTRCT_CNT COBOL Name: SCL-SRVC-OTHR-STF-CNTRCT-CNT Other Social Service Staff - Full-Time 8 1145 1152 NUMBER Description: Number of full-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_FLTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-FLTM-CNT Other Social Service Staff - Part-Time 8 1153 1160 NUMBER Description: Number of part-time staff hours provided by other social services staff. SAS Name: SCL_SRVC_OTHR_STF_PRTM_CNT COBOL Name: SCL-SRVC-OTHR-STF-PRTM-CNT Pharmacists - Contract 8 1172 1179 NUMBER Description: The number of full-time equivalent pharmacists under contract to a facility. SAS Name: PHRMCST_CNTRCT_CNT COBOL Name: PHRMCST-CNTRCT-CNT Pharmacists - Full-Time 8 1180 1187 NUMBER Description: The number of full-time equivalent pharmacists employed by a facility on a full-time basis. SAS Name: PHRMCST_FLTM_CNT COBOL Name: PHRMCST-FLTM-CNT Pharmacists - Part-Time 8 1188 1195 NUMBER * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: The number of full-time equivalent pharmacists employed by a facility on a part-time basis. SAS Name: PHRMCST_PRTM_CNT COBOL Name: PHRMCST-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Physical Therapists - Contract 8 1212 1219 NUMBER Description: The number of full-time equivalent physical therapists under contract to a facility. SAS Name: PHYS_THRPST_CNTRCT_CNT COBOL Name: PHYS-THRPST-CNTRCT-CNT Physical Therapists - Full-Time 8 1220 1227 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a full-time basis. SAS Name: PHYS_THRPST_FLTM_CNT COBOL Name: PHYS-THRPST-FLTM-CNT Physical Therapists - Part-Time 8 1228 1235 NUMBER Description: The number of full-time equivalent physical therapists employed by a facility on a part-time basis. SAS Name: PHYS_THRPST_PRTM_CNT COBOL Name: PHYS-THRPST-PRTM-CNT Physical Therapy Aide - Contract 8 1244 1251 NUMBER Description: The 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 Physical Therapy Aide - Full-Time 8 1252 1259 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a full-time basis. SAS Name: PT_AIDE_FLTM_CNT COBOL Name: PT-AIDE-FLTM-CNT Physical Therapy Aide - Part-Time 8 1260 1267 NUMBER Description: The number of full-time equivalent physical therapy aides employed by a facility on a part-time basis. SAS Name: PT_AIDE_PRTM_CNT COBOL Name: PT-AIDE-PRTM-CNT Physical Therapy Assistant - Contract 8 1268 1275 NUMBER Description: Number of contract staff hours for physical therapy assistants. SAS Name: PT_ASTNT_CNTRCT_CNT COBOL Name: PT-ASTNT-CNTRCT-CNT Physical Therapy Assistant - Full-Time 8 1276 1283 NUMBER Description: Number of full-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_FLTM_CNT COBOL Name: PT-ASTNT-FLTM-CNT Physical Therapy Assistant - Part-Time 8 1284 1291 NUMBER Description: Number of part-time staff hours for physical therapy assistants. SAS Name: PT_ASTNT_PRTM_CNT COBOL Name: PT-ASTNT-PRTM-CNT Physician Extender - Contract 8 1300 1307 NUMBER Description: The number of full-time equivalent physician extenders under contract to the facility. SAS Name: PHYSN_EXT_CNTRCT_CNT COBOL Name: PHYSN-EXT-CNTRCT-CNT Physician Extender Full-Time Count (F37B) 8 1308 1315 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a full-time basis. SAS Name: PHYSN_EXT_FLTM_CNT COBOL Name: PHYSN-EXT-FLTM-CNT Physician Extender Part-Time Count (F37C) 8 1316 1323 NUMBER Description: The number of full-time equivalent physician extenders employed by the facility on a part-time basis. SAS Name: PHYSN_EXT_PRTM_CNT COBOL Name: PHYSN-EXT-PRTM-CNT Physician Extender Service Offsite To Resident Switch 1 1324 1324 VARCHAR2 (F37A3) Description: Indicates if physician extender services are provided offsite to residents. SAS Name: PHYSN_EXT_SRVC_OFSITE_RSDNT_SW COBOL Name: PHYSN-EXT-SRVC-OFSITE-RSDNT-SW Physician Extender Service Onsite To Non-Resident 1 1325 1325 VARCHAR2 Switch (F37A2) Description: Indicates if physician extender services are provided onsite to non-residents. SAS Name: PHYSN_EXT_SRVC_ONST_NRSDNT_SW COBOL Name: PHYSN-EXT-SRVC-ONST-NRSDNT-SW Physician Extender Service Onsite To Resident Switch 1 1326 1326 VARCHAR2 (F37A1) 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 Podiatrists - Contract 8 1351 1358 NUMBER Description: The number of full-time equivalent podiatrists under contract to a facility. SAS Name: PDTRST_CNTRCT_CNT COBOL Name: PDTRST-CNTRCT-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Podiatrists - Full-Time 8 1359 1366 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a full-time basis. SAS Name: PDTRST_FLTM_CNT COBOL Name: PDTRST-FLTM-CNT Podiatrists - Part-Time 8 1367 1374 NUMBER Description: The number of full-time equivalent podiatrists employed by a facility on a part-time basis. SAS Name: PDTRST_PRTM_CNT COBOL Name: PDTRST-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Based Facility 1 1400 1400 VARCHAR2 Description: Indicates if a long term care facility is provider based. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurse - Contract 8 1441 1448 NUMBER Description: The number of full-time equivalent registered nurses under contract to a facility. SAS Name: RN_CNTRCT_CNT COBOL Name: RN-CNTRCT-CNT Registered Nurse - Full-Time 8 1449 1456 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a full-time basis. SAS Name: RN_FLTM_CNT COBOL Name: RN-FLTM-CNT Registered Nurse - Part-Time 8 1457 1464 NUMBER Description: The number of full-time equivalent registered nurses employed by a facility on a part-time basis. SAS Name: RN_PRTM_CNT COBOL Name: RN-PRTM-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM RN Director of Nursing - Contract 8 1540 1547 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing under contract to a facility. * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: RN_DRCTR_CNTRCT_CNT COBOL Name: RN-DRCTR-CNTRCT-CNT RN Director of Nursing - Full-Time 8 1548 1555 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a full-time basis. SAS Name: RN_DRCTR_FLTM_CNT COBOL Name: RN-DRCTR-FLTM-CNT RN Director of Nursing - Part-Time 8 1556 1563 NUMBER Description: The number of full-time equivalent registered nurse directors of nursing employed by a facility on a part-time basis. SAS Name: RN_DRCTR_PRTM_CNT COBOL Name: RN-DRCTR-PRTM-CNT Service: Activities-Offsite-Residents Switch 1 1564 1564 VARCHAR2 Description: Indicates if activity services are provided off-site to residents. SAS Name: ACTVTY_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OFSITE-RSDNT-SW Service: Activities-Onsite-Nonresidents Switch 1 1565 1565 VARCHAR2 Description: Indicates if activity services are provided on-site to nonresidents. SAS Name: ACTVTY_ONST_NRSDNT_SW COBOL Name: ACTVTY-ONST-NRSDNT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Activities-Onsite-Residents Switch 1 1566 1566 VARCHAR2 Description: Indicates if activity services are provided on-site to residents. SAS Name: ACTVTY_ONST_RSDNT_SW COBOL Name: ACTVTY-ONST-RSDNT-SW Service: Blood Administered-Offsite-Resident 1 1568 1568 VARCHAR2 Description: Indicates if administration and storage of blood services are provided off-site to residents. SAS Name: BLOOD_SRVC_OFSITE_RSDNT_SW COBOL Name: BLOOD-SRVC-OFSITE-RSDNT-SW Service: Blood Administered-Onsite-Nonresident 1 1569 1569 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to nonresidents. SAS Name: BLOOD_SRVC_ONST_NRSDNT_SW COBOL Name: BLOOD-SRVC-ONST-NRSDNT-SW Service: Blood Administered-Onsite-Resident 1 1570 1570 VARCHAR2 Description: Indicates if administration and storage of blood services are provided onsite to residents. SAS Name: BLOOD_SRVC_ONST_RSDNT_SW COBOL Name: BLOOD-SRVC-ONST-RSDNT-SW Service: Clinical Laboratory-Offsite-Resident 1 1571 1571 VARCHAR2 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Clinical Laboratory-Onsite-Nonresident 1 1572 1572 VARCHAR2 Description: Indicates if clinical laboratory services are provided onsite to nonresidents. SAS Name: CL_SRVC_ONST_NRSDNT_SW COBOL Name: CL-SRVC-ONST-NRSDNT-SW Service: Clinical Laboratory-Onsite-Resident 1 1573 1573 VARCHAR2 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 Service: Dental On-Site Nonresidents 1 1575 1575 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 Service: Dental Off-Site Residents 1 1576 1576 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 Service: Dental On-Site Residents 1 1577 1577 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 Service: Dietary On-Site Nonresidents 1 1578 1578 VARCHAR2 Description: Indicates if dietary services are provided on-site to nonresidents. SAS Name: DTRY_ONST_NRSDNT_SW COBOL Name: DTRY-ONST-NRSDNT-SW Service: Dietary Off-Site Residents 1 1579 1579 VARCHAR2 Description: Indicates if dietary services are provided off-site to residents. SAS Name: DTRY_OFSITE_RSDNT_SW COBOL Name: DTRY-OFSITE-RSDNT-SW Service: Dietary On-Site Residents 1 1580 1580 VARCHAR2 Description: Indicates if dietary services are provided on-site to residents. SAS Name: DTRY_ONST_RSDNT_SW COBOL Name: DTRY-ONST-RSDNT-SW Service: Housekeeping On-Site to Nonresidents 1 1584 1584 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 Service: Housekeeping Off-Site to Residents 1 1585 1585 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 Service: Housekeeping On-Site to Residents 1 1586 1586 VARCHAR2 Description: Indicates if housekeeping services are provided on-site to residents. SAS Name: HSEKPNG_SRVC_ONST_RSDNT_SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: HSEKPNG-SRVC-ONST-RSDNT-SW Service: Mental Health Off-Site to Residents 1 1591 1591 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 Service: Mental Health On-Site to Residents 1 1592 1592 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 Service: Mental Health On-site to Nonresidents 1 1593 1593 VARCHAR2 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 Service: Nursing On-Site to Nonresidents 1 1595 1595 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 Service: Nursing Off-Site to Residents 1 1598 1598 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 Service: Nursing On-Site to Residents 1 1599 1599 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 Service: Occupational Therapy On-Site to 1 1601 1601 VARCHAR2 Nonresidents 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 Service: Occupational Therapy Off-Site to Residents 1 1604 1604 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 Service: Occupational Therapy On-Site to Residents 1 1605 1605 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 Service: Other Activities-Offsite-Residents Switch 1 1609 1609 VARCHAR2 Description: Field 3 - indicates other activity services provided by staff off-site to residents. SAS Name: ACTVTY_OTHR_OFSITE_RSDNT_SW COBOL Name: ACTVTY-OTHR-OFSITE-RSDNT-SW Service: Other Activities-Onsite-Nonresidents Switch 1 1610 1610 VARCHAR2 Description: Field 2 - indicates other activity services provided by staff on-site to nonresidents. SAS Name: ACTVTY_OTHR_ONST_NRSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-NRSDNT-SW Service: Other Activities-Onsite-Residents Switch 1 1611 1611 VARCHAR2 Description: Field 1 - indicates other activity services provided by staff on-site to residents. SAS Name: ACTVTY_OTHR_ONST_RSDNT_SW COBOL Name: ACTVTY-OTHR-ONST-RSDNT-SW Service: Other Off-Site to Residents 1 1612 1612 VARCHAR2 Description: Field 3 - indicates services provided by other social services staff off-site to residents. SAS Name: SCL_SRVC_OTHR_OFSITE_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-OFSITE-RSDNT-SW Service: Other On-Site to Nonresidents 1 1613 1613 VARCHAR2 Description: Indicates if other social services are provided on-site to nonresidents. SAS Name: SCL_SRVC_OTHR_ONST_NRSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-NRSDNT-SW Service: Other On-Site to Residents 1 1614 1614 VARCHAR2 Description: Field 1 - indicates services provided by social service staff on-site to residents. SAS Name: SCL_SRVC_OTHR_ONST_RSDNT_SW COBOL Name: SCL-SRVC-OTHR-ONST-RSDNT-SW Service: Pharmacy Off-Site to Residents 1 1615 1615 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 Service: Pharmacy On-Site to Nonresidents 1 1616 1616 VARCHAR2 Description: Indicates if pharmacy services are provided on-site to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE non residents. SAS Name: PHRMCY_SRVC_ONST_NRSDNT_SW COBOL Name: PHRMCY-SRVC-ONST-NRSDNT-SW Service: Pharmacy On-Site to Residents 1 1617 1617 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 Service: Physical Therapy Off-Site to Residents 1 1620 1620 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 Service: Physical Therapy On-Site to Nonresidents 1 1621 1621 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Physical Therapy On-Site to Residents 1 1622 1622 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 Service: Physician Off-Site to Residents 1 1626 1626 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 Service: Physician On-Site to Nonresidents 1 1627 1627 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Physician On-Site to Residents 1 1628 1628 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 Service: Podiatry Off-Site to Residents 1 1629 1629 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 Service: Podiatry On-Site to Nonresidents 1 1630 1630 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 Service: Podiatry On-Site to Residents 1 1631 1631 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Social Work Off-Site to Residents 1 1641 1641 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 Service: Social Work On-Site to Nonresidents 1 1642 1642 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 Service: Social Work On-Site to Residents 1 1643 1643 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 Service: Speech Pathology Off-Site to Residents 1 1646 1646 VARCHAR2 Description: Indicates if speech/language pathology services are provided offsite to residents. SAS Name: SPCH_PTHLGY_OFSITE_RSDNT_SW COBOL Name: SPCH-PTHLGY-OFSITE-RSDNT-SW Service: Speech Pathology On-Site to Nonresidents 1 1647 1647 VARCHAR2 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 Service: Speech Pathology On-Site to Residents 1 1648 1648 VARCHAR2 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 Service: Therapeutic Recreational Specialty Off-Site 1 1650 1650 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE to Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1651 1651 VARCHAR2 to Non Residents 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 Service: Therapeutic Recreational Specialty On-Site 1 1652 1652 VARCHAR2 to Residents 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 Service: Vocational Off-Site to Residents 1 1654 1654 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 Service: Vocational On-Site to Nonresidents 1 1655 1655 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Vocational On-Site to Residents 1 1656 1656 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 Service: X-ray Off-Site Residents 1 1657 1657 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 Service: X-ray On-Site Nonresidents 1 1658 1658 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 Service: X-ray On-Site Residents 1 1659 1659 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 Social Worker - Contract 8 3955 3962 NUMBER Description: The number of full-time equivalent social workers under contract to a facility. SAS Name: SCL_WORKR_CNTRCT_CNT COBOL Name: SCL-WORKR-CNTRCT-CNT Social Worker - Full-Time 8 3963 3970 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a full-time basis. SAS Name: SCL_WORKR_FLTM_CNT COBOL Name: SCL-WORKR-FLTM-CNT Social Worker - Part-Time 8 3971 3978 NUMBER Description: The number of full-time equivalent social workers employed by a facility on a part time basis. SAS Name: SCL_WORKR_PRTM_CNT COBOL Name: SCL-WORKR-PRTM-CNT Special Care Bed - Specialized Rehab 3 3987 3989 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with specialized rehab needs. SAS Name: REHAB_BED_CNT COBOL Name: REHAB-BED-CNT Special Care Beds - AIDS 3 3990 3992 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with AIDS. SAS Name: AIDS_BED_CNT COBOL Name: AIDS-BED-CNT Special Care Beds - Alzheimers 3 3993 3995 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Alzheimer's disease. SAS Name: ALZHMR_BED_CNT COBOL Name: ALZHMR-BED-CNT Special Care Beds - Dialysis 3 3996 3998 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents needing dialysis. SAS Name: DLYS_BED_CNT COBOL Name: DLYS-BED-CNT Special Care Beds - Disabled Child 3 3999 4001 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for disabled children. SAS Name: DSBL_CHLDRN_BED_CNT COBOL Name: DSBL-CHLDRN-BED-CNT Special Care Beds - Head Trauma 3 4002 4004 NUMBER Description: The number of beds in a unit identified and dedicated by the facilty for residents with head trauma. SAS Name: HEAD_TRMA_BED_CNT COBOL Name: HEAD-TRMA-BED-CNT Special Care Beds - Hospice 3 4005 4007 NUMBER Description: The number of beds in a unit identified and dedicated by a facility for residents needing hospice services. SAS Name: HOSPC_BED_CNT COBOL Name: HOSPC-BED-CNT Special Care Beds - Huntingtons 3 4008 4010 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with Huntington's disease. SAS Name: HNTGTN_DEASE_BED_CNT COBOL Name: HNTGTN-DEASE-BED-CNT Special Care Beds - Ventilator 3 4011 4013 NUMBER Description: The number of beds in a unit identified and dedicated by the facility for residents with ventilator/resipiratory * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE care needs. SAS Name: VNTLTR_BED_CNT COBOL Name: VNTLTR-BED-CNT Speech Pathologist - Contract 8 4026 4033 NUMBER Description: The number of full-time equivalent speech pathologists under contract to a facility. SAS Name: SPCH_PTHLGST_CNTRCT_CNT COBOL Name: SPCH-PTHLGST-CNTRCT-CNT Speech Pathologist - Full-Time 8 4034 4041 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a full-time basis. SAS Name: SPCH_PTHLGST_FLTM_CNT COBOL Name: SPCH-PTHLGST-FLTM-CNT Speech Pathologist - Part-Time 8 4042 4049 NUMBER Description: The number of full-time equivalent speech pathologists employed by a facility on a part-time basis. SAS Name: SPCH_PTHLGST_PRTM_CNT COBOL Name: SPCH-PTHLGST-PRTM-CNT Therapeutic Recreational Specialty - Contract 8 4109 4116 NUMBER Description: Number of contract staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_CNTRCT_CNT COBOL Name: THRPTC-RCRTNL-CNTRCT-CNT Therapeutic Recreational Specialty - Full-Time 8 4117 4124 NUMBER Description: Number of full-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_FLTM_CNT COBOL Name: THRPTC-RCRTNL-FLTM-CNT Therapeutic Recreational Specialty - Part-Time 8 4125 4132 NUMBER Description: Number of part-time staff hours provided by therapeutic recreation specialist. SAS Name: THRPTC_RCRTNL_PRTM_CNT COBOL Name: THRPTC-RCRTNL-PRTM-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 11=Intermediate Care Facility-Mentally Retarded Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Certification Date 8 58 65 DATE Description: 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Eligibility Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. SAS Name: INTRMDRY_CARR_CD COBOL Name: INTRMDRY-CARR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) 07302=PINNACLE (MISSISSIPPI) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 00241=BLUE CROSS (MISSOURI) 00250=BLUE CROSS (MONTANA) 00260=BLUE CROSS (NEBRASKA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VA=VIRGINIA VI=VIRGIN ISLANDS VT=VERMONT WA=WASHINGTON WI=WISCONSIN WV=WEST VIRGINIA WY=WYOMING * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Outpatient Physical Therapy/Speech Pathology, CATEGORY = "08" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 08=NONPAYMENT OF FEES - CLIA Only 09=REV/UNSUCCESSFUL PARTICIPATION IN PT - CLIA Only 10=REV/OTHER REASON - CLIA Only 11=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates the nature of the organization that operates a provider of services. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND COBOL Name: CBSA-URBN-RRL-IND Admission Suspension Date 8 353 360 DATE Description: The date that payments for new admissions in a long-term care facility will be denied if an intermediate sanction is taken against the facility. SAS Name: ADMSN_SUSPNSN_DT COBOL Name: ADMSN-SUSPNSN-DT Admission Suspension Prior Date 8 361 368 DATE Description: Previous date a suspension of admissions was invoked for a provider. SAS Name: ADMSN_SUSPNSN_PRIOR_DT COBOL Name: ADMSN-SUSPNSN-PRIOR-DT Beds - ICF / MR 4 370 373 NUMBER Description: Number of certified beds in an intermediate care facility for the mentally retarded. SAS Name: MR_BED_CNT COBOL Name: MR-BED-CNT Beds - Total Certified 4 386 389 NUMBER Description: Number of beds in Medicare and/or Medicaid certified areas within a facility. SAS Name: CRTFD_BED_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: CRTFD-BED-CNT Beds-Total 4 390 393 NUMBER Description: Total number of beds in a facility, including those in non-participating or non-licensed areas. SAS Name: BED_CNT COBOL Name: BED-CNT Compliance: Beds Per Room Waiver 1 483 483 VARCHAR2 Description: Indicates if a waiver of the beds per room requirement has been recommended for a facility. SAS Name: BED_PER_ROOM_WVR_SW COBOL Name: BED-PER-ROOM-WVR-SW Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Compliance: Patient Room Size 1 485 485 VARCHAR2 Description: Indicates if a waiver of patient room size has been recommended for a facility. SAS Name: ROOM_SIZE_WVR_SW COBOL Name: ROOM-SIZE-WVR-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Direct Care Personnel 8 579 586 NUMBER Description: Number of full-time equivalent direct care personnel employed by an intermediate care facility for the mentally retarded. SAS Name: DRCT_CARE_PRSNEL_CNT COBOL Name: DRCT-CARE-PRSNEL-CNT Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Licensed Practical/Vocational Nurses 8 711 718 NUMBER Description: Number of full-time equivalent licensed practical or vocational nurses employed by a facility. SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT LTC Agreement Beginning Date 8 751 758 DATE Description: The beginning date of a certified long term care facility's time-limited agreement. SAS Name: AGRMT_BGN_DT COBOL Name: AGRMT-BGN-DT LTC Agreement Ending Date 8 759 766 DATE Description: The ending date of a certified long term care facility's time-limited agreement. SAS Name: AGRMT_END_DT COBOL Name: AGRMT-END-DT LTC Agreement Extension Date 8 767 774 DATE Description: The last date of an extension of a certified long term care facility's time-limited agreement. SAS Name: AGRMT_EXTNSN_DT COBOL Name: AGRMT-EXTNSN-DT Prior LTC Agreement Ending Date 8 1375 1382 DATE Description: The last date of a certified long term care facility's time-limited agreement for a prior survey. SAS Name: AGRMT_END_PRIOR_DT COBOL Name: AGRMT-END-PRIOR-DT Prior LTC Agreement Extension Date 8 1383 1390 DATE Description: The last date of an extension of a certified long term care facility's time-limited agreement for a prior survey. SAS Name: AGRMT_EXTNSN_PRIOR_DT COBOL Name: AGRMT-EXTNSN-PRIOR-DT Prior Rescind Suspension Date 8 1391 1398 DATE Description: The effective date of a previous suspension of admissions to a long term care (LTC) facility. SAS Name: RSCND_SUSPNSN_PRIOR_DT COBOL Name: RSCND-SUSPNSN-PRIOR-DT Program Participation 1 1399 1399 VARCHAR2 Description: Indicates if the provider participates in Medicare, * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicaid, or both programs. SAS Name: PGM_PRTCPTN_CD COBOL Name: PGM-PRTCPTN-CD VALUES: 1=MEDICARE ONLY 2=MEDICAID ONLY 3=MEDICARE AND MEDICAID Provider Based Facility 1 1400 1400 VARCHAR2 Description: Indicates if a long term care facility is provider based. SAS Name: PRVDR_BSD_FAC_SW COBOL Name: PRVDR-BSD-FAC-SW Regional Override # 1 (Number Beds) 1 1438 1438 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_BED_CNT_SW COBOL Name: OVRRD-BED-CNT-SW Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Registered Nurses 8 1465 1472 NUMBER Description: The number of full-time equivalent registered professional nurses employed by a provider. SAS Name: RN_CNT COBOL Name: RN-CNT Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Rescind Suspension Date 8 1520 1527 DATE Description: Date that the suspension of payments for new admissions to a long term care (LTC) facility is rescinded. SAS Name: RSCND_SUSPNSN_DT COBOL Name: RSCND-SUSPNSN-DT Total Number of Employees 9 4159 4167 NUMBER Description: The total number of full-time employees in a hospice or an intermediate care facility/mental retardation facility. SAS Name: EMPLEE_CNT COBOL Name: EMPLEE-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 12=Rural Health Clinic Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Status 1 44 44 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00231=BLUE CROSS (LOUISIANA) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) 07102=PINNACLE (ARKANSAS) 07201=PINNACLE (LOUISIANA) 07202=PINNACLE (LOUISIANA) 07301=PINNACLE (MISSISSIPPI) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 15004=CIGNA HHH B 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location of the provider. SAS Name: RGN_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the state where the provider is located. SAS Name: STATE_RGN_CD COBOL Name: STATE-RGN-CD VALUES: AK/001=ALASKA AK/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=AAAASF Federal Program Support 1 611 611 VARCHAR2 Description: Indicates if a clinic is receiving support from a federal program to provide health services in a medically underserved area or in an area with a shortage of primary care health manpower. SAS Name: FED_PGM_SPRT_SW COBOL Name: FED-PGM-SPRT-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Nurse Practitioners 8 964 971 NUMBER Description: Number of full-time equivalent nurse practitioners in a rural health clinic. SAS Name: NRS_PRCTNR_CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 End Stage Renal Disease Facility, CATEGORY = "09" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NRS-PRCTNR-CNT Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Physician Assistants (PA) 8 1292 1299 NUMBER Description: The number of full-time equivalent physician assistants (PA) employed by a hospital or rural health clinic. SAS Name: PHYSN_ASTNT_CNT COBOL Name: PHYSN-ASTNT-CNT Physicians 8 1327 1334 NUMBER Description: The number of full-time equivalent physicians employed by a provider. SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Title of Federal Program 26 4133 4158 VARCHAR2 Description: The name of a federal program which provides support to a rural health clinic to provide services in a medically underserved area or an area with a shortage of primary care health manpower. SAS Name: FED_PGM_NAME COBOL Name: FED-PGM-NAME VALUES: COMM HLTH PRG (330)=COMMUNITY HEALTH PROGRAM (330) INDIAN HEALTH SERV=INDIAN HEALTH SERVICE MIGRT HLTH PRG (329)=MIGRANT HEALTH PROGRAM (329) NATNL HEALTH SRV DEL=NATIONAL HEALTH SERVICE DELIVERY PROGRAM RURAL OUTREACH DEMO=RURAL OUTREACH DEMO GRANT PROGRAM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=Comprehensive Outpatient Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 14=Comprehensive Outpatient Rehab Facility * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA County Code 3 45 47 VARCHAR2 Description: SSA (State Survey Agency) geographic code indicating the county where the facility 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Certification Date 8 58 65 DATE Description: 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 Switch 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Facility Name 50 67 116 VARCHAR2 Description: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 00824=NORIDIAN GVT SERVICES (CO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 01390=AETNA (WASHINGTON) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 05101=WPS (IOWA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 20=NOTIFICATION BANKRUPTCY - CLIA Only 33=ACCREDITATION NOT CONFIRMED - CLIA Only 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE - CLIA Only Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=CARF 2=ACCREDISOURCE Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Orthotic/Prosthetic Service Code 1 1080 1080 VARCHAR2 Description: Indicates how orthotic/prosthetic services are provided by a comprehensive outpatient rehabilitation facility. SAS Name: ORTHTC_PRSTHTC_SRVC_CD COBOL Name: ORTHTC-PRSTHTC-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Participation Medicare OPT / SP 1 1171 1171 VARCHAR2 Description: Indicates if a 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 Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Service: Nursing 1 1594 1594 VARCHAR2 Description: Indicates how nursing services are provided. SAS Name: NRSNG_SRVC_CD COBOL Name: NRSNG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Nursing #2 1 1596 1596 VARCHAR2 Description: Indicates how nursing service is provided. SAS Name: NRSNG_2_SRVC_CD COBOL Name: NRSNG-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Nursing #3 1 1597 1597 VARCHAR2 Description: Indicates how nursing service is provided. SAS Name: NRSNG_3_SRVC_CD COBOL Name: NRSNG-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Occupational Therapy #2 1 1602 1602 VARCHAR2 Description: Indicates how occupational therapy service is provided by a Comprehensive Outpatient Rehab Facility. SAS Name: OT_2_SRVC_CD COBOL Name: OT-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Occupational Therapy #3 1 1603 1603 VARCHAR2 Description: Indicates how occupational therapy service is provided by a Comprehensive Outpatient Rehab Facility. SAS Name: OT_3_SRVC_CD COBOL Name: OT-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Orthotic Prosthetic #2 1 1606 1606 VARCHAR2 Description: Indicates how orthotic prosthetic service is provided by a Comprehensive Outpatient Rehab Facility. SAS Name: ORTHTC_PRSTHTC_2_SRVC_CD COBOL Name: ORTHTC-PRSTHTC-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Orthotic/Prosthetic #3 1 1607 1607 VARCHAR2 Description: Indicates how orthotic prosthetic service is provided by a Comprehensive Outpatient Rehab Facility. SAS Name: ORTHTC_PRSTHTC_3_SRVC_CD COBOL Name: ORTHTC-PRSTHTC-3-SRVC-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Physical Therapy #2 1 1618 1618 VARCHAR2 Description: Indicates how physical therapy service is provided. SAS Name: PT_2_SRVC_CD COBOL Name: PT-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Physical Therapy #3 1 1619 1619 VARCHAR2 Description: Indicates how physical therapy service is provided. SAS Name: PT_3_SRVC_CD COBOL Name: PT-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Physician 1 1623 1623 VARCHAR2 Description: Indicates how physician services are provided. SAS Name: PHYSN_SRVC_CD COBOL Name: PHYSN-SRVC-CD VALUES: 0=NOT PROVIDED * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Physician #2 1 1624 1624 VARCHAR2 Description: Indicates how physician service is provided by a CORF. SAS Name: PHYSN_2_SRVC_CD COBOL Name: PHYSN-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Physician #3 1 1625 1625 VARCHAR2 Description: Indicates how physician service is provided by a CORF. SAS Name: PHYSN_3_SRVC_CD COBOL Name: PHYSN-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Psychological 1 1632 1632 VARCHAR2 Description: Indicates how psychological services are provided. SAS Name: PSYCHLGCL_SRVC_CD COBOL Name: PSYCHLGCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Psychological #2 1 1633 1633 VARCHAR2 Description: Indicates how psychological service is provided. SAS Name: PSYCHLGCL_2_SRVC_CD COBOL Name: PSYCHLGCL-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Psychological #3 1 1634 1634 VARCHAR2 Description: Indicates how psychological service is provided. SAS Name: PSYCHLGCL_3_SRVC_CD COBOL Name: PSYCHLGCL-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Respiratory Care #2 1 1636 1636 VARCHAR2 Description: Indicates how respiratory care service is provided. SAS Name: RSPRTRY_CARE_2_SRVC_CD COBOL Name: RSPRTRY-CARE-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Respiratory Care #3 1 1637 1637 VARCHAR2 Description: Indicates how respiratory care service is provided. SAS Name: RSPRTRY_CARE_3_SRVC_CD COBOL Name: RSPRTRY-CARE-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Social #2 1 1639 1639 VARCHAR2 Description: Indicates how social service is provided. SAS Name: SCL_2_SRVC_CD COBOL Name: SCL-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Service: Social #3 1 1640 1640 VARCHAR2 Description: Indicates how social service is provided. SAS Name: SCL_3_SRVC_CD COBOL Name: SCL-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Speech Pathology #2 1 1644 1644 VARCHAR2 Description: Indicates how speech pathology service is provided. SAS Name: SPCH_PTHLGY_2_SRVC_CD COBOL Name: SPCH-PTHLGY-2-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Speech Pathology #3 1 1645 1645 VARCHAR2 Description: Indicates how speech pathology service is provided. SAS Name: SPCH_PTHLGY_3_SRVC_CD COBOL Name: SPCH-PTHLGY-3-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Occupational Therapy 1 2786 2786 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Physical Therapy 1 3270 3270 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Respiratory Care 1 3671 3671 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 EMPLOYEES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Respiratory Care Description 44 3672 3715 VARCHAR2 Description: Indicates how respiratory care services are provided. SAS Name: RSPRTRY_CARE_SRVC_DESC COBOL Name: RSPRTRY-CARE-SRVC-DESC Services Provided: Social 1 3716 3716 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_CD COBOL Name: SCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Social Description 39 3717 3755 VARCHAR2 Description: Indicates how social services are provided. SAS Name: SCL_SRVC_DESC COBOL Name: SCL-SRVC-DESC Services Provided: Speech Pathology 1 3756 3756 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY EMPLOYEES 2=PROVIDED UNDER ARRANGEMENT 3=PROVIDED BY INDEPENDENT CONTRACTOR Services Provided: Speech Pathology Description 39 3757 3795 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 15=Ambulatory Surgical Center Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Eligibility Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 02050=OCCIDENTAL (CALIFORNIA) 02101=NATIONAL HERITAGE (ALASKA) 02102=NATIONAL HERITAGE (ALASKA) 02201=NATIONAL HERITAGE (IDAHO) 02202=NATIONAL HERITAGE (IDAHO) 02301=NATIONAL HERITAGE (OREGON) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 06004=NORIDIAN HHH D 07101=PINNACLE (ARKANSAS) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=MUTUAL OF OMAHA 57400=COOPERATIVA (PUERTO RICO) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 WA/D4B=S KING COUNTY WA/D5A=PIERCE CTY & PENINSULA WA/D5B=PIERCE CTY & GRAYS HARBOR WA/D6=OLYMPIA AREA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA/LAB=LABORATORIES WI/001=WISCONSIN WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 11=INCMPLETE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=PROPRIETARY 02=NON PROFIT 03=GOVERNMENT ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND COBOL Name: CBSA-URBN-RRL-IND * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=JC 2=AAAHC 3=AAAASF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 4=AOA/HFAP 5=DNV * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Date Center Began Providing Services 8 507 514 DATE Description: The date an Ambulatory Surgical Center (ASC) began providing health care services. SAS Name: ASC_BGN_SRVC_DT COBOL Name: ASC-BGN-SRVC-DT Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility'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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Hospital Based Switch 1 676 676 VARCHAR2 Description: Hospital based indicator. SAS Name: HOSP_BSD_SW COBOL Name: HOSP-BSD-SW Operating Rooms 2 1076 1077 NUMBER Description: The number of operating rooms in an ambulatory surgical center. SAS Name: OPRTG_ROOM_CNT COBOL Name: OPRTG-ROOM-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Service: EKG 1 1581 1581 VARCHAR2 Description: Indicates if EKG services are provided by an ambulatory surgical center (ASC). SAS Name: EKG_SRVC_CD COBOL Name: EKG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Laboratory 1 1588 1588 VARCHAR2 Description: Indicates how laboratory services are provided. SAS Name: LAB_SRVC_CD COBOL Name: LAB-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Radiology 1 1635 1635 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 Services Provided: Pharmacy 1 3230 3230 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_CD COBOL Name: PHRMCY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Pharmacy Description 39 3231 3269 VARCHAR2 Description: Indicates how pharmacy services are provided. SAS Name: PHRMCY_SRVC_DESC COBOL Name: PHRMCY-SRVC-DESC Speciality: Thoracic Surgery 1 4014 4014 VARCHAR2 Description: Indicates if thoracic surgery is offered by an ambulatory surgical center. SAS Name: THORC_SRGRY_SW COBOL Name: THORC-SRGRY-SW Speciality: Urology 1 4015 4015 VARCHAR2 Description: Indicates if urology surgery is offered by an ambulatory surgical center. SAS Name: URLGY_SRGRY_SW COBOL Name: URLGY-SRGRY-SW Specialty: Cardiovascular 1 4016 4016 VARCHAR2 Description: Indicates if cardiovascular surgery is offered by an Ambulatory Surgical Center (ASC). * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: CRDVSCLR_SRGRY_SW COBOL Name: CRDVSCLR-SRGRY-SW Specialty: Foot 1 4017 4017 VARCHAR2 Description: Indicates if foot surgery is offered by an ambulatory surgical center. SAS Name: FT_SRGRY_SW COBOL Name: FT-SRGRY-SW Specialty: Neurological 1 4018 4018 VARCHAR2 Description: Indicates if neurological surgery is offered by an ambulatory surgical center. SAS Name: NRLGCL_SRGRY_SW COBOL Name: NRLGCL-SRGRY-SW Specialty: Obstetrics / Gynecology 1 4019 4019 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 Specialty: Opthamology 1 4020 4020 VARCHAR2 Description: Indicates if opthamology surgery is offered by an ambulatory surgical center. SAS Name: OPTHMLGY_SRGRY_SW COBOL Name: OPTHMLGY-SRGRY-SW Specialty: Oral 1 4021 4021 VARCHAR2 Description: Indicates if oral surgery is offered by an ambulatory surgical center. SAS Name: ORAL_SRGRY_SW COBOL Name: ORAL-SRGRY-SW Specialty: Orthopedic 1 4022 4022 VARCHAR2 Description: Indicates if orthopedic surgery is offered by an ambulatory surgical center. SAS Name: ORTHPDC_SRGRY_SW COBOL Name: ORTHPDC-SRGRY-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Ambulatory Surgical Center, CATEGORY = "15" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Specialty: Otolaryngology 1 4023 4023 VARCHAR2 Description: Indicates if otolaryngology surgery is offered by an ambulatory surgical center. SAS Name: OTLRYNGLGY_SRGRY_SW COBOL Name: OTLRYNGLGY-SRGRY-SW Specialty: Plastic Surgery 1 4024 4024 VARCHAR2 Description: Indicates if plastic surgery is offered by an ambulatory surgical center. SAS Name: PLSTC_SRGRY_SW COBOL Name: PLSTC-SRGRY-SW Specialty: Surgery 1 4025 4025 VARCHAR2 Description: Indicates if general surgery is offered by an ambulatory surgical center. SAS Name: GNRL_SRGRY_SW COBOL Name: GNRL-SRGRY-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=Hospice Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 16=Hospice Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA County Code 3 45 47 VARCHAR2 Description: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Facility Name 50 67 116 VARCHAR2 Description: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. SAS Name: INTRMDRY_CARR_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 00241=BLUE CROSS (MISSOURI) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 52280=MUTUAL OF OMAHA 57400=COOPERATIVA (PUERTO RICO) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Region Code 2 169 170 VARCHAR2 Description: The regional location 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA KS=KANSAS KY=KENTUCKY LA=LOUISIANA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WA=WASHINGTON WI=WISCONSIN WV=WEST VIRGINIA WY=WYOMING SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 FL/MIA=MIAMI FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=FOREIGN 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Nursing Facility, CATEGORY = "10" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=REV/OTHER REASON - CLIA Only 11=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 Accreditation Type Code 1 279 279 VARCHAR2 Description: This code indicates the organization that is responsible for the accreditation of the provider. SAS Name: ACRDTN_TYPE_CD COBOL Name: ACRDTN-TYPE-CD VALUES: 0=UNACCREDITED 1=JC 2=CHAP 3=ACHC Acute/Respite Care Code 1 328 328 VARCHAR2 Description: Indicates if the hospice provides acute and/or respite short-term inpatient care. 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 Compliance: Life Safety Code 1 484 484 VARCHAR2 Description: INDICATES IF A WAIVER OF ANY LIFE SAFETY CODE (LSC) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE PROVISIONS HAS BEEN RECOMMENDED FOR A PROVIDER. SAS Name: LSC_WVR_SW COBOL Name: LSC-WVR-SW Counselors - Staff 8 488 495 NUMBER Description: The number of full-time equivalent counselors employed by a hospice. SAS Name: CNSLR_EMPLEE_CNT COBOL Name: CNSLR-EMPLEE-CNT Counselors - Volunteer 8 496 503 NUMBER Description: The number of full-time equivalent volunteer counselors in a hospice. SAS Name: CNSLR_VLNTR_CNT COBOL Name: CNSLR-VLNTR-CNT Fiscal Year Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Home Health Aides - Volunteer 8 643 650 NUMBER Description: The number of full-time equivalent volunteer home health aides in a hospice. SAS Name: HH_AIDE_VLNTR_CNT COBOL Name: HH-AIDE-VLNTR-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Homemakers - Staff 8 659 666 NUMBER Description: The number of full-time equivalent homemakers employed by a hospice. SAS Name: HMMKR_EMPLEE_CNT COBOL Name: HMMKR-EMPLEE-CNT Homemakers - Volunteer 8 667 674 NUMBER Description: The number of full-time equivalent homemakers in a hospice. SAS Name: HMMKR_VLNTR_CNT COBOL Name: HMMKR-VLNTR-CNT Licensed Practical/Vocational Nurses 8 711 718 NUMBER Description: Number of full-time equivalent licensed practical or vocational nurses employed by a facility. SAS Name: LPN_LVN_CNT COBOL Name: LPN-LVN-CNT LPNS/LVNS Volunteer 8 743 750 NUMBER Description: The number of full-time equivalent volunteer licensed practical/vocational nurses in a hospice. SAS Name: LPN_LVN_VLNTR_CNT COBOL Name: LPN-LVN-VLNTR-CNT Medical Social Workers 8 816 823 NUMBER Description: Number of full-time equivalent medical social workers employed by a hospital or hospice. SAS Name: MDCL_SCL_WORKR_CNT COBOL Name: MDCL-SCL-WORKR-CNT Medical Social Workers - Volunteer 8 824 831 NUMBER Description: The number of full-time equivalent volunteer medical social workers in a hospice. SAS Name: MDCL_SCL_WORKR_VLNTR_CNT COBOL Name: MDCL-SCL-WORKR-VLNTR-CNT Other Personnel 8 1105 1112 NUMBER Description: The number of full-time equivalent other salaried personnel employed by a facility. SAS Name: PRSNEL_OTHR_CNT COBOL Name: PRSNEL-OTHR-CNT Physicians 8 1327 1334 NUMBER Description: The number of full-time equivalent physicians employed by a provider. SAS Name: PHYSN_CNT COBOL Name: PHYSN-CNT Physicians - Volunteer 8 1343 1350 NUMBER Description: The number of full-time equivalent volunteer physicians in a hospice. SAS Name: PHYSN_VLNTR_CNT COBOL Name: PHYSN-VLNTR-CNT Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Registered Nurses 8 1465 1472 NUMBER Description: The number of full-time equivalent registered professional nurses employed by a provider. SAS Name: RN_CNT COBOL Name: RN-CNT Registered Nurses - Volunteer 8 1473 1480 NUMBER Description: The number of full-time equivalent volunteer registered * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 0 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE nurses in a hospice. SAS Name: RN_VLNTR_CNT COBOL Name: RN-VLNTR-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Service: Counseling 1 1574 1574 VARCHAR2 Description: Indicates how counseling services are provided by a hospice. SAS Name: CNSLNG_SRVC_CD COBOL Name: CNSLNG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Home Health Aide 1 1582 1582 VARCHAR2 Description: Indicates how home health aide services are provided. SAS Name: HH_AIDE_SRVC_CD COBOL Name: HH-AIDE-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Homemaker 1 1583 1583 VARCHAR2 Description: Indicates how homemaker services are provided by a 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 Service: Medical Social 1 1589 1589 VARCHAR2 Description: Indicates how medical social services are provided. SAS Name: MDCL_SCL_SRVC_CD COBOL Name: MDCL-SCL-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Service: Medical Supplies 1 1590 1590 VARCHAR2 Description: Indicates how medical supply services are provided by a 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 Service: Nursing 1 1594 1594 VARCHAR2 Description: Indicates how nursing services are provided. SAS Name: NRSNG_SRVC_CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Hospice, CATEGORY = "16" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: NRSNG-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Other 1 1608 1608 VARCHAR2 Description: Indicates how other (non-specified) services are provided. SAS Name: OTHR_SRVC_CD COBOL Name: OTHR-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Physician 1 1623 1623 VARCHAR2 Description: Indicates how physician services are provided. SAS Name: PHYSN_SRVC_CD COBOL Name: PHYSN-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Service: Short Term Inpatient 1 1638 1638 VARCHAR2 Description: Indicates how short term inpatient care services are provided by a 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 Services Provided: Occupational Therapy 1 2786 2786 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_CD COBOL Name: OT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Occupational Therapy Description 39 2787 2825 VARCHAR2 Description: Indicates how occupational therapy services are provided. SAS Name: OT_SRVC_DESC COBOL Name: OT-SRVC-DESC Services Provided: Physical Therapy 1 3270 3270 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_CD COBOL Name: PT-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Physical Therapy Description 39 3271 3309 VARCHAR2 Description: Indicates how physical therapy services are provided. SAS Name: PT_SRVC_DESC COBOL Name: PT-SRVC-DESC Services Provided: Speech Pathology 1 3756 3756 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_CD COBOL Name: SPCH-PTHLGY-SRVC-CD VALUES: 0=NOT PROVIDED 1=PROVIDED BY STAFF 2=PROVIDED UNDER ARRANGEMENT 3=COMBINATION Services Provided: Speech Pathology Description 39 3757 3795 VARCHAR2 Description: Indicates how speech pathology services are provided. SAS Name: SPCH_PTHLGY_SRVC_DESC COBOL Name: SPCH-PTHLGY-SRVC-DESC Total Number of Employees 9 4159 4167 NUMBER Description: The total number of full-time employees in a hospice or an intermediate care facility/mental retardation facility. SAS Name: EMPLEE_CNT COBOL Name: EMPLEE-CNT Type of Facility 2 4168 4169 VARCHAR2 Description: Indicates the category which represents the type of facility. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=HOSPITAL 02=SKILLED NURSING FACILITY 03=NURSING FACILITY 04=HOME HEALTH AGENCY 05=FREESTANDING HOSPICE Volunteers - Other 8 4171 4178 NUMBER Description: The number of full-time equivalent other volunteers in a hospice. SAS Name: VLNTR_OTHR_CNT COBOL Name: VLNTR-OTHR-CNT Volunteers - Total 9 4179 4187 NUMBER Description: The number of full-time volunteers in a hospice. SAS Name: VLNTR_CNT COBOL Name: VLNTR-CNT * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 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: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=Organ Procurement Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 17=Organ Procurement Organization Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Compliance: Status 1 44 44 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Intermediate Care Facility-Mentally Retarded, 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 15004=CIGNA HHH B 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. SAS Name: INTRMDRY_CARR_PRIOR_CD COBOL Name: INTRMDRY-CARR-PRIOR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00322=NORIDIAN PART A (AK/WA) 00323=NORIDIAN PART A (ID/OR) 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 12301=HIGHMARK (MARYLAND) 12302=HIGHMARK (MARYLAND) 12401=HIGHMARK (NEW JERSEY) 12402=HIGHMARK (NEW JERSEY) 12501=HIGHMARK (PENNSYLVANIA) 12502=HIGHMARK (PENNSYLVANIA) 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 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31140=NATIONAL HERITAGE (CA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 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=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Intermediate Care Facility-Mentally Retarded, CATEGORY = "11" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only 13=MULTIPLE TO SINGLE SITE CERTIFICATE - CLIA Only * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Organ Procurement Organization, CATEGORY = "17" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 Ending Date 4 613 616 VARCHAR2 Description: The ending date (month and day) of a facility's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=HHA Branch 02=OPT Extension Provider Category Code 2 3 4 VARCHAR2 Description: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 18=Extension or Branch Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA County Code 3 45 47 VARCHAR2 Description: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Eligibility Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=BOSTON 02=NEW YORK * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03=PHILADELPHIA 04=ATLANTA 05=CHICAGO 06=DALLAS 07=KANSAS CITY 08=DENVER 09=SAN FRANCISCO 10=SEATTLE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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=FOREIGN 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 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 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE WI/LAB=LABORATORIES WV/001=WEST VIRGINIA WV/LAB=LABORATORIES WY/001=WYOMING WY/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Extension or Branch, CATEGORY = "18" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 19=Community Mental Health Center Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00820=BLUE SHIELD (NORTH DAKOTA) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Rural Health Clinic, CATEGORY = "12" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 16360=NATIONWIDE (OHIO) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE State Abbreviation 2 172 173 VARCHAR2 Description: The 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE SSA State Code 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 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=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 6 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 262 262 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Community Mental Health Center, CATEGORY = "19" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM Provider Category Subtype Code 2 1 2 VARCHAR2 Description: This field is used mainly by batch report programs to determine the breakdown of the provider category. This field is mainly used for SNFs and hospitals. 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: This code identifies the category which is most descriptive of the facility identified on the Medicare/Medicaid Certification and Transmittal Form (CMS 1539). SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 21=Federally Qualified Health Center Change of Ownership Count 2 5 6 NUMBER Description: The number of times a change of ownership (CHOW) has taken place for a particular provider. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT Change of Ownership Date 8 7 14 DATE Description: Effective date of a change of ownership. SAS Name: CHOW_DT COBOL Name: CHOW-DT City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Plan of Correction 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: Indicates if a provider is in compliance with program requirements. 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: SSA (State Survey Agency) geographic code indicating the county where the facility 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: 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 Switch 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: The name of a provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Intermediary Carrier Code 5 117 121 VARCHAR2 Description: A number assigned to an intermediary or carrier servicing a provider or supplier. Not all numbers apply to all provider types. 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 5 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 10 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 15004=CIGNA HHH B 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) Medicare or Medicaid Vendor Number 15 122 136 VARCHAR2 Description: A number which may be assigned to a facility by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Participation Date 8 137 144 DATE Description: The date a facility is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior Change of Ownership Date 8 145 152 DATE Description: The date of a prior change of ownership. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Intermediary Carrier Prior Code 5 153 157 VARCHAR2 Description: The previous intermediary carrier number. 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 00460=BLUE CROSS (WYOMING) 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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) 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 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 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) 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 4 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04901=MUTUAL LEGACY 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) 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) 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 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) * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Provider Number 10 158 167 VARCHAR2 Description: A six or ten position identification number that is assigned to a certified provider. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Record Status Code 1 168 168 VARCHAR2 Description: This indicator specifies the current status of the record. SAS Name: REC_STUS_CD COBOL Name: REC-STUS-CD VALUES: A=ACCEPTED RECORD C=COMPLAINT RECORD Region Code 2 169 170 VARCHAR2 Description: The regional location 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Skeleton Record Switch 1 171 171 VARCHAR2 Description: Indicates the record is a skeleton record. Only a limited set of the provider data is available for this provider. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 172 173 VARCHAR2 Description: The 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=FOREIGN 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 2 174 175 VARCHAR2 Description: SSA (Social Security Administration) geographic code indicating the state of the provider's residence. Must agree with the first two positions of the Provider number (except California: 05 and 55; Texas: 45 and 67; FL: 10 and 68; MD: 21 and 80). SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=FOREIGN State Region Code 3 176 178 VARCHAR2 Description: For selected states, identifies the particular region within the 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 FL/MIA=MIAMI * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 7 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FL/ORL=ORLANDO FL/PEN=PENSACOLA FL/STP=ST. PETERSBURG FL/TAL=TALLAHASSEE FL/TAM=TAMPA FM/001=FEDERATED STATES OF MICRO FN/001=FOREIGN 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 8 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 9 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 PA/001=PENNSYLVANIA PA/LAB=LABORATORIES PR/001=PUERTO RICO PR/LAB=LABORATORIES PW/001=PALAU RI/001=RHODE ISLAND RI/LAB=LABORATORIES * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 2 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 3 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Street Address 50 179 228 VARCHAR2 Description: Street address of a provider that is certified to provide Medicare and/or Medicaid services. SAS Name: ST_ADR COBOL Name: ST-ADR * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Telephone Number 10 229 238 VARCHAR2 Description: The 10-digit telephone number of the primary contact or the operator of a provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 1 2 239 240 VARCHAR2 Description: Termination code number one: the reason a facility has been terminated from the CLIA, Medicare and/or Medicaid programs. 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=INCMPLETE 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Federally Qualified Health Center, CATEGORY = "21" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Termination Date / Expiration Date 1 8 241 248 DATE Description: The date the laboratory's certificate terminated or the expiration date of the current CLIA certificate. For other non-CLIA providers, it is the date the facility was terminated. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action 1 249 249 VARCHAR2 Description: Type of action on the 'official' survey record. This field is copied from type of action on the HCFA-1539, certification and transmittal. SAS Name: SRVY_PRPSE_CD COBOL Name: SRVY-PRPSE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 6=ONSITE SURVEY DUE TO FLEXIBLE SURVEY - CLIA Only 8=FULL SURVEY AFTER COMPLAINT - CLIA ONLY General Type of Control Code 2 250 251 VARCHAR2 Description: Indicates the nature of the organization that operates a provider of services. 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 ZIP Code 5 252 256 VARCHAR2 Description: The five-digit postal code for the provider. SAS Name: ZIP_CD COBOL Name: ZIP-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FIPS State Code 2 257 258 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD FIPS County Code 3 259 261 VARCHAR2 Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CBSA Urban Rural Indicator 1 262 262 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 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Federally Funded Health Center 1 612 612 VARCHAR2 Description: Indicates whether this FQHC (Federally Qualified Health Center) is federally funded. SAS Name: FED_FUNDD_FQHC_SW COBOL Name: FED-FUNDD-FQHC-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE FQHC Approved Rural Health Clinic 1 641 641 VARCHAR2 Description: Indicates if the Federally Qualified Health Center (FQHC) was a Medicare certified Rural Health Clinic (RHC). SAS Name: FQHC_APRVD_RHC_SW COBOL Name: FQHC-APRVD-RHC-SW * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE: 01/01/2013 DATE: 01/01/2013 POS RECORD LAYOUT PAGE: 1 Comprehensive Outpatient Rehab Facility, CATEGORY = "14" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Regional Override # 2 (Staffing) 1 1439 1439 VARCHAR2 Description: This field is set to 'Y' when the regional office has to approve a pending record in the special fields screen. This field only applies to categories in ODIE data entry system. SAS Name: OVRRD_STFG_SW COBOL Name: OVRRD-STFG-SW Related Provider Number 10 1510 1519 CHAR Description: Related provider number SAS Name: RLTD_PRVDR_NUM COBOL Name: RLTD-PRVDR-NUM