|
1 |
SUBMTG_STATE_PRVDR_ID |
Submitting State Provider Identification Number |
| 2 |
PRVDR_LGL_NAME |
Provider Legal Name |
| 3 |
STATE_CD |
Submitting State Alpha Abbreviation |
| 4 |
SUBMTG_STATE_CD |
Submitting State FIPS Code |
| 5 |
CMS_RGN |
CMS Region for Submitting State |
| 6 |
PRVDR_ENT_TYPE_CD |
Provider Entity Type Code — individual, group or facility |
| 7 |
PRVDR_TAX_NAME |
Provider Tax (IRS) Name |
| 8 |
PRVDR_ORG_NAME |
Provider Organization Name |
| 9 |
PRVDR_DBA_NAME |
Provider Doing Business as (DBA) Name |
| 10 |
PRVDR_NPI_1 |
Provider NPI — First Occurrence |
| 11 |
PRVDR_NPI_2 |
Provider NPI — Second Occurrence |
| 12 |
PRVDR_NPI_CNT |
Provider NPI Count |
| 13 |
SUBMTG_STATE_PRVDR_IND_01 |
Submitting State Provider Identifier Indicator — January |
| 14 |
SUBMTG_STATE_PRVDR_IND_02 |
Submitting State Provider Identifier Indicator — February |
| 15 |
SUBMTG_STATE_PRVDR_IND_03 |
Submitting State Provider Identifier Indicator — March |
| 16 |
SUBMTG_STATE_PRVDR_IND_04 |
Submitting State Provider Identifier Indicator — April |
| 17 |
SUBMTG_STATE_PRVDR_IND_05 |
Submitting State Provider Identifier Indicator — May |
| 18 |
SUBMTG_STATE_PRVDR_IND_06 |
Submitting State Provider Identifier Indicator — June |
| 19 |
SUBMTG_STATE_PRVDR_IND_07 |
Submitting State Provider Identifier Indicator — July |
| 20 |
SUBMTG_STATE_PRVDR_IND_08 |
Submitting State Provider Identifier Indicator — August |
| 21 |
SUBMTG_STATE_PRVDR_IND_9 |
Submitting State Provider Identifier Indicator — September |
| 22 |
SUBMTG_STATE_PRVDR_IND_10 |
Submitting State Provider Identifier Indicator — October |
| 23 |
SUBMTG_STATE_PRVDR_IND_11 |
Submitting State Provider Identifier Indicator — November |
| 24 |
SUBMTG_STATE_PRVDR_IND_12 |
Submitting State Provider Identifier Indicator — December |
| 25 |
PRVDR_LAST_NAME |
Provider Last Name — Individual |
| 26 |
PRVDR_FIRST_NAME |
Provider First Name — Individual |
| 27 |
PRVDR_MDL_INITL_NAME |
Provider Middle Initial — Individual |
| 28 |
PRVDR_SEX_CD |
Provider Sex Code |
| 29 |
PRVDR_BIRTH_DT |
Provider Date of Birth |
| 30 |
PRVDR_DEATH_DT |
Provider Date of Death |
| 31 |
PRVDR_AGE |
Provider Age (in Years) |
| 32 |
TCHNG_IND |
Provider Organization Teaching Facility Indicator — Ever in Calendar Year |
| 33 |
OWNRSHP_CD |
Provider Ownership Code — Latest in Year |
| 34 |
OWNRSHP_CTGRY_CD |
Provider Ownership Category Code — Latest in Year |
| 35 |
PRVDR_PRFT_STUS_CD |
Provider Profit Status Code — Latest in Year |
| 36 |
ACPTG_NEW_PTNTS_IND |
Provider Accepting New Patients Indicator — Ever in Calendar Year |
| 37 |
PRVDR_MDCD_ENRLMT_IND |
Enrolled in Medicaid Indicator — Ever in Calendar Year |
| 38 |
PRVDR_CHIP_ENRLMT_IND |
Enrolled in CHIP Indicator — Ever in Calendar Year |
| 39 |
NOT_SP_AFLTD_IND |
Not Affiliated with State Plan Indicator — Ever in Calendar Year |
| 40 |
PRVDR_ENRLMT_STUS_ACTV_IND |
Medicaid or CHIP Active Enrollment Indicator — Ever in Calendar Year |
| 41 |
PRVDR_ENRLMT_STUS_DND_IND |
Medicaid or CHIP Enrollment Denied Indicator — Ever in Calendar Year |
| 42 |
PRVDR_ENRLMT_STUS_TRMNTD_IND |
Medicaid or CHIP Enrollment Terminated Indicator — Ever in Calendar Year |
| 43 |
PRVDR_ENRLMT_STUS_PENDG_IND |
Medicaid or CHIP Enrollment Status Pending Indicator — Ever in Calendar Year |
| 44 |
MLT_SNGL_SPCLTY_GRP_TXNMY_IND |
Multi- or Single-Specialty Group Taxonomy Indicator — Ever in Calendar Year |
| 45 |
ALPTHC_OSTPTHC_PHYSN_TXNMY_IND |
Allopathic or Osteopathic Physician Taxonomy Indicator — Ever in Calendar Year |
| 46 |
BHVRL_HLTH_SCL_SRVC_TXNMY_IND |
Behavioral Health-Social Service Provider Taxonomy Indicator — Ever in Calendar Year |
| 47 |
CHRPRCTIC_TXNMY_IND |
Chiropractic Provider Taxonomy Indicator — Ever in Calendar Year |
| 48 |
DNTL_TXNMY_IND |
Dental Provider Taxonomy Indicator — Ever in Calendar Year |
| 49 |
DTRY_NTRTNL_SRVC_TXNMY_IND |
Dietary or Nutritional Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 50 |
EMER_MDCL_SRVC_TXNMY_IND |
Emergency Medical Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 51 |
EYE_VSN_SRVC_TXNMY_IND |
Eye or Vision Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 52 |
NRSNG_SRVC_TXNMY_IND |
Nursing Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 53 |
RLTD_NRSNG_SRVC_TXNMY_IND |
Related Nursing Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 54 |
OTHR_INDVDL_SRVC_TXNMY_IND |
Other Individual Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 55 |
PHRMCY_SRVC_TXNMY_IND |
Pharmacy Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 56 |
PA_APN_TXNMY_IND |
Physician Assistant or Advanced Practice Nursing Taxonomy Indicator — Ever in Calendar Year |
| 57 |
PDTRY_TXNMY_IND |
Podiatry Taxonomy Indicator — Ever in Calendar Year |
| 58 |
RT_DEVMTL_REHAB_RSTRTV_TXNMY_IND |
Respiratory, Development, Rehabilitate, or Restorative Services Taxonomy Indicator — Ever in Year |
| 59 |
SPCH_LANG_HEARG_TXNMY_IND |
Speech, Language or Hearing Services Taxonomy Indicator — Ever in Calendar Year |
| 60 |
STDNT_HLTH_CARE_PRVDR_TXNMY_IND |
Student Health Care Provider Taxonomy Indicator — Ever in Calendar Year |
| 61 |
RDLGY_OTHR_TCHNCL_SRVC_TXNMY_IND |
Radiologic and Other Technical Services Taxonomy Indicator — Ever in Calendar Year |
| 62 |
AGNCY_PRVDR_TXNMY_IND |
Agency Provider Taxonomy Indicator — Ever in Calendar Year |
| 63 |
AMBLTRY_CLNC_TXNMY_IND |
Ambulatory Health Services Clinic Taxonomy Indicator — Ever in Calendar Year |
| 64 |
HOSP_UNIT_TXNMY_IND |
Hospital Unit Provider Taxonomy Indicator — Ever in Calendar Year |
| 65 |
HOSP_TXNMY_IND |
Hospital Provider Taxonomy Indicator — Ever in Calendar Year |
| 66 |
LAB_TXNMY_IND |
Laboratory Provider Taxonomy Indicator — Ever in Calendar Year |
| 67 |
MCO_TXNMY_IND |
Managed Care Organization Taxonomy Indicator — Ever in Calendar Year |
| 68 |
NRSNG_CSTDL_CARE_PRVDR_TXNMY_IND |
Nursing Custodial Care Provider Taxonomy Indicator — Ever in Calendar Year |
| 69 |
LDGNG_MEALS_PRVDR_TXNMY_IND |
Lodging or Meals Provider Taxonomy Indicator — Ever in Calendar Year |
| 70 |
RSDNTL_TRTMT_FAC_TXNMY_IND |
Residential Treatment Facility Taxonomy Indicator — Ever in Calendar Year |
| 71 |
RESP_CARE_FAC_TXNMY_IND |
Respite Care Facility Taxonomy Indicator — Ever in Calendar Year |
| 72 |
SUPLR_PRVDR_TXNMY_IND |
Supplier Provider (DME, Pharmacy, Organs, Etc.) Taxonomy Indicator — Ever in Calendar Year |
| 73 |
TRNSPRTN_SRVC_TXNMY_IND |
Transportation Services Provider Taxonomy Indicator — Ever in Calendar Year |
| 74 |
SUD_SRVC_PRVDR_CLSFCTN_IND |
Substance Use Disorder Service Provider Classification Indicator — Ever in Calendar Year |
| 75 |
MH_SRVC_PRVDR_CLSFCTN_IND |
Mental Health Service Provider Classification Indicator — Ever in Calendar Year |
| 76 |
EMER_SRVC_PRVDR_CLSFCTN_IND |
Emergency Services Provider Classification Indicator — Ever in Calendar Year |
| 77 |
SPLMTL_ADDR_LCTN |
Annual Provider Record in Supplemental Provider Address Location File |
| 78 |
SPLMTL_LCNS_ACRDTN |
Annual Provider Record in Supplemental Provider License and Accreditation File |
| 79 |
SPLMTL_PRVDR_ID |
Annual Provider Record in Supplemental Identifier File |
| 80 |
SPLMTL_AFLTD_GRP |
Annual Provider Record in Supplemental Affiliated Groups File |
| 81 |
SPLMTL_AFLTD_PGM |
Annual Provider Record in Supplemental Affiliated Programs File |
| 82 |
SPLMTL_TXNMY |
Annual Provider Record in Supplemental Taxonomy File |
| 83 |
SPLMTL_ENRLMT |
Annual Provider Record in Supplemental Enrollment File |
| 84 |
SPLMTL_BED_TYPE |
Annual Provider Record in Supplemental Bed Type File |
| 85 |
CCW_APL_LINK_KEY |
CCW Key to Link APL base Record to Related Supplement Records |
| 86 |
DA_RUN_ID |
TAF Production Run Identifier (unique for each TAF run) |
| 87 |
PR_VRSN |
Provider File Version Representing the Iteration of the File |
| 88 |
RFRNC_YR |
Reference Year (TAF) |
| 89 |
CCW_LD_DT |
CCW Load Date |