Type of Provider (Inactive)

70.20 - Type of Provider (Inactive) (Rev.12894; 10-17-24; Effective:11-01-24; Implementation:11-01-24) A3-3898.20 The intermediary reports provider enrollment application data in the following columns for all lines on Form 3. Column (1) - Total - The sum of columns 2-16 for each line. Column (2) - Accredited Hospital - Provider applications indicating provider type as an accredited hospital. Column (3) - Non-Accredited Hospital - Provider applications indicating provider type as a non- accredited hospital. Column (4) - Religious Nonmedical Health Care Facility - Hospital - Provider applications indicating provider type as a Religious Nonmedical Health Care Facility - hospital. Column (5) - Rural Primary Care Hospital - Provider applications indicating provider type as a rural primary care hospital. Column (6) - SNF - Provider applications indicating provider type as a skilled nursing facility (i.e., long term care facility). Column (7) - HHA. - Provider applications indicating provider type as a home health agency. Column (8) - Hospice - Provider applications indicating provider type as a hospice facility. Column (9) - ESRD - Provider applications indicating provider type as an end stage renal disease dialysis facility. Column (10) - CORF - Provider applications indicating provider type as a comprehensive outpatient rehabilitation facility. Column (11) - RHC - Provider applications indicating provider type as a rural health clinic. Column (12) - FQHC - Provider applications indicating provider type as a federally qualified health center. Column (13) - CMHC - Provider applications indicating provider type as a community mental health center. Column (14) - IHS - Provider applications indicating provider type as an Indian Health Service facility. Column (15) - Outp. Speech Path./Phy.Ther - Provider applications indicating provider type as either outpatient speech pathology or outpatient physical therapy facility. Column (16) - Other - Provider applications indicating provider type other than those defined for columns 1 through 15.