********************************************* * * * 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. * * * DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 2 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE * FILE CREATION DATE = 01/02/2018 * * * ********************************************* DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 2 Provider Category Subtype Code 2 1 2 VARCHAR2 Description: Identifies the subtype of the provider, within the primary category. Used in reporting to show the breakdown of provider categories, mainly for hospitals and SNFs. SAS Name: PRVDR_CTGRY_SBTYP_CD COBOL Name: PRVDR-CTGRY-SBTYP-CD VALUES: 01=CLIA88 Laboratory Provider Category Code 2 3 4 VARCHAR2 Description: Identifies the type of provider participating in the Medicare/Medicaid program. SAS Name: PRVDR_CTGRY_CD COBOL Name: PRVDR-CTGRY-CD VALUES: 22=CLIA Laboratory CHOW Count 2 5 6 NUMBER Description: Number of times this provider has undergone a change of ownership. SAS Name: CHOW_CNT COBOL Name: CHOW-CNT CHOW Date 8 7 14 DATE Description: Effective date of the most recent change of ownership for this provider. SAS Name: CHOW_DT COBOL Name: CHOW-DT Address: City 28 15 42 VARCHAR2 Description: City in which the provider is physically located. SAS Name: CITY_NAME COBOL Name: CITY-NAME Compliance: Acceptable POC 1 43 43 VARCHAR2 Description: Indicates if a provider is in compliance with program requirements based on an acceptable plan for correction of deficiencies. SAS Name: ACPTBL_POC_SW COBOL Name: ACPTBL-POC-SW Compliance: Status 1 44 44 VARCHAR2 Description: Compliance status of a provider at the time of certification survey. SAS Name: CMPLNC_STUS_CD COBOL Name: CMPLNC-STUS-CD VALUES: A=IN COMPLIANCE B=NOT IN COMPLIANCE SSA County Code 3 45 47 VARCHAR2 Description: Social Security Administration geographic code indicating the county where the provider is located. SAS Name: SSA_CNTY_CD COBOL Name: SSA-CNTY-CD Cross Ref Provider Number 10 48 57 CHAR Description: Cross reference provider number SAS Name: CROSS_REF_PROVIDER_NUMBER COBOL Name: CROSS-REF-PROVIDER-NUMBER Certification Date 8 58 65 DATE Description: Equal to the exit date of the initial visit of the Health DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 3 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE survey for certifications completed after July 28, 2012. For certifications prior to that date, the certification date is equal to the exit date of the initial visit of the Health survey or LSC survey, whichever is later. SAS Name: CRTFCTN_DT COBOL Name: CRTFCTN-DT Eligibility Indicator 1 66 66 VARCHAR2 Description: Indicates if a facility is eligible to participate in the Medicare and/or Medicaid programs. SAS Name: ELGBLTY_SW COBOL Name: ELGBLTY-SW Facility Name 50 67 116 VARCHAR2 Description: Name of the provider certified to participate in the Medicare and/or Medicaid programs. SAS Name: FAC_NAME COBOL Name: FAC-NAME Medicare Administrative Contractor (MAC) or 5 117 121 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_CD COBOL Name: INTRMDRY-CARR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 4 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 5 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01111=Noridian (CA) 01112=Noridian (NF) 01120=AETNA (HAWAII) 01182=Noridian (SF) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01211=Noridian (AS, GU, HI) 01212=Noridian (AS, GU, HI) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01311=Noridian (NV) 01312=Noridian (NV) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 01911=Noridian (AS, GU, HI, NV) 02050=OCCIDENTAL (CALIFORNIA) 02101=Noridian AK 02102=Noridian AK 02201=Noridian ID 02202=Noridian ID 02301=Noridian OR 02302=Noridian OR 02401=Noridian WA 02402=Noridian WA 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 6 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04211=NOVITAS (NEW MEXICO) 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06001=NGS (WI) 06004=National Govt Serv HHH 06101=NGS (IL) 06102=NGS (IL) 06201=NGS (MN) 06202=NGS (MN) 06301=NGS (WI) 06302=NGS (WI) 07101=Novitas AR 07102=Novitas AR 07201=Novitas LA 07202=Novitas LA 07301=Novitas MS 07302=Novitas MS 08101=WPS IN 08102=WPS IN 08201=WPS MI 08202=WPS MI 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 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 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 7 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=Novitas DE 12102=Novitas DE 12201=Novitas DC 12202=Novitas DC 12301=Novitas MD 12302=Novitas MD 12401=Novitas NJ 12402=Novitas NJ 12501=Novitas PA 12502=Novitas PA 12901=Novitas Solutions DC, DE, MD, PA 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NGS (UN) 13292=NGS (QN) 14004=NATIONAL HERITAGE (HHA - A) 14014=NGS (HHA) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14111=NGS (ME) 14112=NGS (ME) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14211=NGS (MA) 14212=NGS (MA) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14311=NGS (NH) 14312=NGS (NH) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14411=NGS (RI) 14412=NGS (RI) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 14511=NGS (VT) 14512=NGS (VT) 15004=CGS Administrators HHH 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 8 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 51390=AETNA (FORT WASHINGTON) 52280=WISCONSIN PHYSICIANS SERVICE 57400=COOPERATIVA (PUERTO RICO) Medicaid Vendor Number 15 122 136 VARCHAR2 Description: Number which may be assigned to a provider by the state Medicaid agency for external control or billing purposes. SAS Name: MDCD_VNDR_NUM COBOL Name: MDCD-VNDR-NUM Original Participation Date 8 137 144 DATE Description: Date a provider is first approved to provide Medicare and/or Medicaid services. SAS Name: ORGNL_PRTCPTN_DT COBOL Name: ORGNL-PRTCPTN-DT Prior CHOW Date 8 145 152 DATE Description: Effective date of the previous change of ownership for this provider. SAS Name: CHOW_PRIOR_DT COBOL Name: CHOW-PRIOR-DT Prior Medicare Administrative Contractor (MAC) or 5 153 157 VARCHAR2 Intermediary or Carrier Code Description: Number assigned to the previous Medicare Administrative Contractor, intermediary or carrier servicing this provider. SAS Name: INTRMDRY_CARR_PRIOR_CD COBOL Name: INTRMDRY-CARR-PRIOR-CD VALUES: 00000=DUMMY FOR MEDICAID HHA 00010=BLUE CROSS (ALABAMA) 00011=CAHABA 00020=BLUE CROSS (ARKANSAS) 00040=BLUE CROSS (CALIFORNIA) 00060=BLUE CROSS (CONNECTICUT) 00070=BLUE CROSS (DELAWARE) 00090=BLUE CROSS (FLORIDA) 00101=BLUE CROSS (GEORGIA) 00121=HEALTH CARE SERVICE CORPORATION 00122=HCSC - MICHIGAN 00123=HCSC OF MICHIGAN 00130=NATIONAL GOVERNMENT SERVICES 00131=NATIONAL GOVERNMENT SERVICES 00140=BLUE CROSS (IOWA/SOUTH DAKOTA) 00150=BLUE CROSS (KANSAS) 00160=NATIONAL GOVERNMENT SERVICES 00180=NATIONAL GOVERNMENT SERVICES 00181=NATIONAL GOVERNMENT SERVICES 00190=BLUE CROSS (MARYLAND) 00200=BLUE CROSS (MASSACHUSETTS) 00210=BLUE CROSS (MICHIGAN) 00220=BLUE CROSS (MINNESOTA) 00230=BLUE CROSS (MISSISSIPPI) 00231=BLUE CROSS (LOUISIANA) 00233=PINNACLE 00241=BLUE CROSS (MISSOURI) 00260=BLUE CROSS (NEBRASKA) 00270=NATIONAL GOVERNMENT SERVICES 00280=BLUE CROSS (NEW JERSEY) 00290=BLUE CROSS (NEW MEXICO) 00308=NATIONAL GOVERNMENT SERVICES 00310=BLUE CROSS (NORTH CAROLINA) 00320=NORIDIAN PART A 00322=NORIDIAN PART A (AK/WA) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 9 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00323=NORIDIAN PART A (ID/OR) 00325=NORIDIAN 00332=NATIONAL GOVERNMENT SERVICES 00340=BLUE CROSS (OKLAHOMA) 00350=BLUE CROSS (OREGON) 00351=BLUE CROSS (OREGON) (IDAHO CLAIMS) 00362=BLUE CROSS (INDEPENDENCE) 00363=BLUE CROSS (WESTERN PENNSYLVANIA) 00366=HIGHMARK MEDICARE SERVICES 00370=BLUE CROSS (RHODE ISLAND) 00380=BLUE CROSS (SOUTH CAROLINA) 00390=BLUE CROSS (TENNESSEE) 00400=BLUE CROSS (TEXAS) 00410=BLUE CROSS (UTAH) 00423=BLUE CROSS (VIRGINIA/WEST VA) 00430=BLUE CROSS (WASHINGTON & ALASKA) 00450=NATIONAL GOVERNMENT SERVICES 00452=NATIONAL GOVERNMENT SERVICES 00453=NATIONAL GOVERNMENT SERVICES 00454=NATIONAL GOVERNMENT SERVICES 00456=NATIONAL GOVERNMENT SERVICES 00468=BLUE CROSS (NORTH CAROLINA FOR PR) 00510=BLUE SHIELD (ALABAMA) 00511=CAHABA 00512=CAHABA 00520=BLUE SHIELD (ARKANSAS) 00528=BLUE SHIELD (ARKANSAS/LOUISIANA) 00542=BLUE SHIELD (CALIFORNIA) 00550=BLUE SHIELD (COLORADO) 00570=BLUE SHIELD (DELAWARE) 00580=BLUE SHIELD (DISTRICT OF COLUMBIA) 00590=BLUE SHIELD (FLORIDA) 00621=BLUE SHIELD (ILLINOIS) 00630=NATIONAL GOVERNMENT SERVICES 00640=BLUE SHIELD (IOWA) 00650=BLUE SHIELD (KANSAS) 00655=BLUE SHIELD (KANSAS/NEBRASKA) 00660=NATIONAL GOVERNMENT SERVICES 00690=BLUE SHIELD (MARYLAND) 00700=BLUE SHIELD (MASSACHUSETTS) 00710=BLUE SHIELD (MICHIGAN) 00720=BLUE SHIELD (MINNESOTA) 00740=BLUE SHIELD (KANSAS CITY) 00770=BLUE SHIELD (NEW HAMPSHIRE/VERMONT) 00780=BLUE SHIELD (TRI-STATE) 00801=BLUE SHIELD (BUFFALO) 00803=NATIONAL GOVERNMENT SERVICES 00805=NATIONAL GOVERNMENT SERVICES 00821=NORIDIAN 00824=NORIDIAN GVT SERVICES (CO) 00826=NORIDIAN GVT SERVICES (IA) 00831=NORIDIAN GVT SERVICES (AK) 00832=NORIDIAN GVT SERVICES (AZ) 00833=NORIDIAN GVT SERVICES (HI) 00834=NORIDIAN GVT SERVICES (NV) 00835=NORIDIAN GVT SERVICES (OR) 00836=NORIDIAN GVT SERVICES (WA) 00860=BLUE SHIELD (PENNSYLVANIA/NEW JERSEY) 00865=BLUE SHIELD (PENNSYLVANIA) 00870=BLUE SHIELD (RHODE ISLAND) 00880=BLUE SHIELD (SOUTH CAROLINA) 00883=PALMETTO GBA PART B 00884=PALMETTO GBA 00889=NORIDIAN GVT SERVICES (SD) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 10 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 00900=BLUE SHIELD (TEXAS) 00901=TRAILBLAZERS HEALTH ENTERPRISES 00904=TRAILBLAZER 00910=BLUE SHIELD (UTAH) 00930=BLUE SHIELD (WASHINGTON) 00951=WISCONSIN PHYSICIANS SERVICE 00952=WPS - ILLINOIS 00953=WPS - MICHIGAN 00954=WI PHYSICIAN SERVICES - MN 00973=BLUE SHIELD (PUERTO RICO) 00974=BLUE SHIELD (VIRGIN ISLANDS) 01010=AETNA (PEORIA) 01020=AETNA (ALASKA) 01030=AETNA (ARIZONA) 01040=AETNA (GEORGIA) 01101=PALMETTO (CALIFORNIA) 01102=PALMETTO (CALIFORNIA (NORTH) 01111=Noridian (CA) 01112=Noridian (NF) 01120=AETNA (HAWAII) 01182=Noridian (SF) 01192=PALMETTO (CALIFORNIA SOUTH) 01201=PALMETTO (HAWAII) 01202=PALMETTO (HAWAII) 01211=Noridian (AS, GU, HI) 01212=Noridian (AS, GU, HI) 01290=AETNA (NEVADA) 01301=PALMETTO (NEVADA) 01302=PALMETTO (NEVADA) 01311=Noridian (NV) 01312=Noridian (NV) 01360=AETNA (NEW MEXICO) 01370=AETNA (OKLAHOMA) 01380=AETNA (OREGON) 01390=AETNA (WASHINGTON) 01901=PALMETTO GBA 01902=PALMETTO GBA 01911=Noridian (AS, GU, HI, NV) 02050=OCCIDENTAL (CALIFORNIA) 02101=Noridian AK 02102=Noridian AK 02201=Noridian ID 02202=Noridian ID 02301=Noridian OR 02302=Noridian OR 02401=Noridian WA 02402=Noridian WA 03001=NORIDIAN ADMIN SERVICES 03101=NORIDAN (ARIZONA) 03102=NORIDAN (ARIZONA) 03201=NORIDAN (MONTANA) 03202=NORIDAN (MONTANA) 03301=NORDIAN (NORTH DAKOTA) 03302=NORDIAN (NORTH DAKOTA) 03401=NORIDIAN (SOUTH DAKOTA) 03402=NORIDIAN (SOUTH DAKOTA) 03501=NORIDIAN (UTAH) 03502=NORIDIAN (UTAH) 03601=NORIDIAN (WYOMING) 03602=NORIDIAN (WYOMING) 04001=TRAILBLAZER 04101=TRAILBLAZER (COLORADO) 04102=TRAILBLAZER (COLORADO) 04111=NOVITAS (COLORADO) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 11 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 04112=NOVITAS (COLORADO) 04201=TRAILBLAZER (NEW MEXICO) 04202=TRAILBLAZER (NEW MEXICO) 04211=NOVITAS (NEW MEXICO) 04212=NOVITAS (NEW MEXICO) 04301=TRAILBLAZER (OKLAHOMA) 04302=TRAILBLAZER (OKLAHOMA) 04311=NOVITAS (OKLAHOMA) 04312=NOVITAS (OKLAHOMA) 04401=TRAILBLAZER (TEXAS) 04402=TRAILBLAZER (TEXAS) 04411=NOVITAS (TEXAS) 04412=NOVITAS (TEXAS) 04901=MUTUAL LEGACY 04911=NOVITAS 05101=WPS (IOWA) 05102=WPS (IOWA) 05130=EQICOR (IDAHO) 05201=WPS (KANSAS) 05202=WPS (KANSAS) 05301=WPS (MISSOURI) 05302=WPS (MISSOURI WEST) 05392=WPS (MISSOURI EAST) 05401=WPS (NEBRASKA) 05402=WPS (NEBRASKA) 05440=EQICOR (TENNESSEE) 05535=EQICOR (NORTH CAROLINA) 05901=WISCONSIN PHYSICIANS SERVICE 06001=NGS (WI) 06004=National Govt Serv HHH 06101=NGS (IL) 06102=NGS (IL) 06201=NGS (MN) 06202=NGS (MN) 06301=NGS (WI) 06302=NGS (WI) 07101=Novitas AR 07102=Novitas AR 07201=Novitas LA 07202=Novitas LA 07301=Novitas MS 07302=Novitas MS 08101=WPS IN 08102=WPS IN 08201=WPS MI 08202=WPS MI 09101=FIRST COAST (FLORIDA) 09102=FIRST COAST (FLORIDA) 09201=FIRST COAST (PUERTO RICO/VIRGIN ISLANDS) 09202=FIRST COAST (PUERTO RICO) 09302=FIRST COAST (VIRGIN ISLANDS) 10071=TRAVELERS (RRB) 10101=CAHABA GBA (AL) 10102=CAHABA GBA (AL) 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 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 12 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 11201=PALMETTO GBA (SC) 11202=PALMETTO GBA (SC) 11260=GENERAL AMERICAN 11301=PALMETTO GBA (VA) 11302=PALMETTO GBA (VA) 11401=PALMETTO GBA (WV) 11402=PALMETTO GBA (WV) 11501=PALMETTO GBA (NC) 11502=PALMETTO GBA (NC) 12101=Novitas DE 12102=Novitas DE 12201=Novitas DC 12202=Novitas DC 12301=Novitas MD 12302=Novitas MD 12401=Novitas NJ 12402=Novitas NJ 12501=Novitas PA 12502=Novitas PA 12901=Novitas Solutions DC, DE, MD, PA 12902=HIGHMARK 13101=NATIONAL GOVT SERVICES (CONNECTICUT) 13102=NATIONAL GOVT SERVICES (CONNECTICUT) 13201=NATIONAL GOVT SERVICES (NEW YORK) 13202=NATIONAL GOVT SERVICES (NEW YORK - EMPIRE) 13282=NGS (UN) 13292=NGS (QN) 14004=NATIONAL HERITAGE (HHA - A) 14014=NGS (HHA) 14101=NATIONAL HERITAGE (MAINE) 14102=NATIONAL HERITAGE (MAINE) 14111=NGS (ME) 14112=NGS (ME) 14201=NATIONAL HERITAGE (MASSACHUSETTS) 14202=NATIONAL HERITAGE (MASSACHUSETTS) 14211=NGS (MA) 14212=NGS (MA) 14301=NATIONAL HERITAGE (NEW HAMPSHIRE) 14302=NATIONAL HERITAGE (NEW HAMPSHIRE) 14311=NGS (NH) 14312=NGS (NH) 14330=GROUP HEALTH INC (NEW YORK) 14401=NATIONAL HERITAGE (RHODE ISLAND) 14402=NATIONAL HERITAGE (RHODE ISLAND) 14411=NGS (RI) 14412=NGS (RI) 14501=NATIONAL HERITAGE (VERMONT) 14502=NATIONAL HERITAGE (VERMONT) 14511=NGS (VT) 14512=NGS (VT) 15004=CGS Administrators HHH 15101=CGS (KENTUCKY) 15102=CGS (KENTUCKY) 15201=CGS (OHIO) 15202=CGS (OHIO) 16360=NATIONWIDE (OHIO) 16510=NATIONWIDE (WEST VIRGINIA) 17120=HAWAII MEDICAL SERVICE ASSOCIATION 21200=MASSACHUSETTS/MAINE 31142=NATIONAL HERITAGE INSURANCE CO (MAINE) 31143=NATIONAL HERITAGE INSURANCE CO 31144=NATIONAL HERITAGE INSURANCE CO 50333=TRAVELERS (NEW YORK) 51051=AETNA (PETALUMA) DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 13 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 51070=AETNA (FARMINGTON) 51100=AETNA (CLEARWATER) 51140=AETNA (PEORIA) 51390=AETNA (FORT WASHINGTON) 52280=WISCONSIN PHYSICIANS SERVICE 57400=COOPERATIVA (PUERTO RICO) CCN 10 158 167 VARCHAR2 Description: Six or ten position identification number that is assigned to a certified provider. This is the CMS Certification Number. SAS Name: PRVDR_NUM COBOL Name: PRVDR-NUM Region Code 2 168 169 VARCHAR2 Description: Indicates the CMS Regional Office responsible for the certification of the provider. SAS Name: RGN_CD COBOL Name: RGN-CD VALUES: 01=Boston 02=New York 03=Philadelphia 04=Atlanta 05=Chicago 06=Dallas 07=Kansas City 08=Denver 09=San Francisco 10=Seattle Skeleton Record Indicator 1 170 170 VARCHAR2 Description: Indicates if the record is a skeleton record. Only a limited set of data is available for this provider; no survey data exists. Only provider categories 01,17,19,21and 22 can have skeleton providers. SAS Name: SKLTN_REC_SW COBOL Name: SKLTN-REC-SW State Abbreviation 2 171 172 VARCHAR2 Description: Two-character state abbreviation. SAS Name: STATE_CD COBOL Name: STATE-CD VALUES: AK=ALASKA AL=ALABAMA AR=ARKANSAS AS=AMERICAN SAMOA AZ=ARIZONA CA=CALIFORNIA CN=CANADA CO=COLORADO CT=CONNECTICUT DC=DISTRICT OF COLUMBIA DE=DELAWARE FL=FLORIDA FN=INTERNATIONAL GA=GEORGIA GU=GUAM HI=HAWAII IA=IOWA ID=IDAHO IL=ILLINOIS IN=INDIANA KS=KANSAS KY=KENTUCKY DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 14 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE LA=LOUISIANA MA=MASSACHUSETTS MD=MARYLAND ME=MAINE MI=MICHIGAN MN=MINNESOTA MO=MISSOURI MP=SAIPAN MS=MISSISSIPPI MT=MONTANA MX=MEXICO NC=NORTH CAROLINA ND=NORTH DAKOTA NE=NEBRASKA NH=NEW HAMPSHIRE NJ=NEW JERSEY NM=NEW MEXICO NV=NEVADA NY=NEW YORK OH=OHIO OK=OKLAHOMA OR=OREGON PA=PENNSYLVANIA PR=PUERTO RICO RI=RHODE ISLAND SC=SOUTH CAROLINA SD=SOUTH DAKOTA TN=TENNESSEE TX=TEXAS UT=UTAH VA=VIRGINIA VI=VIRGIN ISLANDS VT=VERMONT WA=WASHINGTON WI=WISCONSIN WV=WEST VIRGINIA WY=WYOMING SSA State Code 2 173 174 VARCHAR2 Description: Social Security Administration geographic code indicating the state where the provider is located. SAS Name: SSA_STATE_CD COBOL Name: SSA-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 03=ARIZONA 04=ARKANSAS 05=CALIFORNIA 06=COLORADO 07=CONNECTICUT 08=DELAWARE 09=DISTRICT OF COLUMBIA 10=FLORIDA 11=GEORGIA 12=HAWAII 13=IDAHO 14=ILLINOIS 15=INDIANA 16=IOWA 17=KANSAS 18=KENTUCKY 19=LOUISIANA 20=MAINE 21=MARYLAND DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 15 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 22=MASSACHUSETTS 23=MICHIGAN 24=MINNESOTA 25=MISSISSIPPI 26=MISSOURI 27=MONTANA 28=NEBRASKA 29=NEVADA 30=NEW HAMPSHIRE 31=NEW JERSEY 32=NEW MEXICO 33=NEW YORK 34=NORTH CAROLINA 35=NORTH DAKOTA 36=OHIO 37=OKLAHOMA 38=OREGON 39=PENNSYLVANIA 40=PUERTO RICO 41=RHODE ISLAND 42=SOUTH CAROLINA 43=SOUTH DAKOTA 44=TENNESSEE 45=TEXAS 46=UTAH 47=VERMONT 48=VIRGIN ISLANDS 49=VIRGINIA 50=WASHINGTON 51=WEST VIRGINIA 52=WISCONSIN 53=WYOMING 54=AFRICA 56=CANADA 57=WEST INDIES 58=EUROPE 59=MEXICO 60=OCEANIA 61=PHILIPPINES 62=SOUTH AMERICA 63=UNITED STATES POSSESSIONS 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN 99=INTERNATIONAL State Region Code 3 175 177 VARCHAR2 Description: Identifies the region within a state where the provider is located. SAS Name: STATE_RGN_CD COBOL Name: STATE-RGN-CD VALUES: AK/001=ALASKA AK/LAB=LABORATORIES 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 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 16 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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=INTERNATIONAL FN/LAB=LABORATORIES GA/001=GEORGIA GA/GAA=GEORGIA ALL GA/GAC=GEORGIA CENTRAL GA/GAE=GEORGIA EASTERN GA/GAN=GEORGIA NORTH GA/GAS=GEORGIA SOUTH GA/GAW=GEORGIA WESTERN GA/LAB=LABORATORIES GU/001=GUAM GU/LAB=LABORATORIES HI/001=HAWAII HI/LAB=LABORATORIES IA/001=IOWA IA/LAB=LABORATORIES ID/001=IDAHO ID/LAB=LABORATORIES DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 17 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE IL/001=ILLINOIS IL/LAB=LABORATORIES IN/001=INDIANA IN/LAB=LABORATORIES KS/KCK=KANSAS CITY KS/KDH=KDHE 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 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 18 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 19 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 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 Address: Street 50 178 227 VARCHAR2 Description: Street address where the provider is located. SAS Name: ST_ADR COBOL Name: ST-ADR Telephone Number 10 228 237 VARCHAR2 Description: Telephone number of the provider. SAS Name: PHNE_NUM COBOL Name: PHNE-NUM Termination Code 2 238 239 VARCHAR2 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 20 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates the current termination status for the provider. SAS Name: PGM_TRMNTN_CD COBOL Name: PGM-TRMNTN-CD VALUES: 00=ACTIVE PROVIDER 01=VOLUNTARY-MERGER, CLOSURE 02=VOLUNTARY-DISSATISFACTION WITH REIMBURSEMENT 03=VOLUNTARY-RISK OF INVOLUNTARY TERMINATION 04=VOLUNTARY-OTHER REASON FOR WITHDRAWAL 05=INVOLUNTARY-FAILURE TO MEET HEALTH/SAFETY REQ 06=INVOLUNTARY-FAILURE TO MEET AGREEMENT 07=OTHER-PROVIDER STATUS CHANGE 08=NONPAYMENT OF FEES - CLIA Only 09=REV/UNSUCCESSFUL PARTICIPATION IN PT - CLIA Only 10=REV/OTHER REASON - CLIA Only 11=INCOMPLETE CLIA APPLICATION INFORMATION - CLIA Only 12=NO LONGER PERFORMING TESTS - CLIA Only 13=MULTIPLE TO SINGLE SITE CERTIFICATE - CLIA Only 14=SHARED LABORATORY - CLIA Only 15=FAILURE TO RENEW WAIVER PPM CERTIFICATE - CLIA Only 16=DUPLICATE CLIA NUMBER - CLIA Only 17=MAIL RETURNED NO FORWARD ADDRESS CERT ENDED - CLIA Only 20=NOTIFICATION BANKRUPTCY - CLIA Only 33=ACCREDITATION NOT CONFIRMED - CLIA Only 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE - CLIA Only Termination or Expiration Date 8 240 247 DATE Description: Date the provider was terminated. For CLIA providers, date the laboratory's certificate was terminated or the expiration date of the current CLIA certificate. SAS Name: TRMNTN_EXPRTN_DT COBOL Name: TRMNTN-EXPRTN-DT Type of Action Code 1 248 248 VARCHAR2 Description: Identifies the reason for the certification. Type of action from the official survey record, CMS 1539 form. SAS Name: CRTFCTN_ACTN_TYPE_CD COBOL Name: CRTFCTN-ACTN-TYPE-CD VALUES: 1=INITIAL 2=RECERTIFICATION 3=TERMINATION 4=CHANGE OF OWNERSHIP 5=VALIDATION 8=FULL SURVEY AFTER COMPLAINT Ownership Type Code 2 249 250 VARCHAR2 Description: Indicates the ownership type of the provider. SAS Name: GNRL_CNTL_TYPE_CD COBOL Name: GNRL-CNTL-TYPE-CD VALUES: 01=RELIGIOUS AFFILIATION 02=PRIVATE 03=OTHER 04=PROPRIETARY 05=GOVERNMENT - CITY 06=GOVERNMENT - COUNTY 07=GOVERNMENT - STATE 08=GOVERNMENT - FEDERAL 09=GOVERNMENT - OTHER 10=UNKNOWN Address: ZIP Code 5 251 255 VARCHAR2 Description: Five-digit ZIP code for a provider's physical address. SAS Name: ZIP_CD DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 21 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: ZIP-CD FIPS State Code 2 256 257 VARCHAR2 Description: FIPS State Code SAS Name: FIPS_STATE_CD COBOL Name: FIPS-STATE-CD VALUES: 01=ALABAMA 02=ALASKA 04=ARIZONA 05=ARKANSAS 06=CALIFORNIA 08=COLORADO 09=CONNECTICUT 10=DELAWARE 11=DISTRICT OF COLUMBIA 12=FLORIDA 13=GEORGIA 15=HAWAII 16=IDAHO 17=ILLINOIS 18=INDIANA 19=IOWA 20=KANSAS 21=KENTUCKY 22=LOUISIANA 23=MAINE 24=MARYLAND 25=MASSACHUSETTS 26=MICHIGAN 27=MINNESOTA 28=MISSISSIPPI 29=MISSOURI 30=MONTANA 31=NEBRASKA 32=NEVADA 33=NEW HAMPSHIRE 34=NEW JERSEY 35=NEW MEXICO 36=NEW YORK 37=NORTH CAROLINA 38=NORTH DAKOTA 39=OHIO 40=OKLAHOMA 41=OREGON 42=PENNSYLVANIA 43=PUERTO RICO 44=RHODE ISLAND 45=SOUTH CAROLINA 46=SOUTH DAKOTA 47=TENNESSEE 48=TEXAS 49=UTAH 50=VERMONT 51=VIRGINIA 53=WASHINGTON 54=WEST VIRGINIA 55=WISCONSIN 56=WYOMING 64=AMERICAN SAMOA 65=GUAM 66=SAIPAN/MARIANA IS. 78=VIRGIN ISLANDS FIPS County Code 3 258 260 VARCHAR2 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 22 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: FIPS County Code SAS Name: FIPS_CNTY_CD COBOL Name: FIPS-CNTY-CD CBSA Urban Rural Indicator 1 261 261 VARCHAR2 Description: CBSA (Core Based Statistical Area) indicates whether the county is defined as Urban or Rural. SAS Name: CBSA_URBN_RRL_IND COBOL Name: CBSA-URBN-RRL-IND CBSA Code 5 262 266 VARCHAR2 Description: CBSA (Core Based Statistical Area) geographic entities defined by the U.S. Office of Management and Budget (OMB) on June 6, 2003 for use by Federal statistical agencies in collecting, tabulating, and publishing Federal statistics. CBSA collectively refers to MSA. SAS Name: CBSA_CD COBOL Name: CBSA-CD Address: Street 2nd Line 50 267 316 VARCHAR2 Description: Second line of a laboratory's street address. SAS Name: ADDTNL_ST_ADR COBOL Name: ADDTNL-ST-ADR Affiliated Provider Number 1 10 317 326 CHAR Description: Affiliated provider number 1 SAS Name: AFFILIATED_PROVIDER_NUMBER_1 COBOL Name: AFFILIATED-PROVIDER-NUMBER-1 Affiliated Provider Number 2 10 327 336 CHAR Description: Affiliated provider number 2 SAS Name: AFFILIATED_PROVIDER_NUMBER_2 COBOL Name: AFFILIATED-PROVIDER-NUMBER-2 Affiliated Provider Number 3 10 337 346 CHAR Description: Affiliated provider number 3 SAS Name: AFFILIATED_PROVIDER_NUMBER_3 COBOL Name: AFFILIATED-PROVIDER-NUMBER-3 Affiliated Provider Number 4 10 347 356 CHAR Description: Affiliated provider number 4 SAS Name: AFFILIATED_PROVIDER_NUMBER_4 COBOL Name: AFFILIATED-PROVIDER-NUMBER-4 Affiliated Provider Number 5 10 357 366 CHAR Description: Affiliated provider number 5 SAS Name: AFFILIATED_PROVIDER_NUMBER_5 COBOL Name: AFFILIATED-PROVIDER-NUMBER-5 Affiliated Provider Number 6 10 367 376 CHAR Description: Affiliated provider number 6 SAS Name: AFFILIATED_PROVIDER_NUMBER_6 COBOL Name: AFFILIATED-PROVIDER-NUMBER-6 Affiliated Provider Number 7 10 377 386 CHAR Description: Affiliated provider number 7 SAS Name: AFFILIATED_PROVIDER_NUMBER_7 COBOL Name: AFFILIATED-PROVIDER-NUMBER-7 Affiliated Provider Number 8 10 387 396 CHAR Description: Affiliated provider number 8 SAS Name: AFFILIATED_PROVIDER_NUMBER_8 COBOL Name: AFFILIATED-PROVIDER-NUMBER-8 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 23 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE AO A2LA Accredited Code 1 397 397 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Association for Laboratory Accreditation. This information is from the lab's CMS-116. SAS Name: A2LA_ACRDTD_CD COBOL Name: A2LA-ACRDTD-CD VALUES: X=ACCREDITED AO A2LA Accredited Y Match Date 8 398 405 DATE Description: Date the American Association for Laboratory Accreditation confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: A2LA_ACRDTD_Y_MATCH_DT COBOL Name: A2LA-ACRDTD-Y-MATCH-DT AO A2LA Accredited Y Match Indicator 1 406 406 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Association for Laboratory Accreditation. SAS Name: A2LA_ACRDTD_Y_MATCH_SW COBOL Name: A2LA-ACRDTD-Y-MATCH-SW AO AABB Accredited Code 1 407 407 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Association of Blood Banks. This information is from the lab's CMS-116. SAS Name: AABB_ACRDTD_CD COBOL Name: AABB-ACRDTD-CD VALUES: X=ACCREDITED AO AABB Accredited Y Match Date 8 408 415 DATE Description: Date the American Association of Blood Banks confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: AABB_ACRDTD_Y_MATCH_DT COBOL Name: AABB-ACRDTD-Y-MATCH-DT AO AABB Accredited Y Match Indicator 1 416 416 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Association of Blood Banks. SAS Name: AABB_ACRDTD_Y_MATCH_SW COBOL Name: AABB-ACRDTD-Y-MATCH-SW AO AOA Accredited Code 1 417 417 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Osteopathic Association. This information is from the lab's CMS-116. SAS Name: AOA_ACRDTD_CD COBOL Name: AOA-ACRDTD-CD VALUES: X=ACCREDITED AO AOA Accredited Y Match Date 8 418 425 DATE Description: Date the American Osteopathic Association confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: AOA_ACRDTD_Y_MATCH_DT COBOL Name: AOA-ACRDTD-Y-MATCH-DT AO AOA Accredited Y Match Indicator 1 426 426 VARCHAR2 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 24 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Indicates if the lab is confirmed as accredited by the American Osteopathic Association. SAS Name: AOA_ACRDTD_Y_MATCH_SW COBOL Name: AOA-ACRDTD-Y-MATCH-SW AO ASHI Accredited Code 1 427 427 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the American Society for Histocompatibility and Immunogenetics. This information is from the lab's CMS-116. SAS Name: ASHI_ACRDTD_CD COBOL Name: ASHI-ACRDTD-CD VALUES: X=ACCREDITED AO ASHI Accredited Y Match Date 8 428 435 DATE Description: Date the American Society for Histocompatibility and Immunogenetics confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: ASHI_ACRDTD_Y_MATCH_DT COBOL Name: ASHI-ACRDTD-Y-MATCH-DT AO ASHI Accredited Y Match Indicator 1 436 436 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the American Society for Histocompatibility and Immunogenetics. SAS Name: ASHI_ACRDTD_Y_MATCH_SW COBOL Name: ASHI-ACRDTD-Y-MATCH-SW AO CAP Accredited Code 1 437 437 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the College of American Pathologists. This information is from the lab's CMS-116. SAS Name: CAP_ACRDTD_CD COBOL Name: CAP-ACRDTD-CD VALUES: X=ACCREDITED AO CAP Accredited Y Match Date 8 438 445 DATE Description: Date the College of American Pathologists confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: CAP_ACRDTD_Y_MATCH_DT COBOL Name: CAP-ACRDTD-Y-MATCH-DT AO CAP Accredited Y Match Indicator 1 446 446 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the College of American Pathologists. SAS Name: CAP_ACRDTD_Y_MATCH_SW COBOL Name: CAP-ACRDTD-Y-MATCH-SW AO COLA Accredited Code 1 447 447 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the Commission on Office Laboratory Accreditation. This information is from the lab's CMS-116. SAS Name: COLA_ACRDTD_CD COBOL Name: COLA-ACRDTD-CD VALUES: X=ACCREDITED AO COLA Accredited Y Match Date 8 448 455 DATE Description: Date the Commission on Office Laboratory Accreditation confirmed the lab is accredited. When the lab is DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 25 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: COLA_ACRDTD_Y_MATCH_DT COBOL Name: COLA-ACRDTD-Y-MATCH-DT AO COLA Accredited Y Match Indicator 1 456 456 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the Commission on Office Laboratory Accreditation. SAS Name: COLA_ACRDTD_Y_MATCH_SW COBOL Name: COLA-ACRDTD-Y-MATCH-SW AO JC Accredited Code 1 457 457 VARCHAR2 Description: Indicates if the lab reported that it is accredited by the Joint Commission. This information is from the lab's CMS-116. SAS Name: JCAHO_ACRDTD_CD COBOL Name: JCAHO-ACRDTD-CD VALUES: X=ACCREDITED AO JC Accredited Y Match Date 8 458 465 DATE Description: Date the Joint Commission confirmed the lab is accredited. When the lab is accredited by multiple accrediting organizations, the earliest Y match date initiates billing of the certificate of accreditation fees. SAS Name: JCAHO_ACRDTD_Y_MATCH_DT COBOL Name: JCAHO-ACRDTD-Y-MATCH-DT AO JC Accredited Y Match Indicator 1 466 466 VARCHAR2 Description: Indicates if the lab is confirmed as accredited by the Joint Commission. SAS Name: JCAHO_ACRDTD_Y_MATCH_SW COBOL Name: JCAHO-ACRDTD-Y-MATCH-SW Application Received SA Date 8 467 474 DATE Description: Date the CMS-116 application was entered in the online system and a CLIA number was issued. SAS Name: APLCTN_RCVD_DT COBOL Name: APLCTN-RCVD-DT Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD VALUES: 1=COMPLIANCE 2=WAIVER 3=ACCREDITATION 4=PPM Category-specific Facility Type Code 2 476 477 VARCHAR2 Description: Indicates the category-specific facility type code, for certain provider categories only. SAS Name: GNRL_FAC_TYPE_CD COBOL Name: GNRL-FAC-TYPE-CD VALUES: 01=Ambulance 02=Ambulatory Surgery Center 03=Ancillary Test Site 04=Assisted Living Facility 05=Blood Banks 06=Community Clinic 07=Comprehensive Outpatient Rehab 08=End Stage Renal Disease Dialysis 09=Federally Qualified Health Center DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 26 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=Health Fair 11=Health Maintenance Organization 12=Home Health Agency 13=Hospice 14=Hospital 15=Independent 16=Industrial 17=Insurance 18=Intermediate Care Facility/Individuals with Intellectual Disabilities 19=Mobile Lab 20=Pharmacy 21=Physician Office 22=Other Practitioner 23=Prison 24=Public Health Laboratory 25=Rural Health Clinic 26=School/Student Health Service 27=Skilled Nursing/Nursing Facility 28=Tissue Bank/Repositories 29=Other CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD VALUES: 1=COMP 2=WAIVER 3=ACCRED 4=PPM 9=REG Current CLIA Lab Clsfctn CD 2 495 496 CHAR Description: Current Lab Classification SAS Name: CURRENT_CLIA_LAB_CLSFCTN_CD COBOL Name: CURRENT-CLIA-LAB-CLSFCTN-CD VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 1 2 497 498 CHAR Description: Laboratory Classification 1 SAS Name: CLIA_LAB_CLASSIFICATION_CD_1 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-1 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 10 2 499 500 CHAR Description: Laboratory Classification 10 SAS Name: CLIA_LAB_CLASSIFICATION_CD_10 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-10 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 27 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=CLIA VA LABORATORY CLIA Lab Classification CD 2 2 501 502 CHAR Description: Laboratory Classification 2 SAS Name: CLIA_LAB_CLASSIFICATION_CD_2 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-2 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 3 2 503 504 CHAR Description: Laboratory Classification 3 SAS Name: CLIA_LAB_CLASSIFICATION_CD_3 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-3 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 4 2 505 506 CHAR Description: Laboratory Classification 4 SAS Name: CLIA_LAB_CLASSIFICATION_CD_4 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-4 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 5 2 507 508 CHAR Description: Laboratory Classification 5 SAS Name: CLIA_LAB_CLASSIFICATION_CD_5 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-5 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 6 2 509 510 CHAR Description: Laboratory Classification 6 SAS Name: CLIA_LAB_CLASSIFICATION_CD_6 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-6 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 7 2 511 512 CHAR Description: Laboratory Classification 7 SAS Name: CLIA_LAB_CLASSIFICATION_CD_7 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-7 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 8 2 513 514 CHAR Description: Laboratory Classification 8 SAS Name: CLIA_LAB_CLASSIFICATION_CD_8 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-8 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY 10=CLIA VA LABORATORY CLIA Lab Classification CD 9 2 515 516 CHAR Description: Laboratory Classification 9 SAS Name: CLIA_LAB_CLASSIFICATION_CD_9 COBOL Name: CLIA-LAB-CLASSIFICATION-CD-9 VALUES: 00=CLIA LABORATORY 05=CLIA EXEMPT LABORATORY DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 28 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE 10=CLIA VA LABORATORY CLIA Medicare Number 12 517 528 VARCHAR2 Description: Contains medicare numbers from prior to CLIA88. Optional field. SAS Name: CLIA_MDCR_NUM COBOL Name: CLIA-MDCR-NUM CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-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 09=REV/UNSUCCESSFUL PARTICIPATION IN PT 10=REV/OTHER REASON 11=INCOMPLETE CLIA APPLICATION INFORMATION 12=NO LONGER PERFORMING TESTS 13=MULTIPLE TO SINGLE SITE CERTIFICATE 14=SHARED LABORATORY 15=FAILURE TO RENEW WAIVER PPM CERTIFICATE 16=DUPLICATE CLIA NUMBER 17=MAIL RETURNED NO FORWARD ADDRESS CERT ENDED 20=NOTIFICATION BANKRUPTCY 33=ACCREDITATION NOT CONFIRMED 80=AWAITING STATE APPROVAL 99=OIG ACTION - DO NOT ACTIVATE CMS-116 Accreditation Schedule Code 1 531 531 VARCHAR2 Description: Indicates the lab's accreditation schedule code calculated by the CLIA system, based on the information in the most recent CMS-116 application form. Applies only to labs with a certificate of accreditation. SAS Name: ACRDTN_SCHDL_CD COBOL Name: ACRDTN-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 CMS-116 Accredited Annual Test Volume 13 532 544 NUMBER Description: Sum for all specialties as reported on the most recent CMS-116 application form. Applies only to labs with a certificate of accreditation. SAS Name: FORM_116_ACRDTD_TEST_VOL_CNT COBOL Name: FORM-116-ACRDTD-TEST-VOL-CNT CMS-116 Annual Test Volume 13 545 557 NUMBER Description: Sum for all specialties as reported on the most recent DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 29 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE CMS-116 application form. Applies only to labs with a certificate of compliance. SAS Name: FORM_116_TEST_VOL_CNT COBOL Name: FORM-116-TEST-VOL-CNT Director Affiliated Lab Count 3 558 560 NUMBER Description: Number of laboratories with which the lab's director is affiliated. SAS Name: DRCTLY_AFLTD_LAB_CNT COBOL Name: DRCTLY-AFLTD-LAB-CNT Fax Phone Number 10 561 570 VARCHAR2 Description: 10-digit fax phone number of the primary contact or the operator of the provider. SAS Name: FAX_PHNE_NUM COBOL Name: FAX-PHNE-NUM Fiscal Year End Date (MMDD) 4 571 574 VARCHAR2 Description: End date, consisting of the month and day, of the provider's fiscal year. SAS Name: FY_END_MO_DAY_CD COBOL Name: FY-END-MO-DAY-CD Multiple Site Certificate Indicator 1 575 575 VARCHAR2 Description: Indicates if a lab has applied for a single site CLIA certificate to cover multiple testing locations. SAS Name: MLT_SITE_EXCPTN_SW COBOL Name: MLT-SITE-EXCPTN-SW Multiple Site Exception: Hospital Campus Indicator 1 576 576 VARCHAR2 Description: Indicates if the single site CLIA certificate is for a hospital with several labs on a single hospital campus and under common direction. SAS Name: HOSP_LAB_EXCPTN_SW COBOL Name: HOSP-LAB-EXCPTN-SW Multiple Site Exception: Public Health Indicator 1 577 577 VARCHAR2 Description: Indicates if the single site CLIA certificate is for multiple sites with non-profit, federal, state or local government status and engaged in limited public health testing. SAS Name: NON_PRFT_EXCPTN_SW COBOL Name: NON-PRFT-EXCPTN-SW Multiple Site Exception: Temporary Testing Site 1 578 578 VARCHAR2 Indicator Description: Indicates if the single site CLIA certificate is for a lab with multiple temporary testing sites. SAS Name: LAB_TEMP_TSTG_SITE_SW COBOL Name: LAB-TEMP-TSTG-SITE-SW Multiple Site Lab Count 4 579 582 NUMBER Description: Total number of lab sites for which a lab has applied for a single certificate for multiple sites. SAS Name: LAB_SITE_CNT COBOL Name: LAB-SITE-CNT PPM Test Volume Count 13 583 595 NUMBER Description: Estimated total annual Provider Performed Microscopy tests performed by the lab. SAS Name: PPMP_TEST_VOL_CNT COBOL Name: PPMP-TEST-VOL-CNT Provider Name 2nd Line 50 596 645 VARCHAR2 DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 30 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE Description: Second line of a laboratory name. SAS Name: ADDTNL_FAC_NAME COBOL Name: ADDTNL-FAC-NAME Related Provider Number 10 646 655 CHAR Description: Related provider number SAS Name: RELATED_PROVIDER_NUMBER COBOL Name: RELATED-PROVIDER-NUMBER Shared Lab Indicator 1 656 656 VARCHAR2 Description: Applies to physician office labs when two or more physicians collectively pool resources to fund a lab's operation. SAS Name: SHR_LAB_SW COBOL Name: SHR-LAB-SW Shared Lab Xref Number 10 657 666 CHAR Description: Shared lab xref number SAS Name: SHARED_LAB_XREF_NUMBER COBOL Name: SHARED-LAB-XREF-NUMBER Survey Compliance Certificate Schedule Code 1 667 667 VARCHAR2 Description: Certificate Compliance schedule code based on the information gathered at survey. SAS Name: FORM_1557_CRTFCT_SCHDL_CD COBOL Name: FORM-1557-CRTFCT-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 Survey Compliance Schedule Code 1 668 668 VARCHAR2 Description: Compliance schedule code based on the information gathered at survey. SAS Name: FORM_1557_CMPLNC_SCHDL_CD COBOL Name: FORM-1557-CMPLNC-SCHDL-CD VALUES: A=SPEC COUNT < 4 (2,001 TO 10,000 TOT. VOL.) B=SPEC COUNT > 3 (2,001 T0 10,000 TOT. VOL.) C=SPEC COUNT < 4 (10,001 TO 25,000 TOT. VOL.) D=SPEC COUNT > 3 (10,001 TO 25,000 TOT. VOL.) E=SPEC COUNT > 0 (25,001 TO 50,000 TOT. VOL.) F=SPEC COUNT > 0 (50,001 TO 75,000 TOT. VOL.) G=SPEC COUNT > 0 (75,001 TO 100,000 TOT. VOL.) H=SPEC COUNT > 0 (100,001 TO 500,000 TOT. VOL.) I=SPEC COUNT > 0 (500,001 TO 1,000,000 TOT VOL) J=SPEC COUNT > 0 (1,000,001 OR MORE TOT. VOL.) V=TOTAL VOLUME: 1 TO 2,000 Survey Test Volume Count 13 669 681 NUMBER Description: Sum of tests performed annually in a laboratory, as verified at the time of the state survey. SAS Name: FORM_1557_TEST_VOL_CNT COBOL Name: FORM-1557-TEST-VOL-CNT Waived Test Volume Count 13 682 694 NUMBER Description: Estimated total annual waived tests performed by the lab. SAS Name: WVD_TEST_VOL_CNT DATE: 01/02/2018 POS RECORD LAYOUT PAGE: 31 CLIA Laboratory, CATEGORY = "22" (SEE POSITIONS 3-4) SHORT DESCRIPTION LEN START END TYPE COBOL Name: WVD-TEST-VOL-CNT