CMS-10237 Medicare Advantage Provider HSD Table

2017 CMS MA Provider HSD Table

SSA State/County
Code

Name of Physician or
Mid-Level Practitioner

National Provider
Identifier (NPI)
Number

Specialty

Specialty Code

Contract Type

Provider Street
Address

Provider City

Provider State

Provider Zip Code

If PCP, Accepts New
Patients? (Y or N)

Name of Medical
Group Affiliation or
"DC"

Uses CMS MA
Contract Amendment
(Y or N)