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       *           A T T E N T I O N               *
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       *   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.             *
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       *   FILE CREATION DATE = 01/01/2009         *
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1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  SHORT TERM
               02                  LONG TERM
               03                  RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTIONS
               04                  PSYCHIATRIC
               05                  REHABILITATION
               06                  CHILDRENS
               07                  DISTINCT PART PSYCH HOSPITAL
               11                  CRITICAL ACCESS HOSPITALS

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   01                  HOSPITALS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1
   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00230               BLUE CROSS (MISSISSIPPI)
               00231               BLUE CROSS (LOUISIANA)
               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)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)
               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP
               5                   VALIDATION (ACCRD)
               8                   FULL SURVEY AFTER COMPLAINT

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  VOLUNTARY NON-PROFIT - CHURCH
               02                  VOLUNTARY NON-PROFIT - PRIVATE
               03                  VOLUNTARY NON-PROFIT - OTHER
               04                  PROPRIETARY
               05                  GOVERNMENT - FEDERAL
               06                  GOVERNMENT - STATE
               07                  GOVERNMENT - LOCAL
               08                  GOV. - HOSP. DIST. OR AUTH.

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   ACCREDITATION EFFECTIVE DATE                8     274   281  C    PROV0000
     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).
     COBOL NAME: ACCRED-EFF-DT
   ACCREDITATION EXPIRATION DATE               8     282   289  C    PROV0005
     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).
     COBOL NAME: ACCRED-EXP-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ACCREDITATION INDICATOR                     1     290   290  C    PROV0010
     INDICATES THE ORGANIZATION THAT IS RESPONSIBLE FOR
     THE ACCREDITATION OF THE PROVIDER.
     COBOL NAME: ACCRED-STAT
     VALUES:   0                   NONE
               1                   JCAHO
               2                   AOA
               4                   BOTH
               5                   DNV
               6                   DNV & TJC
               7                   DNV & AOA
               8                   DNV, TJC, & AOA

   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   CERTIFIED RN ANESTHETISTS                   7.2   299   305  N    PROV0760
     NUMBER OF FULL-TIME EQUIVALENT CERTIFIED REGISTERED
     NURSE ANESTHETISTS (CRNA) EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-CERT-RN-ANEST
   CLIA - HOSP LAB ID #1                       10    306   315  C    PROV0130
     NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN
     ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT
     ACT (CLIA).
     COBOL NAME: CLIA-ID-NUM-A
   CLIA - HOSP LAB ID #2                       10    316   325  C    PROV0135
     NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN
     ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT
     ACT (CLIA).
     COBOL NAME: CLIA-ID-NUM-B
   CLIA - HOSP LAB ID #3                       10    326   335  C    PROV0140
     NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN
     ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT
     ACT (CLIA).
     COBOL NAME: CLIA-ID-NUM-C
   CLIA - HOSP LAB ID #4                       10    336   345  C    PROV0145
     NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN
     ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT
     ACT (CLIA).
     COBOL NAME: CLIA-ID-NUM-D





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CLIA - HOSP LAB ID #5                       10    346   355  C    PROV0150
     NUMBER ASSIGNED TO A HOSPITAL LABORATORY LICENSED IN
     ACCORDANCE WITH THE CLINICAL LABORATORY IMPROVEMENT
     ACT (CLIA).
     COBOL NAME: CLIA-ID-NUM-E
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: SCOPE OF SERVICE                1     357   357  C    PROV0280
     INDICATES IF A WAIVER OF THE SCOPE OF SERVICES
     REQUIREMENT HAS BEEN RECOMMENDED FOR A HOSPITAL.
     COBOL NAME: COMPL-SCOPE-OF-SERV
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: TECHNICAL PERSONNEL             1     358   358  C    PROV0285
     INDICATES IF A WAIVER OF THE TECHNICAL PERSONNEL
     REQUIREMENT HAS BEEN RECOMMENDED FOR A HOSPITAL.
     COBOL NAME: COMPL-TECH-PERSNL
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 24 HR REGISTERED NURSE          1     359   359  C    PROV0290
     INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE
     REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-24-HR-RN
     VALUES:   1                   WAIVER RECOMMENDED

   CURRENT SURVEY EVER ACCREDITED              1     360   360  C    PROV3545
     INDICATES IF THIS PROVIDER WAS AN ACCREDITED HOSPITAL
     ANYTIME DURING THE CURRENT SURVEY.
     COBOL NAME: CURRENT-EVER-ACCRED
     VALUES:   N                   NO
               Y                   YES

   CURRENT SURVEY EVER NON-ACCRED              1     361   361  C    PROV3555
     INDICATES IF THIS PROVIDER WAS A NON-ACCREDITED
     HOSPITAL ANYTINE DURING THE CURRENT SURVEY.
     COBOL NAME: CURRENT-EVER-NON-ACCRED
     VALUES:   N                   NO
               Y                   YES

   CURRENT SURVEY EVER SWINGBED                1     362   362  C    PROV3550
     INDICATES IF THIS PROVIDER WAS A SWINGBED HOSPITAL
     ANYTIME DURING THE CURRENT SURVEY.
     COBOL NAME: CURRENT-EVER-SWINGBED
     VALUES:   N                   NO


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               Y                   YES

   DATE OF LAST VALIDATION SURVEY              8     363   370  C    PROV0450
     DATE THE LAST VALIDATION SURVEY WAS PERFORMED
     BY THE STATE AGENCY FOR A JCAH, AOA ACCREDITED
     HOSPITAL OR OTHER PROVIDER TYPE.
     COBOL NAME: DT-VALID-SURVEY
   DIETICIANS                                  7.2   371   377  N    PROV0820
     NUMBER OF FULL-TIME EQUIVALENT DIETICIANS EMPLOYED BY A
     FACILITY.
     COBOL NAME: NUM-DIETICIANS
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   LICENSED PRACT/VOCAT NURSES                 7.2   382   388  N    PROV0955
     NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR
     VOCATIONAL NURSES EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-LPN-LVN
   MEDICAL SCHOOL AFFILIATION                  1     389   389  C    PROV0645
     THE TYPE OF AFFILIATION THAT A HOSPITAL MAY HAVE WITH
     A MEDICAL SCHOOL.
     COBOL NAME: MED-SCHL-AFF
     VALUES:   1                   MAJOR
               2                   LIMITED
               3                   GRADUATE
               4                   NO AFFILIATION

   MEDICAL TECHNOLOGISTS (LAB)                 7.2   390   396  N    PROV6290
     NUMBER OF FULL TIME EQUIVALENT MEDICAL LABORATORY
     TECHNOLOGISTS EMPLOYED BY A HOSPITAL
     COBOL NAME: NUM-LAB-MED-TECHS
   MEETS 1861 DEFINITION                       1     397   397  C    PROV0670
     INDICATES IF AN EMERGENCY HOSPITAL MEETS THE DEFINITION
     OF "HOSPITAL" CONTAINED IN SECTION 1861 OF THE SOCIAL
     SECURITY ACT.
     COBOL NAME: MEETS-1861
     VALUES:   Y                   MEETS 1861(E)(1)

   NUCLEAR MEDICINE TECHNICIANS                7.2   398   404  N    PROV6295
     NUMBER OF FULL TIME EQUIVALENT NUCLEAR MEDICINE
     TECHNICIANS EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-NUCL-MED-TECHS
   OCCUPATIONAL THERAPISTS                     7.2   405   411  N    PROV1050
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-OCCUP-THERAPISTS



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   PARTICIPATING CODE (Y,N)                    1     419   419  C    PROV1575
     THIS CODE INDICATES WHETHER A PROVIDER IS PARTICIPATING
     IN THE MEDICAID OR MEDICARE PROGRAM.
     COBOL NAME: PARTICIPATING-CD
     VALUES:   N                   NON-PARTICIPATING PROVIDER
               Y                   PARTICIPATING PROVIDER

   PHYSICAL THERAPISTS                         7.2   420   426  N    PROV1125
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-PHYS-THERAPY
   PHYSICIAN ASSISTANTS                        7.2   427   433  N    PROV1115
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN ASSISTANTS
     EMPLOYED BY A HOSPITAL OR RURAL HEALTH CLINIC.
     COBOL NAME: NUM-PHYS-ASSIST
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   1                   MEDICARE ONLY
               3                   MEDICARE AND MEDICAID

   PSYCHIATRIC UNIT BEDS                       3     435   437  N    PROV1690
     THE NUMBER OF BEDS IN A PPS EXEMPT PSYCHIATRIC UNIT OF
     A HOSPITAL.
     COBOL NAME: PSY-UNIT-BED-SZ
   PSYCHIATRIC UNIT EFFECTIVE DATE             8     438   445  C    PROV1695
     THE DATE A PSYCHIATRIC UNIT BECAME EXEMPT FROM THE
     PROSPECTIVE PAYMENT SYSTEM (PPS).
     COBOL NAME: PSY-UNIT-EFF-DT
   PSYCHIATRIC UNIT INDICATOR                  1     446   446  C    PROV1700
     INDICATES IF A HOSPITAL HAS A PPS EXEMPT PSYCHIATRIC
     UNIT.
     COBOL NAME: PSY-UNIT-IND
     VALUES:   Y                   PSYCH UNIT

   PSYCHIATRIC UNIT TERMINATION CODE           1     447   447  C    PROV1705
     INDICATES THE REASON THAT A PSYCHIATRIC UNIT IS NO
     LONGER EXEMPT FROM PPS.
     COBOL NAME: PSY-UNIT-TERM-CD
     VALUES:   0                   ACTIVE
               1                   VOLUNTARY-MERGER OR CLOSURE
               2                   VOLUNTARY-DISSATISFIED WITH REIMBURSEMENT
               3                   RISK OF INVOLUNTARY TERMINATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               4                   VOLUNTARY-OTHER
               5                   FAILURE TO MEET HEALTH/SAFETY
               6                   FAILURE TO MEET AGREEMENT
               7                   PROVIDER STATUS CHANGE

   PSYCHIATRIC UNIT TERMINATION DATE           8     448   455  C    PROV1710
     THE DATE A PSYCHIATRIC UNIT IS NO LONGER EXEMPT FROM
     THE PROSPECTIVE PAYMENT SYSTEM.
     COBOL NAME: PSY-UNIT-TERM-DT
   PSYCHOLOGISTS                               7.2   456   462  N    PROV6300
     NUMBER OF FULL TIME EQUIVALENT PSYCHOLOGISTS
     EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-PSYCHOL
   RADIOLOGY TECHNICIANS (DIAGNOSTIC)          7.2   463   469  N    PROV6305
     NUMBER OF FULL TIME EQUIVALENT DIAGNOSTIC RADIOLOGY
     TECHNICIANS EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-RADIO-TECHS
   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #3 (NURSE - BED)          1     472   472  C    PROV1555
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-3
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGISTERED NURSES                           7.2   473   479  N    PROV1145
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PROFESSIONAL NURSES EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-REG-NURS





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   REGISTERED PHARMACISTS                      7.2   480   486  N    PROV1100
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PHARMACISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-PHARMACIST-REG
   REHABILITATION UNIT BEDS                    3     487   489  N    PROV1730
     THE NUMBER OF BEDS IN A PPS EXEMPT REHABILITATION UNIT
     OF A HOSPITAL.
     COBOL NAME: REHAB-UNIT-BED-SZ
   REHABILITATION UNIT EFFECT DATE             8     490   497  C    PROV1735
     THE DATE A REHABILITATION UNIT BECAME EXEMPT FROM THE
     PROSPECTIVE PAYMENT SYSTEM.
     COBOL NAME: REHAB-UNIT-EFF-DT
   REHABILITATION UNIT INDICATOR               1     498   498  C    PROV1740
     INDICATES IF A HOSPITAL HAS A PPS EXEMPT REHABILITATION
     UNIT.
     COBOL NAME: REHAB-UNIT-IND
     VALUES:   Y                   REHAB UNIT

   REHABILITATION UNIT TERMINAT CODE           1     499   499  C    PROV1745
     THIS ELEMENT INDICATES THE REASON FOR A HOSPITAL
     REHABILITATION UNIT'S TERMINATION OF ITS EXCLUSION
     STATUS UNDER PROSPECTIVE PAYMENT SYSTEM.
     COBOL NAME: REHAB-UNIT-TERM-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 TERMINAT DATE           8     500   507  C    PROV1750
     THIS ELEMENT IS THE DATE THE HOSPITAL'S PSYCHIATRIC
     UNIT IS NO LONGER EXCLUDED FROM PROSPECTIVE PAYMENT
     SYSTEM.
     COBOL NAME: REHAB-UNIT-TERM-DT
   RESIDENT PROGRAM APPROVED BY ADA            1     508   508  C    PROV1805
     INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS
     APPROVED BY THE AMERICAN DENTAL ASSOCIATION
     COBOL NAME: RES-PGM-APPR-ADA
     VALUES:   N                   NOT APPROVED
               Y                   APPROVED

   RESIDENT PROGRAM APPROVED BY AMA            1     509   509  C    PROV1810
     INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS
     APPROVED BY THE AMERICAN MEDICAL ASSOCIATION.
     COBOL NAME: RES-PGM-APPR-AMA
     VALUES:

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               N                   NOT APPROVED
               Y                   APPROVED

   RESIDENT PROGRAM APPROVED BY AOA            1     510   510  C    PROV1815
     INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS
     APPROVED BY THE AMERICAN OSTEOPATHIC ASSOCIATION.
     COBOL NAME: RES-PGM-APPR-AOA
     VALUES:   N                   NOT APPROVED
               Y                   APPROVED

   RESIDENT PROGRAM APPROVED BY OTHER          1     511   511  C    PROV1820
     INDICATES IF THE RESIDENT PROGRAM AT A HOSPITAL IS
     APPROVED BY OTHER PROFESSIONAL ORGANIZATIONS.
     COBOL NAME: RES-PGM-APPR-OTHER
     VALUES:   N                   NOT APPROVED
               Y                   APPROVED

   RESIDENTS (PHYSICIANS)                      7.2   512   518  N    PROV1165
     THE NUMBER OF FULL-TIME EQUIVALENT RESIDENTS
     (PHYSICIANS) EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-RESID-PHYS
   RESPIRATORY THERAPISTS                      7.2   519   525  N    PROV0950
     NUMBER OF FULLTIME EQUIVALENT RESPIRATORY THERAPISTS
     EMPLOYED BY A HOSPITAL.
     COBOL NAME: NUM-INHAL-THERAPY
   SRV: ACUTE RENAL DIALYSIS                   1     526   526  C    PROV2055
     INDICATES HOW ACUTE RENAL DIALYSIS SERVICES ARE
     PROVIDED IN A HOSPITAL.
     COBOL NAME: SP-ACUTE-REN-DIAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ALCOHOL AND/OR DRUG                    1     527   527  C    PROV2065
     INDICATES HOW ALCOHOL AND/OR DRUG SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-ALCOH-DRUG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: AMBULANCE (OWNED)                      1     528   528  C    PROV6155
     INDICATES HOW AMBULANCE (OWNED) SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-AMBUL-OWNED
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ANESTHESIA                             1     529   529  C    PROV2070
     INDICATES HOW ANESTHESIA SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-ANESTH
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: AUDIOLOGY                              1     530   530  C    PROV6160
     INDICATES HOW AUDIOLOGY SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-AUDIO
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: BLOOD BANK                             1     531   531  C    PROV5675
     INDICIATES HOW BLOOD BANK SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-BLOOD-BANK
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: BURN CARE UNIT                         1     532   532  C    PROV2090
     INDICATES HOW BURN CARE UNIT SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-BURN-UNIT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: CARDIAC CATHETERIZATION LAB            1     533   533  C    PROV6165
     INDICATES HOW CARDIAC CATHETERIZATION LABORATORY
     SERVICES ARE PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-CARD-CATH-LAB
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: CARDIO-THORACIC SURGERY                1     534   534  C    PROV2285
     INDICATES HOW CARDIO-THORACIC SURGERY SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-OPEN-HEART-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: CHEMOTHERAPY SERVICE                   1     535   535  C    PROV6170
     INDICATES HOW CHEMOTHERAPY SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-CHEMOTHER
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: CHIROPRACTIC                           1     536   536  C    PROV2100
     INDICATES HOW CHIROPRACTICE SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-CHIROPRATIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: CT SCANNER                             1     537   537  C    PROV6175
     INDICATES HOW CT SCANNER SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-CT-SCAN
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: DENTAL                                 1     538   538  C    PROV2120
     INDICATES HOW DENTAL SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-DENTAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: DIETARY                                1     539   539  C    PROV2130
     INDICATES HOW DIETARY SERVICES ARE PROVIDED BY A
     HOSPITAL
     COBOL NAME: SP-DIETARY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: EMERGENCY DEPT (DEDICATED)             1     540   540  C    PROV6180
     INDICATES HOW DEDICATED EMERGENCY DEPARTMENT SERVICES
     ARE PROVIDED BY A HOSPITAL
     COBOL NAME: SP-EMERG-DEDICATED
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: EMERGENCY SERVICES                     1     541   541  C    PROV2140
     INDICATES HOW EMERGENCY SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-EMERG-DEPT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: GERONTOLOGICAL SPECIALTY               1     542   542  C    PROV6190
     INDICATES HOW GERONTOLOGICAL SPECIALTY SERVICES
     ARE PROVIDED IN A HOSPITAL.
     COBOL NAME: SP-GERON-SPEC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: HOME HEALTH SERVICES                   1     543   543  C    PROV2160
     INDICATES HOW HOME HEALTH SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-HOME-CARE-UNIT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: HOSPICE                                1     544   544  C    PROV2175
     INDICATES HOW HOSPICE SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-HOSPICE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ICU - CARDIAC (NON-SURGICAL)           1     545   545  C    PROV2110
     INDICATES HOW ICU - CARDIAC (NON-SURGICAL)SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-CORONARY-CARE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ICU - MEDICAL/SURGICAL                 1     546   546  C    PROV2185
     INDICATES HOW ICU - MEDICAL/SURGICAL SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-ICU
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ICU - NEONATAL                         1     547   547  C    PROV6195
     INDICATES HOW ICU - NEONATAL SERVICES ARE PROVIDED
     IN A HOSPITAL.
     COBOL NAME: SP-ICU-NEONATAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ICU - PEDIATRIC                        1     548   548  C    PROV6200
     INDICATES HOW ICU - PEDIATRIC SERVICES ARE PROVIDED
     IN A HOSPITAL.
     COBOL NAME: SP-ICU-PEDIATRIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: ICU - SURGICAL                         1     549   549  C    PROV6205
     INDICATES HOW ICU - SURGICAL SERVICES ARE PROVIDED
     IN A HOSPITAL.
     COBOL NAME: SP-ICU-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: LABORATORY (ANATOMICAL)                1     550   550  C    PROV2205
     INDICATES HOW ANATOMICAL LABORATORY SERVICES ARE
     PROVIDED IN A HOSPITAL.
     COBOL NAME: SP-LABORATORY-ANATOM
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: LABORATORY (CLINICAL)                  1     551   551  C    PROV2210
     INDICATES HOW CLINICAL LABORATORY SERVICES ARE PROVIDED
     IN A HOSPITAL.
     COBOL NAME: SP-LABORATORY-CLINIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: LONG TERM CARE (SWING-BEDS)            1     552   552  C    PROV2215
     INDICATES HOW LONG TERM CARE (SWING-BEDS) SERVICES ARE
     PROVIDED IN A HOSPITAL
     COBOL NAME: SP-LTC-UNIT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: MAGNETIC RESONANCE IMAGING             1     553   553  C    PROV6210
     INDICATES HOW MAGNETIC RESONANCE IMAGING (MRI)
     SERVICES ARE PROVIDED IN A HOSPITAL.
     COBOL NAME: SP-MRI
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: NEONATAL NURSERY                       1     554   554  C    PROV2235
     INDICATES HOW NEONATAL NURSERY SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-NEONATAL-NURS
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: NEUROSURGICAL SERVICES                 1     555   555  C    PROV6215
     INDICATES HOW NEUROSURGICAL SERVICES ARE PROVIDED
     IN A HOSPITAL.
     COBOL NAME: SP-NEURO-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: NUCLEAR MEDICINE                       1     556   556  C    PROV2245
     INDICATES HOW  NUCLEAR MEDICINE SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-NUCLEAR-MED
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OBSTETRICS                             1     557   557  C    PROV2265
     INDICATES HOW OBSTETRIC SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-OBSTETRICS
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OCCUPATIONAL THERAPY                   1     558   558  C    PROV2270
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 25
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: OPERATING ROOMS                        1     559   559  C    PROV2300
     INDICATES HOW OPERATING ROOM SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-OR-ROOMS
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OPTHALMIC SURGERY                      1     560   560  C    PROV6220
     INDICATES HOW OPTHALMIC SURGERY SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-OPTHALMIC-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OPTOMETRIC                             1     561   561  C    PROV2295
     INDICATES HOW OPTOMETRIC SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-OPTOMETRIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ORGAN BANK                             1     562   562  C    PROV2310
     INDICATES HOW ORGAN BANK SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-ORGAN-BANK
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: ORGAN TRANSPLANT                       1     563   563  C    PROV2315
     INDICATES HOW ORGAN TRANSPLANT SERVICES ARE PROVIDED BY
     A HOSPITAL.
     COBOL NAME: SP-ORGAN-TRANS
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 26
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: ORTHOPEDIC SURGERY                     1     564   564  C    PROV6225
     INDICATES HOW ORTHOPEDIC SURGERY SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-ORTHOPEDIC-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OUTPATIENT                             1     565   565  C    PROV2350
     INDICATES HOW OUTPATIENT SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-OUTPAT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: OUTPATIENT SURGERY UNIT                1     566   566  C    PROV2355
     INDICATES HOW OUTPATIENT SURGERY UNIT SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-OUTPAT-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PEDIATRIC                              1     567   567  C    PROV2360
     INDICATES HOW PEDIATRIC SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-PEDIATRIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PET SCAN SERVICES                      1     568   568  C    PROV6230
     INDICATES HOW POSITRON EMISSION TOMOGRAPHY (PET) SCAN
     SERVICES ARE PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-POS-EMIS-TOM-SCAN
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 27
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHARMACY                               1     569   569  C    PROV2365
     INDICATES HOW PHARMACY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHARMACY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PHYSICAL THERAPY                       1     570   570  C    PROV2370
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: POSTOPERATIVE RECOVERY ROOM            1     571   571  C    PROV2410
     INDICATES HOW POSTOPERATIVE RECOVERY ROOM SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-POSTOP-REC-RM
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC                            1     572   572  C    PROV2415
     INDICATES HOW PSYCHIATRIC SERVICES ARE PROVIDED BY A
     HOSPITAL.
     COBOL NAME: SP-PSYCHIATRIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC - FORENSIC                 1     573   573  C    PROV6245
     INDICATES HOW FORENSIC PSYCHIATRIC SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-PSY-FORENSIC
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC - GERIATRIC                1     574   574  C    PROV6250
     INDICATES HOW GERIATRIC PSYCHIATRIC SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-PSY-GERIATRIC
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 28
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC - OUTPATIENT               1     575   575  C    PROV6255
     INDICATES HOW OUTPPATIENT PSYCHIATRIC SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-PSY-OUTPAT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC CHILD/ADOLESCENT           1     576   576  C    PROV6240
     INDICATES HOW CHILD/ADOLESCENT PSYCHIATRIC SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-PSY-CHILD-ADOL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: PSYCHIATRIC-EMERGENCY                  1     577   577  C    PROV6235
     INDICATES HOW EMERGENCY PSYCHIATRIC SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-PSY-EMERG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: RADIOLOGY (DIAGNOSTIC)                 1     578   578  C    PROV2440
     INDICATES HOW DIAGNOSTIC RADIOLOGY SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-RADIOLOGY-DIAG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: RADIOLOGY (THERAPEUTIC)                1     579   579  C    PROV2445
     INDICATES HOW THERAPEUTIC RADIOLOGY SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-RADIOLOGY-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 29
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: RECONSTRUCTIVE SURGERY                 1     580   580  C    PROV6260
     INDICATES HOW RECONSTRUCTIVE SURGERY SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-RECON-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: REHAB - INPATIENT (CARF)               1     581   581  C    PROV6270
     INDICATES HOW INPATIENT REHABILITATION (CARF
     ACCREDITED) SERVICES ARE PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-REHABIL-CARF
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: REHAB - OUTPATIENT                     1     582   582  C    PROV6265
     INDICATES HOW OUTPATIENT REHABILITATION SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-REHABIL-OUTPAT
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: REHAB INPATIENT (NOT CARF)             1     583   583  C    PROV2450
     INDICATES HOW INPATIENT REHABILITIATION (NOT CARF
     ACCREDITED) SERVICES ARE PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-REHABIL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: SHOCK WAVE LITHOTRIPTER                1     584   584  C    PROV6185
     INDICATES HOW EXTRACORPOREAL SHOCK WAVE LITHOTRIPTER
     SERVICES ARE PROVIDED IN A HOSPITAL.
     COBOL NAME: SP-EXTRAC-SHOCK-WAVE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 30
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL                                 1     585   585  C    PROV2485
     INDICATES HOW SOCIAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-SOCIAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: SPEECH PATHOLOGY                       1     586   586  C    PROV2505
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT OR AGREEMENT
               3                   COMBINATION

   SRV: SURGICAL SERVICES-INPATIENT            1     587   587  C    PROV2190
     INDICATES HOW INPATIENT SURGICAL SERVICES ARE PROVIDED
     BY A HOSPITAL.
     COBOL NAME: SP-INPAT-SURG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: TRANSPLANT CENTER, MEDICARE            1     588   588  C    PROV6275
     INDICATES HOW MEDICARE CERTIFIED TRANSPLANT CENTER
     SERVICES ARE PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-TRANS-MEDICARE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: TRAUMA CENTER (CERTIFIED)              1     589   589  C    PROV2475
     INDICATES HOW CERTIFIED TRAUMA CENTER SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-SHOCK-TRAUMA
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SRV: URGENT CARE CENTER SERVICES            1     590   590  C    PROV6280
     INDICATES HOW URGENT CARE CENTER SERVICES ARE
     PROVIDED BY A HOSPITAL.
     COBOL NAME: SP-URGENT-CARE
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 31
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   SWING BED INDICATOR                         1     591   591  C    PROV2795
     INDICATES IF A HOSPITAL PROVIDES SWING BED SERVICES -
     BEDS CAN BE USED FOR EITHER HOSPITAL OR LONG TERM CARE
     SERVICES.
     COBOL NAME: SWINGBED-IND
     VALUES:   N                   NO
               Y                   YES

   SWING BED SIZE CODE                         1     592   592  C    PROV2800
     INDICATES THE SIZE OF A HOSPITAL PROVIDING SWING BED
     SERVICES.
     COBOL NAME: SWINGBED-SIZE-CD
     VALUES:   1                   49 OR FEWER BEDS
               2                   50 TO 99 BEDS

   TYPE OF FACILITY                            2     593   594  C    PROV2890
     INDICATES THE CATEGORY WHICH REPRESENTS THE TYPE OF
     FACILITY.
     COBOL NAME: TYPE-FACILITY
     VALUES:   01                  SHORT - TERM
               02                  LONG - TERM
               03                  RELIGIOUS NONMEDICAL HEALTH CARE INSTITUTION
               04                  PSYCHIATRIC
               05                  REHABILITATION
               06                  CHILDRENS
               07                  DISTINCT PART PSYCH HOSPITAL
               11                  CRITICAL ACCESS HOSPITALS

   TYPE OF NON-PARTICIPATING PROVIDER          1     595   595  C    PROV0690
     INDICATES WHETHER A NON-PARTICIPATING HOSPITAL IS
     FEDERAL OR OTHER THAN FEDERAL.
     COBOL NAME: NON-PARTICIPATING-TYPE
     VALUES:   E                   EMERGENCY HOSPITAL NON-FEDERAL
               F                   EMERGENCY HOSPITAL FEDERAL

   SPEECH PATHOLOGISTS, AUDIOLOGISTS           7.2   1446  1452 N    PROV1220
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     OR AUDIOLOGISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-SPEECH-PATH-AUDIO
   NURSE PRACTITIONERS                         7.2   1622  1628 N    PROV1015
     NUMBER OF FULL-TIME EQUIVALENT NURSE PRACTITIONERS.
     COBOL NAME: NUM-NURSE-PRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 32
                 HOSPITALS, CATEGORY = "01" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PHYSICIANS                                  7.2   1639  1645 N    PROV1110
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED
     BY A PROVIDER.
     COBOL NAME: NUM-PHYS
   SRV: RESPIRATORY CARE                       1     1688  1688 C    PROV2455
     INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED.
     COBOL NAME: SP-RESP-CARE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY STAFF AND THROUGH AGREEMENT

   MEDICAL SOCIAL WORKERS                      7.2   1765  1771 N    PROV0975
     NUMBER OF FULL-TIME EQUIVALENT MEDICAL SOCIAL WORKERS
     EMPLOYED BY A HOSPITAL OR HOSPICE.
     COBOL NAME: NUM-MED-SOCIAL-WRKS
   FAX PHONE NUMBER                            10    2039  2048 C    PROV5800
     THE 10 DIGIT FAX PHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF THE LABORATORY OR HOSPITAL
     COBOL NAME: FAX-NUM






























 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   03                  TITLE 18/19

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   02                  SNF/NF (DUALLY CERTIFIED)

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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                  LIMITED LIABILITY CORPORATION

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   WAIVER RECOMMENDED

   COMPLIANCE: 24 HR REGISTERED NURSE          1     359   359  C    PROV0290
     INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE
     REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-24-HR-RN
     VALUES:   1                   WAIVER RECOMMENDED

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   1                   MEDICARE ONLY
               2                   MEDICAID ONLY
               3                   MEDICARE AND MEDICAID

   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   ACTIVITY PROFESSIONAL - CONTRACT            7.2   596   602  N    PROV0695
     THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ACT-THER-CONTRACT
   ACTIVITY PROFESSIONAL - FULL TIME           7.2   603   609  N    PROV0700
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED FULL TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-FULL-TIME
   ACTIVITY PROFESSIONAL - PART TIME           7.2   610   616  N    PROV0705
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED PART TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ADMINISTRATION - CONTRACT                   7.2   617   623  N    PROV0710
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ADMN-CONTRACT
   ADMINISTRATOR - FULL TIME                   7.2   624   630  N    PROV0715
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A FULL TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-FULL-TIME
   ADMINISTRATOR - PART TIME                   7.2   631   637  N    PROV0720
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A PART-TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-PART-TIME
   BEDS - MEDICARE SNF                         4     638   641  N    PROV1445
     NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY.
     COBOL NAME: NUM-T18-SNF-BEDS
   BEDS - NURSING FACILITY                     4     642   645  N    PROV1455
     NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE
     BEDS IN A FACILITY.
     COBOL NAME: NUM-T19-SNF-BEDS
   BEDS - SNF/NF                               4     646   649  N    PROV1450
     NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID
     SKILLED NURSING CARE IN A LONG TERM CARE FACILITY.
     COBOL NAME: NUM-T1819-SNF-BEDS
   CERT NURSE AIDES - CONTRACT                 7.2   650   656  N    PROV1000
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-AID-CONTRACT
   CERT NURSE AIDES - FULL TIME                7.2   657   663  N    PROV1005
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-FULL-TIME
   CERT NURSE AIDES - PART TIME                7.2   664   670  N    PROV1010
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-PART-TIME
   CHRISTIAN SCIENCE INDICATOR                 1     671   671  C    PROV0110
     INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY
     COBOL NAME: CHRISTIAN-SCIENCE-IND
     VALUES:   Y                   CHRISTIAN SCIENCE

   COMPLIANCE: BEDS PER ROOM WAIVER            1     672   672  C    PROV0225
     INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT
     HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-BEDS-PER-ROOM
     VALUES:   1                   WAIVER RECOMMENDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: PATIENT ROOM SIZE               1     673   673  C    PROV0270
     INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN
     RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-PATIENT-ROOM-SZ
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 7 DAY REGISTERED NURSE          1     674   674  C    PROV0295
     INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE
     REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF.
     COBOL NAME: COMPL-7-DAY-RN
     VALUES:   1                   WAIVER RECOMMENDED

   DENTISTS - CONTRACT                         7.2   675   681  N    PROV0785
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-DENTIST-CONTRACT
   DENTISTS - FULL TIME                        7.2   682   688  N    PROV0790
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DENTIST-FULL-TIME
   DENTISTS - PART TIME                        7.2   689   695  N    PROV0795
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DENTIST-PART-TIME
   DIETITIANS - CONTRACT                       7.2   696   702  N    PROV0805
     THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO
     A FACILITY.
     COBOL NAME: NUM-DIET-CONTRACT
   DIETITIANS - FULL TIME                      7.2   703   709  N    PROV0810
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DIET-FULL-TIME
   DIETITIANS - PART TIME                      7.2   710   716  N    PROV0815
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DIET-PART-TIME
   EXPERIMENTAL RESEARCH CONDUCTED             1     717   717  C    PROV0465
     INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND
     TEST CLINICAL TREATMENTS.
     COBOL NAME: EXPER-RESEARCH
     VALUES:   Y                   YES

   FOOD SERVICE - CONTRACT                     7.2   718   724  N    PROV0860
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-FOOD-SRV-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   FOOD SERVICE - FULL TIME                    7.2   725   731  N    PROV0865
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-FULL-TIME
   FOOD SERVICE - PART TIME                    7.2   732   738  N    PROV0870
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-PART-TIME
   HOUSEKEEPING - CONTRACT                     7.2   739   745  N    PROV0925
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-HOUSE-CONTRACT
   HOUSEKEEPING - FULL TIME                    7.2   746   752  N    PROV0930
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-HOUSE-FULL-TIME
   HOUSEKEEPING - PART TIME                    7.2   753   759  N    PROV0935
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-HOUSE-PART-TIME
   LPN/LVN - CONTRACT                          7.2   760   766  N    PROV1465
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-VOC-NURSE-CONTRACT
   LPN/LVN - FULL TIME                         7.2   767   773  N    PROV1470
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-FULL-TIME
   LPN/LVN - PART TIME                         7.2   774   780  N    PROV1475
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-PART-TIME
   LTC CROSS REFERENCE PROVIDER #              6     781   786  C    PROV0640
     THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER
     NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY
     CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA
     LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO.
     COBOL NAME: LTC-CROSS-REF-PROV-NUM
   MEDICAL DIRECTOR - CONTRACT                 7.2   787   793  N    PROV0960
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-MED-CONTRACT
   MEDICAL DIRECTOR - FULL TIME                7.2   794   800  N    PROV0965
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-MED-FULL-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICAL DIRECTOR - PART TIME                7.2   801   807  N    PROV0970
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-MED-PART-TIME
   MEDICATION AIDES/TECHS-CONTRACT             7.2   808   814  N    PROV5180
     THE NUMBER OF FULL-TIMR EQUIVALENT MEDICATION AIDES/
     TECHNICIANS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MED-AID-CONTRACT
   MEDICATION AIDES/TECHS-FULL TIME            7.2   815   821  N    PROV5170
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-FULL-TIME
   MEDICATION AIDES/TECHS-PART TIME            7.2   822   828  N    PROV5175
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BYA FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-PART-TIME
   MENTAL HEALTH SERVICES - CONTRACT           7.2   829   835  N    PROV0980
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MEN-HLTH-CONTRACT
   MENTAL HEALTH SERVICES - FULL TIME          7.2   836   842  N    PROV0985
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-FULL-TIME
   MENTAL HEALTH SERVICES - PART TIME          7.2   843   849  N    PROV0990
     THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-PART-TIME
   MULTI-FACILITY ORGANIZATION NAME            38    850   887  C    PROV0680
     THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS
     THE FACILITY.
     COBOL NAME: NAME-MULT-FACL-ORG
   MULTI-FACILITY ORGANIZATION OWNED           1     888   888  C    PROV0675
     INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION
     THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES.
     COBOL NAME: MULT-FACL-ORG
     VALUES:   Y                   YES

   NURSE AIDES IN TRNG - CONTRACT              7.2   889   895  N    PROV5165
     NUMBER OF FULL TIME EQUIVALENT NURSE AIDES IN TRAINING
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-AID-TRNG-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   NURSE AIDES IN TRNG-FULL TIME               7.2   896   902  N    PROV5155
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-FULL-TIME
   NURSE AIDES IN TRNG-PART TIME               7.2   903   909  N    PROV5160
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-PART-TIME
   NURSES WITH ADMIN DUTIES-CONTRACT           7.2   910   916  N    PROV5150
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-ADM-CONTRACT
   NURSES WITH ADMIN DUTIES-FULL TIME          7.2   917   923  N    PROV5135
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-FULL-TIME
   NURSES WITH ADMIN DUTIES-PART TIME          7.2   924   930  N    PROV5145
     NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A
     PART TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-PART-TIME
   OCCUP THERAPIST, FULL TIME, STAFF           7.2   931   937  N    PROV1040
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-THER-FULL-TIME
   OCCUP THERAPISTS, CONTRACT/ARRANGE          7.2   938   944  N    PROV1035
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-THER-CONTRACT
   OCCUP THERAPY AIDE - CONTRACT               7.2   945   951  N    PROV1020
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPY AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-AID-CONTRACT
   OCCUP THERAPY AIDE - FULL TIME              7.2   952   958  N    PROV1025
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-AID-FULL-TIME
   OCCUP THERAPY AIDE - PART TIME              7.2   959   965  N    PROV1030
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-AID-PART-TIME
   OCCUP THERAPY ASST - CONTRACT               7.2   966   972  N    PROV5195
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-OCC-ASST-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OCCUP THERAPY ASST - FULL TIME              7.2   973   979  N    PROV5185
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-FULL-TIME
   OCCUP THERAPY ASST - PART TIME              7.2   980   986  N    PROV5190
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-PART-TIME
   OCCUPATIONAL THERAPIST - PART TIME          7.2   987   993  N    PROV1045
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-THER-PART-TIME
   ORGANIZED FAMILY GROUP                      1     994   994  C    PROV1535
     INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF
     FAMILY MEMBERS OF RESIDENTS.
     COBOL NAME: ORG-FAMILY-GRP
     VALUES:   Y                   YES

   ORGANIZED RESIDENT GROUP                    1     995   995  C    PROV1540
     INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS
     GROUP.
     COBOL NAME: ORG-RESID-GRP
     VALUES:   Y                   YES

   OTHER - CONTRACT                            7.2   996   1002 N    PROV3265
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-OTH-CONTRACT
   OTHER - FULL TIME                           7.2   1003  1009 N    PROV3245
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     FULL-TIME BASIS.
     COBOL NAME: NUM-OTH-FULL-TIME
   OTHER - PART TIME                           7.2   1010  1016 N    PROV3255
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     PART-TIME BASIS.
     COBOL NAME: NUM-OTH-PART-TIME
   OTHER ACTIVITIES STAFF-CONTRACT             7.2   1017  1023 N    PROV5270
     NUMBER OF CONTRACT STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-CONTRACT
   OTHER ACTIVITIES STAFF-FULL TIME            7.2   1024  1030 N    PROV5260
     NUMBER OF FULL-TIME STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-FULL-TIME
   OTHER ACTIVITIES STAFF-PART TIME            7.2   1031  1037 N    PROV5305
     NUMBER OF PART TIME STAFF HOURS PROVIDED BY OTHER ACTIV
     ITIES STAFF.
     COBOL NAME: NUM-OTH-ACT-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PHYSICIAN - CONTRACT                  7.2   1038  1044 N    PROV1060
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     UNDER CONTRACT TO A FACILITY
     COBOL NAME: NUM-OTH-PHY-CONTRACT
   OTHER PHYSICIAN - FULL TIME                 7.2   1045  1051 N    PROV1065
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-FULL-TIME
   OTHER PHYSICIAN - PART TIME                 7.2   1052  1058 N    PROV1070
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-PART-TIME
   OTHR SOCIAL SERV STAFF-CONTRACT             7.2   1059  1065 N    PROV5300
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY OTHER SOCIAL
     SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-CONTRACT
   OTHR SOCIAL SERV STAFF-FULL TIME            7.2   1066  1072 N    PROV5290
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-FULL-TIME
   OTHR SOCIAL SERV STAFF-PART TIME            7.2   1073  1079 N    PROV5295
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-PART-TIME
   PHARMACISTS - CONTRACT                      7.2   1080  1086 N    PROV1085
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-PHAR-CONTRACT
   PHARMACISTS - FULL TIME                     7.2   1087  1093 N    PROV1090
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-PHAR-FULL-TIME
   PHARMACISTS - PART TIME                     7.2   1094  1100 N    PROV1095
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-PHAR-PART-TIME
   PHYS THER ASST - CONTRACT                   7.2   1101  1107 N    PROV5210
     NUMBER OF CONTRACT STAFF HOURS FOR PHYSICAL THERAPY ASS
     ISTANTS.
     COBOL NAME: NUM-THER-ASST-CONTRACT
   PHYS THER ASST - FULL TIME                  7.2   1108  1114 N    PROV5200
     NUMBER OF FULL-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-FULL-TIME
   PHYS THER ASST - PART TIME                  7.2   1115  1121 N    PROV5205
     NUMBER OF PART-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PHYSICAL THERAPISTS - CONTRACT              7.2   1122  1128 N    PROV1430
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-CONTRACT
   PHYSICAL THERAPISTS - FULL TIME             7.2   1129  1135 N    PROV1435
     THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-FULL-TIME
   PHYSICAL THERAPISTS - PART TIME             7.2   1136  1142 N    PROV1440
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-PART-TIME
   PHYSICAL THERAPY AIDE - CONTRACT            7.2   1143  1149 N    PROV1415
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-AID-CONTRACT
   PHYSICAL THERAPY AIDE - FULL TIME           7.2   1150  1156 N    PROV1420
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-AID-FULL-TIME
   PHYSICAL THERAPY AIDE - PART TIME           7.2   1157  1163 N    PROV1425
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-AID-PART-TIME
   PHYSICIAN EXTENDER - CONTRACT               7.2   1164  1170 N    PROV3270
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-PHYS-EXT-CONTRACT
   PHYSICIAN EXTENDER - FULL TIME              7.2   1171  1177 N    PROV3250
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-FULL-TIME
   PHYSICIAN EXTENDER - PART TIME              7.2   1178  1184 N    PROV3260
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A PART-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-PART-TIME
   PODIATRISTS - CONTRACT                      7.2   1185  1191 N    PROV1130
     THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-POD-CONTRACT
   PODIATRISTS - FULL TIME                     7.2   1192  1198 N    PROV1135
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A AFCILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-POD-FULL-TIME
   PODIATRISTS - PART TIME                     7.2   1199  1205 N    PROV1140
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-POD-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER BASED FACILITY                     1     1206  1206 C    PROV1675
     INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER
     BASED.
     COBOL NAME: PROV-BASED-FACILITY
     VALUES:   Y                   HOSPITAL BASED

   REGISTERED NURSE - CONTRACT                 7.2   1207  1213 N    PROV1150
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-REG-NURSE-CONTRACT
   REGISTERED NURSE - FULL TIME                7.2   1214  1220 N    PROV1155
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-FULL-TIME
   REGISTERED NURSE - PART TIME                7.2   1221  1227 N    PROV1160
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-PART-TIME
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   RN DIRECTOR OF NURSING - CONTRACT           7.2   1238  1244 N    PROV5130
     THE NUMBER OF FULL TIME EQUIVALENT RN DIRECTOR OF NURSI
     NG UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-RN-DON-CONTRACT
   RN DIRECTOR OF NURSING - FULL TIME          7.2   1245  1251 N    PROV5120
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-RN-DON-FULL-TIME
   RN DIRECTOR OF NURSING - PART TIME          7.2   1252  1258 N    PROV5140
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-RN-DON-PART-TIME
   SOCIAL WORKER - CONTRACT                    7.2   1259  1265 N    PROV1170
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SOCIAL-CONTRACT
   SOCIAL WORKER - FULL TIME                   7.2   1266  1272 N    PROV1175
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SOCIAL-FULL-TIME
   SOCIAL WORKER - PART TIME                   7.2   1273  1279 N    PROV1180
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SOCIAL-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPECIAL CARE BEDS-AIDS                      3     1280  1282 N    PROV0725
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH AIDS.
     COBOL NAME: NUM-AIDS-BEDS
   SPECIAL CARE BEDS-ALZHEIMERS                3     1283  1285 N    PROV0730
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS.
     COBOL NAME: NUM-ALZHEIMERS-BEDS
   SPECIAL CARE BEDS-DIALYSIS                  3     1286  1288 N    PROV0800
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS.
     COBOL NAME: NUM-DIAL-BEDS
   SPECIAL CARE BEDS-DISABLED CHILD            3     1289  1291 N    PROV0855
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR DEISCABLED CHILDREN.
     COBOL NAME: NUM-DIS-CHILD-BEDS
   SPECIAL CARE BEDS-HEAD TRAUMA               3     1292  1294 N    PROV0905
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA.
     COBOL NAME: NUM-HEAD-TRAUMA-BEDS
   SPECIAL CARE BEDS-HOSPICE                   3     1295  1297 N    PROV0920
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES.
     COBOL NAME: NUM-HOSPICE-BEDS
   SPECIAL CARE BEDS-HUNTINGTONS               3     1298  1300 N    PROV0940
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE
     COBOL NAME: NUM-HUNTING-DIS-BEDS
   SPECIAL CARE BEDS-SPEC REHAB                3     1301  1303 N    PROV1205
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB
     NEEDS.
     COBOL NAME: NUM-SPEC-REHAB-BEDS
   SPECIAL CARE BEDS-VENTILATOR                3     1304  1306 N    PROV1460
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/
     RESIPIRATORY CARE NEEDS.
     COBOL NAME: NUM-VENT-RESP-BEDS
   SPEECH PATHOLOGIST - CONTRACT               7.2   1307  1313 N    PROV1190
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SPCH-PATH-CONTRACT
   SPEECH PATHOLOGIST - FULL TIME              7.2   1314  1320 N    PROV1195
     THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-FULL-TIME




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEECH PATHOLOGIST - PART TIME              7.2   1321  1327 N    PROV1200
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-PART-TIME
   SRV: ACTIVITIES-OFFSITE-RESIDENTS           1     1328  1328 C    PROV3390
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-NON RES              1     1329  1329 C    PROV3385
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-RESIDENTS            1     1330  1330 C    PROV3380
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-OFFSITE-RESIDENTS          1     1331  1331 C    PROV3525
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-NONRES              1     1332  1332 C    PROV3520
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-RESIDENTS           1     1333  1333 C    PROV3515
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: CLINICAL LAB-OFFSITE-RESIDENT          1     1334  1334 C    PROV3495
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-NON RES            1     1335  1335 C    PROV3490
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-RESIDENTS          1     1336  1336 C    PROV3485
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-OFFSITE-RESIDENTS               1     1337  1337 C    PROV3435
     INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-NON RESIDENTS            1     1338  1338 C    PROV3430
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-RESIDENTS                1     1339  1339 C    PROV3425
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-OFFSITE-RESIDENTS              1     1340  1340 C    PROV3345
     INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 25
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: DIETARY-ONSITE-NON RESIDENTS           1     1341  1341 C    PROV3340
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-ONSITE-RESIDENTS               1     1342  1342 C    PROV3335
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING ONSITE-NON RES            1     1343  1343 C    PROV3535
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-OFFSITE-RES               1     1344  1344 C    PROV3540
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-ONSITE-RESIDENTS          1     1345  1345 C    PROV3530
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-OFFSITE-RES              1     1346  1346 C    PROV3465
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-ONSITE-NON RES           1     1347  1347 C    PROV3460
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 26
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: MENTAL HEALTH-ONSITE-RESID             1     1348  1348 C    PROV3455
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-OFFSITE-RESIDENTS              1     1349  1349 C    PROV3315
     INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-NON RESIDENTS           1     1350  1350 C    PROV3310
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-NURSING-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-RESIDENTS               1     1351  1351 C    PROV3305
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-OFFSITE-RESIDENTS           1     1352  1352 C    PROV3360
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-NON RESID            1     1353  1353 C    PROV3355
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-RESIDENTS            1     1354  1354 C    PROV3350
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 27
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: OTH ACTIVITIES-OFFSITE TO RES          1     1355  1355 C    PROV5255
     FIELD 3 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE NONRES           1     1356  1356 C    PROV5250
     FIELD 2 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE RES              1     1357  1357 C    PROV5245
     FIELD 1 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-OFFSITE TO RES             1     1358  1358 C    PROV5285
     FIELD 3 - INDICATES SERVICES PROVIDED BY OTHER SOCIAL S
     ERVICES STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO NONRES           1     1359  1359 C    PROV5280
     INDICATES IF OTHER SOCIAL SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO RES              1     1360  1360 C    PROV5275
     FIELD 1 - INDICATES SERVICES PROVIDED BY SOCIAL SERVICE
     S STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-OFFSITE-RESIDENTS             1     1361  1361 C    PROV3330
     INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 28
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHARMACY-ONSITE-NON RESIDENTS          1     1362  1362 C    PROV3325
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-ONSITE-RESIDENTS              1     1363  1363 C    PROV3320
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-OFFSITE-RESID            1     1364  1364 C    PROV3300
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-NON RES           1     1365  1365 C    PROV3295
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-RESIDENT          1     1366  1366 C    PROV3290
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-OFFSITE-RESIDENTS            1     1367  1367 C    PROV3375
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-ONSITE-NON RESIDENT          1     1368  1368 C    PROV3370
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 29
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHYS THER-ONSITE-RESIDENTS             1     1369  1369 C    PROV3365
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-OFFSITE-RESIDENTS            1     1370  1370 C    PROV3285
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-NON RESIDENT          1     1371  1371 C    PROV3280
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHYS-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-RESIDENTS             1     1372  1372 C    PROV3275
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-OFFSITE-RESIDENTS             1     1373  1373 C    PROV3450
     INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-NON RESIDENTS          1     1374  1374 C    PROV3445
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-RESIDENTS              1     1375  1375 C    PROV3440
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 30
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL WORK-OFFSITE-RESIDENTS          1     1376  1376 C    PROV3405
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-NON RESID           1     1377  1377 C    PROV3400
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-RESIDENTS           1     1378  1378 C    PROV3395
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-OFFSITE-RESIDEN            1     1379  1379 C    PROV3420
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-NON RESID           1     1380  1380 C    PROV3415
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-RESIDENTS           1     1381  1381 C    PROV3410
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-OFFSITE TO RES           1     1382  1382 C    PROV5225
     INDICATES IF THERAPEUTIC RECRECATION SPECIALIST
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 31
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: THER REC SPEC-ONSITE-NONRES            1     1383  1383 C    PROV5220
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-THER-REC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-ONSITE-RESIDENT          1     1384  1384 C    PROV5215
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-OFFSITE-RESIDENTS           1     1385  1385 C    PROV3480
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-VOC-GUID-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-NON RESID            1     1386  1386 C    PROV3475
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-RESIDENTS            1     1387  1387 C    PROV3470
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-OFFSITE-RESIDENTS                 1     1388  1388 C    PROV3510
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-ONSITE-NON RESIDENTS              1     1389  1389 C    PROV3505
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 32
         SNF/NF (DUALLY CERTIFIED), CATEGORY = "02" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: XRAY-ONSITE-RESIDENTS                  1     1390  1390 C    PROV3500
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   THER REC SPEC - CONTRACT                    7.2   1391  1397 N    PROV5240
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-CONTRACT
   THER REC SPEC - FULL TIME                   7.2   1398  1404 N    PROV5230
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-FULL-TIME
   THER REC SPEC - PART TIME                   7.2   1405  1411 N    PROV5235
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-PART-TIME































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   03                  TITLE 18/19

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   03                  SNF/NF (DISTINCT PART)

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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                  LIMITED LIABILITY CORPORATION

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   WAIVER RECOMMENDED

   COMPLIANCE: 24 HR REGISTERED NURSE          1     359   359  C    PROV0290
     INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE
     REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-24-HR-RN
     VALUES:   1                   WAIVER RECOMMENDED

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   1                   MEDICARE ONLY
               2                   MEDICAID ONLY
               3                   MEDICARE AND MEDICAID

   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   ACTIVITY PROFESSIONAL - CONTRACT            7.2   596   602  N    PROV0695
     THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ACT-THER-CONTRACT
   ACTIVITY PROFESSIONAL - FULL TIME           7.2   603   609  N    PROV0700
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED FULL TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-FULL-TIME
   ACTIVITY PROFESSIONAL - PART TIME           7.2   610   616  N    PROV0705
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED PART TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ADMINISTRATION - CONTRACT                   7.2   617   623  N    PROV0710
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ADMN-CONTRACT
   ADMINISTRATOR - FULL TIME                   7.2   624   630  N    PROV0715
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A FULL TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-FULL-TIME
   ADMINISTRATOR - PART TIME                   7.2   631   637  N    PROV0720
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A PART-TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-PART-TIME
   BEDS - MEDICARE SNF                         4     638   641  N    PROV1445
     NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY.
     COBOL NAME: NUM-T18-SNF-BEDS
   BEDS - NURSING FACILITY                     4     642   645  N    PROV1455
     NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE
     BEDS IN A FACILITY.
     COBOL NAME: NUM-T19-SNF-BEDS
   BEDS - SNF/NF                               4     646   649  N    PROV1450
     NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID
     SKILLED NURSING CARE IN A LONG TERM CARE FACILITY.
     COBOL NAME: NUM-T1819-SNF-BEDS
   CERT NURSE AIDES - CONTRACT                 7.2   650   656  N    PROV1000
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-AID-CONTRACT
   CERT NURSE AIDES - FULL TIME                7.2   657   663  N    PROV1005
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-FULL-TIME
   CERT NURSE AIDES - PART TIME                7.2   664   670  N    PROV1010
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-PART-TIME
   CHRISTIAN SCIENCE INDICATOR                 1     671   671  C    PROV0110
     INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY
     COBOL NAME: CHRISTIAN-SCIENCE-IND
     VALUES:   Y                   CHRISTIAN SCIENCE

   COMPLIANCE: BEDS PER ROOM WAIVER            1     672   672  C    PROV0225
     INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT
     HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-BEDS-PER-ROOM
     VALUES:   1                   WAIVER RECOMMENDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: PATIENT ROOM SIZE               1     673   673  C    PROV0270
     INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN
     RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-PATIENT-ROOM-SZ
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 7 DAY REGISTERED NURSE          1     674   674  C    PROV0295
     INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE
     REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF.
     COBOL NAME: COMPL-7-DAY-RN
     VALUES:   1                   WAIVER RECOMMENDED

   DENTISTS - CONTRACT                         7.2   675   681  N    PROV0785
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-DENTIST-CONTRACT
   DENTISTS - FULL TIME                        7.2   682   688  N    PROV0790
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DENTIST-FULL-TIME
   DENTISTS - PART TIME                        7.2   689   695  N    PROV0795
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DENTIST-PART-TIME
   DIETITIANS - CONTRACT                       7.2   696   702  N    PROV0805
     THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO
     A FACILITY.
     COBOL NAME: NUM-DIET-CONTRACT
   DIETITIANS - FULL TIME                      7.2   703   709  N    PROV0810
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DIET-FULL-TIME
   DIETITIANS - PART TIME                      7.2   710   716  N    PROV0815
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DIET-PART-TIME
   EXPERIMENTAL RESEARCH CONDUCTED             1     717   717  C    PROV0465
     INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND
     TEST CLINICAL TREATMENTS.
     COBOL NAME: EXPER-RESEARCH
     VALUES:   Y                   YES

   FOOD SERVICE - CONTRACT                     7.2   718   724  N    PROV0860
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-FOOD-SRV-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   FOOD SERVICE - FULL TIME                    7.2   725   731  N    PROV0865
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-FULL-TIME
   FOOD SERVICE - PART TIME                    7.2   732   738  N    PROV0870
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-PART-TIME
   HOUSEKEEPING - CONTRACT                     7.2   739   745  N    PROV0925
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-HOUSE-CONTRACT
   HOUSEKEEPING - FULL TIME                    7.2   746   752  N    PROV0930
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-HOUSE-FULL-TIME
   HOUSEKEEPING - PART TIME                    7.2   753   759  N    PROV0935
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-HOUSE-PART-TIME
   LPN/LVN - CONTRACT                          7.2   760   766  N    PROV1465
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-VOC-NURSE-CONTRACT
   LPN/LVN - FULL TIME                         7.2   767   773  N    PROV1470
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-FULL-TIME
   LPN/LVN - PART TIME                         7.2   774   780  N    PROV1475
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-PART-TIME
   LTC CROSS REFERENCE PROVIDER #              6     781   786  C    PROV0640
     THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER
     NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY
     CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA
     LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO.
     COBOL NAME: LTC-CROSS-REF-PROV-NUM
   MEDICAL DIRECTOR - CONTRACT                 7.2   787   793  N    PROV0960
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-MED-CONTRACT
   MEDICAL DIRECTOR - FULL TIME                7.2   794   800  N    PROV0965
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-MED-FULL-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICAL DIRECTOR - PART TIME                7.2   801   807  N    PROV0970
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-MED-PART-TIME
   MEDICATION AIDES/TECHS-CONTRACT             7.2   808   814  N    PROV5180
     THE NUMBER OF FULL-TIMR EQUIVALENT MEDICATION AIDES/
     TECHNICIANS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MED-AID-CONTRACT
   MEDICATION AIDES/TECHS-FULL TIME            7.2   815   821  N    PROV5170
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-FULL-TIME
   MEDICATION AIDES/TECHS-PART TIME            7.2   822   828  N    PROV5175
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BYA FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-PART-TIME
   MENTAL HEALTH SERVICES - CONTRACT           7.2   829   835  N    PROV0980
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MEN-HLTH-CONTRACT
   MENTAL HEALTH SERVICES - FULL TIME          7.2   836   842  N    PROV0985
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-FULL-TIME
   MENTAL HEALTH SERVICES - PART TIME          7.2   843   849  N    PROV0990
     THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-PART-TIME
   MULTI-FACILITY ORGANIZATION NAME            38    850   887  C    PROV0680
     THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS
     THE FACILITY.
     COBOL NAME: NAME-MULT-FACL-ORG
   MULTI-FACILITY ORGANIZATION OWNED           1     888   888  C    PROV0675
     INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION
     THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES.
     COBOL NAME: MULT-FACL-ORG
     VALUES:   Y                   YES

   NURSE AIDES IN TRNG - CONTRACT              7.2   889   895  N    PROV5165
     NUMBER OF FULL TIME EQUIVALENT NURSE AIDES IN TRAINING
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-AID-TRNG-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   NURSE AIDES IN TRNG-FULL TIME               7.2   896   902  N    PROV5155
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-FULL-TIME
   NURSE AIDES IN TRNG-PART TIME               7.2   903   909  N    PROV5160
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-PART-TIME
   NURSES WITH ADMIN DUTIES-CONTRACT           7.2   910   916  N    PROV5150
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-ADM-CONTRACT
   NURSES WITH ADMIN DUTIES-FULL TIME          7.2   917   923  N    PROV5135
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-FULL-TIME
   NURSES WITH ADMIN DUTIES-PART TIME          7.2   924   930  N    PROV5145
     NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A
     PART TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-PART-TIME
   OCCUP THERAPIST, FULL TIME, STAFF           7.2   931   937  N    PROV1040
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-THER-FULL-TIME
   OCCUP THERAPISTS, CONTRACT/ARRANGE          7.2   938   944  N    PROV1035
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-THER-CONTRACT
   OCCUP THERAPY AIDE - CONTRACT               7.2   945   951  N    PROV1020
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPY AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-AID-CONTRACT
   OCCUP THERAPY AIDE - FULL TIME              7.2   952   958  N    PROV1025
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-AID-FULL-TIME
   OCCUP THERAPY AIDE - PART TIME              7.2   959   965  N    PROV1030
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-AID-PART-TIME
   OCCUP THERAPY ASST - CONTRACT               7.2   966   972  N    PROV5195
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-OCC-ASST-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OCCUP THERAPY ASST - FULL TIME              7.2   973   979  N    PROV5185
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-FULL-TIME
   OCCUP THERAPY ASST - PART TIME              7.2   980   986  N    PROV5190
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-PART-TIME
   OCCUPATIONAL THERAPIST - PART TIME          7.2   987   993  N    PROV1045
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-THER-PART-TIME
   ORGANIZED FAMILY GROUP                      1     994   994  C    PROV1535
     INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF
     FAMILY MEMBERS OF RESIDENTS.
     COBOL NAME: ORG-FAMILY-GRP
     VALUES:   Y                   YES

   ORGANIZED RESIDENT GROUP                    1     995   995  C    PROV1540
     INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS
     GROUP.
     COBOL NAME: ORG-RESID-GRP
     VALUES:   Y                   YES

   OTHER - CONTRACT                            7.2   996   1002 N    PROV3265
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-OTH-CONTRACT
   OTHER - FULL TIME                           7.2   1003  1009 N    PROV3245
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     FULL-TIME BASIS.
     COBOL NAME: NUM-OTH-FULL-TIME
   OTHER - PART TIME                           7.2   1010  1016 N    PROV3255
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     PART-TIME BASIS.
     COBOL NAME: NUM-OTH-PART-TIME
   OTHER ACTIVITIES STAFF-CONTRACT             7.2   1017  1023 N    PROV5270
     NUMBER OF CONTRACT STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-CONTRACT
   OTHER ACTIVITIES STAFF-FULL TIME            7.2   1024  1030 N    PROV5260
     NUMBER OF FULL-TIME STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-FULL-TIME
   OTHER ACTIVITIES STAFF-PART TIME            7.2   1031  1037 N    PROV5305
     NUMBER OF PART TIME STAFF HOURS PROVIDED BY OTHER ACTIV
     ITIES STAFF.
     COBOL NAME: NUM-OTH-ACT-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PHYSICIAN - CONTRACT                  7.2   1038  1044 N    PROV1060
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     UNDER CONTRACT TO A FACILITY
     COBOL NAME: NUM-OTH-PHY-CONTRACT
   OTHER PHYSICIAN - FULL TIME                 7.2   1045  1051 N    PROV1065
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-FULL-TIME
   OTHER PHYSICIAN - PART TIME                 7.2   1052  1058 N    PROV1070
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-PART-TIME
   OTHR SOCIAL SERV STAFF-CONTRACT             7.2   1059  1065 N    PROV5300
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY OTHER SOCIAL
     SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-CONTRACT
   OTHR SOCIAL SERV STAFF-FULL TIME            7.2   1066  1072 N    PROV5290
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-FULL-TIME
   OTHR SOCIAL SERV STAFF-PART TIME            7.2   1073  1079 N    PROV5295
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-PART-TIME
   PHARMACISTS - CONTRACT                      7.2   1080  1086 N    PROV1085
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-PHAR-CONTRACT
   PHARMACISTS - FULL TIME                     7.2   1087  1093 N    PROV1090
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-PHAR-FULL-TIME
   PHARMACISTS - PART TIME                     7.2   1094  1100 N    PROV1095
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-PHAR-PART-TIME
   PHYS THER ASST - CONTRACT                   7.2   1101  1107 N    PROV5210
     NUMBER OF CONTRACT STAFF HOURS FOR PHYSICAL THERAPY ASS
     ISTANTS.
     COBOL NAME: NUM-THER-ASST-CONTRACT
   PHYS THER ASST - FULL TIME                  7.2   1108  1114 N    PROV5200
     NUMBER OF FULL-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-FULL-TIME
   PHYS THER ASST - PART TIME                  7.2   1115  1121 N    PROV5205
     NUMBER OF PART-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PHYSICAL THERAPISTS - CONTRACT              7.2   1122  1128 N    PROV1430
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-CONTRACT
   PHYSICAL THERAPISTS - FULL TIME             7.2   1129  1135 N    PROV1435
     THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-FULL-TIME
   PHYSICAL THERAPISTS - PART TIME             7.2   1136  1142 N    PROV1440
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-PART-TIME
   PHYSICAL THERAPY AIDE - CONTRACT            7.2   1143  1149 N    PROV1415
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-AID-CONTRACT
   PHYSICAL THERAPY AIDE - FULL TIME           7.2   1150  1156 N    PROV1420
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-AID-FULL-TIME
   PHYSICAL THERAPY AIDE - PART TIME           7.2   1157  1163 N    PROV1425
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-AID-PART-TIME
   PHYSICIAN EXTENDER - CONTRACT               7.2   1164  1170 N    PROV3270
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-PHYS-EXT-CONTRACT
   PHYSICIAN EXTENDER - FULL TIME              7.2   1171  1177 N    PROV3250
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-FULL-TIME
   PHYSICIAN EXTENDER - PART TIME              7.2   1178  1184 N    PROV3260
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A PART-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-PART-TIME
   PODIATRISTS - CONTRACT                      7.2   1185  1191 N    PROV1130
     THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-POD-CONTRACT
   PODIATRISTS - FULL TIME                     7.2   1192  1198 N    PROV1135
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A AFCILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-POD-FULL-TIME
   PODIATRISTS - PART TIME                     7.2   1199  1205 N    PROV1140
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-POD-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER BASED FACILITY                     1     1206  1206 C    PROV1675
     INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER
     BASED.
     COBOL NAME: PROV-BASED-FACILITY
     VALUES:   Y                   HOSPITAL BASED

   REGISTERED NURSE - CONTRACT                 7.2   1207  1213 N    PROV1150
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-REG-NURSE-CONTRACT
   REGISTERED NURSE - FULL TIME                7.2   1214  1220 N    PROV1155
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-FULL-TIME
   REGISTERED NURSE - PART TIME                7.2   1221  1227 N    PROV1160
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-PART-TIME
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   RN DIRECTOR OF NURSING - CONTRACT           7.2   1238  1244 N    PROV5130
     THE NUMBER OF FULL TIME EQUIVALENT RN DIRECTOR OF NURSI
     NG UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-RN-DON-CONTRACT
   RN DIRECTOR OF NURSING - FULL TIME          7.2   1245  1251 N    PROV5120
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-RN-DON-FULL-TIME
   RN DIRECTOR OF NURSING - PART TIME          7.2   1252  1258 N    PROV5140
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-RN-DON-PART-TIME
   SOCIAL WORKER - CONTRACT                    7.2   1259  1265 N    PROV1170
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SOCIAL-CONTRACT
   SOCIAL WORKER - FULL TIME                   7.2   1266  1272 N    PROV1175
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SOCIAL-FULL-TIME
   SOCIAL WORKER - PART TIME                   7.2   1273  1279 N    PROV1180
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SOCIAL-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPECIAL CARE BEDS-AIDS                      3     1280  1282 N    PROV0725
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH AIDS.
     COBOL NAME: NUM-AIDS-BEDS
   SPECIAL CARE BEDS-ALZHEIMERS                3     1283  1285 N    PROV0730
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS.
     COBOL NAME: NUM-ALZHEIMERS-BEDS
   SPECIAL CARE BEDS-DIALYSIS                  3     1286  1288 N    PROV0800
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS.
     COBOL NAME: NUM-DIAL-BEDS
   SPECIAL CARE BEDS-DISABLED CHILD            3     1289  1291 N    PROV0855
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR DEISCABLED CHILDREN.
     COBOL NAME: NUM-DIS-CHILD-BEDS
   SPECIAL CARE BEDS-HEAD TRAUMA               3     1292  1294 N    PROV0905
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA.
     COBOL NAME: NUM-HEAD-TRAUMA-BEDS
   SPECIAL CARE BEDS-HOSPICE                   3     1295  1297 N    PROV0920
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES.
     COBOL NAME: NUM-HOSPICE-BEDS
   SPECIAL CARE BEDS-HUNTINGTONS               3     1298  1300 N    PROV0940
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE
     COBOL NAME: NUM-HUNTING-DIS-BEDS
   SPECIAL CARE BEDS-SPEC REHAB                3     1301  1303 N    PROV1205
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB
     NEEDS.
     COBOL NAME: NUM-SPEC-REHAB-BEDS
   SPECIAL CARE BEDS-VENTILATOR                3     1304  1306 N    PROV1460
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/
     RESIPIRATORY CARE NEEDS.
     COBOL NAME: NUM-VENT-RESP-BEDS
   SPEECH PATHOLOGIST - CONTRACT               7.2   1307  1313 N    PROV1190
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SPCH-PATH-CONTRACT
   SPEECH PATHOLOGIST - FULL TIME              7.2   1314  1320 N    PROV1195
     THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-FULL-TIME




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEECH PATHOLOGIST - PART TIME              7.2   1321  1327 N    PROV1200
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-PART-TIME
   SRV: ACTIVITIES-OFFSITE-RESIDENTS           1     1328  1328 C    PROV3390
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-NON RES              1     1329  1329 C    PROV3385
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-RESIDENTS            1     1330  1330 C    PROV3380
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-OFFSITE-RESIDENTS          1     1331  1331 C    PROV3525
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-NONRES              1     1332  1332 C    PROV3520
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-RESIDENTS           1     1333  1333 C    PROV3515
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: CLINICAL LAB-OFFSITE-RESIDENT          1     1334  1334 C    PROV3495
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-NON RES            1     1335  1335 C    PROV3490
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-RESIDENTS          1     1336  1336 C    PROV3485
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-OFFSITE-RESIDENTS               1     1337  1337 C    PROV3435
     INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-NON RESIDENTS            1     1338  1338 C    PROV3430
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-RESIDENTS                1     1339  1339 C    PROV3425
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-OFFSITE-RESIDENTS              1     1340  1340 C    PROV3345
     INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 25
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: DIETARY-ONSITE-NON RESIDENTS           1     1341  1341 C    PROV3340
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-ONSITE-RESIDENTS               1     1342  1342 C    PROV3335
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING ONSITE-NON RES            1     1343  1343 C    PROV3535
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-OFFSITE-RES               1     1344  1344 C    PROV3540
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-ONSITE-RESIDENTS          1     1345  1345 C    PROV3530
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-OFFSITE-RES              1     1346  1346 C    PROV3465
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-ONSITE-NON RES           1     1347  1347 C    PROV3460
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 26
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: MENTAL HEALTH-ONSITE-RESID             1     1348  1348 C    PROV3455
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-OFFSITE-RESIDENTS              1     1349  1349 C    PROV3315
     INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-NON RESIDENTS           1     1350  1350 C    PROV3310
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-NURSING-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-RESIDENTS               1     1351  1351 C    PROV3305
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-OFFSITE-RESIDENTS           1     1352  1352 C    PROV3360
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-NON RESID            1     1353  1353 C    PROV3355
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-RESIDENTS            1     1354  1354 C    PROV3350
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 27
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: OTH ACTIVITIES-OFFSITE TO RES          1     1355  1355 C    PROV5255
     FIELD 3 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE NONRES           1     1356  1356 C    PROV5250
     FIELD 2 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE RES              1     1357  1357 C    PROV5245
     FIELD 1 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-OFFSITE TO RES             1     1358  1358 C    PROV5285
     FIELD 3 - INDICATES SERVICES PROVIDED BY OTHER SOCIAL S
     ERVICES STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO NONRES           1     1359  1359 C    PROV5280
     INDICATES IF OTHER SOCIAL SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO RES              1     1360  1360 C    PROV5275
     FIELD 1 - INDICATES SERVICES PROVIDED BY SOCIAL SERVICE
     S STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-OFFSITE-RESIDENTS             1     1361  1361 C    PROV3330
     INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 28
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHARMACY-ONSITE-NON RESIDENTS          1     1362  1362 C    PROV3325
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-ONSITE-RESIDENTS              1     1363  1363 C    PROV3320
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-OFFSITE-RESID            1     1364  1364 C    PROV3300
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-NON RES           1     1365  1365 C    PROV3295
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-RESIDENT          1     1366  1366 C    PROV3290
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-OFFSITE-RESIDENTS            1     1367  1367 C    PROV3375
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-ONSITE-NON RESIDENT          1     1368  1368 C    PROV3370
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 29
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHYS THER-ONSITE-RESIDENTS             1     1369  1369 C    PROV3365
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-OFFSITE-RESIDENTS            1     1370  1370 C    PROV3285
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-NON RESIDENT          1     1371  1371 C    PROV3280
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHYS-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-RESIDENTS             1     1372  1372 C    PROV3275
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-OFFSITE-RESIDENTS             1     1373  1373 C    PROV3450
     INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-NON RESIDENTS          1     1374  1374 C    PROV3445
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-RESIDENTS              1     1375  1375 C    PROV3440
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 30
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL WORK-OFFSITE-RESIDENTS          1     1376  1376 C    PROV3405
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-NON RESID           1     1377  1377 C    PROV3400
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-RESIDENTS           1     1378  1378 C    PROV3395
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-OFFSITE-RESIDEN            1     1379  1379 C    PROV3420
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-NON RESID           1     1380  1380 C    PROV3415
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-RESIDENTS           1     1381  1381 C    PROV3410
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-OFFSITE TO RES           1     1382  1382 C    PROV5225
     INDICATES IF THERAPEUTIC RECRECATION SPECIALIST
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 31
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: THER REC SPEC-ONSITE-NONRES            1     1383  1383 C    PROV5220
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-THER-REC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-ONSITE-RESIDENT          1     1384  1384 C    PROV5215
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-OFFSITE-RESIDENTS           1     1385  1385 C    PROV3480
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-VOC-GUID-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-NON RESID            1     1386  1386 C    PROV3475
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-RESIDENTS            1     1387  1387 C    PROV3470
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-OFFSITE-RESIDENTS                 1     1388  1388 C    PROV3510
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-ONSITE-NON RESIDENTS              1     1389  1389 C    PROV3505
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 32
          SNF/NF (DISTINCT PART), CATEGORY = "03" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: XRAY-ONSITE-RESIDENTS                  1     1390  1390 C    PROV3500
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   THER REC SPEC - CONTRACT                    7.2   1391  1397 N    PROV5240
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-CONTRACT
   THER REC SPEC - FULL TIME                   7.2   1398  1404 N    PROV5230
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-FULL-TIME
   THER REC SPEC - PART TIME                   7.2   1405  1411 N    PROV5235
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-PART-TIME































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  TITLE 18 ONLY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   04                  SKILLED NURSING FACILITIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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                  LIMITED LIABILITY CORPORATION

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   WAIVER RECOMMENDED

   COMPLIANCE: 24 HR REGISTERED NURSE          1     359   359  C    PROV0290
     INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE
     REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-24-HR-RN
     VALUES:   1                   WAIVER RECOMMENDED

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   1                   MEDICARE ONLY
               2                   MEDICAID ONLY
               3                   MEDICARE AND MEDICAID

   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   ACTIVITY PROFESSIONAL - CONTRACT            7.2   596   602  N    PROV0695
     THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ACT-THER-CONTRACT
   ACTIVITY PROFESSIONAL - FULL TIME           7.2   603   609  N    PROV0700
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED FULL TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-FULL-TIME
   ACTIVITY PROFESSIONAL - PART TIME           7.2   610   616  N    PROV0705
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED PART TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ADMINISTRATION - CONTRACT                   7.2   617   623  N    PROV0710
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ADMN-CONTRACT
   ADMINISTRATOR - FULL TIME                   7.2   624   630  N    PROV0715
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A FULL TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-FULL-TIME
   ADMINISTRATOR - PART TIME                   7.2   631   637  N    PROV0720
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A PART-TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-PART-TIME
   BEDS - MEDICARE SNF                         4     638   641  N    PROV1445
     NUMBER OF MEDICARE CERTIFIED SNF BEDS IN A FACILITY.
     COBOL NAME: NUM-T18-SNF-BEDS
   BEDS - NURSING FACILITY                     4     642   645  N    PROV1455
     NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE
     BEDS IN A FACILITY.
     COBOL NAME: NUM-T19-SNF-BEDS
   BEDS - SNF/NF                               4     646   649  N    PROV1450
     NUMBER OF BEDS CERTIFIED FOR BOTH MEDICARE AND MEDICAID
     SKILLED NURSING CARE IN A LONG TERM CARE FACILITY.
     COBOL NAME: NUM-T1819-SNF-BEDS
   CERT NURSE AIDES - CONTRACT                 7.2   650   656  N    PROV1000
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-AID-CONTRACT
   CERT NURSE AIDES - FULL TIME                7.2   657   663  N    PROV1005
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-FULL-TIME
   CERT NURSE AIDES - PART TIME                7.2   664   670  N    PROV1010
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-PART-TIME
   CHRISTIAN SCIENCE INDICATOR                 1     671   671  C    PROV0110
     INDICATES IF A PROVIDER IS A CHRISTIAN SCIENCE FACILITY
     COBOL NAME: CHRISTIAN-SCIENCE-IND
     VALUES:   Y                   CHRISTIAN SCIENCE

   COMPLIANCE: BEDS PER ROOM WAIVER            1     672   672  C    PROV0225
     INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT
     HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-BEDS-PER-ROOM
     VALUES:   1                   WAIVER RECOMMENDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: PATIENT ROOM SIZE               1     673   673  C    PROV0270
     INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN
     RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-PATIENT-ROOM-SZ
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 7 DAY REGISTERED NURSE          1     674   674  C    PROV0295
     INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE
     REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF.
     COBOL NAME: COMPL-7-DAY-RN
     VALUES:   1                   WAIVER RECOMMENDED

   DENTISTS - CONTRACT                         7.2   675   681  N    PROV0785
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-DENTIST-CONTRACT
   DENTISTS - FULL TIME                        7.2   682   688  N    PROV0790
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DENTIST-FULL-TIME
   DENTISTS - PART TIME                        7.2   689   695  N    PROV0795
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DENTIST-PART-TIME
   DIETITIANS - CONTRACT                       7.2   696   702  N    PROV0805
     THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO
     A FACILITY.
     COBOL NAME: NUM-DIET-CONTRACT
   DIETITIANS - FULL TIME                      7.2   703   709  N    PROV0810
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DIET-FULL-TIME
   DIETITIANS - PART TIME                      7.2   710   716  N    PROV0815
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DIET-PART-TIME
   EXPERIMENTAL RESEARCH CONDUCTED             1     717   717  C    PROV0465
     INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND
     TEST CLINICAL TREATMENTS.
     COBOL NAME: EXPER-RESEARCH
     VALUES:   Y                   YES

   FOOD SERVICE - CONTRACT                     7.2   718   724  N    PROV0860
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-FOOD-SRV-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   FOOD SERVICE - FULL TIME                    7.2   725   731  N    PROV0865
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-FULL-TIME
   FOOD SERVICE - PART TIME                    7.2   732   738  N    PROV0870
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-PART-TIME
   HOUSEKEEPING - CONTRACT                     7.2   739   745  N    PROV0925
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-HOUSE-CONTRACT
   HOUSEKEEPING - FULL TIME                    7.2   746   752  N    PROV0930
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-HOUSE-FULL-TIME
   HOUSEKEEPING - PART TIME                    7.2   753   759  N    PROV0935
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-HOUSE-PART-TIME
   LPN/LVN - CONTRACT                          7.2   760   766  N    PROV1465
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-VOC-NURSE-CONTRACT
   LPN/LVN - FULL TIME                         7.2   767   773  N    PROV1470
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-FULL-TIME
   LPN/LVN - PART TIME                         7.2   774   780  N    PROV1475
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-PART-TIME
   LTC CROSS REFERENCE PROVIDER #              6     781   786  C    PROV0640
     THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER
     NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY
     CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA
     LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO.
     COBOL NAME: LTC-CROSS-REF-PROV-NUM
   MEDICAL DIRECTOR - CONTRACT                 7.2   787   793  N    PROV0960
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-MED-CONTRACT
   MEDICAL DIRECTOR - FULL TIME                7.2   794   800  N    PROV0965
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-MED-FULL-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICAL DIRECTOR - PART TIME                7.2   801   807  N    PROV0970
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-MED-PART-TIME
   MEDICATION AIDES/TECHS-CONTRACT             7.2   808   814  N    PROV5180
     THE NUMBER OF FULL-TIMR EQUIVALENT MEDICATION AIDES/
     TECHNICIANS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MED-AID-CONTRACT
   MEDICATION AIDES/TECHS-FULL TIME            7.2   815   821  N    PROV5170
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-FULL-TIME
   MEDICATION AIDES/TECHS-PART TIME            7.2   822   828  N    PROV5175
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BYA FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-PART-TIME
   MENTAL HEALTH SERVICES - CONTRACT           7.2   829   835  N    PROV0980
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MEN-HLTH-CONTRACT
   MENTAL HEALTH SERVICES - FULL TIME          7.2   836   842  N    PROV0985
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-FULL-TIME
   MENTAL HEALTH SERVICES - PART TIME          7.2   843   849  N    PROV0990
     THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-PART-TIME
   MULTI-FACILITY ORGANIZATION NAME            38    850   887  C    PROV0680
     THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS
     THE FACILITY.
     COBOL NAME: NAME-MULT-FACL-ORG
   MULTI-FACILITY ORGANIZATION OWNED           1     888   888  C    PROV0675
     INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION
     THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES.
     COBOL NAME: MULT-FACL-ORG
     VALUES:   Y                   YES

   NURSE AIDES IN TRNG - CONTRACT              7.2   889   895  N    PROV5165
     NUMBER OF FULL TIME EQUIVALENT NURSE AIDES IN TRAINING
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-AID-TRNG-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   NURSE AIDES IN TRNG-FULL TIME               7.2   896   902  N    PROV5155
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-FULL-TIME
   NURSE AIDES IN TRNG-PART TIME               7.2   903   909  N    PROV5160
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-PART-TIME
   NURSES WITH ADMIN DUTIES-CONTRACT           7.2   910   916  N    PROV5150
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-ADM-CONTRACT
   NURSES WITH ADMIN DUTIES-FULL TIME          7.2   917   923  N    PROV5135
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-FULL-TIME
   NURSES WITH ADMIN DUTIES-PART TIME          7.2   924   930  N    PROV5145
     NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A
     PART TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-PART-TIME
   OCCUP THERAPIST, FULL TIME, STAFF           7.2   931   937  N    PROV1040
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-THER-FULL-TIME
   OCCUP THERAPISTS, CONTRACT/ARRANGE          7.2   938   944  N    PROV1035
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-THER-CONTRACT
   OCCUP THERAPY AIDE - CONTRACT               7.2   945   951  N    PROV1020
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPY AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-AID-CONTRACT
   OCCUP THERAPY AIDE - FULL TIME              7.2   952   958  N    PROV1025
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-AID-FULL-TIME
   OCCUP THERAPY AIDE - PART TIME              7.2   959   965  N    PROV1030
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-AID-PART-TIME
   OCCUP THERAPY ASST - CONTRACT               7.2   966   972  N    PROV5195
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-OCC-ASST-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OCCUP THERAPY ASST - FULL TIME              7.2   973   979  N    PROV5185
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-FULL-TIME
   OCCUP THERAPY ASST - PART TIME              7.2   980   986  N    PROV5190
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-PART-TIME
   OCCUPATIONAL THERAPIST - PART TIME          7.2   987   993  N    PROV1045
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-THER-PART-TIME
   ORGANIZED FAMILY GROUP                      1     994   994  C    PROV1535
     INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF
     FAMILY MEMBERS OF RESIDENTS.
     COBOL NAME: ORG-FAMILY-GRP
     VALUES:   Y                   YES

   ORGANIZED RESIDENT GROUP                    1     995   995  C    PROV1540
     INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS
     GROUP.
     COBOL NAME: ORG-RESID-GRP
     VALUES:   Y                   YES

   OTHER - CONTRACT                            7.2   996   1002 N    PROV3265
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-OTH-CONTRACT
   OTHER - FULL TIME                           7.2   1003  1009 N    PROV3245
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     FULL-TIME BASIS.
     COBOL NAME: NUM-OTH-FULL-TIME
   OTHER - PART TIME                           7.2   1010  1016 N    PROV3255
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     PART-TIME BASIS.
     COBOL NAME: NUM-OTH-PART-TIME
   OTHER ACTIVITIES STAFF-CONTRACT             7.2   1017  1023 N    PROV5270
     NUMBER OF CONTRACT STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-CONTRACT
   OTHER ACTIVITIES STAFF-FULL TIME            7.2   1024  1030 N    PROV5260
     NUMBER OF FULL-TIME STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-FULL-TIME
   OTHER ACTIVITIES STAFF-PART TIME            7.2   1031  1037 N    PROV5305
     NUMBER OF PART TIME STAFF HOURS PROVIDED BY OTHER ACTIV
     ITIES STAFF.
     COBOL NAME: NUM-OTH-ACT-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PHYSICIAN - CONTRACT                  7.2   1038  1044 N    PROV1060
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     UNDER CONTRACT TO A FACILITY
     COBOL NAME: NUM-OTH-PHY-CONTRACT
   OTHER PHYSICIAN - FULL TIME                 7.2   1045  1051 N    PROV1065
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-FULL-TIME
   OTHER PHYSICIAN - PART TIME                 7.2   1052  1058 N    PROV1070
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-PART-TIME
   OTHR SOCIAL SERV STAFF-CONTRACT             7.2   1059  1065 N    PROV5300
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY OTHER SOCIAL
     SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-CONTRACT
   OTHR SOCIAL SERV STAFF-FULL TIME            7.2   1066  1072 N    PROV5290
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-FULL-TIME
   OTHR SOCIAL SERV STAFF-PART TIME            7.2   1073  1079 N    PROV5295
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-PART-TIME
   PHARMACISTS - CONTRACT                      7.2   1080  1086 N    PROV1085
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-PHAR-CONTRACT
   PHARMACISTS - FULL TIME                     7.2   1087  1093 N    PROV1090
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-PHAR-FULL-TIME
   PHARMACISTS - PART TIME                     7.2   1094  1100 N    PROV1095
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-PHAR-PART-TIME
   PHYS THER ASST - CONTRACT                   7.2   1101  1107 N    PROV5210
     NUMBER OF CONTRACT STAFF HOURS FOR PHYSICAL THERAPY ASS
     ISTANTS.
     COBOL NAME: NUM-THER-ASST-CONTRACT
   PHYS THER ASST - FULL TIME                  7.2   1108  1114 N    PROV5200
     NUMBER OF FULL-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-FULL-TIME
   PHYS THER ASST - PART TIME                  7.2   1115  1121 N    PROV5205
     NUMBER OF PART-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PHYSICAL THERAPISTS - CONTRACT              7.2   1122  1128 N    PROV1430
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-CONTRACT
   PHYSICAL THERAPISTS - FULL TIME             7.2   1129  1135 N    PROV1435
     THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-FULL-TIME
   PHYSICAL THERAPISTS - PART TIME             7.2   1136  1142 N    PROV1440
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-PART-TIME
   PHYSICAL THERAPY AIDE - CONTRACT            7.2   1143  1149 N    PROV1415
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-AID-CONTRACT
   PHYSICAL THERAPY AIDE - FULL TIME           7.2   1150  1156 N    PROV1420
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-AID-FULL-TIME
   PHYSICAL THERAPY AIDE - PART TIME           7.2   1157  1163 N    PROV1425
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-AID-PART-TIME
   PHYSICIAN EXTENDER - CONTRACT               7.2   1164  1170 N    PROV3270
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-PHYS-EXT-CONTRACT
   PHYSICIAN EXTENDER - FULL TIME              7.2   1171  1177 N    PROV3250
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-FULL-TIME
   PHYSICIAN EXTENDER - PART TIME              7.2   1178  1184 N    PROV3260
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A PART-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-PART-TIME
   PODIATRISTS - CONTRACT                      7.2   1185  1191 N    PROV1130
     THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-POD-CONTRACT
   PODIATRISTS - FULL TIME                     7.2   1192  1198 N    PROV1135
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A AFCILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-POD-FULL-TIME
   PODIATRISTS - PART TIME                     7.2   1199  1205 N    PROV1140
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-POD-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER BASED FACILITY                     1     1206  1206 C    PROV1675
     INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER
     BASED.
     COBOL NAME: PROV-BASED-FACILITY
     VALUES:   Y                   HOSPITAL BASED

   REGISTERED NURSE - CONTRACT                 7.2   1207  1213 N    PROV1150
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-REG-NURSE-CONTRACT
   REGISTERED NURSE - FULL TIME                7.2   1214  1220 N    PROV1155
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-FULL-TIME
   REGISTERED NURSE - PART TIME                7.2   1221  1227 N    PROV1160
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-PART-TIME
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   RN DIRECTOR OF NURSING - CONTRACT           7.2   1238  1244 N    PROV5130
     THE NUMBER OF FULL TIME EQUIVALENT RN DIRECTOR OF NURSI
     NG UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-RN-DON-CONTRACT
   RN DIRECTOR OF NURSING - FULL TIME          7.2   1245  1251 N    PROV5120
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-RN-DON-FULL-TIME
   RN DIRECTOR OF NURSING - PART TIME          7.2   1252  1258 N    PROV5140
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-RN-DON-PART-TIME
   SOCIAL WORKER - CONTRACT                    7.2   1259  1265 N    PROV1170
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SOCIAL-CONTRACT
   SOCIAL WORKER - FULL TIME                   7.2   1266  1272 N    PROV1175
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SOCIAL-FULL-TIME
   SOCIAL WORKER - PART TIME                   7.2   1273  1279 N    PROV1180
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SOCIAL-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPECIAL CARE BEDS-AIDS                      3     1280  1282 N    PROV0725
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH AIDS.
     COBOL NAME: NUM-AIDS-BEDS
   SPECIAL CARE BEDS-ALZHEIMERS                3     1283  1285 N    PROV0730
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS.
     COBOL NAME: NUM-ALZHEIMERS-BEDS
   SPECIAL CARE BEDS-DIALYSIS                  3     1286  1288 N    PROV0800
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS.
     COBOL NAME: NUM-DIAL-BEDS
   SPECIAL CARE BEDS-DISABLED CHILD            3     1289  1291 N    PROV0855
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR DEISCABLED CHILDREN.
     COBOL NAME: NUM-DIS-CHILD-BEDS
   SPECIAL CARE BEDS-HEAD TRAUMA               3     1292  1294 N    PROV0905
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA.
     COBOL NAME: NUM-HEAD-TRAUMA-BEDS
   SPECIAL CARE BEDS-HOSPICE                   3     1295  1297 N    PROV0920
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES.
     COBOL NAME: NUM-HOSPICE-BEDS
   SPECIAL CARE BEDS-HUNTINGTONS               3     1298  1300 N    PROV0940
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE
     COBOL NAME: NUM-HUNTING-DIS-BEDS
   SPECIAL CARE BEDS-SPEC REHAB                3     1301  1303 N    PROV1205
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB
     NEEDS.
     COBOL NAME: NUM-SPEC-REHAB-BEDS
   SPECIAL CARE BEDS-VENTILATOR                3     1304  1306 N    PROV1460
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/
     RESIPIRATORY CARE NEEDS.
     COBOL NAME: NUM-VENT-RESP-BEDS
   SPEECH PATHOLOGIST - CONTRACT               7.2   1307  1313 N    PROV1190
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SPCH-PATH-CONTRACT
   SPEECH PATHOLOGIST - FULL TIME              7.2   1314  1320 N    PROV1195
     THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-FULL-TIME




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEECH PATHOLOGIST - PART TIME              7.2   1321  1327 N    PROV1200
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-PART-TIME
   SRV: ACTIVITIES-OFFSITE-RESIDENTS           1     1328  1328 C    PROV3390
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-NON RES              1     1329  1329 C    PROV3385
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-RESIDENTS            1     1330  1330 C    PROV3380
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-OFFSITE-RESIDENTS          1     1331  1331 C    PROV3525
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-NONRES              1     1332  1332 C    PROV3520
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-RESIDENTS           1     1333  1333 C    PROV3515
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: CLINICAL LAB-OFFSITE-RESIDENT          1     1334  1334 C    PROV3495
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-NON RES            1     1335  1335 C    PROV3490
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-RESIDENTS          1     1336  1336 C    PROV3485
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-OFFSITE-RESIDENTS               1     1337  1337 C    PROV3435
     INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-NON RESIDENTS            1     1338  1338 C    PROV3430
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-RESIDENTS                1     1339  1339 C    PROV3425
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-OFFSITE-RESIDENTS              1     1340  1340 C    PROV3345
     INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 25
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: DIETARY-ONSITE-NON RESIDENTS           1     1341  1341 C    PROV3340
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-ONSITE-RESIDENTS               1     1342  1342 C    PROV3335
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING ONSITE-NON RES            1     1343  1343 C    PROV3535
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-OFFSITE-RES               1     1344  1344 C    PROV3540
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-ONSITE-RESIDENTS          1     1345  1345 C    PROV3530
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-OFFSITE-RES              1     1346  1346 C    PROV3465
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-ONSITE-NON RES           1     1347  1347 C    PROV3460
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 26
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: MENTAL HEALTH-ONSITE-RESID             1     1348  1348 C    PROV3455
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-OFFSITE-RESIDENTS              1     1349  1349 C    PROV3315
     INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-NON RESIDENTS           1     1350  1350 C    PROV3310
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-NURSING-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-RESIDENTS               1     1351  1351 C    PROV3305
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-OFFSITE-RESIDENTS           1     1352  1352 C    PROV3360
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-NON RESID            1     1353  1353 C    PROV3355
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-RESIDENTS            1     1354  1354 C    PROV3350
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 27
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: OTH ACTIVITIES-OFFSITE TO RES          1     1355  1355 C    PROV5255
     FIELD 3 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE NONRES           1     1356  1356 C    PROV5250
     FIELD 2 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE RES              1     1357  1357 C    PROV5245
     FIELD 1 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-OFFSITE TO RES             1     1358  1358 C    PROV5285
     FIELD 3 - INDICATES SERVICES PROVIDED BY OTHER SOCIAL S
     ERVICES STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO NONRES           1     1359  1359 C    PROV5280
     INDICATES IF OTHER SOCIAL SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO RES              1     1360  1360 C    PROV5275
     FIELD 1 - INDICATES SERVICES PROVIDED BY SOCIAL SERVICE
     S STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-OFFSITE-RESIDENTS             1     1361  1361 C    PROV3330
     INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 28
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHARMACY-ONSITE-NON RESIDENTS          1     1362  1362 C    PROV3325
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-ONSITE-RESIDENTS              1     1363  1363 C    PROV3320
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-OFFSITE-RESID            1     1364  1364 C    PROV3300
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-NON RES           1     1365  1365 C    PROV3295
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-RESIDENT          1     1366  1366 C    PROV3290
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-OFFSITE-RESIDENTS            1     1367  1367 C    PROV3375
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-ONSITE-NON RESIDENT          1     1368  1368 C    PROV3370
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 29
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHYS THER-ONSITE-RESIDENTS             1     1369  1369 C    PROV3365
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-OFFSITE-RESIDENTS            1     1370  1370 C    PROV3285
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-NON RESIDENT          1     1371  1371 C    PROV3280
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHYS-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-RESIDENTS             1     1372  1372 C    PROV3275
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-OFFSITE-RESIDENTS             1     1373  1373 C    PROV3450
     INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-NON RESIDENTS          1     1374  1374 C    PROV3445
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-RESIDENTS              1     1375  1375 C    PROV3440
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 30
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL WORK-OFFSITE-RESIDENTS          1     1376  1376 C    PROV3405
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-NON RESID           1     1377  1377 C    PROV3400
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-RESIDENTS           1     1378  1378 C    PROV3395
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-OFFSITE-RESIDEN            1     1379  1379 C    PROV3420
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-NON RESID           1     1380  1380 C    PROV3415
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-RESIDENTS           1     1381  1381 C    PROV3410
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-OFFSITE TO RES           1     1382  1382 C    PROV5225
     INDICATES IF THERAPEUTIC RECRECATION SPECIALIST
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 31
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: THER REC SPEC-ONSITE-NONRES            1     1383  1383 C    PROV5220
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-THER-REC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-ONSITE-RESIDENT          1     1384  1384 C    PROV5215
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-OFFSITE-RESIDENTS           1     1385  1385 C    PROV3480
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-VOC-GUID-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-NON RESID            1     1386  1386 C    PROV3475
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-RESIDENTS            1     1387  1387 C    PROV3470
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-OFFSITE-RESIDENTS                 1     1388  1388 C    PROV3510
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-ONSITE-NON RESIDENTS              1     1389  1389 C    PROV3505
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 32
        SKILLED NURSING FACILITIES, CATEGORY = "04" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: XRAY-ONSITE-RESIDENTS                  1     1390  1390 C    PROV3500
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   THER REC SPEC - CONTRACT                    7.2   1391  1397 N    PROV5240
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-CONTRACT
   THER REC SPEC - FULL TIME                   7.2   1398  1404 N    PROV5230
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-FULL-TIME
   THER REC SPEC - PART TIME                   7.2   1405  1411 N    PROV5235
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-PART-TIME































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  HOME HEALTH AGENCY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   05                  HOME HEALTH AGENCIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   00000               DUMMY FOR MEDICAID HHA
               00011               CAHABA
               00040               BLUE CROSS (CALIFORNIA)
               00121               HEALTH CARE SERVICE CORPORATION
               00122               HCSC - MICHIGAN
               00123               HCSC OF MICHIGAN
               00131               NATIONAL GOVERNMENT SERVICES
               00140               BLUE CROSS (IOWA/SOUTH DAKOTA)
               00150               BLUE CROSS (KANSAS)
               00180               NATIONAL GOVERNMENT SERVICES
               00181               NATIONAL GOVERNMENT SERVICES
               00230               BLUE CROSS (MISSISSIPPI)
               00290               BLUE CROSS (NEW MEXICO)
               00332               NATIONAL GOVERNMENT SERVICES
               00362               BLUE CROSS (INDEPENDENCE)
               00366               HIGHMARK MEDICARE SERVICES
               00370               BLUE CROSS (RHODE ISLAND)
               00380               BLUE CROSS (SOUTH CAROLINA)
               00400               BLUE CROSS (TEXAS)
               00410               BLUE CROSS (UTAH)
               00450               NATIONAL GOVERNMENT SERVICES
               00452               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)
               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14004               NATIONAL HERITAGE (HHA)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               31140               NATIONAL HERITAGE (CA)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31144               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               51051               AETNA (PETALUMA)
               51100               AETNA (CLEARWATER)
               51390               AETNA (FORT WASHINGTON)
               52280               MUTUAL OF OMAHA
               57400               COOPERATIVA (PUERTO RICO)

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   00000               DUMMY FOR MEDICAID HHA
               00011               CAHABA
               00030               BLUE CROSS (ARIZONA)
               00040               BLUE CROSS (CALIFORNIA)
               00121               HEALTH CARE SERVICE CORPORATION
               00122               HCSC - MICHIGAN
               00123               HCSC OF MICHIGAN
               00131               NATIONAL GOVERNMENT SERVICES
               00140               BLUE CROSS (IOWA/SOUTH DAKOTA)
               00150               BLUE CROSS (KANSAS)
               00180               BLUE CROSS (MAINE)
               00181               NATIONAL GOVERNMENT SERVICES
               00230               BLUE CROSS (MISSISSIPPI)
               00290               BLUE CROSS (NEW MEXICO)
               00332               NATIONAL GOVERNMENT SERVICES
               00362               BLUE CROSS (INDEPENDENCE)
               00366               HIGHMARK MEDICARE SERVICES
               00370               BLUE CROSS (RHODE ISLAND)
               00380               BLUE CROSS (SOUTH CAROLINA)
               00400               BLUE CROSS (TEXAS)
               00410               BLUE CROSS (UTAH)
               00450               NATIONAL GOVERNMENT SERVICES
               00452               NATIONAL GOVERNMENT SERVICES
               00453               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               31140               NATIONAL HERITAGE (CA)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31144               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE
               51051               AETNA (PETALUMA)
               51100               AETNA (CLEARWATER)
               51390               AETNA (FORT WASHINGTON)
               52280               MUTUAL OF OMAHA
               57400               COOPERATIVA (PUERTO RICO)

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP
               5                   VALIDATION (ACCRD)
               8                   FULL SURVEY AFTER COMPLAINT

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  VOL. NON-PROF. - RELIGIOUS AFF.
               02                  VOLUNTARY NON-PROFIT - PRIVATE
               03                  VOLUNTARY NON-PROFIT - OTHER
               04                  PROPRIETARY
               05                  GOVERNMENT - STATE/COUNTY
               06                  GOVERNMENT - COMB. GOVT & VOL.
               07                  GOVERNMENT - LOCAL




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   ACCREDITATION INDICATOR                     1     290   290  C    PROV0010
     INDICATES THE ORGANIZATION THAT IS RESPONSIBLE FOR
     THE ACCREDITATION OF THE PROVIDER.
     COBOL NAME: ACCRED-STAT
     VALUES:   0                   NONE
               1                   JCAHO
               2                   CHAP
               3                   ACHC

   DATE OF LAST VALIDATION SURVEY              8     363   370  C    PROV0450
     DATE THE LAST VALIDATION SURVEY WAS PERFORMED
     BY THE STATE AGENCY FOR A JCAH, AOA ACCREDITED
     HOSPITAL OR OTHER PROVIDER TYPE.
     COBOL NAME: DT-VALID-SURVEY
   DIETICIANS                                  7.2   371   377  N    PROV0820
     NUMBER OF FULL-TIME EQUIVALENT DIETICIANS EMPLOYED BY A
     FACILITY.
     COBOL NAME: NUM-DIETICIANS
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   LICENSED PRACT/VOCAT NURSES                 7.2   382   388  N    PROV0955
     NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR
     VOCATIONAL NURSES EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-LPN-LVN
   OCCUPATIONAL THERAPISTS                     7.2   405   411  N    PROV1050
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-OCCUP-THERAPISTS





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   1                   MEDICARE ONLY
               2                   MEDICAID ONLY
               3                   MEDICARE AND MEDICAID

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGISTERED NURSES                           7.2   473   479  N    PROV1145
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PROFESSIONAL NURSES EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-REG-NURS
   REGISTERED PHARMACISTS                      7.2   480   486  N    PROV1100
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PHARMACISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-PHARMACIST-REG
   SRV: OCCUPATIONAL THERAPY                   1     558   558  C    PROV2270
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: PHARMACY                               1     569   569  C    PROV2365
     INDICATES HOW PHARMACY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHARMACY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHYSICAL THERAPY                       1     570   570  C    PROV2370
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   TYPE OF FACILITY                            2     593   594  C    PROV2890
     INDICATES THE CATEGORY WHICH REPRESENTS THE TYPE OF
     FACILITY.
     COBOL NAME: TYPE-FACILITY
     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

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   AIDE TRAINING/COMPETENCY PROGRAMS           1     1412  1412 C    PROV0555
     INDICATES HOW THE AGENCY PROVIDES HOME HEALTH AIDE
     TRAINING AND COMPETENCY EVALUATION PROGRAMS.
     COBOL NAME: HHA-PROVIDES-DIRECT
     VALUES:   1                   AIDE TRAINING
               2                   COMPETENCY EVALUATION PROG.
               3                   AIDE TRAINING AND COMPETENCY PROG.
               4                   NEITHER

   BRANCH OPERATION INDICATOR                  1     1413  1413 C    PROV1525
     INDICATES IF THE AGENCY OPERATES ANY BRANCHES.
     COBOL NAME: OPERS-BRANCHES
     VALUES:   N                   NO
               Y                   YES

   BRANCHES                                    3     1414  1416 N    PROV0745
     THE NUMBER OF BRANCHES OPERATED BY THE AGENCY.
     COBOL NAME: NUM-BRANCHES
   CHANGE OF OWNERSHIP INDICATOR               1     1417  1417 C    PROV0105
     INDICATES IF A HOME HEALTH AGENCY HAS UNDERGONE A
     CHANGE OF OWNERSHIP SINCE THE LAST SURVEY.
     COBOL NAME: CHOW-IND
     VALUES:

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               N                   NO
               Y                   YES

   HHA QUALIFIED FOR OPT                       1     1418  1418 C    PROV0560
     INDICATES IF A HOME HEALTH AGENCY IS QUALIFIED TO
     PROVIDE OUTPATIENT PHYSICAL THERAPY/SPEECH SERVICES.
     COBOL NAME: HHA-QUAL-FOR-OPT
     VALUES:   N                   NO
               Y                   YES

   HOME HEALTH AIDES                           7.2   1419  1425 N    PROV0910
     NUMBER OF FULL-TIME EQUIVALENT HOME HEALTH AIDES
     EMPLOYED BY A HOME HEALTH AGENCY OR HOSPICE.
     COBOL NAME: NUM-HOME-HEALTH-AIDES
   HOSPICE INDICATOR                           1     1426  1426 C    PROV0665
     INDICATES IF THE HOME HEALTH AGENCY ALSO PARTICIPATES
     IN THE MEDICARE PROGRAM AS A HOSPICE.
     COBOL NAME: MEDICARE-CERT-HOSPICE
     VALUES:   N                   NO
               Y                   YES

   MEDICARE HOSPICE PROVIDER NUMBER            6     1427  1432 C    PROV0570
     IF THE AGENCY ALSO PARTICIPATES IN THE MEDICARE PROGRAM
     AS A HOSPICE, THE HOSPICE PROVIDER NUMBER.
     COBOL NAME: HOSPICE-PROV-NUM
   MEDICARE/MEDICAID PROVIDER NUMBER           6     1433  1438 C    PROV0650
     IF THE AGENCY IS BASED IN ANOTHER MEDICARE OR MEDICAID
     FACILITY, THE PROVIDER NUMBER OF THAT FACILITY.
     COBOL NAME: MEDICAID-CARE-VEND-NUM
   SOCIAL WORKERS                              7.2   1439  1445 N    PROV1185
     THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY THE AGENCY.
     COBOL NAME: NUM-SOCIAL-WRKS
   SPEECH PATHOLOGISTS, AUDIOLOGISTS           7.2   1446  1452 N    PROV1220
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     OR AUDIOLOGISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-SPEECH-PATH-AUDIO
   SRV: APPLIANCE AND EQUIPMENT                1     1453  1453 C    PROV2075
     INDICATES HOW APPLIANCE AND EQUIPMENT SERVICES ARE
     PROVIDED BY A HOME HEALTH AGENCY.
     COBOL NAME: SP-APPLIANCE-EQUIP
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: HOME HEALTH AIDE/HOMEMAKER             1     1454  1454 C    PROV2155
     INDICATES HOW HOME HEALTH AIDE SERVICES ARE PROVIDED
     BY A HOME HEALTH AGENCY.
     COBOL NAME: SP-HH-AIDE-HOMEMAKER
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY AGENCY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: INTERNS AND RESIDENTS                  1     1455  1455 C    PROV2195
     INDICATES HOW INTERN AND RESIDENT SERVICES ARE PROVIDED
     BY A HOME HEALTH AGENCY.
     COBOL NAME: SP-INTERNS-RESIDENTS
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: MEDICAL SOCIAL                         1     1456  1456 C    PROV2220
     INDICATES HOW MEDICAL SOCIAL SERVICES ARE PROVIDED
     COBOL NAME: SP-MEDICAL-SOCIAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: NURSING                                1     1457  1457 C    PROV2250
     INDICATES HOW NURSING SERVICES ARE PROVIDED.
     COBOL NAME: SP-NURSING
     VALUES:   1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: NUTRITIONAL GUIDANCE                   1     1458  1458 C    PROV2255
     INDICATES HOW NUTRITIONAL GUIDANCE SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-NUTRITION-GUIDANCE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: OTHER                                  1     1459  1459 C    PROV2340
     INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OTHER
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: SPEECH THERAPY                         1     1460  1460 C    PROV2520
     INDICATES HOW SPEECH THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: VOCATIONAL GUIDANCE                    1     1461  1461 C    PROV2535
     INDICATES HOW VOCATIONAL GUIDANCE SERVICES ARE PROVIDED
     COBOL NAME: SP-VOCAT-GUIDANCE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY AGENCY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SUBUNIT INDICATOR                           1     1462  1462 C    PROV2725
     INDICATES IF THE AGENCY IS A SUBUNIT OF ANOTHER AGENCY.
     COBOL NAME: SUBUNIT-IND
     VALUES:   N                   NO
               Y                   YES

   SUBUNIT OPERATION INDICATOR                 1     1463  1463 C    PROV1530
     INDICATES IF THE AGENCY OPERATES ANY SUBUNITS.
     COBOL NAME: OPERS-SUBUNITS
     VALUES:   N                   NO
               Y                   YES

   SUBUNITS                                    3     1464  1466 N    PROV1240
     THE NUMBER OF SUBUNITS OPERATED BY THE AGENCY.
     COBOL NAME: NUM-SUBUNITS
   SURETY BOND INDICATOR                       1     1467  1467 C    PROV5680
     SURETY BOND INDICATOR, VALID VALUES ARE "N" OR "Y" OR
     "W"
     COBOL NAME: SURETY-BOND-IND
     VALUES:   N                   NO
               W                   WAIVER
               Y                   YES

   PHYSICAL THERAPISTS ON STAFF                7.2   1497  1503 N    PROV1120
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY AN OUTPATIENT PHYSICAL THERAPY PROVIDER OR
     A HOME HEALTH AGENCY PROVIDER.
     COBOL NAME: NUM-PHYS-THERAPISTS



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
           HOME HEALTH AGENCIES, CATEGORY = "05" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: LABORATORY                             1     1720  1720 C    PROV2200
     INDICATES HOW LABORATORY SERVICES ARE PROVIDED.
     COBOL NAME: SP-LABORATORY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION











































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  X-RAY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   07                  PORTABLE X-RAY SUPPLIERS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   00011               CAHABA
               00122               HCSC - MICHIGAN
               00131               NATIONAL GOVERNMENT SERVICES
               00181               NATIONAL GOVERNMENT SERVICES
               00452               NATIONAL GOVERNMENT SERVICES
               00453               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               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)
               00770               BLUE SHIELD (NEW HAMPSHIRE/VERMONT)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00780               BLUE SHIELD (TRI-STATE)
               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)
               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01102               PALMETTO (CALIFORNIA NORTH)
               01120               AETNA (HAWAII)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01290               AETNA (NEVADA)
               01302               PALMETTO (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05102               WPS (IOWA)
               05130               EQICOR (IDAHO)
               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)
               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14330               GROUP HEALTH INC (NEW YORK)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               16360               NATIONWIDE (OHIO)
               16510               NATIONWIDE (WEST VIRGINIA)
               21200               MASSACHUSETTS/MAINE
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31144               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   00011               CAHABA
               00122               HCSC - MICHIGAN
               00131               NATIONAL GOVERNMENT SERVICES
               00181               NATIONAL GOVERNMENT SERVICES
               00452               NATIONAL GOVERNMENT SERVICES
               00453               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00820               BLUE SHIELD (NORTH DAKOTA)
               00825               BLUE SHIELD (NORTH DAKOTA/WYOMING)
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)
               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               14330               GROUP HEALTH INC (NEW YORK)
               16360               NATIONWIDE (OHIO)
               16510               NATIONWIDE (WEST VIRGINIA)
               21200               MASSACHUSETTS/MAINE
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31144               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     VALUES:   AK                  ALASKA
               AL                  ALABAMA
               AR                  ARKANSAS
               AS                  AMERICAN SAMOA
               AZ                  ARIZONA
               CA                  CALIFORNIA
               CN                  CANADA
               CO                  COLORADO
               CT                  CONNECTICUT
               DC                  DISTRICT OF COLUMBIA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               DE                  DELAWARE
               FL                  FLORIDA
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               45                  TEXAS
               46                  UTAH
               47                  VERMONT
               48                  VIRGIN ISLANDS
               49                  VIRGINIA
               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  INDIVIDUAL
               02                  PARTNERSHIP
               03                  CORPORATION
               04                  OTHER THAN PRIVATE

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   DIRECTOR QUALIFICATIONS                     1     1468  1468 C    PROV1715
     INDICATES THE QUALIFICATIONS OF THE DIRECTOR OF A
     SUPPLIER OF PORTABLE X-RAY SERVICES.
     COBOL NAME: QUAL-OF-DIRECTOR
     VALUES:   1                   PHYSICIAN
               2                   PHD/SCD
               3                   MS/MA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
         PORTABLE X-RAY SUPPLIERS, CATEGORY = "07" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               4                   BS/BA
               5                   OTHER

   TECHNOLOGISTS - ASSOC DEGREE                7.2   1469  1475 N    PROV0735
     THE NUMBER OF TECHNOLOGISTS WITH ASSOCIATE DEGREES IN
     RADIOLOGIC TECHNOLOGY.
     COBOL NAME: NUM-AS-RADIO-TECH
   TECHNOLOGISTS - BS/BA DEGREE                7.2   1476  1482 N    PROV0750
     NUMBER OF TECHNOLOGISTS WITH BACHELOR OF SCIENCE
     OR BACHELOR OF ARTS DEGREES IN RADIOLOGIC TECHNOLOGY.
     COBOL NAME: NUM-BS-BA-RAD-TECH
   TECHNOLOGISTS - 2 YEAR RADIOLOGY            7.2   1483  1489 N    PROV1515
     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.
     COBOL NAME: NUM-2YR-RADIO-TECH


































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  OPT OR SPECH PATHOLOGY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   08                  OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               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)
               00770               BLUE SHIELD (NEW HAMPSHIRE/VERMONT)
               00780               BLUE SHIELD (TRI-STATE)
               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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               NORIDIAN (ARIZONA)
               03102               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03202               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03302               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               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)
               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)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               12101               HIGHMARK (DELAWARE)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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               NATL GOVT SERVICES (CONNECTICUT)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               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)
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00825               BLUE SHIELD (NORTH DAKOTA/WYOMING)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               14330               GROUP HEALTH INC (NEW YORK)
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  VOL. NON-PROF. NOT CHURCH
               02                  VOLUNTARY NON PROFIT CHURCH
               03                  STATE GOVERNMENT
               04                  LOCAL GOVERNMENT
               05                  COMBINATION GOVERNMENT & VOL.
               06                  PROPRIETARY

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   OCCUPATIONAL THERAPISTS                     7.2   405   411  N    PROV1050
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-OCCUP-THERAPISTS
   PHYSICAL THERAPISTS                         7.2   420   426  N    PROV1125
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-PHYS-THERAPY
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
   SRV: OCCUPATIONAL THERAPY                   1     558   558  C    PROV2270
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED

   SRV: PHYSICAL THERAPY                       1     570   570  C    PROV2370
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED

   SRV: SPEECH PATHOLOGY                       1     586   586  C    PROV2505
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED

   TYPE OF FACILITY                            2     593   594  C    PROV2890
     INDICATES THE CATEGORY WHICH REPRESENTS THE TYPE OF
     FACILITY.
     COBOL NAME: TYPE-FACILITY
     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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
 OUTPATIENT PHYSICAL THERAPY/SPEECH PATHOLOGY, CATEGORY = "08" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OCCUP THERAPIST, FULL TIME, STAFF           7.2   931   937  N    PROV1040
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-THER-FULL-TIME
   OCCUP THERAPISTS, CONTRACT/ARRANGE          7.2   938   944  N    PROV1035
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-THER-CONTRACT
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   SPEECH PATHOLOGISTS, AUDIOLOGISTS           7.2   1446  1452 N    PROV1220
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     OR AUDIOLOGISTS EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-SPEECH-PATH-AUDIO
   PHYSICAL THERAPIST - ARRANGEMENT            7.2   1490  1496 N    PROV1105
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY ARRANGEMENT IN AN OUTPATIENT PHYSICAL
     THERAPY FACILITY.
     COBOL NAME: NUM-PHY-THER-ARGNM
   PHYSICAL THERAPISTS ON STAFF                7.2   1497  1503 N    PROV1120
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY AN OUTPATIENT PHYSICAL THERAPY PROVIDER OR
     A HOME HEALTH AGENCY PROVIDER.
     COBOL NAME: NUM-PHYS-THERAPISTS
   SPEECH PATHOLOGISTS - ARRANGEMENT           7.2   1504  1510 N    PROV1215
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     EMPLOYED BY ARRANGEMENT IN AN OUTPATIENT PHYSICAL
     THERAPY FACILITY.
     COBOL NAME: NUM-SPEECH-PATH-AR
   SPEECH PATHOLOGISTS - TOTAL                 7.2   1511  1517 N    PROV1210
     THE TOTAL NUMBER OF FULL-TIME EQUIVALENT SPEECH
     PATHOLOGISTS ON STAFF AND BY ARRANGEMENT IN AN
     OUTPATIENT PHYSICAL THERAPY FACILITY.
     COBOL NAME: NUM-SPEECH-PATH












 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  END STAGE RENAL DISEASE

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   09                  END STAGE RENAL DISEASE FACILITIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00901               TRAILBLAZERS HEALTH ENTERPRISES
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01102               PALMETTO (CALIFORNIA NORTH)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01302               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05102               WPS (IOWA)
               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)
               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00901               TRAILBLAZERS HEALTH ENTERPRISES
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     VALUES:   AK                  ALASKA
               AL                  ALABAMA
               AR                  ARKANSAS
               AS                  AMERICAN SAMOA
               AZ                  ARIZONA
               CA                  CALIFORNIA
               CN                  CANADA
               CO                  COLORADO
               CT                  CONNECTICUT
               DC                  DISTRICT OF COLUMBIA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               DE                  DELAWARE
               FL                  FLORIDA
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               45                  TEXAS
               46                  UTAH
               47                  VERMONT
               48                  VIRGIN ISLANDS
               49                  VIRGINIA
               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  FOR PROFIT
               02                  NOT FOR PROFIT
               03                  PUBLIC

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   DIETICIANS                                  7.2   371   377  N    PROV0820
     NUMBER OF FULL-TIME EQUIVALENT DIETICIANS EMPLOYED BY A
     FACILITY.
     COBOL NAME: NUM-DIETICIANS
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   REGISTERED NURSES                           7.2   473   479  N    PROV1145
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PROFESSIONAL NURSES EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-REG-NURS


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MULTI-FACILITY ORGANIZATION NAME            38    850   887  C    PROV0680
     THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS
     THE FACILITY.
     COBOL NAME: NAME-MULT-FACL-ORG
   MULTI-FACILITY ORGANIZATION OWNED           1     888   888  C    PROV0675
     INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION
     THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES.
     COBOL NAME: MULT-FACL-ORG
     VALUES:   Y                   YES

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   SOCIAL WORKERS                              7.2   1439  1445 N    PROV1185
     THE NUMBER OF FULL TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY THE AGENCY.
     COBOL NAME: NUM-SOCIAL-WRKS
   ESRD NETWORK #                              2     1518  1519 C    PROV0685
     THE NUMBER OF THE NETWORK TO WHICH THE END STAGE RENAL
     DIALYSIS FACILITY IS ASSIGNED.
     COBOL NAME: NETWORK-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

   NUMBER OF PATIENTS TUE. 4TH SHIFT           3     1520  1522 N    PROV5540
     NUMBER OF PATIENTS TUE. 4TH SHIFT
     COBOL NAME: NUM-PATIENT-TUE-SHIFT-4




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
    END STAGE RENAL DISEASE FACILITIES, CATEGORY = "09" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATIONS - HEMODIALYSIS                     3     1523  1525 N    PROV1230
     THE TOTAL NUMBER OF HEMODIALYSIS STATIONS IN AN END
     STAGE RENAL DISEASE (ESRD) FACILITY.
     COBOL NAME: NUM-STATIONS-HEMO
   STATIONS - TOTAL                            3     1526  1528 N    PROV2855
     THE TOTAL NUMBER OF APPROVED DIALYSIS STATIONS IN AN
     END STAGE RENAL DIALYSIS FACILITY.
     COBOL NAME: TOT-STATIONS
   HOSPITAL BASED INDICATOR                    1     1704  1704 C    PROV0565
     HOSPITAL BASED INDICATOR
     COBOL NAME: HOSP-BASED-IND
     VALUES:   Y                   HOSPITAL BASED






































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   02                  TITLE 19 ONLY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   10                  NURSING FACILITIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   00452               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   00452               NATIONAL GOVERNMENT SERVICES


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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                  LIMITED LIABILITY CORPORATION

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 24 HR REGISTERED NURSE          1     359   359  C    PROV0290
     INDICATES IF A WAIVER OF THE 24 HOUR REGISTERED NURSE
     REQUIREMENT HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-24-HR-RN
     VALUES:   1                   WAIVER RECOMMENDED

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   2                   MEDICAID ONLY

   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGIONAL OVERRIDE #2 (STAFFING)             1     471   471  C    PROV1550
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN.  THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-2
     VALUES:
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME



















































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               Y                   RECORD HAS BEEN APPROVED

   ACTIVITY PROFESSIONAL - CONTRACT            7.2   596   602  N    PROV0695
     THE NUMBER OF FULL TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ACT-THER-CONTRACT
   ACTIVITY PROFESSIONAL - FULL TIME           7.2   603   609  N    PROV0700
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED FULL TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-FULL-TIME
   ACTIVITY PROFESSIONAL - PART TIME           7.2   610   616  N    PROV0705
     THE NUMBER OF FULL-TIME EQUIVALENT ACTIVITIES
     PROFESSIONALS EMPLOYED PART TIME BY A FACILITY.
     COBOL NAME: NUM-ACT-THER-PART-TIME
   ADMINISTRATION - CONTRACT                   7.2   617   623  N    PROV0710
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-ADMN-CONTRACT
   ADMINISTRATOR - FULL TIME                   7.2   624   630  N    PROV0715
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A FULL TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-FULL-TIME
   ADMINISTRATOR - PART TIME                   7.2   631   637  N    PROV0720
     THE NUMBER OF FULL-TIME EQUIVALENT ADMINISTRATIVE STAFF
     EMPLOYED ON A PART-TIME BASIS BY A FACILITY.
     COBOL NAME: NUM-ADMN-PART-TIME
   BEDS - NURSING FACILITY                     4     642   645  N    PROV1455
     NUMBER OF MEDICAID CERTIFIED SKILLED NURSING CARE
     BEDS IN A FACILITY.
     COBOL NAME: NUM-T19-SNF-BEDS
   CERT NURSE AIDES - CONTRACT                 7.2   650   656  N    PROV1000
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-AID-CONTRACT
   CERT NURSE AIDES - FULL TIME                7.2   657   663  N    PROV1005
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-FULL-TIME
   CERT NURSE AIDES - PART TIME                7.2   664   670  N    PROV1010
     THE NUMBER OF FULL-TIME EQUIVALENT CERTIFIED NURSE
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-NURSE-AID-PART-TIME
   COMPLIANCE: BEDS PER ROOM WAIVER            1     672   672  C    PROV0225
     INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT
     HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-BEDS-PER-ROOM
     VALUES:   1                   WAIVER RECOMMENDED



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: PATIENT ROOM SIZE               1     673   673  C    PROV0270
     INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN
     RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-PATIENT-ROOM-SZ
     VALUES:   1                   WAIVER RECOMMENDED

   COMPLIANCE: 7 DAY REGISTERED NURSE          1     674   674  C    PROV0295
     INDICATES IF A WAIVER OF THE 7 DAY REGISTERED NURSE
     REQUIREMENTS HAS BEEN RECOMMENDED FOR A SNF OR NF.
     COBOL NAME: COMPL-7-DAY-RN
     VALUES:   1                   WAIVER RECOMMENDED

   DENTISTS - CONTRACT                         7.2   675   681  N    PROV0785
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-DENTIST-CONTRACT
   DENTISTS - FULL TIME                        7.2   682   688  N    PROV0790
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DENTIST-FULL-TIME
   DENTISTS - PART TIME                        7.2   689   695  N    PROV0795
     THE NUMBER OF FULL-TIME EQUIVALENT DENTISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DENTIST-PART-TIME
   DIETITIANS - CONTRACT                       7.2   696   702  N    PROV0805
     THE NUMBER OF FULL-TIME EQUIVALENT UNDER CONTRACT TO
     A FACILITY.
     COBOL NAME: NUM-DIET-CONTRACT
   DIETITIANS - FULL TIME                      7.2   703   709  N    PROV0810
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-DIET-FULL-TIME
   DIETITIANS - PART TIME                      7.2   710   716  N    PROV0815
     THE NUMBER OF FULL-TIME EQUIVALENT DIETITIANS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-DIET-PART-TIME
   EXPERIMENTAL RESEARCH CONDUCTED             1     717   717  C    PROV0465
     INDICATES IF A FACILITY USES RESIDENTS TO DEVELOP AND
     TEST CLINICAL TREATMENTS.
     COBOL NAME: EXPER-RESEARCH
     VALUES:   Y                   YES

   FOOD SERVICE - CONTRACT                     7.2   718   724  N    PROV0860
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-FOOD-SRV-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   FOOD SERVICE - FULL TIME                    7.2   725   731  N    PROV0865
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-FULL-TIME
   FOOD SERVICE - PART TIME                    7.2   732   738  N    PROV0870
     THE NUMBER OF FULL-TIME EQUIVALENT FOOD SERVICE
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-FOOD-SRV-PART-TIME
   HOUSEKEEPING - CONTRACT                     7.2   739   745  N    PROV0925
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-HOUSE-CONTRACT
   HOUSEKEEPING - FULL TIME                    7.2   746   752  N    PROV0930
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-HOUSE-FULL-TIME
   HOUSEKEEPING - PART TIME                    7.2   753   759  N    PROV0935
     THE NUMBER OF FULL-TIME EQUIVALENT HOUSEKEEPING
     PERSONNEL EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-HOUSE-PART-TIME
   LPN/LVN - CONTRACT                          7.2   760   766  N    PROV1465
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-VOC-NURSE-CONTRACT
   LPN/LVN - FULL TIME                         7.2   767   773  N    PROV1470
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-FULL-TIME
   LPN/LVN - PART TIME                         7.2   774   780  N    PROV1475
     THE NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL/
     VOCATIONAL NURSES EMPLOYED BY A FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-VOC-NURSE-PART-TIME
   LTC CROSS REFERENCE PROVIDER #              6     781   786  C    PROV0640
     THIS CROSS REFERENCE NUMBER IDENTIFIES LTC PROVIDER
     NUMBERS THAT WERE TERMINATED IN 1985 BECAUSE OF POLICY
     CHANGES WHICH STATES THAT SNF/ICF DISTINCT PARTS OR DUA
     LLY CERTIFIED PORTIONS ARE ASSIGNED SINGLE SNF PROV NO.
     COBOL NAME: LTC-CROSS-REF-PROV-NUM
   MEDICAL DIRECTOR - CONTRACT                 7.2   787   793  N    PROV0960
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-MED-CONTRACT
   MEDICAL DIRECTOR - FULL TIME                7.2   794   800  N    PROV0965
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-MED-FULL-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICAL DIRECTOR - PART TIME                7.2   801   807  N    PROV0970
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICAL DIRECTORS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-MED-PART-TIME
   MEDICATION AIDES/TECHS-CONTRACT             7.2   808   814  N    PROV5180
     THE NUMBER OF FULL-TIMR EQUIVALENT MEDICATION AIDES/
     TECHNICIANS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MED-AID-CONTRACT
   MEDICATION AIDES/TECHS-FULL TIME            7.2   815   821  N    PROV5170
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BY A FACILITY ON A FULL TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-FULL-TIME
   MEDICATION AIDES/TECHS-PART TIME            7.2   822   828  N    PROV5175
     THE NUMBER OF FULL-TIME EQUIVALENT MEDICATION AIDES/
     TECHNICIANS EMPLOYED BYA FACILITY ON A PART TIME
     BASIS.
     COBOL NAME: NUM-MED-AID-PART-TIME
   MENTAL HEALTH SERVICES - CONTRACT           7.2   829   835  N    PROV0980
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-MEN-HLTH-CONTRACT
   MENTAL HEALTH SERVICES - FULL TIME          7.2   836   842  N    PROV0985
     THE NUMBER OF FULL-TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-FULL-TIME
   MENTAL HEALTH SERVICES - PART TIME          7.2   843   849  N    PROV0990
     THE NUMBER OF FULL TIME EQUIVALENT MENTAL HEALTH
     SERVICES PERSONNEL EMPLOYED BY A FACILITY ON A PART
     TIME BASIS.
     COBOL NAME: NUM-MEN-HLTH-PART-TIME
   MULTI-FACILITY ORGANIZATION NAME            38    850   887  C    PROV0680
     THE NAME OF THE MULTI-FACILITY ORGANIZATION THAT OWNS
     THE FACILITY.
     COBOL NAME: NAME-MULT-FACL-ORG
   MULTI-FACILITY ORGANIZATION OWNED           1     888   888  C    PROV0675
     INDICATES IF A FACILITY IS OWNED BY AN ORGANIZATION
     THAT OWNS (OR LEASES) TWO OR MORE NURSING FACILITIES.
     COBOL NAME: MULT-FACL-ORG
     VALUES:   Y                   YES

   NURSE AIDES IN TRNG - CONTRACT              7.2   889   895  N    PROV5165
     NUMBER OF FULL TIME EQUIVALENT NURSE AIDES IN TRAINING
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-AID-TRNG-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   NURSE AIDES IN TRNG-FULL TIME               7.2   896   902  N    PROV5155
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-FULL-TIME
   NURSE AIDES IN TRNG-PART TIME               7.2   903   909  N    PROV5160
     THE NUMBER OF FULL-TIME EQUIVALENT NURSE AIDES IN
     TRAINING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-AID-TRNG-PART-TIME
   NURSES WITH ADMIN DUTIES-CONTRACT           7.2   910   916  N    PROV5150
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-NURSE-ADM-CONTRACT
   NURSES WITH ADMIN DUTIES-FULL TIME          7.2   917   923  N    PROV5135
     THE NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A FULL
     TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-FULL-TIME
   NURSES WITH ADMIN DUTIES-PART TIME          7.2   924   930  N    PROV5145
     NUMBER OF FULL-TIME EQUIVALENT NURSES WITH
     ADMINISTRATIVE DUTIES EMPLOYED BY A FACILITY ON A
     PART TIME BASIS.
     COBOL NAME: NUM-NURSE-ADM-PART-TIME
   OCCUP THERAPIST, FULL TIME, STAFF           7.2   931   937  N    PROV1040
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-THER-FULL-TIME
   OCCUP THERAPISTS, CONTRACT/ARRANGE          7.2   938   944  N    PROV1035
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-THER-CONTRACT
   OCCUP THERAPY AIDE - CONTRACT               7.2   945   951  N    PROV1020
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPY AIDES UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-OCC-AID-CONTRACT
   OCCUP THERAPY AIDE - FULL TIME              7.2   952   958  N    PROV1025
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-AID-FULL-TIME
   OCCUP THERAPY AIDE - PART TIME              7.2   959   965  N    PROV1030
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     AIDES EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-AID-PART-TIME
   OCCUP THERAPY ASST - CONTRACT               7.2   966   972  N    PROV5195
     THE NUMBER OF FULL TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS UNDER CONTRCAT TO A FACILITY.
     COBOL NAME: NUM-OCC-ASST-CONTRACT




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OCCUP THERAPY ASST - FULL TIME              7.2   973   979  N    PROV5185
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-FULL-TIME
   OCCUP THERAPY ASST - PART TIME              7.2   980   986  N    PROV5190
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL THERAPY
     ASSISTANTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-ASST-PART-TIME
   OCCUPATIONAL THERAPIST - PART TIME          7.2   987   993  N    PROV1045
     THE NUMBER OF FULL-TIME EQUIVALENT OCCUPATIONAL
     THERAPISTS EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OCC-THER-PART-TIME
   ORGANIZED FAMILY GROUP                      1     994   994  C    PROV1535
     INDICATES IF THE FACILITY HAS AN ORGANIZED GROUP OF
     FAMILY MEMBERS OF RESIDENTS.
     COBOL NAME: ORG-FAMILY-GRP
     VALUES:   Y                   YES

   ORGANIZED RESIDENT GROUP                    1     995   995  C    PROV1540
     INDICATES IF THE FACILITY HAS AN ORGANIZED RESIDENTS
     GROUP.
     COBOL NAME: ORG-RESID-GRP
     VALUES:   Y                   YES

   OTHER - CONTRACT                            7.2   996   1002 N    PROV3265
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-OTH-CONTRACT
   OTHER - FULL TIME                           7.2   1003  1009 N    PROV3245
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     FULL-TIME BASIS.
     COBOL NAME: NUM-OTH-FULL-TIME
   OTHER - PART TIME                           7.2   1010  1016 N    PROV3255
     THE NUMBER OF FULL-TIME EQUIVALENT PERSONS NOT INCLUDED
     IN ANY OTHER CATEGORIES EMPLOYED BY THE FACILITY ON A
     PART-TIME BASIS.
     COBOL NAME: NUM-OTH-PART-TIME
   OTHER ACTIVITIES STAFF-CONTRACT             7.2   1017  1023 N    PROV5270
     NUMBER OF CONTRACT STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-CONTRACT
   OTHER ACTIVITIES STAFF-FULL TIME            7.2   1024  1030 N    PROV5260
     NUMBER OF FULL-TIME STAFF HOURS FOR OTHER ACTIVITIES.
     COBOL NAME: NUM-OTH-ACT-FULL-TIME
   OTHER ACTIVITIES STAFF-PART TIME            7.2   1031  1037 N    PROV5305
     NUMBER OF PART TIME STAFF HOURS PROVIDED BY OTHER ACTIV
     ITIES STAFF.
     COBOL NAME: NUM-OTH-ACT-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   OTHER PHYSICIAN - CONTRACT                  7.2   1038  1044 N    PROV1060
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     UNDER CONTRACT TO A FACILITY
     COBOL NAME: NUM-OTH-PHY-CONTRACT
   OTHER PHYSICIAN - FULL TIME                 7.2   1045  1051 N    PROV1065
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-FULL-TIME
   OTHER PHYSICIAN - PART TIME                 7.2   1052  1058 N    PROV1070
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER PHYSICIANS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-OTH-PHY-PART-TIME
   OTHR SOCIAL SERV STAFF-CONTRACT             7.2   1059  1065 N    PROV5300
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY OTHER SOCIAL
     SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-CONTRACT
   OTHR SOCIAL SERV STAFF-FULL TIME            7.2   1066  1072 N    PROV5290
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-FULL-TIME
   OTHR SOCIAL SERV STAFF-PART TIME            7.2   1073  1079 N    PROV5295
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY OTHER SOCIA
     L SERVICES STAFF.
     COBOL NAME: NUM-OTH-SOC-PART-TIME
   PHARMACISTS - CONTRACT                      7.2   1080  1086 N    PROV1085
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-PHAR-CONTRACT
   PHARMACISTS - FULL TIME                     7.2   1087  1093 N    PROV1090
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-PHAR-FULL-TIME
   PHARMACISTS - PART TIME                     7.2   1094  1100 N    PROV1095
     THE NUMBER OF FULL-TIME EQUIVALENT PHARMACISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-PHAR-PART-TIME
   PHYS THER ASST - CONTRACT                   7.2   1101  1107 N    PROV5210
     NUMBER OF CONTRACT STAFF HOURS FOR PHYSICAL THERAPY ASS
     ISTANTS.
     COBOL NAME: NUM-THER-ASST-CONTRACT
   PHYS THER ASST - FULL TIME                  7.2   1108  1114 N    PROV5200
     NUMBER OF FULL-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-FULL-TIME
   PHYS THER ASST - PART TIME                  7.2   1115  1121 N    PROV5205
     NUMBER OF PART-TIME STAFF HOURS FOR PHYSICAL THERAPY AS
     SISTANTS.
     COBOL NAME: NUM-THER-ASST-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PHYSICAL THERAPISTS - CONTRACT              7.2   1122  1128 N    PROV1430
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-CONTRACT
   PHYSICAL THERAPISTS - FULL TIME             7.2   1129  1135 N    PROV1435
     THE NUMBER OF FULL TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-FULL-TIME
   PHYSICAL THERAPISTS - PART TIME             7.2   1136  1142 N    PROV1440
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-PART-TIME
   PHYSICAL THERAPY AIDE - CONTRACT            7.2   1143  1149 N    PROV1415
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-THER-AID-CONTRACT
   PHYSICAL THERAPY AIDE - FULL TIME           7.2   1150  1156 N    PROV1420
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-THER-AID-FULL-TIME
   PHYSICAL THERAPY AIDE - PART TIME           7.2   1157  1163 N    PROV1425
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICAL THERAPY
     AIDE EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-THER-AID-PART-TIME
   PHYSICIAN EXTENDER - CONTRACT               7.2   1164  1170 N    PROV3270
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     UNDER CONTRACT TO THE FACILITY.
     COBOL NAME: NUM-PHYS-EXT-CONTRACT
   PHYSICIAN EXTENDER - FULL TIME              7.2   1171  1177 N    PROV3250
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A FULL-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-FULL-TIME
   PHYSICIAN EXTENDER - PART TIME              7.2   1178  1184 N    PROV3260
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN EXTENDERS
     EMPLOYED BY THE FACILITY ON A PART-TIME BASIS.
     COBOL NAME: NUM-PHYS-EXT-PART-TIME
   PODIATRISTS - CONTRACT                      7.2   1185  1191 N    PROV1130
     THE NUMBER OF FULL TIME EQUIVALENT PODIATRISTS UNDER
     CONTRACT TO A FACILITY.
     COBOL NAME: NUM-POD-CONTRACT
   PODIATRISTS - FULL TIME                     7.2   1192  1198 N    PROV1135
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A AFCILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-POD-FULL-TIME
   PODIATRISTS - PART TIME                     7.2   1199  1205 N    PROV1140
     THE NUMBER OF FULL-TIME EQUIVALENT PODIATRISTS EMPLOYED
     BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-POD-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PROVIDER BASED FACILITY                     1     1206  1206 C    PROV1675
     INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER
     BASED.
     COBOL NAME: PROV-BASED-FACILITY
     VALUES:   Y                   HOSPITAL BASED

   REGISTERED NURSE - CONTRACT                 7.2   1207  1213 N    PROV1150
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-REG-NURSE-CONTRACT
   REGISTERED NURSE - FULL TIME                7.2   1214  1220 N    PROV1155
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-FULL-TIME
   REGISTERED NURSE - PART TIME                7.2   1221  1227 N    PROV1160
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED NURSES
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-REG-NURSE-PART-TIME
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   RN DIRECTOR OF NURSING - CONTRACT           7.2   1238  1244 N    PROV5130
     THE NUMBER OF FULL TIME EQUIVALENT RN DIRECTOR OF NURSI
     NG UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-RN-DON-CONTRACT
   RN DIRECTOR OF NURSING - FULL TIME          7.2   1245  1251 N    PROV5120
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-RN-DON-FULL-TIME
   RN DIRECTOR OF NURSING - PART TIME          7.2   1252  1258 N    PROV5140
     THE NUMBER OF FULL-TIME EQUIVALENT RN DIRECTOR OF
     NURSING EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-RN-DON-PART-TIME
   SOCIAL WORKER - CONTRACT                    7.2   1259  1265 N    PROV1170
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SOCIAL-CONTRACT
   SOCIAL WORKER - FULL TIME                   7.2   1266  1272 N    PROV1175
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SOCIAL-FULL-TIME
   SOCIAL WORKER - PART TIME                   7.2   1273  1279 N    PROV1180
     THE NUMBER OF FULL-TIME EQUIVALENT SOCIAL WORKERS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SOCIAL-PART-TIME


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPECIAL CARE BEDS-AIDS                      3     1280  1282 N    PROV0725
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH AIDS.
     COBOL NAME: NUM-AIDS-BEDS
   SPECIAL CARE BEDS-ALZHEIMERS                3     1283  1285 N    PROV0730
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH ALZEHEIMERS.
     COBOL NAME: NUM-ALZHEIMERS-BEDS
   SPECIAL CARE BEDS-DIALYSIS                  3     1286  1288 N    PROV0800
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS NEEDING DIALYSIS.
     COBOL NAME: NUM-DIAL-BEDS
   SPECIAL CARE BEDS-DISABLED CHILD            3     1289  1291 N    PROV0855
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR DEISCABLED CHILDREN.
     COBOL NAME: NUM-DIS-CHILD-BEDS
   SPECIAL CARE BEDS-HEAD TRAUMA               3     1292  1294 N    PROV0905
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILTY FOR RESIDENTS WITH HEAD TRAUMA.
     COBOL NAME: NUM-HEAD-TRAUMA-BEDS
   SPECIAL CARE BEDS-HOSPICE                   3     1295  1297 N    PROV0920
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY A FACILITY FOR RESIDENTS NEEDING HOSPICE SERVICES.
     COBOL NAME: NUM-HOSPICE-BEDS
   SPECIAL CARE BEDS-HUNTINGTONS               3     1298  1300 N    PROV0940
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH HUNTINGTON'S DISEASE
     COBOL NAME: NUM-HUNTING-DIS-BEDS
   SPECIAL CARE BEDS-SPEC REHAB                3     1301  1303 N    PROV1205
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH SPECIALIZED REHAB
     NEEDS.
     COBOL NAME: NUM-SPEC-REHAB-BEDS
   SPECIAL CARE BEDS-VENTILATOR                3     1304  1306 N    PROV1460
     THE NUMBER OF BEDS IN A UNIT IDENTIFIED AND DEDICATED
     BY THE FACILITY FOR RESIDENTS WITH VENTILATOR/
     RESIPIRATORY CARE NEEDS.
     COBOL NAME: NUM-VENT-RESP-BEDS
   SPEECH PATHOLOGIST - CONTRACT               7.2   1307  1313 N    PROV1190
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     UNDER CONTRACT TO A FACILITY.
     COBOL NAME: NUM-SPCH-PATH-CONTRACT
   SPEECH PATHOLOGIST - FULL TIME              7.2   1314  1320 N    PROV1195
     THE NUMBER OF FULL-TIME EQUIVALENT SPPECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A FULL TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-FULL-TIME




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEECH PATHOLOGIST - PART TIME              7.2   1321  1327 N    PROV1200
     THE NUMBER OF FULL-TIME EQUIVALENT SPEECH PATHOLOGISTS
     EMPLOYED BY A FACILITY ON A PART TIME BASIS.
     COBOL NAME: NUM-SPCH-PATH-PART-TIME
   SRV: ACTIVITIES-OFFSITE-RESIDENTS           1     1328  1328 C    PROV3390
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-NON RES              1     1329  1329 C    PROV3385
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: ACTIVITIES-ONSITE-RESIDENTS            1     1330  1330 C    PROV3380
     INDICATES IF ACTIVITIES SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-ACT-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-OFFSITE-RESIDENTS          1     1331  1331 C    PROV3525
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-NONRES              1     1332  1332 C    PROV3520
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: BLOOD ADMIN-ONSITE-RESIDENTS           1     1333  1333 C    PROV3515
     INDICATES IF ADMINISTRATION AND STORAGE OF BLOOD
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-ADM-BLOOD-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: CLINICAL LAB-OFFSITE-RESIDENT          1     1334  1334 C    PROV3495
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-NON RES            1     1335  1335 C    PROV3490
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: CLINICAL LAB-ONSITE-RESIDENTS          1     1336  1336 C    PROV3485
     INDICATES IF CLINICAL LABORATORY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-CLIN-LAB-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-OFFSITE-RESIDENTS               1     1337  1337 C    PROV3435
     INDICATES IF DENTAL SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-NON RESIDENTS            1     1338  1338 C    PROV3430
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DENTAL-ONSITE-RESIDENTS                1     1339  1339 C    PROV3425
     INDICATES IF DENTAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DENTAL-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-OFFSITE-RESIDENTS              1     1340  1340 C    PROV3345
     INDICATES IF DIETARY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: DIETARY-ONSITE-NON RESIDENTS           1     1341  1341 C    PROV3340
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: DIETARY-ONSITE-RESIDENTS               1     1342  1342 C    PROV3335
     INDICATES IF DIETARY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-DIETARY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING ONSITE-NON RES            1     1343  1343 C    PROV3535
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-OFFSITE-RES               1     1344  1344 C    PROV3540
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: HOUSEKEEPING-ONSITE-RESIDENTS          1     1345  1345 C    PROV3530
     INDICATES IF HOUSEKEEPING SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-HOUSE-KP-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-OFFSITE-RES              1     1346  1346 C    PROV3465
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: MENTAL HEALTH-ONSITE-NON RES           1     1347  1347 C    PROV3460
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: MENTAL HEALTH-ONSITE-RESID             1     1348  1348 C    PROV3455
     INDICATES IF MENTAL HEALTH SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MEN-HLTH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-OFFSITE-RESIDENTS              1     1349  1349 C    PROV3315
     INDICATES IF NURSING SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-NON RESIDENTS           1     1350  1350 C    PROV3310
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-NURSING-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: NURSING-ONSITE-RESIDENTS               1     1351  1351 C    PROV3305
     INDICATES IF NURSING SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-NURSING-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-OFFSITE-RESIDENTS           1     1352  1352 C    PROV3360
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-NON RESID            1     1353  1353 C    PROV3355
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OCCUP THER-ONSITE-RESIDENTS            1     1354  1354 C    PROV3350
     INDICATES IF OCCUPATIONAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-OCC-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: OTH ACTIVITIES-OFFSITE TO RES          1     1355  1355 C    PROV5255
     FIELD 3 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE NONRES           1     1356  1356 C    PROV5250
     FIELD 2 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH ACTIVITIES-ONSITE RES              1     1357  1357 C    PROV5245
     FIELD 1 - INDICATES OTHER ACTIVITY SERVICES PROVIDED BY
     STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-ACT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-OFFSITE TO RES             1     1358  1358 C    PROV5285
     FIELD 3 - INDICATES SERVICES PROVIDED BY OTHER SOCIAL S
     ERVICES STAFF OFFSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO NONRES           1     1359  1359 C    PROV5280
     INDICATES IF OTHER SOCIAL SERVICES ARE PROVIDED ONSITE
     TO NONRESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: OTH SOC SRV-ONSITE TO RES              1     1360  1360 C    PROV5275
     FIELD 1 - INDICATES SERVICES PROVIDED BY SOCIAL SERVICE
     S STAFF ONSITE TO RESIDENTS.
     COBOL NAME: SP-OTH-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-OFFSITE-RESIDENTS             1     1361  1361 C    PROV3330
     INDICATES IF PHARMACY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 25
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHARMACY-ONSITE-NON RESIDENTS          1     1362  1362 C    PROV3325
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHARMACY-ONSITE-RESIDENTS              1     1363  1363 C    PROV3320
     INDICATES IF PHARMACY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHARMACY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-OFFSITE-RESID            1     1364  1364 C    PROV3300
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-NON RES           1     1365  1365 C    PROV3295
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS EXTENDER-ONSITE-RESIDENT          1     1366  1366 C    PROV3290
     INDICATES IF PHYSICIAN EXTENDER SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-EXT-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-OFFSITE-RESIDENTS            1     1367  1367 C    PROV3375
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYS THER-ONSITE-NON RESIDENT          1     1368  1368 C    PROV3370
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 26
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: PHYS THER-ONSITE-RESIDENTS             1     1369  1369 C    PROV3365
     INDICATES IF PHYSICAL THERAPY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-PHYS-THER-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-OFFSITE-RESIDENTS            1     1370  1370 C    PROV3285
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-NON RESIDENT          1     1371  1371 C    PROV3280
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PHYS-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PHYSICIAN-ONSITE-RESIDENTS             1     1372  1372 C    PROV3275
     INDICATES IF PHYSICIAN SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PHYS-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-OFFSITE-RESIDENTS             1     1373  1373 C    PROV3450
     INDICATES IF PODIATRY SERVICES ARE PROVIDED OFFSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-NON RESIDENTS          1     1374  1374 C    PROV3445
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     NON RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: PODIATRY-ONSITE-RESIDENTS              1     1375  1375 C    PROV3440
     INDICATES IF PODIATRY SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-PODIATRY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 27
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL WORK-OFFSITE-RESIDENTS          1     1376  1376 C    PROV3405
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-NON RESID           1     1377  1377 C    PROV3400
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SOCIAL WORK-ONSITE-RESIDENTS           1     1378  1378 C    PROV3395
     INDICATES IF SOCIAL WORK SERVICES ARE PROVIDED ONSITE
     TO RESIDENTS.
     COBOL NAME: SP-MED-SOC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-OFFSITE-RESIDEN            1     1379  1379 C    PROV3420
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-NON RESID           1     1380  1380 C    PROV3415
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: SPEECH PATH-ONSITE-RESIDENTS           1     1381  1381 C    PROV3410
     INDICATES IF SPEECH/LANGUAGE PATHOLOGY SERVICES ARE
     PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-SPEECH-PH-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-OFFSITE TO RES           1     1382  1382 C    PROV5225
     INDICATES IF THERAPEUTIC RECRECATION SPECIALIST
     SERVICES ARE PROVIDED OFFSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 28
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: THER REC SPEC-ONSITE-NONRES            1     1383  1383 C    PROV5220
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO NONRESIDENTS.
     COBOL NAME: SP-THER-REC-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: THER REC SPEC-ONSITE-RESIDENT          1     1384  1384 C    PROV5215
     INDICATES IF THERAPEUTIC RECREATION SPECIALIST
     SERVICES ARE PROVIDED ONSITE TO RESIDENTS.
     COBOL NAME: SP-THER-REC-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-OFFSITE-RESIDENTS           1     1385  1385 C    PROV3480
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED OFFSITE
     TO RESIDENTS.
     COBOL NAME: SP-VOC-GUID-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-NON RESID            1     1386  1386 C    PROV3475
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE
     TO NON RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: VOCATIONAL-ONSITE-RESIDENTS            1     1387  1387 C    PROV3470
     INDICATES IF VOCATIONAL SERVICES ARE PROVIDED ONSITE TO
     RESIDENTS.
     COBOL NAME: SP-VOC-GUID-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-OFFSITE-RESIDENTS                 1     1388  1388 C    PROV3510
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     OFFSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-OFF-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   SRV: XRAY-ONSITE-NON RESIDENTS              1     1389  1389 C    PROV3505
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO NON RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-NON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 29
            NURSING FACILITIES, CATEGORY = "10" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: XRAY-ONSITE-RESIDENTS                  1     1390  1390 C    PROV3500
     INDICATES IF DIAGNOSTIC XRAY SERVICES ARE PROVIDED
     ONSITE TO RESIDENTS.
     COBOL NAME: SP-DIAG-XRAY-ON-RES
     VALUES:   N                   SERVICE IS NOT PROVIDED
               Y                   SERVICE IS PROVIDED

   THER REC SPEC - CONTRACT                    7.2   1391  1397 N    PROV5240
     NUMBER OF CONTRACT STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-CONTRACT
   THER REC SPEC - FULL TIME                   7.2   1398  1404 N    PROV5230
     NUMBER OF FULL-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-FULL-TIME
   THER REC SPEC - PART TIME                   7.2   1405  1411 N    PROV5235
     NUMBER OF PART-TIME STAFF HOURS PROVIDED BY THERAPEUTIC
     RECREATION SPECIALIST.
     COBOL NAME: NUM-THER-REC-PART-TIME































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   02                  TITLE 19 ONLY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   11                  INTERMEDIATE CARE FACILITY-MENTALLY RETARDED

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   00452               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   00452               NATIONAL GOVERNMENT SERVICES


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00454               NATIONAL GOVERNMENT SERVICES
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  PRIVATE NON PROFIT
               02                  PRIVATE PROPRIETARY
               03                  STATE
               04                  CITY/TOWN
               05                  COUNTY
               06                  CITY/COUNTY
               07                  OTHER

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   BEDS - TOTAL                                4     291   294  N    PROV0740
     TOTAL NUMBER OF BEDS IN A FACILITY, INCLUDING THOSE
     IN NON-PARTICIPATING OR NON-LICENSED AREAS.
     COBOL NAME: NUM-BEDS
   BEDS - TOTAL CERTIFIED                      4     295   298  N    PROV0755
     NUMBER OF BEDS IN MEDICARE AND/OR MEDICAID CERTIFIED
     AREAS WITHIN A FACILITY.
     COBOL NAME: NUM-CERT-BEDS
   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:   1                   WAIVER RECOMMENDED

   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   LICENSED PRACT/VOCAT NURSES                 7.2   382   388  N    PROV0955
     NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR
     VOCATIONAL NURSES EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-LPN-LVN
   PROGRAM PARTICIPATION                       1     434   434  C    PROV1670
     INDICATES IF THE PROVIDER PARTICIPATES IN MEDICARE,
     MEDICAID, OR BOTH PROGRAMS.
     COBOL NAME: PROG-PARTCI
     VALUES:   2                   MEDICAID ONLY

   REGIONAL OVERRIDE #1 (NUMBER BEDS)          1     470   470  C    PROV1545
     THIS FIELD IS SET TO "Y" WHEN THE REGIONAL OFFICE
     HAS TO OK A PENDING RECORD IN THE SPECIAL FIELDS
     SCREEN. THIS FIELD ONLY APPLIES TO CATEGORIES IN THE
     ODIE DATA ENTRY SYSTEM.
     COBOL NAME: OVERRIDE-1
     VALUES:   Y                   RECORD HAS BEEN APPROVED

   REGISTERED NURSES                           7.2   473   479  N    PROV1145
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PROFESSIONAL NURSES EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-REG-NURS
   COMPLIANCE: BEDS PER ROOM WAIVER            1     672   672  C    PROV0225
     INDICATES IF A WAIVER OF THE BEDS PER ROOM REQUIREMENT
     HAS BEEN RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-BEDS-PER-ROOM
     VALUES:   1                   WAIVER RECOMMENDED





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: PATIENT ROOM SIZE               1     673   673  C    PROV0270
     INDICATES IF A WAIVER OF PATIENT ROOM SIZE HAS BEEN
     RECOMMENDED FOR A FACILITY.
     COBOL NAME: COMPL-PATIENT-ROOM-SZ
     VALUES:   1                   WAIVER RECOMMENDED

   PROVIDER BASED FACILITY                     1     1206  1206 C    PROV1675
     INDICATES IF A LONG TERM CARE FACILITY IS PROVIDER
     BASED.
     COBOL NAME: PROV-BASED-FACILITY
     VALUES:   Y                   DISTINCT PART OF A HOSPITAL, SNF OR ICF

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   ADMISSION SUSPENSION DATE                   8     1529  1536 C    PROV0030
     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.
     COBOL NAME: ADMIN-SUSP-DT
   BEDS - ICF/MR                               4     1537  1540 N    PROV0945
     NUMBER OF CERTIFIED BEDS IN AN INTERMEDIATE CARE
     FACILITY FOR THE MENTALLY RETARDED.
     COBOL NAME: NUM-ICF-MR-BEDS
   DIRECT CARE PERSONNEL                       7.2   1541  1547 N    PROV0780
     NUMBER OF FULL-TIME EQUIVALENT DIRECT CARE PERSONNEL
     EMPLOYED BY AN INTERMEDIATE CARE FACILITY FOR THE
     MENTALLY RETARDED.
     COBOL NAME: NUM-DCARE-PERSNL
   LTC AGREEMENT BEGINNING DATE                8     1548  1555 C    PROV0620
     THE BEGINNING DATE OF A CERTIFIED LONG TERM CARE FACILI
     TY'S TIME LIMITED AGREEMENT.
     COBOL NAME: LTC-AGREE-BEGIN-DT
   LTC AGREEMENT ENDING DATE                   8     1556  1563 C    PROV0625
     THE ENDING DATE OF A CERTIFIED LONG TERM CARE
     FACILITY'S TIME LIMITED AGREEMENT.
     COBOL NAME: LTC-AGREE-END-DT
   LTC AGREEMENT EXTENSION DATE                8     1564  1571 C    PROV0630
     THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM
     CARE FACILITY'S TIME LIMITED AGREEMENT.
     COBOL NAME: LTC-AGREE-EXT-DT
   PRIOR ADMISSION SUSPENSION DATE             8     1572  1579 C    PROV1610
     PREVIOUS DATE A SUSPENSION OF ADMISSIONS WAS INVOKED
     FOR A PROVIDER.
     COBOL NAME: PRIOR-ADMIN-SUSP-DT


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
 INTERMEDIATE CARE FACILITY-MENTALLY RETARDED, CATEGORY = "11" (SEE POSITIONS 3-

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR LTC END DATE                          8     1580  1587 C    PROV1630
     THE LAST DATE OF A CERTIFIED LONG TERM CARE
     FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR SURVEY.
     COBOL NAME: PRIOR-LTC-END-DT
   PRIOR LTC EXTENSION DATE                    8     1588  1595 C    PROV1635
     THE LAST DATE OF AN EXTENSION OF A CERTIFIED LONG TERM
     CARE FACILITY'S TIME LIMITED AGREEMENT FOR A PRIOR
     SURVEY.
     COBOL NAME: PRIOR-LTC-EXT-DT
   PRIOR RESCIND SUSPENSION DATE               8     1596  1603 C    PROV1640
     THE EFFECTIVE DATE OF A PREVIOUS SUSPENSION OF
     ADMISSIONS TO A LTC FACILITY.
     COBOL NAME: PRIOR-RESC-SUSP-DT
   RESCIND SUSPENSION DATE                     8     1604  1611 C    PROV1825
     DATE THAT THE SUPENSION OF PAYMENTS FOR NEW ADMISSIONS
     TO A LONG TERM CARE FACILITY (LTC) IS RESCINDED.
     COBOL NAME: RESC-SUSP-DT
   TOTAL # OF EMPLOYEES                        9.2   1612  1620 N    PROV2850
     THE TOTAL NUMBER OF FULL-TIME EMPLOYEES IN A HOSPICE
     OR AN INTERMEDIATE CARE FACILITY/MENTAL RETARDATION
     FACILITY.
     COBOL NAME: TOT-EMPLOYEES




























 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  RURAL HEALTH CLINICS

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   12                  RURAL HEALTH CLINICS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01102               PALMETTO (CALIFORNIA NORTH)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01302               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)
               05102               WPS (IOWA)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)
               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   PHYSICIAN ASSISTANTS                        7.2   427   433  N    PROV1115
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIAN ASSISTANTS
     EMPLOYED BY A HOSPITAL OR RURAL HEALTH CLINIC.
     COBOL NAME: NUM-PHYS-ASSIST
   FEDERAL PROGRAM SUPPORT                     1     1621  1621 C    PROV0480
     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.
     COBOL NAME: FED-PROG-SUPPORT
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
           RURAL HEALTH CLINICS, CATEGORY = "12" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

     VALUES:   N                   NO
               Y                   YES

   NURSE PRACTITIONERS                         7.2   1622  1628 N    PROV1015
     NUMBER OF FULL-TIME EQUIVALENT NURSE PRACTITIONERS.
     COBOL NAME: NUM-NURSE-PRACT
   PARENT PROVIDER NUMBER                      10    1629  1638 C    PROV1560
     THE IDENTIFICATION NUMBER OF THE PARENT PROVIDER WHEN A
     PROVIDER IS PART OF AN EXISTING MEDICARE PROVIDER.
     COBOL NAME: PARENT-PROV-NUM
   PHYSICIANS                                  7.2   1639  1645 N    PROV1110
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED
     BY A PROVIDER.
     COBOL NAME: NUM-PHYS
   TITLE OF FEDERAL PROGRAM                    26    1646  1671 C    PROV2845
     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.
     COBOL NAME: TITL-FED-PROGR
     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 DELNATIONAL HEALTH SERVICE DELIVERY PROGRAM
               RURAL OUTREACH  DEMORURAL OUTREACH DEMO GRANT PROGRAM

























 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   13                  PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   00011               CAHABA
               00122               HCSC - MICHIGAN
               00452               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               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)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00805               NATIONAL GOVERNMENT SERVICES
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)
               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               14330               GROUP HEALTH INC (NEW YORK)
               16360               NATIONWIDE (OHIO)
               16510               NATIONWIDE (WEST VIRGINIA)
               21200               MASSACHUSETTS/MAINE
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   00011               CAHABA
               00122               HCSC - MICHIGAN
               00452               NATIONAL GOVERNMENT SERVICES
               00454               NATIONAL GOVERNMENT SERVICES
               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)
               00825               BLUE SHIELD (NORTH DAKOTA/WYOMING)
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               14330               GROUP HEALTH INC (NEW YORK)
               16360               NATIONWIDE (OHIO)
               16510               NATIONWIDE (WEST VIRGINIA)
               21200               MASSACHUSETTS/MAINE
               31142               NATIONAL HERITAGE INSURANCE CO (MAINE)
               31143               NATIONAL HERITAGE INSURANCE CO
               31146               NATIONAL HERTAGE INSURANCE

   PROVIDER NUMBER                             10    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM

 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
 PHYSICAL THERAPISTS IN INDEPENDENT PRACTICE, CATEGORY = "13" (SEE POSITIONS 3-4

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD




























 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  COMPREHENSIVE OUTPATIENT

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   14                  COMPREHENSIVE OUTPATIENT REHAB FACILITIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  PROPRIETARY
               02                  NON PROFIT CHURCH
               03                  NON PROFIT OTHER
               04                  GOVERNMENT

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   SRV: OCCUPATIONAL THERAPY                   1     558   558  C    PROV2270
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICAL THERAPY                       1     570   570  C    PROV2370
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: SOCIAL                                 1     585   585  C    PROV2485
     INDICATES HOW SOCIAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-SOCIAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: SPEECH PATHOLOGY                       1     586   586  C    PROV2505
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   SRV: NURSING                                1     1457  1457 C    PROV2250
     INDICATES HOW NURSING SERVICES ARE PROVIDED.
     COBOL NAME: SP-NURSING
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   PARENT PROVIDER NUMBER                      10    1629  1638 C    PROV1560
     THE IDENTIFICATION NUMBER OF THE PARENT PROVIDER WHEN A
     PROVIDER IS PART OF AN EXISTING MEDICARE PROVIDER.
     COBOL NAME: PARENT-PROV-NUM
   PARTICIPATION MEDICARE OPT/SP               1     1672  1672 C    PROV1570
     INDICATES IF A COMPREHENSIVE OUTPATIENT REHABILITATION
     FACILITY ALSO PARTICIPATES IN MEDICARE AS A PROVIDER OF
     OUTPATIENT PHYSICAL THERAPY AND/OR SPEECH PATHOLOGY.
     COBOL NAME: PARTIC-OPT-SP
     VALUES:   N                   NO
               Y                   YES

   SRV: NURSING #2                             1     1673  1673 C    PROV6140
     INDICATES HOW NURSING SERVICES ARE PROVIDED
     COBOL NAME: SP-NURSING-2
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   COMBINATION

   SRV: NURSING #3                             1     1674  1674 C    PROV6145
     INDICATES HOW NURSING SERVICES ARE PROVIDED
     COBOL NAME: SP-NURSING-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: OCCUPATIONAL THERAPY #2                1     1675  1675 C    PROV2275
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY-2
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: OCCUPATIONAL THERAPY #3                1     1676  1676 C    PROV2280
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: ORTHOTIC/PROSTHETIC                    1     1677  1677 C    PROV2325
     INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED
     BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY.
     COBOL NAME: SP-ORTHOTIC-PROSTHET
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: ORTHOTIC/PROSTHETIC #2                 1     1678  1678 C    PROV2330
     INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED
     BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY.
     COBOL NAME: SP-ORTHOTIC-PROSTHET-2
     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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SRV: ORTHOTIC/PROSTHETIC #3                 1     1679  1679 C    PROV2335
     INDICATES HOW ORTHOTIC/PROSTHETIC SERVICES ARE PROVIDED
     BY A COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY.
     COBOL NAME: SP-ORTHOTIC-PROSTHET-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICAL THERAPY #2                    1     1680  1680 C    PROV2375
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY-2
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICAL THERAPY #3                    1     1681  1681 C    PROV2380
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY-3
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICIAN                              1     1682  1682 C    PROV2385
     INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICIAN
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICIAN #2                           1     1683  1683 C    PROV2390
     INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICIAN-2
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PHYSICIAN #3                           1     1684  1684 C    PROV2395
     INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICIAN-3
     VALUES:   1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PSYCHOLOGICAL                          1     1685  1685 C    PROV2420
     INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-PSYCHOLOGICAL
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PSYCHOLOGICAL #2                       1     1686  1686 C    PROV2425
     INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-PSYCHOLOGICAL-2
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: PSYCHOLOGICAL #3                       1     1687  1687 C    PROV2430
     INDICATES HOW PSYCHOLOGICAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-PSYCHOLOGICAL-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: RESPIRATORY CARE                       1     1688  1688 C    PROV2455
     INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED.
     COBOL NAME: SP-RESP-CARE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED BY ARRANGEMENT OR AGREEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: RESPIRATORY CARE #2                    1     1689  1689 C    PROV2460
     INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED.
     COBOL NAME: SP-RESP-CARE-2
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: RESPIRATORY CARE #3                    1     1690  1690 C    PROV2465
     INDICATES HOW RESPIRATORY CARE SERVICES ARE PROVIDED.
     COBOL NAME: SP-RESP-CARE-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: SOCIAL #2                              1     1691  1691 C    PROV2490
     INDICATES HOW SOCIAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-SOCIAL-2
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
 COMPREHENSIVE OUTPATIENT REHAB FACILITIES, CATEGORY = "14" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: SOCIAL #3                              1     1692  1692 C    PROV2495
     INDICATES HOW SOCIAL SERVICES ARE PROVIDED.
     COBOL NAME: SP-SOCIAL-3
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: SPEECH PATHOLOGY #2                    1     1693  1693 C    PROV2510
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH-2
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY EMPLOYEES
               2                   PROVIDED UNDER ARRANGEMENT
               3                   PROVIDED BY INDEPENDENT CONTRACTOR

   SRV: SPEECH PATHOLOGY #3                    1     1694  1694 C    PROV2515
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH-3
     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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  AMBULATORY SURGICAL CENTER

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   15                  AMBULATORY SURGICAL CENTERS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               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)
               00770               BLUE SHIELD (NEW HAMPSHIRE/VERMONT)
               00780               BLUE SHIELD (TRI-STATE)
               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01102               PALMETTO (CALIFORNIA NORTH)
               01120               AETNA (HAWAII)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01290               AETNA (NEVADA)
               01302               PALMETTO (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)
               05102               WPS (IOWA)
               05130               EQICOR (IDAHO)
               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14330               GROUP HEALTH INC (NEW YORK)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               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)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               51390               AETNA (FORT WASHINGTON)
               52280               MUTUAL OF OMAHA
               57400               COOPERATIVA (PUERTO RICO)

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00280               BLUE CROSS (NEW JERSEY)
               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               00320               BLUE CROSS (NORTH DAKOTA)
               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)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00820               BLUE SHIELD (NORTH DAKOTA)
               00825               BLUE SHIELD (NORTH DAKOTA/WYOMING)
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)
               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               14330               GROUP HEALTH INC (NEW YORK)
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP
               5                   VALIDATION (ACCRD)
               8                   FULL SURVEY AFTER COMPLAINT

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  PROPRIETARY
               02                  NON PROFIT
               03                  GOVERNMENT

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   ACCREDITATION INDICATOR                     1     290   290  C    PROV0010
     INDICATES THE ORGANIZATION THAT IS RESPONSIBLE FOR
     THE ACCREDITATION OF THE PROVIDER.
     COBOL NAME: ACCRED-STAT
     VALUES:   0                   NONE
               1                   JCAHO
               2                   AAAHC
               3                   AAAASF
               4                   AOA

   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:   1                   WAIVER RECOMMENDED

   DATE OF LAST VALIDATION SURVEY              8     363   370  C    PROV0450
     DATE THE LAST VALIDATION SURVEY WAS PERFORMED
     BY THE STATE AGENCY FOR A JCAH, AOA ACCREDITED
     HOSPITAL OR OTHER PROVIDER TYPE.
     COBOL NAME: DT-VALID-SURVEY
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   SRV: PHARMACY                               1     569   569  C    PROV2365
     INDICATES HOW PHARMACY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHARMACY
     VALUES:   1                   PROVIDED DIRECTLY BY THE FACILITY
               2                   PROVIDED THROUGH AN OUTSIDE SOURCE
               3                   COMBINATION

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   SRV: OTHER                                  1     1459  1459 C    PROV2340
     INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OTHER
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   DATE CENTER BEGAN PROVIDING SERV            8     1695  1702 C    PROV0415
     THE DATE AN AMBULATORY SURGICAL CENTER (ASC) BEGAN
     PROVIDING HEALTH CARE SERVICES.
     COBOL NAME: DT-SERVICE-BEGAN
   FREE STANDING INDICATOR (ASC)               1     1703  1703 C    PROV0550
     INDICATES IF THE AMBULATORY SURGICAL CENTER IS FREE
     STANDING.  THIS INDICATOR IS USED BY SOME STANDARD
     REPORTS TO GET CERTAIN PROVIDER RANGES.
     COBOL NAME: FREE-STAND-IND
     VALUES:   Y                   YES FREE STANDING

   HOSPITAL BASED INDICATOR                    1     1704  1704 C    PROV0565
     HOSPITAL BASED INDICATOR
     COBOL NAME: HOSP-BASED-IND
     VALUES:   1                   HOSPITAL BASED

   OPERATING ROOMS                             2     1705  1706 N    PROV1055
     THE NUMBER OF OPERATING ROOMS IN AN AMBULATORY SURGICAL
     CENTER.
     COBOL NAME: NUM-OPERATING-ROOMS
   SPEC: CARDIOVASCULAR                        1     1707  1707 C    PROV2095
     INDICATES IF CARDIOVASCULAR SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-CARDIOVASCULAR
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: FOOT                                  1     1708  1708 C    PROV2145
     INDICATES IF FOOT SURGERY IS OFFERED BY AN AMBULATORY
     SURGICAL CENTER.
     COBOL NAME: SP-FOOT
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: GENERAL                               1     1709  1709 C    PROV2150
     INDICATES IF GENERAL SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-GENERAL
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: NEUROLOGICAL                          1     1710  1710 C    PROV2240
     INDICATES IF NEUROLOGICAL SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-NEUROLOGICAL
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEC: OBSTETRICS/GYNECOLOGY                 1     1711  1711 C    PROV2260
     INDICATES IF OBSTETRICS/GYNECOLOGY SURGERY IS OFFERED
     BY AN AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-OBSTETR-GYNECOL
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: OPTHAMOLOGY                           1     1712  1712 C    PROV2290
     INDICATES IF OPTHAMOLOGY SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-OPTHAMOLOGY-SURG
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: ORAL                                  1     1713  1713 C    PROV2305
     INDICATES IF ORAL SURGERY IS OFFERED BY AN AMBULATORY
     SURGICAL CENTER.
     COBOL NAME: SP-ORAL
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: ORTHOPEDIC                            1     1714  1714 C    PROV2320
     INDICATES IF ORTHOPEDIC SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-ORTHOPEDIC
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: OTOLARYNGOLOGY                        1     1715  1715 C    PROV2345
     INDICATES IF OTOLARYNGOLOGY SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-OTOLARYRGOLOGY
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: PLASTIC                               1     1716  1716 C    PROV2400
     INDICATES IF PLASTIC SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-PLASTIC
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SPEC: THORACIC                              1     1717  1717 C    PROV2525
     INDICATES IF THORACIC SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-THORACIC
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
        AMBULATORY SURGICAL CENTERS, CATEGORY = "15" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   SPEC: UROLOGY                               1     1718  1718 C    PROV2530
     INDICATES IF UROLOGY SURGERY IS OFFERED BY AN
     AMBULATORY SURGICAL CENTER.
     COBOL NAME: SP-UROLOGY
     VALUES:   N                   NOT OFFERED
               Y                   OFFERED

   SRV: EKG                                    1     1719  1719 C    PROV2135
     INDICATES IF EKG SERVICES ARE PROVIDED BY AN AMBULATORY
     SURGICAL CENTER.
     COBOL NAME: SP-EKG
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED DIRECTLY BY THE FACILITY
               2                   PROVIDED THROUGH AN OUTSIDE SOURCE
               3                   COMBINATION

   SRV: LABORATORY                             1     1720  1720 C    PROV2200
     INDICATES HOW LABORATORY SERVICES ARE PROVIDED.
     COBOL NAME: SP-LABORATORY
     VALUES:   1                   PROVIDED DIRECTLY BY THE FACILITY
               2                   PROVIDED THROUGH AN OUTSIDE SOURCE
               3                   COMBINATION

   SRV: RADIOLOGY                              1     1721  1721 C    PROV2435
     INDICATES HOW RADIOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-RADIOLOGY
     VALUES:   1                   PROVIDED DIRECTLY BY THE FACILITY
               2                   PROVIDED THROUGH AN OUTSIDE SOURCE
               3                   COMBINATION





















 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  HOSPICE

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   16                  HOSPICES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP
               5                   VALIDATION (ACCRD)
               8                   FULL SURVEY AFTER COMPLAINT

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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 GOV. & NONPROFIT
               13                  OTHER

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   ACCREDITATION INDICATOR                     1     290   290  C    PROV0010
     INDICATES THE ORGANIZATION THAT IS RESPONSIBLE FOR
     THE ACCREDITATION OF THE PROVIDER.
     COBOL NAME: ACCRED-STAT
     VALUES:   0                   NONE
               1                   JCAHO
               2                   CHAP





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   COMPLIANCE: LIFE SAFETY CODE                1     356   356  C    PROV0240
     INDICATES IF A WAIVER OF THE LIFE SAFETY CODE HAS BEEN
     RECOMMENDED FOR A PROVIDER.
     COBOL NAME: COMPL-LSC
     VALUES:   1                   WAIVER RECOMMENDED

   DATE OF LAST VALIDATION SURVEY              8     363   370  C    PROV0450
     DATE THE LAST VALIDATION SURVEY WAS PERFORMED
     BY THE STATE AGENCY FOR A JCAH, AOA ACCREDITED
     HOSPITAL OR OTHER PROVIDER TYPE.
     COBOL NAME: DT-VALID-SURVEY
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   LICENSED PRACT/VOCAT NURSES                 7.2   382   388  N    PROV0955
     NUMBER OF FULL-TIME EQUIVALENT LICENSED PRACTICAL OR
     VOCATIONAL NURSES EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-LPN-LVN
   OTHER PERSONNEL                             7.2   412   418  N    PROV1075
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER SALARIED
     PERSONNEL EMPLOYED BY A FACILITY.
     COBOL NAME: NUM-OTHER-PERSNL
   REGISTERED NURSES                           7.2   473   479  N    PROV1145
     THE NUMBER OF FULL-TIME EQUIVALENT REGISTERED
     PROFESSIONAL NURSES EMPLOYED BY A PROVIDER.
     COBOL NAME: NUM-REG-NURS
   SRV: OCCUPATIONAL THERAPY                   1     558   558  C    PROV2270
     INDICATES HOW OCCUPATIONAL THERAPY SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OCCUP-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: PHYSICAL THERAPY                       1     570   570  C    PROV2370
     INDICATES HOW PHYSICAL THERAPY SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICAL-THERAPY
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: SPEECH PATHOLOGY                       1     586   586  C    PROV2505
     INDICATES HOW SPEECH PATHOLOGY SERVICES ARE PROVIDED.
     COBOL NAME: SP-SPEECH-PATH
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT OR AGREEMENT
               3                   COMBINATION

   TYPE OF FACILITY                            2     593   594  C    PROV2890
     INDICATES THE CATEGORY WHICH REPRESENTS THE TYPE OF
     FACILITY.
     COBOL NAME: TYPE-FACILITY
     VALUES:   01                  HOSPITAL
               02                  SKILLED NURSING FACILITY
               03                  NURSING FACILITY
               04                  HOME HEALTH AGENCY
               05                  FREESTANDING HOSPICE

   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   HOME HEALTH AIDES                           7.2   1419  1425 N    PROV0910
     NUMBER OF FULL-TIME EQUIVALENT HOME HEALTH AIDES
     EMPLOYED BY A HOME HEALTH AGENCY OR HOSPICE.
     COBOL NAME: NUM-HOME-HEALTH-AIDES
   SRV: MEDICAL SOCIAL                         1     1456  1456 C    PROV2220
     INDICATES HOW MEDICAL SOCIAL SERVICES ARE PROVIDED
     COBOL NAME: SP-MEDICAL-SOCIAL
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: NURSING                                1     1457  1457 C    PROV2250
     INDICATES HOW NURSING SERVICES ARE PROVIDED.
     COBOL NAME: SP-NURSING
     VALUES:   1                   PROVIDED BY STAFF
               3                   COMBINATION

   SRV: OTHER                                  1     1459  1459 C    PROV2340
     INDICATES HOW OTHER (NOT SPECIFIED) SERVICES ARE
     PROVIDED.
     COBOL NAME: SP-OTHER
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TOTAL # OF EMPLOYEES                        9.2   1612  1620 N    PROV2850
     THE TOTAL NUMBER OF FULL-TIME EMPLOYEES IN A HOSPICE
     OR AN INTERMEDIATE CARE FACILITY/MENTAL RETARDATION
     FACILITY.
     COBOL NAME: TOT-EMPLOYEES
   PHYSICIANS                                  7.2   1639  1645 N    PROV1110
     THE NUMBER OF FULL-TIME EQUIVALENT PHYSICIANS EMPLOYED
     BY A PROVIDER.
     COBOL NAME: NUM-PHYS
   SRV: PHYSICIAN                              1     1682  1682 C    PROV2385
     INDICATES HOW PHYSICIAN SERVICES ARE PROVIDED.
     COBOL NAME: SP-PHYSICIAN
     VALUES:   1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   ACUTE/RESPITE CARE INDICATOR                1     1722  1722 C    PROV0015
     INDICATES IF THE HOSPICE PROVIDES ACUTE AND/OR RESPITE
     SHORT TERM INPATIENT CARE.
     COBOL NAME: ACUTE-RESPITE
     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

   COUNSELORS - STAFF                          7.2   1723  1729 N    PROV1225
     THE NUMBER OF FULL-TIME EQUIVALENT COUNSELORS EMPLOYED
     BY A HOSPICE.
     COBOL NAME: NUM-STAFF-COUNSL
   COUNSELORS - VOLUNTEER                      7.2   1730  1736 N    PROV1480
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER COUNSELORS
     IN A HOSPICE.
     COBOL NAME: NUM-VOL-COUNSL
   HOME HEALTH AIDES - VOLUNTEER               7.2   1737  1743 N    PROV1485
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER HOME
     HEALTH AIDES IN A HOSPICE.
     COBOL NAME: NUM-VOL-HHA
   HOMEMAKERS - STAFF                          7.2   1744  1750 N    PROV0915
     THE NUMBER OF FULL-TIME EQUIVALENT HOMEMAKERS EMPLOYED
     BY A HOSPICE.
     COBOL NAME: NUM-HOMEMAKERS
   HOMEMAKERS - VOLUNTEER                      7.2   1751  1757 N    PROV1490
     THE NUMBER OF FULL-TIME EQUIVALENT HOMEMAKERS IN A
     HOSPICE.
     COBOL NAME: NUM-VOL-HOMEMKR
   LPNS/LVNS - VOLUNTEER                       7.2   1758  1764 N    PROV1495
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER LICENSED
     PRACTICAL/VOCATIONAL NURSES IN A HOSPICE.
     COBOL NAME: NUM-VOL-LPN-LVN


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   MEDICAL SOCIAL WORKERS                      7.2   1765  1771 N    PROV0975
     NUMBER OF FULL-TIME EQUIVALENT MEDICAL SOCIAL WORKERS
     EMPLOYED BY A HOSPITAL OR HOSPICE.
     COBOL NAME: NUM-MED-SOCIAL-WRKS
   MEDICAL SOCIAL WORKERS - VOLUNTEER          7.2   1772  1778 N    PROV1510
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER MEDICAL
     SOCIAL WORKERS IN A HOSPICE.
     COBOL NAME: NUM-VOL-SOC-WORK
   PHYSICIANS - VOLUNTEER                      7.2   1779  1785 N    PROV1500
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER PHYSICIANS
     IN A HOSPICE.
     COBOL NAME: NUM-VOL-PHYS
   REGISTERED NURSES - VOLUNTEER               7.2   1786  1792 N    PROV1505
     THE NUMBER OF FULL-TIME EQUIVALENT VOLUNTEER REGISTERED
     NURSES IN A HOSPICE.
     COBOL NAME: NUM-VOL-REG-NURS
   SRV: COUNSELING                             1     1793  1793 C    PROV2115
     INDICATES HOW COUNSELING SERVICES ARE PROVIDED BY A
     HOSPICE.
     COBOL NAME: SP-COUNSELING
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: HOME HEALTH AIDE                       1     1794  1794 C    PROV2165
     INDICATES HOW HOME HEALTH AIDE SERVICES ARE PROVIDED BY
     A HOSPICE.
     COBOL NAME: SP-HOME-HEALTH-AIDE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: HOMEMAKER                              1     1795  1795 C    PROV2170
     INDICATES HOW HOMEMAKER SERVICES ARE PROVIDED BY A
     HOSPICE.
     COBOL NAME: SP-HOMEMAKER
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: MEDICAL SUPPLIES                       1     1796  1796 C    PROV2225
     INDICATES HOW MEDICAL SUPPLIES SERVICES ARE PROVIDED BY
     A HOSPICE.
     COBOL NAME: SP-MEDICAL-SUPPLIES
     VALUES:   0                   NOT PROVIDED


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
                 HOSPICES, CATEGORY = "16" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   SRV: SHORT TERM INPATIENT CARE              1     1797  1797 C    PROV2480
     INDICATES HOW SHORT TERM INPATIENT CARE SERVICES ARE
     PROVIDED BY A HOSPICE.
     COBOL NAME: SP-SHORT-TERM-INCARE
     VALUES:   0                   NOT PROVIDED
               1                   PROVIDED BY STAFF
               2                   PROVIDED UNDER ARRANGEMENT
               3                   COMBINATION

   VOLUNTEERS - OTHER                          7.2   1798  1804 N    PROV1080
     THE NUMBER OF FULL-TIME EQUIVALENT OTHER VOLUNTEERS IN
     A HOSPICE.
     COBOL NAME: NUM-OTHER-VOLS
   VOLUNTEERS - TOTAL                          9.2   1805  1813 N    PROV2860
     THE NUMBER OF FULL-TIME VOLUNTEERS IN A HOSPICE.
     COBOL NAME: TOT-VOLS






























 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  ORGAN PROCUREMENT

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   17                  ORGAN PROCUREMENT ORGANIZATIONS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01102               PALMETTO (CALIFORNIA NORTH)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01302               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)
               05102               WPS (IOWA)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)
               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               50                  WASHINGTON
               51                  WEST VIRGINIA
               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               3                   TERMINATION


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
      ORGAN PROCUREMENT ORGANIZATIONS, CATEGORY = "17" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD































 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  COMMUNITY MENTAL HEALTH CENTERS

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   19                  COMMUNITY MENTAL HEALTH CENTERS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01101               PALMETTO (CALIFORNIA)
               01201               PALMETTO (HAWAII)
               01301               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02101               NATIONAL HERITAGE (ALASKA)
               02201               NATIONAL HERITAGE (IDAHO)
               02301               NATIONAL HERITAGE (OREGON)
               02401               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03101               NORIDIAN (ARIZONA)
               03201               NORIDIAN (MONTANA)
               03301               NORIDIAN (NORTH DAKOTA)
               03401               NORIDIAN (SOUTH DAKOTA)
               03501               NORIDIAN (UTAH)
               03601               NORIDIAN (WYOMING)
               04101               TRAILBLAZER (COLORADO)
               04201               TRAILBLAZER (NEW MEXICO)
               04301               TRAILBLAZER (OKLAHOMA)
               04401               TRAILBLAZER (TEXAS)
               05101               WPS (IOWA)
               05201               WPS (KANSAS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05301               WPS (MISSOURI)
               05401               WPS (NEBRASKA)
               07101               PINNACLE (ARKANSAS)
               07201               PINNACLE (LOUISIANA)
               07301               PINNACLE (MISSISSIPPI)
               08101               PINNACLE (INDIANA)
               08201               PINNACLE (MICHIGAN)
               09101               FIRST COAST (FLORIDA)
               09201               FIRST COAST (PUERTO RICO/VIRGIN ISLANDS)
               12101               HIGHMARK (DELAWARE)
               12201               HIGHMARK (DISTRICT OF COLUMBIA)
               12301               HIGHMARK (MARYLAND)
               12401               HIGHMARK NEW JERSEY)
               12501               HIGHMARK (PENNSYLVANIA)
               13101               NATL GOVT SERVICES (CONNECTICUT)
               13201               NATL GOVT SERVICES (NEW YORK)
               14101               NATIONAL HERITAGE (MAINE)
               14201               NATIONAL HERITAGE (MASSACHUSETTS)
               14301               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14401               NATIONAL HERITAGE (RHODE ISLAND)
               14501               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA
               ID                  IDAHO
               IL                  ILLINOIS


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA
               02                  ALASKA
               03                  ARIZONA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               3                   TERMINATION




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
      COMMUNITY MENTAL HEALTH CENTERS, CATEGORY = "19" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  PROPRIETARY
               02                  CHURCH RELATED
               03                  NONPROFIT CORPORATION
               04                  OTHER NONPROFIT
               05                  STATE
               06                  LOCAL
               07                  FEDERAL

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM

















 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  FEDERALLY QUALIFIED HEALTH CENTERS

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   21                  FEDERALLY QUALIFIED HEALTH CENTERS

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               00468               BLUE CROSS (NORTH CAROLINA FOR PR)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01102               PALMETTO (CALIFORNIA NORTH)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01302               PALMETTO (NEVADA)
               01390               AETNA (WASHINGTON)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)
               05102               WPS (IOWA)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)
               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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               BLUE CROSS (NORTH DAKOTA)
               00332               NATIONAL GOVERNMENT SERVICES
               00340               BLUE CROSS (OKLAHOMA)
               00350               BLUE CROSS (OREGON)
               00351               BLUE CROSS (OREGON) (IDAHO CLAIMS)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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)
               00511               CAHABA
               00883               PALMETTO
               00952               WPS - ILLINOIS
               00953               WPS - MICHIGAN
               00954               WI PHYSICIAN SERVICES - MN
               01390               AETNA (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               17120               HAWAII MEDICAL SERVICE ASSOCIATION
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               P                   PENDING
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO
               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     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
               GA                  GEORGIA
               GU                  GUAM
               HI                  HAWAII
               IA                  IOWA
               ID                  IDAHO
               IL                  ILLINOIS


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     VALUES:   01                  ALABAMA
               02                  ALASKA
               03                  ARIZONA


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               52                  WISCONSIN
               53                  WYOMING
               56                  CANADA
               59                  MEXICO
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM
   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               3                   TERMINATION




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
    FEDERALLY QUALIFIED HEALTH CENTERS, CATEGORY = "21" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     VALUES:   01                  RELIGIOUS AFFILIATION
               02                  PRIVATE
               03                  OTHER
               04                  PROPRIETARY
               05                  GOVERNMENT - STATE/COUNTY
               06                  GOVERNMENT - COMB. GOVT & VOL.

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   RELATED PROVIDER NUMBER                     10    1228  1237 C    PROV1755
     THIS FIELD IS USED WHEN A PROVIDER'S FACILITY CONTAINS
     MORE THAN ONE DISTINCT PROVIDER,SUCH AS A HOSPITAL WITH
     DISTINCT PART LONG TERM CARE.  THE NUMBER IN THIS FIELD
     WILL BE THE PROVIDER NMBR OF THE HIGHEST LEVEL OF CARE.
     COBOL NAME: RELATED-PROV-NUM
   FEDERALLY FUNDED HEALTH CENTER              1     1814  1814 C    PROV3710
     INDICATED WHETHER THIS FQHC IS FEDERALLY FUNDED.
     COBOL NAME: FED-FUNDED-FFHC
     VALUES:   N                   NO
               Y                   YES

   FQHC APPROVED RHC PROVIDER #                6     1815  1820 C    PROV3705
     APPROVED FQHC'S RELATED RHC PROVIDER NUMBER.
     COBOL NAME: APPROVED-RHC-PROV-NUM
   FQHC APPROVED RURAL HEALTH CLINIC           1     1821  1821 C    PROV3700
     INDICATES IF THE FQHC WAS A MEDICARE CERTIFIED RURAL
     HEALTH CLINIC.
     COBOL NAME: APPROVED-MEDICARE-RHC
     VALUES:   N                   NO
               Y                   YES



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  1
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CATEGORY - SUBTYPE OF PROVIDER              2     1     2    C    PROV0085
     A FURTHER BREAKDOWN OF PROVIDER CATEGORY FOR SKILLED
     NURSING FACILITIES AND HOSPITALS.
     COBOL NAME: CATEGORY-SUBTYPE-IND
     VALUES:   01                  CLIA88 LABORATORY

   CATEGORY OF PROVIDER/SUPPLIER               2     3     4    C    PROV0075
     IDENTIFIES THE CATEGORY WHICH IS MOST INDICATIVE OF THE
     PROVIDER OR SUPPLIER.
     COBOL NAME: CATEGORY
     VALUES:   22                  CLIA88 LABORATORIES

   CHANGE OF OWNERSHIP COUNTER                 2     5     6    N    PROV0095
     THE NUMBER OF TIMES A CHANGE OF OWNERSHIP (CHOW) HAS
     TAKEN PLACE FOR A PARTICULAR PROVIDER.
     COBOL NAME: CHOW-CNT
   CHANGE OF OWNERSHIP DATE                    8     7     14   C    PROV0100
     EFFECTIVE DATE OF A CHANGE OF OWNERSHIP.
     COBOL NAME: CHOW-DT
   CITY                                        28    15    42   C    PROV3225
     CITY IN WHICH THE PROVIDER IS PHYSICALLY LOCATED.
     COBOL NAME: CITY
   COMPLIANCE: PLAN OF CORRECTION              1     43    43   C    PROV0220
     INDICATES IF A PROVIDER IS IN COMPLIANCE WITH PROGRAM
     REQUIREMENTS BASED ON AN ACCEPTABLE PLAN FOR CORRECTION
     OF DEFICIENCIES.
     COBOL NAME: COMPL-ACCEPT-PLAN-COR
     VALUES:   1                   COMPLIANCE BASED ON ACCEPTABLE POC

   COMPLIANCE: STATUS                          1     44    44   C    PROV2715
     INDICATES IF A PROVIDER OR SUPPLIER IS IN COMPLIANCE
     WITH PROGRAM REQUIREMENTS.
     COBOL NAME: STATUS-COMPL
     VALUES:   A                   IN COMPLIANCE
               B                   NOT IN COMPLIANCE

   COUNTY CODE                                 3     45    47   C    PROV2695
     SSA GEOGRAPHIC CODE INDICATING COUNTY WHERE FACILITY
     IS LOCATED.
     COBOL NAME: SSA-COUNTY
   CROSS REFERENCE PROVIDER NUMBER             10    48    57   C    PROV0300
     NUMBER PREVIOUSLY ASSIGNED TO A PARTICULAR PROVIDER.
     COBOL NAME: CROSS-REF-PROV-NUM
   CURRENT FMS SURVEY DATE                     8     58    65   C    PROV0500
     CURRENT FMS SURVEY DATE
     COBOL NAME: FMS-SURVEY-DT-1




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  2
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CURRENT SURVEY DATE                         8     66    73   C    PROV2740
     THE DATE OF THE HEALTH OR LIFE SAFETY CODE SURVEY,
     WHICHEVER IS LATER.  THE "OFFICIAL" SURVEY DATE FOR
     THE PROVIDER.
     COBOL NAME: SURVEY-DT-1
   ELIGIBILITY CODE                            1     74    74   C    PROV0455
     INDICATES IF A FACILITY IS ELIGIBLE TO PARTICIPATE IN
     THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: ELIG-CD
     VALUES:   1                   ELIGIBLE TO PARTICIPATE
               2                   NOT ELIGIBLE TO PARTICIPATE

   FACILITY NAME                               50    75    124  C    PROV0475
     THE NAME OF A PROVIDER OR SUPPLIER CERTIFIED TO
     PARTICIPATE IN THE MEDICARE AND/OR MEDICAID PROGRAMS.
     COBOL NAME: FACILITY-NAME
   INTERMEDIARY NUMBER                         5     125   129  C    PROV0605
     A NUMBER ASSIGNED TO AN INTERMEDIARY OR CARRIER
     SERVICING A PROVIDER OR SUPPLIER.
     COBOL NAME: INTER-CARRIER-NUM
     VALUES:   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)
               00241               BLUE CROSS (MISSOURI)
               00260               BLUE CROSS (NEBRASKA)
               00270               NATIONAL GOVERNMENT SERVICES
               00280               BLUE CROSS (NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  3
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               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
               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)
               00770               BLUE SHIELD (NEW HAMPSHIRE/VERMONT)
               00780               BLUE SHIELD (TRI-STATE)
               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  4
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01102               PALMETTO (CALIFORNIA NORTH)
               01120               AETNA (HAWAII)
               01192               PALMETTO (CALIFORNIA SOUTH)
               01202               PALMETTO (HAWAII)
               01290               AETNA (NEVADA)
               01302               PALMETTO (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               02102               NATIONAL HERITAGE (ALASKA)
               02202               NATIONAL HERITAGE (IDAHO)
               02302               NATIONAL HERITAGE (OREGON)
               02402               NATIONAL HERITAGE (WASHINGTON)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN (ARIZONA)
               03202               NORIDIAN (MONTANA)
               03302               NORIDIAN (NORTH DAKOTA)
               03402               NORIDIAN (SOUTH DAKOTA)
               03502               NORIDIAN (UTAH)
               03602               NORIDIAN (WYOMING)
               04102               TRAILBLAZER (COLORADO)
               04202               TRAILBLAZER (NEW MEXICO)
               04302               TRAILBLAZER (OKLAHOMA)
               04402               TRAILBLAZER (TEXAS)
               05102               WPS (IOWA)
               05130               EQICOR (IDAHO)
               05202               WPS (KANSAS)
               05302               WPS (MISSOURI WEST)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  5
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               05392               WPS (MISSOURI EAST)
               05402               WPS (NEBRASKA)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               07102               PINNACLE (ARKANSAS)
               07202               PINNACLE (LOUISIANA)
               07302               PINNACLE (MISSISSIPPI)
               08102               PINNACLE (INDIANA)
               08202               PINNACLE (MICHIGAN)
               09102               FIRST COAST (FLORIDA)
               09202               FIRST COAST (PUERTO RICO)
               09302               FIRST COAST (VIRGIN ISLANDS)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN
               12102               HIGHMARK (DELAWARE)
               12202               HIGHMARK (DISTRICT OF COLUMBIA)
               12302               HIGHMARK (MARYLAND)
               12402               HIGHMARK (NEW JERSEY)
               12502               HIGHMARK (PENNSYLVANIA)
               13102               NATL GOVT SERVICES (CONNECTICUT)
               13202               NATL GOVT SERVICES (NEW YORK (EMPIRE))
               13282               NATL GOVT SERVICES (NEW YORK (HEALTHNOW))
               13292               NATL GOVT SERVICES (NEW YORK (GHI))
               14102               NATIONAL HERITAGE (MAINE)
               14202               NATIONAL HERITAGE (MASSACHUSETTS)
               14302               NATIONAL HERITAGE (NEW HAMPSHIRE)
               14330               GROUP HEALTH INC (NEW YORK)
               14402               NATIONAL HERITAGE (RHODE ISLAND)
               14502               NATIONAL HERITAGE (VERMONT)
               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)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  6
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               51390               AETNA (FORT WASHINGTON)
               52280               MUTUAL OF OMAHA
               57400               COOPERATIVA (PUERTO RICO)

   MEDICARE OR MEDICAID VENDOR NUMBER          15    130   144  C    PROV0655
     A NUMBER WHICH MAY BE ASSIGNED TO A FACILITY BY THE
     STATE MEDICAID AGENCY FOR EXTERNAL CONTROL OR BILLING
     PURPOSES.
     COBOL NAME: MEDICAID-VEND-NUM
   PARTICIPATION DATE                          8     145   152  C    PROV1565
     THE DATE A FACILITY IS FIRST APPROVED TO PROVIDE
     MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: PARTCI-DT
   PRIOR CHANGE OF OWNERSHIP                   8     153   160  C    PROV1615
     THE DATE OF A PRIOR CHANGE OF OWNERSHIP.
     COBOL NAME: PRIOR-CHOW-DT
   PRIOR INTERMEDIARY NUMBER                   5     161   165  C    PROV1620
     A PREVIOUS INTERMEDIARY NUMBER.WHEN
     COBOL NAME: PRIOR-INTER-CARRIER-NUM
     VALUES:   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               BLUE CROSS (KENTUCKY)
               00180               BLUE CROSS (MAINE)
               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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  7
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00280               BLUE CROSS (NEW JERSEY)
               00290               BLUE CROSS (NEW MEXICO)
               00308               NATIONAL GOVERNMENT SERVICES
               00310               BLUE CROSS (NORTH CAROLINA)
               00320               BLUE CROSS (NORTH DAKOTA)
               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)


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  8
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               00801               BLUE SHIELD (BUFFALO)
               00803               NATIONAL GOVERNMENT SERVICES
               00805               NATIONAL GOVERNMENT SERVICES
               00820               BLUE SHIELD (NORTH DAKOTA)
               00825               BLUE SHIELD (NORTH DAKOTA/WYOMING)
               00860               BLUE SHIELD (PENNSYLVANIA/NEW JERSEY)
               00865               BLUE SHIELD (PENNSYLVANIA)
               00870               BLUE SHIELD (RHODE ISLAND)
               00880               BLUE SHIELD (SOUTH CAROLINA)
               00883               PALMETTO
               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)
               01120               AETNA (HAWAII)
               01290               AETNA (NEVADA)
               01360               AETNA (NEW MEXICO)
               01370               AETNA (OKLAHOMA)
               01380               AETNA (OREGON)
               01390               AETNA (WASHINGTON)
               02050               OCCIDENTAL (CALIFORNIA)
               03001               NORIDIAN ADMIN SERVICES
               03102               NORIDIAN ADMIN SERVICES (ARIZONA)
               03202               NORIDIAN ADMIN SERVICES (MONTANA)
               03302               NORIDIAN ADMIN SERVICES (NORTH DAKOTA)
               03402               NORIDIAN ADMIN SERVICES (MONTANA)
               03502               NORIDIAN ADMIN SERVICES (UTAH)
               03602               NORIDIAN ADMIN SERVICES (WYOMING)
               05130               EQICOR (IDAHO)
               05440               EQICOR (TENNESSEE)
               05535               EQICOR (NORTH CAROLINA)
               10071               TRAVELERS (RRB)
               10230               TRAVELERS (CONNECTICUT)
               10240               TRAVELERS (MINNESOTA)
               10250               TRAVELERS (MISSISSIPPI)
               10490               TRAVELERS (VIRGINIA)
               10492               TRAVELERS - VIRGINIA SPECIAL PROJECT
               11260               GENERAL AMERICAN


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE:  9
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               14330               GROUP HEALTH INC (NEW YORK)
               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    166   175  C    PROV1680
     A SIX OR TEN POSITION IDENTIFICATION NUMBER THAT IS AS-
     SIGNED TO A CERTIFIED PROVIDER OR SUPPLIER.  A PROVIDER
     IS ISSUED A 6 POSITION NUMERIC OR ALPHANUMERIC NUMBER,
     A SUPPLIER IS ISSUED A 10 POSITION ALPHANUMERIC NUMBER.
     COBOL NAME: PROV-NUM
   RECORD TYPE                                 1     176   176  C    PROV1720
     THIS INDICATOR SPECIFIES THE CURRENT STATUS OF RECORD.
     COBOL NAME: RECORD-TYPE
     VALUES:   A                   ACCEPTED
               D                   DELETED
               N                   NOT-A-LAB
               P                   PENDING
               T                   TEMPORARY (CLIA ONLY)
               W                   WORK

   REGION CODE                                 2     177   178  C    PROV1725
     THE HCFA REGIONAL OFFICE HAVING RESPONSIBILITY FOR THE
     STATE IN WHICH THE PROVIDER IS LOCATED.
     COBOL NAME: REGION
     VALUES:   01                  I    BOSTON
               02                  II   NEW YORK
               03                  III  PHILADELPHIA
               04                  IV   ATLANTA
               05                  V    CHICAGO
               06                  VI   DALLAS
               07                  VII  KANSAS CITY
               08                  VIII DENVER
               09                  IX  SAN FRANCISCO


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 10
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               10                  X    SEATTLE

   SKELETON RECORD INDICATOR                   1     179   179  C    PROV2045
     INDICATES RECORD IS A SKELETON RECORD.  THIS MEANS
     ONLY A LIMITED SET OF THE PROVIDER DATA IS AVAILABLE
     FOR THIS PROVIDER.
     COBOL NAME: SKELETON-IND
     VALUES:   Y                   YES

   STATE ABBREVIATION                          2     180   181  C    PROV3230
     STATE ABBREVIATION
     COBOL NAME: STATE-ABBREV
     VALUES:   AK                  ALASKA
               AL                  ALABAMA
               AR                  ARKANSAS
               AS                  AMERICAN SAMOA
               AZ                  ARIZONA
               CA                  CALIFORNIA
               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
               NC                  NORTH CAROLINA
               ND                  NORTH DAKOTA
               NE                  NEBRASKA
               NH                  NEW HAMPSHIRE
               NJ                  NEW JERSEY


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 11
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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

   STATE CODE (SSA)                            2     182   183  C    PROV2700
     TWO DIGIT CODE INDICATING STATE WHERE FACILITY IS
     LOCATED.
     COBOL NAME: SSA-STATE
     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:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 12
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               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
               64                  AMERICAN SAMOA
               65                  GUAM
               66                  SAIPAN
               99                  FOREIGN

   STATE REGION CODE                           3     184   186  C    PROV2710
     FOR SELECTED STATES, IDENTIFIES THE PARTICULAR REGION
     WITHIN THE STATE WHERE THE FACILITY IS LOCATED
     COBOL NAME: STATE-REGION-CD
   STREET ADDRESS                              50    187   236  C    PROV2720
     STREET ADDRESS OF A PROVIDER THAT IS CERTIFIED TO
     PROVIDE MEDICARE AND/OR MEDICAID SERVICES.
     COBOL NAME: STREET-ADDRESS
   TELEPHONE NUMBER                            10    237   246  C    PROV1605
     THE 10 DIGIT TELEPHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF A PROVIDER.
     COBOL NAME: PHONE-NUM


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 13
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TERMINATION CODE # 1                        2     247   248  C    PROV4770
     TERMINATION CODE #1, THE REASON A FACILITY HAS BEEN
     TERMINATED FROM THE CLIA, MEDICARE AND/OR MEDICAID
     PROGRAMS.
     COBOL NAME: TERM-CD-1
     VALUES:   00                  ACTIVE
               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG
               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 PPMP CERTIFICATE
               16                  DUPLICATE CLIA NUMBER
               17                  UNDELIVERABLE
               20                  NOTIFICATION BANKRUPTCY
               33                  LAB NOT AFFILIATED WITH ACCRED ORGANIZATION
               80                  AWAITING STATE APPROVAL
               99                  OIG ACTION - DO NOT ACTIVATE

   TERMINATION DATE/EXPIRATION DATE 1          8     249   256  C    PROV4500
     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.
     COBOL NAME: EXP-DT-1
   TYPE OF ACTION                              1     257   257  C    PROV2880
     IDENTIFIES THE PURPOSE FOR WHICH THE CERTIFICATION AND
     TRANSMITTAL FORM WAS PREPARED.
     COBOL NAME: TYPE-ACTION
     VALUES:   1                   INITIAL
               2                   RECERTIFICATION
               3                   TERMINATION
               4                   CHANGE OF OWNERSHIP
               5                   CLIA VALIDATION
               6                   ONSITE SURVEY DUE TO FLEXIBLE SURVEY






 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 14
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   TYPE OF CONTROL                             2     258   259  C    PROV2885
     INDICATES THE NATURE OF THE ORGANIZATION THAT OPERATES
     A PROVIDER OF SERVICES.
     COBOL NAME: TYPE-CONTROL
     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

   ZIP CODE                                    5     260   264  C    PROV2905
     THE FIVE DIGIT POSTAL CODE FOR THE PROVIDER.
     COBOL NAME: ZIP-CD
   FIPS STATE CODE                             2     265   266  C    FIPSTATE
     FIPS STATE CODE
     COBOL NAME: WS-FIPS-STATE
   FIPS COUNTY CODE                            3     267   269  C    FIPCNTY
     FIPS COUNTY CODE
     COBOL NAME: WS-FIPS-CNTY
   SSA MSA CODE                                3     270   272  C    SSAMSACD
     SSA MSA CODE
     COBOL NAME: WS-SSA-MSA-CD
   SSA MSA SIZE CODE                           1     273   273  C    SSAMSASZ
     SSA MSA SIZE CODE
     COBOL NAME: WS-SSA-MSA-SIZE-CD
   DATE OF LAST VALIDATION SURVEY              8     363   370  C    PROV0450
     DATE THE LAST VALIDATION SURVEY WAS PERFORMED
     BY THE STATE AGENCY FOR A JCAH, AOA ACCREDITED
     HOSPITAL OR OTHER PROVIDER TYPE.
     COBOL NAME: DT-VALID-SURVEY
   FISCAL YEAR ENDING DATE                     4     378   381  C    PROV0485
     THE ENDING DATE (MONTH AND DAY) OF A FACILITY'S FISCAL
     YEAR.
     COBOL NAME: FISC-YR-END-DT
   TYPE OF FACILITY                            2     593   594  C    PROV2890
     INDICATES THE CATEGORY WHICH REPRESENTS THE TYPE OF
     FACILITY.
     COBOL NAME: TYPE-FACILITY
     VALUES:   01                  AMBULANCE
               02                  AMBULATORY SURGERY CENTER
               03                  ANCILLARY TEST SITE
               04                  ASSISTED LIVING FACILITY
               05                  BLOOD BANKS


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 15
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               06                  COMMUNITY CLINIC
               07                  COMPREHENSIVE OUTPATIENT REHAB
               08                  END STAGE RENAL DISEASE DIALYSIS
               09                  FEDERALLY QUALIFIED HEALTH CENTER
               10                  HEALTH FAIR
               11                  HEALTH MAINTENANCE ORGANIZATION
               12                  HOME HEALTH AGENCY
               13                  HOSPICE
               14                  HOSPITAL
               15                  INDEPENDENT
               16                  INDUSTRIAL
               17                  INSURANCE
               18                  ICF FOR MENTALLY RETARDED
               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

   ACCREDITED BY AABB                          1     1822  1822 C    PROV4205
     INDICATES IF THE LAB IS ACCREDITED THE AMERICAN
     ASSOCIATION OF BLOOD BANKS.  THIS INFORMATION IS FROM
     THE LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-AABB-IND
     VALUES:   X                   YES

   ACCREDITED BY AOA                           1     1823  1823 C    PROV4200
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     OSTEOPATHIC ASSOCIATION.  THIS INFORMATION IS FROM THE
     LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-AOA-IND
     VALUES:   X                   YES

   ACCREDITED BY ASHI                          1     1824  1824 C    PROV4225
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     SOCIETY FOR HISTOCOMPATIBILITY AND IMMUNOGENETICS.
     THIS INFORMATION IS FROM THE LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-ASHI-IND
     VALUES:   X                   YES





 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 16
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ACCREDITED BY A2LA                          1     1825  1825 C    PROV6535
     INDICATES IF THE LAB IS ACCREDITED THE AMERICAN
     ASSOCIATION OF LAB ACCRED.  THIS INFORMATION IS FROM
     THE LABORATORY'S CMS-116.
     COBOL NAME: ACCRED-A2LA-IND
     VALUES:   X                   YES

   ACCREDITED BY CAP                           1     1826  1826 C    PROV4210
     INDICATES IF THE LAB IS ACCREDITED BY THE COLLEGE OF
     AMERICAN PATHOLOGISTS.  THIS INFORMATION IS FROM THE
     LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-CAP-IND
     VALUES:   X                   YES

   ACCREDITED BY COLA                          1     1827  1827 C    PROV4215
     INDICATES IF THE LAB IS ACCREDITED BY THE COMMISSION ON
     OFFICE LABORATORY ACCREDITATION.  THIS INFORMATION IS
     FROM THE LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-COLA-IND
     VALUES:   X                   YES

   ACCREDITED BY JCAHO                         1     1828  1828 C    PROV4195
     INDICATES IF THE LAB IS ACCREDITED BY THE JOINT
     COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATION.
     THIS INFORMATION IS FROM THE LABORATORY'S HCFA-116.
     COBOL NAME: ACCRED-JCAHO-IND
     VALUES:   X                   YES

   ACCREDITED Y MATCH DATE AABB                8     1829  1836 C    PROV5040
     THE DATE THE AMERICAN ASSOCIATION OF BLOOD BANKS
     NOTIFIES HCFA THAT LAB IS ACCREDITED WITH AABB. THE
     EARLIEST Y MATCH DATE INITIATES THE BILLING OF THE
     CERTIFICATE OF ACCREDITATION FEES.
     COBOL NAME: ACCRED-AABB-DT
   ACCREDITED Y MATCH DATE AOA                 8     1837  1844 C    PROV5045
     THE DATE THE LAB WAS ACCREDITED BY THE AMERICAN
     OSTEOPATHIC ASSOCIATION. THIS INFORMATION IS SUPPLIED
     BY THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-AOA-DT
   ACCREDITED Y MATCH DATE ASHI                8     1845  1852 C    PROV5055
     THE DATE THE LAB WAS ACCREDITED BY THE AMERICAN SOCIETY
     FOR HISTOCOMPATIBILITY AND IMMUNOGENETICS. THIS
     INFORMATION IS SUPPLIED BY THE ACCREDITING ORGANIZATION
     COBOL NAME: ACCRED-ASHI-DT
   ACCREDITED Y MATCH DATE A2LA                8     1853  1860 C    PROV6530
     THE DATE THE AMERICAN ASSOCIATION OF LABORATORY ACCRED.
     NOTIFIES CMS THAT LAB IS ACCREDITED WITH A2LA. THE
     EARLIEST Y MATCH DATE INITIATES THE BILLING OF THE
     CERTIFICATE OF ACCREDITATION FEES.
     COBOL NAME: ACCRED-A2LA-DT
 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 17
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ACCREDITED Y MATCH DATE CAP                 8     1861  1868 C    PROV5060
     THE DATE THE COLLEGE OF AMERICAN PATHOLOGIST NOTIFIES
     HCFA THAT LAB IS ACCREDITED BY CAP.  THE EARLIEST Y
     MATCH DATE INITIATES THE BILLING FOR THE CERTIFICATE OF
     ACCREDITATION FEES.
     COBOL NAME: ACCRED-CAP-DT
   ACCREDITED Y MATCH DATE COLA                8     1869  1876 C    PROV5065
     THE DATE THE COMMISSION ON OFFICE LABORATORY
     ACCREDITATION NOTIFIES  HCFA THAT LAB IS ACCREDITED
     WITH COLA. THE EARLIEST Y MATCH DATE INITIATES THE
     BILLING OF THE CERTIFICATE OF ACCREDITATION FEES
     COBOL NAME: ACCRED-COLA-DT
   ACCREDITED Y MATCH DATE JCAHO               8     1877  1884 C    PROV5070
     THE DATE THE JOINT COMMISSION ON ACCREDITATION OF
     HEALTHCARE ORGANIZATIONS NOTIFIES HCFA THAT LAB IS
     ACCREDITED.  THE EARLIEST Y MATCH DATE INITIATES THE
     BILLING OF THE CERTIFICATE OF ACCREDITATION FEES
     COBOL NAME: ACCRED-JCAHO-DT
   ACCREDITED Y MATCH IND AABB                 1     1885  1885 C    PROV4970
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     ASSOCIATION OF BLOOD BANKS.  THIS INFORMATION IS
     SUPPLIED BY THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-AABB-MATCH-IND
     VALUES:   Y                   YES

   ACCREDITED Y MATCH IND AOA                  1     1886  1886 C    PROV4975
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     OSTEOPATHIC ASSOCIATION.  THIS INFORMATION IS SUPPLIED
     BY THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-AOA-MATCH-IND
     VALUES:   Y                   YES

   ACCREDITED Y MATCH IND ASHI                 1     1887  1887 C    PROV4985
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     SOCIETY FOR HISTOCOMPATIBILITY AND IMMUNOGENETICS.
     THIS INFORMATION IS SUPPLIED BY THE ACCREDITING
     ORGANIZATION.
     COBOL NAME: ACCRED-ASHI-MATCH-IND
     VALUES:   Y                   YES

   ACCREDITED Y MATCH IND A2LA                 1     1888  1888 C    PROV6540
     INDICATES IF THE LAB IS ACCREDITED BY THE AMERICAN
     ASSOCIATION OF LAB ACCRED.  THIS INFORMATION IS
     SUPPLIED BY THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-A2LA-MATCH-IND
     VALUES:   Y                   YES




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 18
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   ACCREDITED Y MATCH IND CAP                  1     1889  1889 C    PROV4990
     INDICATES IF THE LAB IS ACCREDITED BY COLLEGE OF
     AMERICAN PATHOLOGISTS.  THIS INFORMATION IS SUPPLIED BY
     THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-CAP-MATCH-IND
     VALUES:   Y                   YES

   ACCREDITED Y MATCH IND COLA                 1     1890  1890 C    PROV4960
     INDICATES IF THE LAB IS ACCREDITED BY THE COMMISSION ON
     OFFICE LABORATORY ACCREDITATION.  THIS INFORMATION IS
     SUPPLIED BY THE ACCREDITING ORGANIZATION.
     COBOL NAME: ACCRED-COLA-MATCH-IND
     VALUES:   Y                   YES

   ACCREDITED Y MATCH IND JCAHO                1     1891  1891 C    PROV4995
     INDICATES IF LAB IS ACCREDITED BY THE JOINT
     COMMISSION ON ACCREDITAION OF HEALTHCARE ORGANIZATIONS.
     THIS INFORMATION IS SUPPLIED BY THE ACCREDITING
     ORGANIZATION.
     COBOL NAME: ACCRED-JCAHO-MATCH-IND
     VALUES:   Y                   YES

   AFFILIATED PROVIDER #1                      10    1892  1901 C    PROV4240
     AFFILIATED PROVIDER #1
     COBOL NAME: AFFIL-PROV-NUM-1
   AFFILIATED PROVIDER #2                      10    1902  1911 C    PROV4245
     AFFILIATED PROVIDER #2
     COBOL NAME: AFFIL-PROV-NUM-2
   AFFILIATED PROVIDER #3                      10    1912  1921 C    PROV4250
     AFFILIATED PROVIDER #3
     COBOL NAME: AFFIL-PROV-NUM-3
   AFFILIATED PROVIDER #4                      10    1922  1931 C    PROV4255
     AFFILIATED PROVIDER #4
     COBOL NAME: AFFIL-PROV-NUM-4
   AFFILIATED PROVIDER #5                      10    1932  1941 C    PROV4260
     AFFILIATED PROVIDER #5
     COBOL NAME: AFFIL-PROV-NUM-5
   AFFILIATED PROVIDER #6                      10    1942  1951 C    PROV4265
     AFFILIATED PROVIDER #6
     COBOL NAME: AFFIL-PROV-NUM-6
   AFFILIATED PROVIDER #7                      10    1952  1961 C    PROV4270
     AFFILIATED PROVIDER #7
     COBOL NAME: AFFIL-PROV-NUM-7
   AFFILIATED PROVIDER #8                      10    1962  1971 C    PROV4275
     AFFILIATED PROVIDER #8
     COBOL NAME: AFFIL-PROV-NUM-8




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 19
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   APPLICATION ACCRED ANNUAL TEST VOL          13    1972  1984 N    PROV4390
     ACCREDITED ANNUAL TEST VOLUME. THIS FIELD IS CALCULATED
     USING THE CLIA APPLICATION DATA.
     COBOL NAME: APPL-ACCR-ANN-TEST-VOL
   APPLICATION ACCRED SCHEDULE CODE            1     1985  1985 C    PROV4365
     ACCREDITATION SCHEDULE CODE.  THIS SCHEDULE IS FIGURED
     USING THE CLIA APPLICATION DATA.
     COBOL NAME: APPL-ACCRED-SCHED-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

   APPLICATION RECEIVED DATE                   8     1986  1993 C    PROV4340
     APPLICATION RECEIVED DATE. THE DATE THE APPLICATION WAS
     ADDED OR THE 109 DATA WAS UPDATED WITH APPLICATION DATA
     COBOL NAME: APPL-RECEIVED-DT
   APPLICATION TOTAL ANNUAL TEST VOL           13    1994  2006 N    PROV4325
     APPLICATION TOTAL ANNUAL TEST VOLUME.  THIS FIELD IS
     CALCULATED USING CLIA APPLICATION DATA.
     COBOL NAME: APPL-TOT-ANN-TEST-VOL
   APPLICATION TYPE                            1     2007  2007 C    PROV4695
     THE TYPE OF CLIA CERTIFICATE APPLIED FOR BY A LAB
     COBOL NAME: TYPE-APPLICATION
     VALUES:   1                   COMP
               2                   WAIV
               3                   ACCR
               4                   PPMP

   CERT TYPE CODE # 1                          1     2008  2008 C    PROV3810
     A CODE THAT IDENTIFIES THE TYPE OF LABORATORY
     CERTIFICATE CURRENTLY IN EFFECT
     COBOL NAME: CERT-TYPE-CD-1
     VALUES:   1                   COMPLIANCE
               2                   WAIVER
               3                   ACCREDITATION
               4                   MICROSCOPY
               5                   PARTIAL ACC
               9                   REGISTRATION




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 20
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   CERTIFICATE MAILED DATE 1                   8     2009  2016 C    PROV4700
     CERTIFICATE MAILED DATE 1
     COBOL NAME: CERT-MAILED-DT-1
   CLIA CERT. EFFECTIVE DATE # 1               8     2017  2024 C    PROV3860
     DATE THE CURRENT LABORATORY CERTIFICATE IS EFFECTIVE,
     DETERMINED BY THE APPROVAL DATE OF THE CERTIFICATE
     APPLICATION UNLESS OVERRIDDEN.
     COBOL NAME: EFF-DT-1
   CLIA MEDICARE NUMBER                        12    2025  2036 C    PROV4885
     CLIA MEDICARE NUMBER
     COBOL NAME: CLIA-MEDICARE-NUM
   CURRENT LABORATORY CLASSSIFICATION          2     2037  2038 C    PROV5935
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB
     IS CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   FAX PHONE NUMBER                            10    2039  2048 C    PROV5800
     THE 10 DIGIT FAX PHONE NUMBER OF THE PRIMARY CONTACT OR
     THE OPERATOR OF THE LABORATORY OR HOSPITAL
     COBOL NAME: FAX-NUM
   LABORATORY CLASSIFICATION 1                 2     2049  2050 C    PROV5945
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB
     IS CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-1
     VALUES:   00                  NON EXEMPT LAB
               05                  EXEMPT LAB
               10                  VA LAB

   LABORATORY CLASSIFICATION 10                2     2051  2052 C    PROV5940
     CLIA LABORTORY CLASSIFICATION DETERMINES IF LAB IS CLIA
     EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-10
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 2                 2     2053  2054 C    PROV5955
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB
     IS CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-2
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY




 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 21
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   LABORATORY CLASSIFICATION 3                 2     2055  2056 C    PROV5965
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB
     IS CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-3
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 4                 2     2057  2058 C    PROV5990
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-4
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 5                 2     2059  2060 C    PROV5985
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATARY
     COBOL NAME: CLIA-LAB-CLASS-CD-5
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 6                 2     2061  2062 C    PROV5975
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-6
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 7                 2     2063  2064 C    PROV5970
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-7
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   LABORATORY CLASSIFICATION 8                 2     2065  2066 C    PROV5960
     CLIA LABORATORY CLASSIFICATION DETERMINES IS LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-8
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY



 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 22
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

   LABORATORY CLASSIFICATION 9                 2     2067  2068 C    PROV5950
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB IS
     CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: CLIA-LAB-CLASS-CD-9
     VALUES:   00                  CLIA LABORATORY
               05                  CLIA EXEMPT
               10                  VA LABORATORY

   MULTIPLE SITE CERTIFICATE IND               1     2069  2069 C    PROV4175
     INDICATES IF A LAB HAS APPLIED FOR ONE CERTIFICATE FOR
     MULTIPLE SITES.
     COBOL NAME: MULTI-SITE-IND
     VALUES:   N                   NO
               Y                   YES

   NON-PROFIT CODE                             1     2070  2070 C    PROV4190
     ONE TYPE OF MULTIPLE SITE EXCEPTION (MORE THAN ONE
     SITE UNDER ONE CERTIFICATE) AS DESCRIBED IN CLIA
     REQUIREMENTS 42 CFR 493.
     COBOL NAME: NON-PROFIT-IND
     VALUES:   N                   NO
               Y                   YES

   NUMBER OF LAB SITES                         4     2071  2074 N    PROV4180
     THE TOTAL NUMBER OF LAB SITES FOR WHICH A LAB HAS
     APPLIED FOR A SINGLE CERTIFICATE.
     COBOL NAME: TOT-NUM-SITES
   NUMBER OF LABS DIRECTLY AFFILIATED          1     2075  2075 N    PROV4235
     NUMBER OF LABORATORIES DIRECTLY AFFILIATED
     COBOL NAME: NUM-AFFIL-LABS
   PENDING LABORATORY CLASSIFICATION           2     2076  2077 C    PROV5980
     CLIA LABORATORY CLASSIFICATION DETERMINES IF LAB
     IS CLIA EXEMPT, VA LABORATORY OR STANDARD LABORATORY
     COBOL NAME: PEND-CLIA-LAB-CLASS-CD
   PREVIOUSLY REGULATED INDICATOR              1     2078  2078 C    PROV3610
     INDICATES IF THE LABORATORY WAS LICENSED UNDER CLIA 67
     OR PARTICPATED IN THE MEDICARE/MEDICAID PROGRAMS.
     COBOL NAME: CLIA67-IND
     VALUES:   N                   NO
               Y                   YES

   SHARED LAB CROSS REFERENCE #                10    2079  2088 C    PROV4890
     SHARED LAB CROSS REFERENCE #
     COBOL NAME: SHARED-LAB-XREF-NUM
   SHARED LAB INDICATOR                        1     2089  2089 C    PROV4880
     SHARED LAB INDICATOR
     COBOL NAME: SHARED-LAB-IND
     VALUES:   N                   NO


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 23
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               Y                   YES

   SURVEY CERTIFICATE SCHEDULE CODE            1     2090  2090 C    PROV4470
     1557 CERTIFICATE SCHEDULE CODE.  THIS CODE IS SYSTEM
     GENERATED AND IS BASED ON THE TEST VOLUME AND SPECIAL
     TIES ENTERED INTO ODIE FOLLOWING THE SURVEY.
     CLIA FEES ARE BASED ON THE SCHEDULE CODES.
     COBOL NAME: SURV-CERT-SCHED-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     2091  2091 C    PROV4475
     1557 COMPLIANCE SCHEDULE CODE   THIS CODE IS SYSTEM
     GENERATED AND IS BASED ON THE NUMBER OF TESTS AND
     SPECIALTIES ENTERED INTO ODIE FOLLOWING THE SURVEY.
     CLIA FEES ARE BASED ON THE SCHEDULE CODES.
     COBOL NAME: SURV-COMPL-SCHED-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 TOTAL                    13    2092  2104 N    PROV4460
     SURVEY TEST VOLUME TOTAL. THE NUMBER OF TESTS PERFORMED
     ANNUALLY IN A LABORATORY.  THIS INFORMATION IS
     COLLECTED AT THE TIME OF THE STATE SURVEY AGENCY
     INSPECTION.
     COBOL NAME: SURV-TOT-ANN-TEST-VOL
   TERMINATION CODE                            2     2105  2106 C    PROV5805
     THE REASON A LABORATORY'S CLIA CERTIFICATE HAS ENDED
     COBOL NAME: TERM-CD
     VALUES:   00                  ACTIVE


 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
1DATE: 01/01/2009              POS RECORD LAYOUT                      PAGE: 24
            CLIA88 LABORATORIES, CATEGORY = "22" (SEE POSITIONS 3-4)

   SHORT DESCRIPTION                          LEN  START  END  TYPE  SAS NAME

               01                  VOL-MERG,CLOSE
               02                  VOL-REIMBURSE
               03                  VOL-RISK INVOL
               04                  VOL-OTHER
               05                  INVOL-FAIL REQ
               06                  INVOL-AGREEMNT
               07                  OTH-STATUS CHG
               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 PPMP CERTIFICATE
               16                  DUPLICATE CLIA NUMBER
               17                  UNDELIVERABLE
               20                  NOTIFICATION BANKRUPTCY
               33                  LAB NOT AFFILIATED WITH ACCRED ORGANIZATION
               80                  AWAITING STATE APPROVAL
               99                  OIG ACTION - DO NOT ACTIVATE

   TOTAL PPM TEST VOLUMES                      13    2107  2119 N    PROV6430
     NUMBER OF ESTIMATED ANNUAL TEST VOLUME FOR ALL PROVIDER
     PERFORMED MICROSCOPY TESTS PERFORMED IN A LAB.  TEST
     VOLUME MAY BE PRESENT FOR LABS HOLDING PPM, COMPLIANCE
     AND ACCREDITATION CERTIFICATES.
     COBOL NAME: TOT-ANN-TEST-VOL-PPM
   TOTAL WAIVED TEST VOL                       13    2120  2132 N    PROV4280
     THE NUMBER OF ESTIMATED TOTAL ANNUAL TEST VOLUME FOR
     ALL WAIVED TESTS PERFORMED IN A LAB HOLDING A CERTIFI-
     CATE OF WAIVER, PPM, COMPLIANCE OR ACCREDITATION.
     COBOL NAME: TOT-ANN-TEST-VOL-WAIVED

















 * INDICATES THIS FIELD HAS BEEN ADDED OR CHANGED SINCE:  10/03/2008
