US · guidance
CMS Pub. 100-06, ch. 6, § 70.20
Type of Provider (Inactive)
A3-3898.20
The intermediary reports provider enrollment application data in the following columns for all
lines on Form 3.
Column (1) - Total - The sum of columns 2-16 for each line.
Column (2) - Accredited Hospital - Provider applications indicating provider type as an accredited
hospital.
Column (3) - Non-Accredited Hospital - Provider applications indicating provider type as a non-accredited hospital.
Column (4) - Religious Nonmedical Health Care Facility - Hospital - Provider applications
indicating provider type as a Religious Nonmedical Health Care Facility - hospital.
Column (5) - Rural Primary Care Hospital - Provider applications indicating provider type as a
rural primary care hospital.
Column (6) - SNF - Provider applications indicating provider type as a skilled nursing facility (i.e.,
long term care facility).
Column (7) - HHA. - Provider applications indicating provider type as a home health agency.
Column (8) - Hospice - Provider applications indicating provider type as a hospice facility.
Column (9) - ESRD - Provider applications indicating provider type as an end stage renal disease
dialysis facility.
Column (10) - CORF - Provider applications indicating provider type as a comprehensive
outpatient rehabilitation facility.
Column (11) - RHC - Provider applications indicating provider type as a rural health clinic.
Column (12) - FQHC - Provider applications indicating provider type as a federally qualified
health center.
Column (13) - CMHC - Provider applications indicating provider type as a community mental
health center.
Column (14) - IHS - Provider applications indicating provider type as an Indian Health Service
facility.
Column (15) - Outp. Speech Path./Phy.Ther - Provider applications indicating provider type as
either outpatient speech pathology or outpatient physical therapy facility.
Column (16) - Other - Provider applications indicating provider type other than those defined for
columns 1 through 15.
History
(Rev.12894; 10-17-24; Effective:11-01-24; Implementation:11-01-24)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
10fc6c0ed62d550e6da1c21ae5a83d91b2aa2e44870df1db1002ca5a580e0d18
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