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ISDN Hospital Service Report
State Form 49476 (R /702)
IC 16216Status: Finalized
I. Hospital Information
Hospital
METHODIST HOSPITAL NORTHLAND CAMPUS
Name:
Provider #: 150002
City: Gary
County: Lake
Year:
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Provider 150002 is needed by healthcare service providers who want to register and participate in a specific healthcare program or network. This form helps to establish their credentials and eligibility to provide services within the program.
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What is provider 150002?
Provider 150002 is a specific form used in the healthcare industry for reporting certain types of information related to healthcare providers.
Who is required to file provider 150002?
Healthcare providers who participate in government health programs, including Medicare and Medicaid, are required to file provider 150002.
How to fill out provider 150002?
To fill out provider 150002, you need to enter the required information accurately, including provider details, services rendered, and any applicable codes as specified in the instructions provided with the form.
What is the purpose of provider 150002?
The purpose of provider 150002 is to collect essential information for billing and reimbursement purposes, ensuring compliance with healthcare regulations.
What information must be reported on provider 150002?
Provider 150002 must report details such as provider identification, service dates, types of services provided, and patient information as applicable.
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