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PRINTED: 03/02/2021 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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Form CMS-10114 download PDF may be needed by individuals or organizations involved in healthcare services or those required to report specific information to the Centers for Medicare & Medicaid Services (CMS). This form is typically used for reporting Medicare payment issues or requesting information related to Medicare enrollment, claims, or billing. It is essential for healthcare providers, insurers, or entities dealing with Medicare-related matters.
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Form CMS-10114 is a document used by healthcare providers to gather and report information required by the Centers for Medicare & Medicaid Services (CMS).
Healthcare providers who wish to participate in Medicare or Medicaid programs are required to file Form CMS-10114.
To fill out Form CMS-10114, download the PDF form, enter the required information carefully, ensuring all fields are accurately completed, and then submit it as per the submission guidelines.
The purpose of Form CMS-10114 is to collect essential information from healthcare providers that will be used for enrollment in Medicare and Medicaid programs.
The form requires information such as the provider's name, address, National Provider Identifier (NPI), and other relevant details necessary for processing.
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