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KPMG LLP Complex 255210
WEST SUBURBAN HOSP MED CTR
Provider CCN: 140049In Lieu of Form
CMS255210Period :
From: 05/01/2017
To: 04/30/2018Run Date: 09/25/2018
Run Time: 10:50
Version: 2018.04 (09/20/2018)HOSPITAL
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How to fill out provider ccn 14-0049
How to fill out provider ccn 14-0049
01
To fill out provider ccn 14-0049, follow these steps:
02
Begin by filling out the provider's basic information, including the name, address, and contact details.
03
Provide the provider's CCN number, which can be obtained from the relevant authority.
04
Indicate the type of services provided by the provider.
05
Fill out the financial information, including the provider's income and expenses.
06
Provide any additional required documentation, such as proof of insurance or licenses.
07
Review the completed form for accuracy and completeness.
08
Submit the filled-out provider ccn 14-0049 form to the designated authority for processing.
Who needs provider ccn 14-0049?
01
Anyone who intends to provide services and requires a CCN (Certificate of Clinical Necessity) needs to fill out provider ccn 14-0049.
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What is provider ccn 14-0049?
Provider ccn 14-0049 is a unique identification number assigned to a specific healthcare provider.
Who is required to file provider ccn 14-0049?
Healthcare providers who are enrolled in Medicare are required to file provider ccn 14-0049.
How to fill out provider ccn 14-0049?
Provider ccn 14-0049 can be filled out by entering specific information about the healthcare provider, such as name, address, and other relevant details.
What is the purpose of provider ccn 14-0049?
The purpose of provider ccn 14-0049 is to accurately identify healthcare providers and track their Medicare enrollment.
What information must be reported on provider ccn 14-0049?
Provider ccn 14-0049 requires information such as provider name, address, National Provider Identifier (NPI), and other enrollment details.
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