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cms-gov/www.cms.gov/files/document/py-2021-py-2022-sample-file-general-payments-csv.csv
Scott Williams b906a0e722 Initial commit
2025-02-28 14:41:14 -05:00

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1APPLICABLE_MANUFACTURER_OR_APPLICABLE_GPO_NAMEAPPLICABLE_MANUFACTURER_OR_APPLICABLE_GPO_IDCONSOLIDATED_REPORT_INDICATORRESUBMISSION_FILE_INDICATORCOVERED_RECIPIENT_TYPETEACHING_HOSPITAL_NAMETEACHING_HOSPITAL_TAX_ID_NUMBER_TINCOVERED_RECIPIENT_FIRST_NAMECOVERED_RECIPIENT_MIDDLE_NAMECOVERED_RECIPIENT_LAST_NAMECOVERED_RECIPIENT_NAME_SUFFIXRECIPIENT_PRIMARY_BUSINESS_STREET_ADDRESS_LINE_1RECIPIENT_PRIMARY_BUSINESS_STREET_ADDRESS_LINE_2RECIPIENT_CITYRECIPIENT_STATERECIPIENT_ZIP_CODERECIPIENT_COUNTRYRECIPIENT_PROVINCERECIPIENT_POSTAL_CODERECIPIENT_EMAIL_ADDRESSCOVERED_RECIPIENT_PRIMARY_TYPECOVERED_RECIPIENT_NPICOVERED_RECIPIENT_SPECIALTYCOVERED_RECIPIENT_LICENSE_STATE_AND_LICENSE_NUMBER_1COVERED_RECIPIENT_LICENSE_STATE_AND_LICENSE_NUMBER_2COVERED_RECIPIENT_LICENSE_STATE_AND_LICENSE_NUMBER_3COVERED_RECIPIENT_LICENSE_STATE_AND_LICENSE_NUMBER_4COVERED_RECIPIENT_LICENSE_STATE_AND_LICENSE_NUMBER_5RELATED_PRODUCT_INDICATORCOVERED_OR_NONCOVERED_INDICATOR_1INDICATE_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_1PRODUCT_CATEGORY_OR_THERAPEUTIC_AREA_1NAME_OF_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_1ASSOCIATED_DRUG_OR_BIOLOGICAL_NDC_1PRIMARY_DEVICE_IDENTIFIER_1COVERED_OR_NONCOVERED_INDICATOR_2INDICATE_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_2PRODUCT_CATEGORY_OR_THERAPEUTIC_AREA_2NAME_OF_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_2ASSOCIATED_DRUG_OR_BIOLOGICAL_NDC_2PRIMARY_DEVICE_IDENTIFIER_2COVERED_OR_NONCOVERED_INDICATOR_3INDICATE_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_3PRODUCT_CATEGORY_OR_THERAPEUTIC_AREA_3NAME_OF_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_3ASSOCIATED_DRUG_OR_BIOLOGICAL_NDC_3PRIMARY_DEVICE_IDENTIFIER_3COVERED_OR_NONCOVERED_INDICATOR_4INDICATE_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_4PRODUCT_CATEGORY_OR_THERAPEUTIC_AREA_4NAME_OF_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_4ASSOCIATED_DRUG_OR_BIOLOGICAL_NDC_4PRIMARY_DEVICE_IDENTIFIER_4COVERED_OR_NONCOVERED_INDICATOR_5INDICATE_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_5PRODUCT_CATEGORY_OR_THERAPEUTIC_AREA_5NAME_OF_DRUG_OR_BIOLOGICAL_OR_DEVICE_OR_MEDICAL_SUPPLY_5ASSOCIATED_DRUG_OR_BIOLOGICAL_NDC_5PRIMARY_DEVICE_IDENTIFIER_5APPLICABLE_MANUFACTURER_OR_APPLICABLE_GPO_MAKING_PAYMENT_NAMEAPPLICABLE_MANUFACTURER_OR_APPLICABLE_GPO_MAKING_PAYMENT_REGISTRATION_IDHOME_SYSTEM_PAYMENT_IDRESUBMITTED_PAYMENT_RECORD_IDPREVIOUSLY_DELETED_INDICATORPREVIOUSLY_DELETED_PAYMENT_RECORD_IDTOTAL_AMOUNT_OF_PAYMENTDATE_OF_PAYMENTNUMBER_OF_PAYMENTS_INCLUDED_IN_TOTAL_AMOUNTFORM_OF_PAYMENT_OR_TRANSFER_OF_VALUENATURE_OF_PAYMENT_OR_TRANSFER_OF_VALUECITY_OF_TRAVELSTATE_OF_TRAVELCOUNTRY_OF_TRAVELPHYSICIAN_OWNERSHIP_INDICATORTHIRD_PARTY_PAYMENT_RECIPIENT_INDICATORNAME_OF_THIRD_PARTY_ENTITY_RECEIVING_PAYMENT_OR_TRANSFER_OF_VALUECHARITY_INDICATORTHIRD_PARTY_EQUALS_COVERED_RECIPIENT_INDICATORCONTEXTUAL_INFORMATION
2ABCDE Manufacturer1000000001NN1JohnHWhittaker2701 Sedwick StFairfaxVA22051USjohn_whittaker@xyz.com21111223334207RC0000XVA-1245662WV-1665578MD-6899892111EndocrinologyTriptorelin9999-9999-9911EndocrinologyTriptorelin pamoate3333-3333-1111EndocrinologyTrastuzumab4333-4442-22ABCDE Manufacturer10000000011234123456N1234520220101214N3