CMS-1500 Form Word Scramble
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| Question | Answer |
| Block 25 | Federal Tax ID Number |
| Block 26 | Patients Account Number |
| Block 27 | Accepts Assignments Yes or No |
| Block 28 | Total Charge |
| Block 29 | Amount Paid |
| Block 30 | Blank NUCC |
| Block 31 | Signature of Physician or Supplier and Date |
| Block 32 | Service Facility Location Information |
| Block 32 a | Service Provider NPI Number |
| Block 32 b | Blank |
| Block 33 | Billing Provider Info & Phone # |
| Block 33 a | Billing Providers NPI Number |
| Block 33 b | Blank |
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Leiannlg
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