NM1

Provider Name

Pos: 050	Max: 1
Detail - Optional
Loop: 2100C	Elements: 9

Ref

Id

Element Name

Req

Type

Min/Max

Usage

NM101

98

Entity Identifier Code
Description: Code identifying an organizational entity, a physical location, property or an individual

M

ID

2/3

Required

Code

Name

1P

Provider

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

1

Person

2

Non-Person Entity

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Provider Last or Organization Name

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Provider First Name
The first name is required when the value in NM102 is ‘1’ and the person has a first name.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Provider Middle Name
The middle name or initial is required when the value in NM102 is ‘1’ and the person has a middle name or initial.

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Industry: Provider Name Prefix
Required if additional name information is needed to identify the provider of service. Recommended if the value in the entity type qualifier is a person.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Provider Name Suffix
Required if additional name information is needed to identify the provider of service. Recommended if the value in the entity type qualifier is a person.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)

C

ID

1/2

Required

Code

Name

FI

Federal Taxpayer's Identification Number

SV

Service Provider Number

When the provider does not have a National Provider ID and Payer has assigned a specific ID number to this provider this code is required.

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Provider Identifier

C

AN

2/80

Required

ExternalCodeList

Name: 537

Description: Health Care Financing Administration National Provider Identifier

1.

P0809 - If either NM108,NM109 is present, then all are required

2.

C1110 - If NM111 is present, then all of NM110 are required

1.

NM102 qualifies NM103.

1.

NM110 and NM111 further define the type of entity in NM101.

Example:

NM1*1P*2*HOME MEDICAL*****SV*987666666~