NM1

Service Provider Name

Pos: 170	Max: 1
Detail - Optional
Loop: 2010E	Elements: 8

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

1T

Physician, Clinic or Group Practice

FA

Facility

SJ

Service 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: Service Provider Last or Organization Name
Required if identifying a specialty person, facility, group practice, or clinic and NM108/NM109 are not present. Not used if identifying a specialty entity.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Service Provider First Name
Required if the service provider is a specific person (NM102 = 1) and NM103 is present.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Service Provider Middle Name
Required if NM104 is present and the middle name/initial of the person is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Service Provider Name Suffix
Use this for the suffix of an individual’s name; e.g., Sr., Jr., or III.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Required if requesting the services of a specific person, facility, group practice, or clinic and the service provider ID is known by the requester.

C

ID

1/2

Situational

Code

Name

24

Employer's Identification Number

34

Social Security Number

46

Electronic Transmitter Identification Number (ETIN)

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Service Provider Identifier
Required if requesting the services of a specific person, facility, group practice, or clinic and the service provider ID is known by the requester.

C

AN

2/80

Situational

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.

Notes:

1. Use this segment to convey the name and identification number of the service provider (person, group, or facility) or to identify the specialty entity.
2. Use the maximum of three occurrences of Loop 2010E in a single Loop 2000E only when it is necessary to identify an individual provider within a specific group and facility when that provider and group provide services at multiple facilities.
3. Do not use multiple occurrences of Loop 2010E within a single Loop 2000E to request certification for admission to a facility and a specialist or services at that facility. In this case, two occurrences of Loop 2000E are required as follows:
The admission request must be expressed in a separate Loop 2000E where the facility is identified in Loop 2010E and Loop 2000F identifies admission review as the request category.
The specialist and services are expressed in a separate Loop 2000E where the specialist or specialty is identified in Loop 2010E and Loop 2000F identifies the services.

Example:

NM1*SJ*1*WATSON*SUSAN****34*987654321~