NM1

Provider Name

Pos: 320	Max: 1
Detail - Optional
Loop: 2310	Elements: 10

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

3D

Obstetrics and Gynecology Facility

OD

Doctor of Optometry

P3

Primary Care Provider

QA

Pharmacy

QN

Dentist

Y2

Managed Care Organization

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
The name should only be used when the sponsor is not able to provide the standard ID number.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Provider First Name
The name should only be used when the sponsor is not able to provide the standard ID number.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Provider Middle Name
The name should only be used when the sponsor is not able to provide the standard ID number.

O

AN

1/25

Situational

NM106

1038

Name Prefix
Description: Prefix to individual name
Industry: Provider Name Prefix
The name should only be used when the sponsor is not able to provide the standard ID number.

O

AN

1/10

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Provider Name Suffix
The name should only be used when the sponsor is not able to provide the standard ID number.

O

AN

1/10

Situational

NM108

66

Identification Code Qualifier
Description: Code designating the system/method of code structure used for Identification Code (67)
Send when required by X12 syntax.

C

ID

1/2

Situational

Code

Name

34

Social Security Number

The social security number may not be used for any Federally administered programs such as Medicare or CHAMPUS.

FI

Federal Taxpayer's Identification Number

SV

Service Provider Number

This is a number assigned by the payer used to identify a provider.

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Provider Identifier
Required when available to the sponsor and transmission is not prohibited by local, state, or Federal law.

C

AN

2/80

Situational

ExternalCodeList

Name: 537

Description: Health Care Financing Administration National Provider Identifier

NM110

706

Entity Relationship Code
Description: Code describing entity relationship
This element indicates whether or not the member is an existing patient of the provider.

C

ID

2/2

Required

Code

Name

25

Established Patient

26

Not Established Patient

72

Unknown

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. The National Provider ID should be passed in NM109. Until that ID is available the Federal Tax ID should be used.
2. Use the name fields, NM103 through NM107, only when the sponsor has the name of the provider but is not able to pass a standard ID in NM109. This may occur because the ID is unknown or because local regulations prevent using Social Security Numbers or Federal Tax IDs.
3. If the entity code, NM102, is 1 for person and the name is being passed, NM103 and NM104 must be used and NM105, NM106 and NM107 may be used. When the name is being passed for a non-person entity only NM103 may be used and NM104 through NM107 must not be sent.

Example:

NM1*P3*1******XX*25341234567*25~