NM1

Service Provider Name

Pos: 030	Max: 1
Detail - Optional
Loop: 2100	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

82

Rendering 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: Rendering Provider Last or Organization Name
Required when needed to confirm the identifier in NM109.

O

AN

1/35

Situational

NM104

1036

Name First
Description: Individual first name
Industry: Rendering Provider First Name
If NM102 is a “2" this element is not used.
Used when NM102=1 and the information is known.

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Rendering Provider Middle Name
If NM102 is a “2" this element is not used.
If this data element is used and contains only one character, it is assumed to represent the middle initial.
The Middle name or initial is required when the individual has a middle name or initial.
Used when NM102=1 and the information is known.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Rendering Provider Name Suffix
The Suffix should be reported whenever this information is necessary for identification of the individual, for instance when a Junior and Senior are covered under the same subscriber.

O

AN

1/10

Not recommended

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

BD

Blue Cross Provider Number

BS

Blue Shield Provider Number

FI

Federal Taxpayer's Identification Number

ADVISED For individual providers as payees, use this number to represent the Social Security Number.

MC

Medicaid Provider Number

PC

Provider Commercial Number

SL

State License Number

UP

Unique Physician Identification Number (UPIN)

XX

Health Care Financing Administration National Provider Identifier

ADVISED

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Rendering 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.

Notes:

1. Use this NM1 segment to provide information about the rendering provider. Any reference number should be provided in NM109. This segment is required when the rendering provider is different from the Payee.
2. This information is provided to facilitate identification of the claim within a payee’s system. Other providers related to the claim but not directly related to the payment are not supported and are not necessary for claim identification.

Example:

NM1*82*2******XX*12345678~