NM1

Other Provider Name

Pos: 250	Max: 1
Detail - Optional
Loop: 2310C	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
The entity identifier in NM101 applies to all segments in Loop ID-2310.

M

ID

2/3

Required

Code

Name

73

Other Physician

Description: Physician not one of the other specified choices

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: Other Physician Last Name
UB-92 Ref. [UB-Name]: 83B, Line b [Other Physician ID]
EMC v.6.0 Reference: Record Type 80 Field No. 11, 12

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Other Physician First Name
UB-92 Ref. [UB-Name]: 83B, Line b [Other Physician ID]
EMC v.6.0 Reference: Record Type 80 Field No. 11, 12
Required if NM102=1 (person).

O

AN

1/25

Situational

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Other Provider Middle Name
Required when NM102=1-Person and the Middle Name or Initial of the person is known by the provider.

O

AN

1/25

Situational

NM107

1039

Name Suffix
Description: Suffix to individual name
Industry: Other Provider Name Suffix
Other Provider Generation
Required if known.

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

24

Employer's Identification Number

34

Social Security Number

XX

Health Care Financing Administration National Provider Identifier

Description: Required value if the National Provider ID is mandated for use. Otherwise, one of the other listed codes may be used.

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Other Physician Identifier
Alias: Other Physician Primary ID
UB-92 Ref. [UB-Name]: 83B, Line a [Other Physician ID]
EMC v.6.0 Reference: Record Type 80 Field No. 7
Record Type 81 Field No. 6

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. Information in Loop ID-2310 applies to the entire claim unless it is overridden on a service line by the presence of Loop ID-2410 with the same value in NM101.
2. Because the usage of this segment is “Situational” this is not a syntactically required loop. If this loop is used, then this segment is a “Required” segment. See Appendix A for further details on ASC X12 nomenclature.
3. Required on all outpatient and home health claims/encounters to indicate the person or organization (Home Health Agency) who rendered the care. In the case where a subsitute provider (locum tenans) was used, that person should be entered here. Required when the Other Provider NM1 information is different than that carried in either the Billing Provider NM1 or the Pay-to Provider in the 2010AA/AB loops.
4. Required on non-outpatient (e.g inpatient, SNF, ICF etc.) claims or encounters to indicate the physician who rendered service for the principal procedure if other than the operating physician reported in Loop 2310B. Not required on non-outpatient claims or ncounters if no principal procedure was performed.

Example:

NM1*73*1*DOE*JOHN*A***34*201749586~