NM1

Supervising Provider Name

Pos: 250	Max: 1
Detail - Optional
Loop: 2310E	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

DQ

Supervising Physician

NM102

1065

Entity Type Qualifier
Description: Code qualifying the type of entity

M

ID

1/1

Required

Code

Name

1

Person

NM103

1035

Name Last or Organization Name
Description: Individual last name or organizational name
Industry: Supervising Provider Last Name
NSF Reference: EA1-18.0

O

AN

1/35

Required

NM104

1036

Name First
Description: Individual first name
Industry: Supervising Provider First Name
NSF Reference: EA1-19.0

O

AN

1/25

Required

NM105

1037

Name Middle
Description: Individual middle name or initial
Industry: Supervising Provider Middle Name
NSF Reference: EA1-20.0
Required if NM102=1 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: Supervising Provider Name Suffix
Alias: Supervising 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)
Required if either Employer’s Identification/Social Security Number or National Provider Identifier is known.

C

ID

1/2

Situational

Code

Name

24

Employer's Identification Number

34

Social Security Number

The social security number may not be used for Medicare.

XX

Health Care Financing Administration National Provider Identifier

NM109

67

Identification Code
Description: Code identifying a party or other code
Industry: Supervising Provider Identifier
Alias: Supervising Provider Primary Identifier
NSF Reference: EA1-16.0
Required if either Employer’s Identification/Social Security Number or National Provider Identifier is known.

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. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101.
2. Required when the rendering provider is supervised by a physician.
3. 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 syntax rules.

Example:

NM1*DQ*1*KILLIAN*BART*B**II*24*222334444~