National Provider Identifiers Registry

Transcription

1 The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the ational Plan and Provider Enumeration System (PPES) to assign these unique identifiers. 2015

2 ALTERATIVE REHAB, IC PI position all-numeric identification number assigned by the PS to uniquely identify a health care provider. Entity Type Organization Code describing the type of health care provider that is being assigned an PI. Codes are: <li>1 = (Person): individual human being who furnishes health care;</li> <li>2 = (on-person): entity other than an individual human being that furnishes health care (for example, hospital, SF, hospital subunit, pharmacy, or HMO).</li> Is Organization Subpart The "Is the organization a subpart?" question must be answered. If the organization is a subpart, the Parent Organization Legal Business ame (LB) and Parent Organization Taxpayer Identification umber (TI) fields must be completed. The Parent Organization LB and TI fields can only be completed if the answer to the subpart question is Yes. Many organization health care providers who apply for PIs are not legal entities themselves but are parts of other organization health care providers that are legal entities (the "parents"). Here are three examples of organization health care providers that may be considered subparts and may apply for PIs if so directed by their "parents": (1) The psychiatric unit in a hospital is not a legal entity but is part of the hospital (the "parent"), which is a legal entity. The legal entity must obtain an PI. The psychiatric unit is an example of a subpart that could have its own PI if the hospital determines that it should. (2) A group practice that is not a sole proprietorship has a main location and could have other offices in different locations, but each office is not a separate legal entity; instead, each office is part of the corporation (the "parent") which is a legal entity. The offices are examples of subparts that could have their own PIs if the main location determines that they should. (3) A pharmacy fills prescriptions for patients whose physicians have prescribed medications for them and may also rent or sell durable medical equipment to patients whose physicians have ordered such equipment for them. either the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization (the "parent") that is a legal entity. Each line of business represents a different Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own PI

3 Provider Organization ame (Legal Business ame) Provider First Line Business Mailing Address Mailing Address City ame Mailing Address State ame ALTERATIVE REHAB, IC FARMIGTO RD BLDG E LIVOIA MI Provide organization name (legal business name used to file tax returns with the IRS). The Organization ame field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''. The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''. The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''. Mailing Address Postal Code The postal ZIP or zone code in the mailing address of the provider being identified. OTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''. Mailing Address Country Code US The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''. Mailing Address Telephone umber Mailing Address Fax umber The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number'' The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''. Provider First Line Business Practice Location Address Practice Location Address City ame Practice Location Address State ame FARMIGTO RD BLDG E LIVOIA MI The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. The city name in the location address of the provider being identified. The State or Province name in the location address of the provider being identified. Practice Location Address Postal Code The postal ZIP or zone code in the location address of the provider being identified. OTE: ZIP code plus 4-digit extension, if available

4 Practice Location Address Country Code US The country code in the location address of the provider being identified. Practice Location Address Telephone umber Practice Location Address Fax umber Provider Enumeration Date The telephone number associated with the location address of the provider being identified The fax number associated with the location address of the provider being identified. 10/09/2006 The date the provider was assigned a unique identifier (assigned an PI). Last Update Date 07/18/2014 The date that a record was last updated or changed. Last ame First ame Middle ame Title or Position ame Prefix Text Credential Text MAIMALETHU TOBY RAJU PRESIDET MR. PT The last name of the person authorized to submit the PI application or to change PS data for a health care provider. The first name of the authorized official The middle name of the authorized official The title or position of the authorized official ame Prefix Text Credential Text Telephone umber The 10-position telephone number of the authorized official. Taxonomy Code # X The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. Taxonomy 1 Physical Therapist Taxonomy #1-4 -

5 umber 1 umber State Code Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License umber field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO OT report the Social Security umber (SS), IRS Individual Taxpayer Identification umber (ITI) in this section. MI umber State Code #1 Switch 1 Taxonomy Code 2 Taxonomy 2 umber 2 umber State Code X Taxonomy Code #2 Physical Therapist Taxonomy # umber #2 MI umber State Code #2 Switch 2 Taxonomy Code 3 Taxonomy 3 umber 3 umber State Code X Taxonomy Code #3 Physical Therapist Taxonomy # umber #3 MI umber State Code #3-5 -

6 Switch 3 Taxonomy Code 4 Taxonomy 4 umber 4 umber State Code X Taxonomy Code #4 Physical Therapist Taxonomy # umber #4 MI umber State Code #4 Switch 4 Taxonomy Code 5 Taxonomy 5 umber 5 umber State Code X Taxonomy Code #5 Physical Therapist Taxonomy # umber #5 MI umber State Code #5 Switch 5 Taxonomy Code 6 Taxonomy 6 225X00000X Taxonomy Code #6 Occupational Therapist Taxonomy #6-6 -

7 umber 6 umber State Code umber #6 MI umber State Code #6 Switch 6 Taxonomy Code 7 Taxonomy 7 umber 7 umber State Code X Taxonomy Code #7 Physical Therapist Taxonomy # umber #7 MI umber State Code #7 Switch 7 Taxonomy Code 8 Taxonomy 8 umber 8 umber State Code X Taxonomy Code #8 Physical Therapist Taxonomy # umber #8 MI umber State Code #8 Switch 8-7 -

8 Taxonomy Code 9 Taxonomy 9 umber 9 umber State Code X Taxonomy Code #9 Physical Therapist Taxonomy # umber #9 MI umber State Code #9 Switch 9 Y Identifier 1 Identifier Type 1 Identifier State 1 Identifier Issuer 1 Identifier 2 Identifier Type 2 Identifier State Identifier #1 OTHER Identifier Type #1 MI Identifier State #1 PI OF SAKIA BOHRA Identifier Issuer # Identifier #2 OTHER Identifier Type #2 MI Identifier State #2 Identifier Issuer 2 PI OF THOMAS SYRIAC Identifier Issuer #2 Identifier 3 Identifier Type 3 Identifier State 3 Identifier Issuer 3 Identifier 4 ========= Identifier #3 OTHER Identifier Type #3 MI Identifier State #3 OUR TAX ID Identifier Issuer # Identifier #4-8 -

9 Identifier Type 4 Identifier State 4 OTHER Identifier Type #4 MI Identifier State #4 Identifier Issuer 4 PI OF RAGHU CHOVVATH Identifier Issuer #4 Identifier 5 Identifier Type 5 Identifier State Identifier #5 OTHER Identifier Type #5 MI Identifier State #5 Identifier Issuer 5 PI OF DEEPAK SEBASTIA Identifier Issuer #5 Identifier 6 Identifier Type 6 Identifier State Identifier #6 OTHER Identifier Type #6 MI Identifier State #6 Identifier Issuer 6 PI OF RAMESH MALLADI Identifier Issuer #6 Identifier 7 Identifier Type 7 Identifier State 7 670H Identifier #7 OTHER Identifier Type #7 MI Identifier State #7 Identifier Issuer 7 SAKIA BOHRA'S BCBS PI Identifier Issuer #7 Identifier 8 Identifier Type 8 Identifier State Identifier #8 OTHER Identifier Type #8 MI Identifier State #8 Identifier Issuer 8 PI OF TOBY MAIMALETHU Identifier Issuer #8 Identifier 9 650H Identifier #9-9 -

10 Identifier Type 9 Identifier State 9 Identifier Issuer 9 OTHER Identifier Type #9 MI Identifier State #9 OUR BCBS GROUP PI Identifier Issuer #9 1 Description 1 2 Description 2 3 Description 3 4 Description 4 5 Description Description 1 2 Description 2 3 Description 3 4 Description 4 5 Description

11 Description 6 7 Description 7 8 Description 8 9 Description 9 Description 6 7 Description 7 8 Description 8 9 Description

12 PPES ational Plan & Enumeration System (PI Toll-Free) (PI TTY) PI Enumerator PO Box 6059 Fargo, D customerservice@npienumerator.com

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