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Data Element Name:  Provider Identification Number
Format-Length:  A/N - 13 Required For:  AS, ED, IP
Effective Date:  1/1/94 Revision Date:  September 2003

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2010AA NM108 66 XX Identification Code Qualifier (Provider)
NM109 67 Service Provider Identifier

Paper Form Locator Code Qualifier
Institutional - UB-04 56 N/A

Definition:

The identification number assigned by the payer associated with this sequence to the provider submitting the bill.

Codes and Values:

  1. Must contain no embedded blanks.

Edit Applications:

  1. Must be a valid entry if Claim Filing Indicator Code is Medicare (MA or MB), Medicaid (MC), or Blue Cross (BL).
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