Middle initial of Name Middle Report the middle name of the prescribing PC 47 Physician 6/24/10 Text Prescribing All 2% C Provider physician here. Middle Physician Name Last name of Name Last Report the last name of the prescribing PC 48 Physician 6/24/10 Text Prescribing All 50% B Provider physician here. Last Physician Name Prescribing Report the Primary DEA number for the PC 49 Physician 6/24/10 Text ID DEA char[9] All 80% B DEA prescribing physician DEA Number National Report the Primary National Provider ID National External Provider (NPI) of the Prescribing Provider in Provider Code External Code Identification PC043. This ID should be found on the PC 50 ID - Source Source 3 - National int[10] All 95% A2 (NPI) of the Provider File in the NPI element (PV039). 3 - Provider ID Prescribing This element is looking to capture the NPI Integer Provider of an individual physician, not a group Report the prescriber's plan number here. PC 51 Physician 11/8/12 Text ID Plan Do not report any value here if not All 10% C Plan Provider Plan ID contracted with the carrier. Number Report the license number for the provider identified in PC043. For a doctor this is the medical license for a Prescribing this is the practice license. Do not PC 52 Physician 11/8/12 Text ID License Physician All 10% B use zero-fill. If not available, or not License License Number applicable, such as for a group or Number corporate entity, do not report any value here. Street address of the Report the street address of the PC 53 Physician 6/24/10 Text Address 1 Provider All 10% C Prescribing Prescribing Physician Street Physician Address
PC 47 Physician Middle Name 6/24/10 Text Name Middle Provider Middle initial of Prescribing Physician Report the middle name of the prescribing physician here. All 2% C PC 48 Physician Last Name 6/24/10 Text Name Last Provider Last name of Prescribing Physician Report the last name of the prescribing physician here. All 50% B PC 49 Physician DEA Number 6/24/10 Text ID DEA char[9] Prescribing DEA Report the Primary DEA number for the prescribing physician All 80% B PC 50 National Provider ID - External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Prescribing Provider Report the Primary National Provider ID (NPI) of the Prescribing Provider in PC043. This ID should be found on the Provider File in the NPI element (PV039). This element is looking to capture the NPI of an individual physician, not a group All 95% A2 PC 51 Physician Plan Number 11/8/12 Text ID Plan Provider Plan ID Report the prescriber's plan number here. Do not report any value here if not contracted with the carrier. All 10% C PC 52 Physician License Number 11/8/12 Text ID License Prescribing Physician License Number Report the license number for the provider identified in PC043. For a doctor this is the medical license for a this is the practice license. Do not use zero-fill. If not available, or not applicable, such as for a group or corporate entity, do not report any value here. All 10% B PC 53 Physician Street Address 6/24/10 Text Address 1 Provider Street address of the Prescribing Physician Report the street address of the Prescribing Physician All 10% C