the health care provider. Refer to Appendix A MC074 APC Version 1/1/2010 Text 2 Version number of the grouper used MC075 Drug Code 1/1/2010 Text 11 An NDC code used only when a medication is paid for as part of a medical claim. Refer to Appendix A Billing Provider 1/1/2010 Text 30 Payer assigned billing provider Number number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. MC077 National 1/1/2010 Text 20 National Provider ID for billing Provider ID provider – Billing Provider Refer to Appendix A Billing Provider 1/1/2010 Text 60 Full name of provider billing organization or last name of Last Name or Organization individual billing provider. Name MC079 Billing Provider 10/1/2014 Text 10 Federal taxpayer's identification Tax ID number MC080 Billing Provider 10/1/2014 Text 55 Address information for billing Address Line 1 provider MC081 Billing Provider 10/1/2014 Text 55 Address information for billing Address Line 2 provider
the health care provider. Refer to Appendix A MC074 APC Version 1/1/2010 Text 2 Version number of the grouper used MC075 Drug Code 1/1/2010 Text 11 An NDC code used only when a medication is paid for as part of a medical claim. Refer to Appendix A Billing Provider Number 1/1/2010 Text 30 Payer assigned billing provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. MC077 National Provider ID – Billing Provider 1/1/2010 Text 20 National Provider ID for billing provider Refer to Appendix A Billing Provider Last Name or Organization Name 1/1/2010 Text 60 Full name of provider billing organization or last name of individual billing provider. MC079 Billing Provider Tax ID 10/1/2014 Text 10 Federal taxpayer's identification number MC080 Billing Provider Address Line 1 10/1/2014 Text 55 Address information for billing provider MC081 Billing Provider Address Line 2 10/1/2014 Text 55 Address information for billing provider