MC104 Member Last 1/1/2010 Text 60 The member last name Name Member 1/1/2010 Text 35 The member name Name Member Middle 1/1/2010 Text 25 The member middle name or Name initial MC107 Attending 1/1/2016 Text 30 Payer assigned attending Provider Number provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. National Provider 1/1/2016 Text 20 National Provider ID for ID Attending attending provider – Provider Refer to Appendix A MC109 Attending 1/1/2016 Text 40 Individual first name Provider First Name MC110 Attending 1/1/2016 Text 25 Individual middle name or Provider Middle initial Name MC111 Attending 1/1/2016 Text 60 Individual last name Provider Last Name Attending 1/1/2016 Text 10 Individual name suffix Provider Suffix The attending provider suffix
MC104 Member Last Name 1/1/2010 Text 60 The member last name Member Name 1/1/2010 Text 35 The member name Member Middle Name 1/1/2010 Text 25 The member middle name or initial MC107 Attending Provider Number 1/1/2016 Text 30 Payer assigned attending provider number. This number should be the identifier used by the payer for internal identification purposes, and does not routinely change. National Provider ID – Attending Provider 1/1/2016 Text 20 National Provider ID for attending provider Refer to Appendix A MC109 Attending Provider First Name 1/1/2016 Text 40 Individual first name MC110 Attending Provider Middle Name 1/1/2016 Text 25 Individual middle name or initial MC111 Attending Provider Last Name 1/1/2016 Text 60 Individual last name Attending Provider Suffix 1/1/2016 Text 10 Individual name suffix The attending provider suffix
Chapter%20243_2015.docx