Provider names for medical services are captured in MC030 and are related to the Service Provider NPI in MC026. Sometimes the service provider name information does not seem logical, complete or correct. This Arkansas APCD tip provides the data user with a methodology to determine the validity of the data.
To obtain additional organization information related to the service NPI that is not included in the medical claims record, reference the NPPS NPI data on the CMS website. These data are comprised of several tables. Download as many of the tables as you wish but specifically include the table called Other Name Reference File (this file name may vary slightly). Select the record(s) with the matching NPI(s) to profile other related organization names. The examples below are for ambulance services.
What is in the APCD
Additional Info from the CMS NPI data
MC026 (APCD Service Provider NPI)
MC030 (APCD Service Provider Name)
NPPES NPI Other Organization Name
1144430760
LINE
Mercy Life Line
1144352998
CITY OF ROGERS*
City of Rogers Ambulance Service
1710931985
JRMC Professional Services
Jefferson Regional Medical Center
1891872552
GALLOPS
MED-FORCE
1073684213
LINCARE INC
United Medical
1164452371
David J Foscue MD PA
Foscue Medical Clinic
1437292877
MCANEAR
Airborne Air Ambulance
1043240682
ROE
Baptist Health Medical Center-Little Rock
1508082389
Walker
Walker Internal Medicine Clinic
*NOTE: In some states, many ambulances services are managed by fire departments operating under municipal government budgets. The organization names may instead reflect the city or municipality. So, the value in MC030 may not make sense without the additional NPI data.