TIP: Resource for Deciphering Service Provider Names

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All submitting entities

Jan 7, 2021

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

Active

Provider

Misc

Tip