NPI |
1346297785 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Entity Type Code |
1 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Last Name Legal Name |
MOYER |
The city name in the location address of the provider being identified. |
Provider First Name |
RICHARD |
The State code in the location of the provider
being identified. |
Provider Middle Name |
ALLEN |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Credential Text |
D.O. |
The country code in the location address of the provider being identified. |
Provider First Line Business Practice Location Address |
307 S COURT ST |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
LAPEER |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address State Name |
MI |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Postal Code |
484462514 |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address Country Code If outside U S |
US |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address Telephone Number |
8106676110 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Fax Number |
8106673562 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Enumeration Date |
5/30/2006 |
|
Last Update Date |
6/4/2014 |
|
Provider Gender Code |
M |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Taxonomy Code 1 |
207X00000X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider License Number 1 |
5101010355 |
|
Provider License Number State Code 1 |
MI |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
4210759 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
05 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
MI |
|
Other Provider Identifier 2 |
205440033 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 2 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 2 |
MI |
|
Other Provider Identifier Issuer 2 |
BCBSM |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |