WISCONSIN DIAGNOSTIC LABORATORIES LLC NPI 1932109675

NPI Details

WISCONSIN DIAGNOSTIC LABORATORIES LLC is a clinical medical laboratory in Milwaukee, WI. The provider is (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. WISCONSIN DIAGNOSTIC LABORATORIES LLC NPI is 1932109675. The provider is registered as an organization entity type.

The provider's business location address is:

9200 W WISCONSIN AVE
MILWAUKEE, WI
ZIP 53226-522
Phone: (414) 805-7699

The provider's authorized official is Robin Herbner .
The authorized official title is Cfo and has the following contact phone number (414) 805-7793.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

• Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled (HCPCS:P9603)
• Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated miles actually travelled (HCPCS:P9603)
• 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc, making use of high throughput technologies as described by cms-2020-01-r (HCPCS:U0004)
• Infectious agent detection by nucleic acid (dna or rna); severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (coronavirus disease [covid-19]), amplified probe technique, cdc or non-cdc, making use of high throughput technologies, completed within (HCPCS:U0005)
• Insertion of needle into vein for collection of blood sample (HCPCS:36415)
• Blood test, basic group of blood chemicals (calcium, total) (HCPCS:80048)
• Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count (HCPCS:85025)
• Blood test, comprehensive group of blood chemicals (HCPCS:80053)
• Collection of venous blood by venipuncture or urine sample by catheterization from an individual in a skilled nursing facility (snf) or by a laboratory on behalf of a home health agency (hha) (HCPCS:G0471)
• Blood test, clotting time (HCPCS:85610)
• Blood test, lipids (cholesterol and triglycerides) (HCPCS:80061)
• Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge (HCPCS:P9604)
• Blood test, thyroid stimulating hormone (tsh) (HCPCS:84443)
• Bacterial colony count, urine (HCPCS:87086)
• Bacterial culture for aerobic isolates (HCPCS:87077)
• Travel allowance one way in connection with medically necessary laboratory specimen collection drawn from home bound or nursing home bound patient; prorated trip charge (HCPCS:P9604)
• Hemoglobin a1c level (HCPCS:83036)
• Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution (HCPCS:87186)
• Vitamin d-3 level (HCPCS:82306)
• Manual urinalysis test with examination using microscope, automated (HCPCS:81001)
• Complete blood cell count (red cells, white blood cell, platelets), automated test (HCPCS:85027)
• Cyanocobalamin (vitamin b-12) level (HCPCS:82607)
• Magnesium level (HCPCS:83735)
• Bacterial urine culture (HCPCS:87088)
• Pathology examination of tissue using a microscope, intermediate complexity (HCPCS:88305)
• Tacrolimus level (HCPCS:80197)
• Parathormone (parathyroid hormone) level (HCPCS:83970)
• Ferritin (blood protein) level (HCPCS:82728)
• Measurement of antibody (ige) to allergic substance, crude allergen extract, each (HCPCS:86003)
• Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19) and influenza virus types a and b (HCPCS:87636)
• Thyroxine (thyroid chemical), free (HCPCS:84439)
• Analysis of substance using immunoassay technique, multiple step method (HCPCS:83516)
• Phosphate level (HCPCS:84100)
• Gammaglobulin (immune system protein) measurement (HCPCS:82784)
• Natriuretic peptide (heart and blood vessel protein) level (HCPCS:83880)
• Nephelometry, test method using light (HCPCS:83883)
• Measurement c-reactive protein for detection of infection or inflammation (HCPCS:86140)
• Hepatitis c antibody screening, for individual at high risk and other covered indication(s) (HCPCS:G0472)
• Folic acid level, serum (HCPCS:82746)
• Urine microalbumin (protein) level (HCPCS:82043)
• Immunologic analysis technique on serum (immunofixation) (HCPCS:86334)
• Protein measurement, serum (HCPCS:84165)
• Detection test by nucleic acid for organism, amplified probe technique (HCPCS:87798)
• Iron level (HCPCS:83540)
• Iron binding capacity (HCPCS:83550)
• Liver function blood test panel (HCPCS:80076)
• Uric acid level, blood (HCPCS:84550)
• Stool culture, additional pathogens (HCPCS:87046)
• Psa (prostate specific antigen) measurement, total (HCPCS:84153)
• Testosterone (hormone) level, total (HCPCS:84403)
• Red blood cell sedimentation rate, to detect inflammation, automated (HCPCS:85652)
• Prostate cancer screening; prostate specific antigen test (psa) (HCPCS:G0103)
• Bacterial culture, any other source except urine, blood or stool, aerobic (HCPCS:87070)
• Detection test by nucleic acid for clostridium difficile, amplified probe technique (HCPCS:87493)
• Thyroid hormone, t3 measurement, free (HCPCS:84481)
• Detection test by nucleic acid for organism, quantification (HCPCS:87799)
• Blood creatinine level (HCPCS:82565)
• Cortisol (hormone) measurement, total (HCPCS:82533)
• Calcium level, ionized (HCPCS:82330)
• Special gram or giemsa stain for microorganism (HCPCS:87205)
• Screening test for autoimmune disorder (HCPCS:86038)
• Measurement of antibody for assessment of autoimmune disorder, any method (HCPCS:86235)
• Creatinine level to test for kidney function or muscle injury (HCPCS:82570)
• Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to gc/ms (any type, single or tandem) and lc/ms (HCPCS:G0480)
• Microscopic examination for white blood cells with manual cell count (HCPCS:85007)
• Valproic acid level, total (HCPCS:80164)
• Urine calcium level (HCPCS:82340)
• Analysis for antibody borrelia burgdorferi (lyme disease bacteria) (HCPCS:86618)
• Total protein level, urine (HCPCS:84156)
• Collagen cross links test, (urine test to evaluate bone health) (HCPCS:82523)
• Stool culture (HCPCS:87045)
• Liver enzyme (sgpt), level (HCPCS:84460)
• Adrenocorticotropic hormone (acth) level (HCPCS:82024)
• Rheumatoid factor level (HCPCS:86431)
• Cystatin c (enzyme inhibitor) level (HCPCS:82610)
• Detection test by nucleic acid for cytomegalovirus, quantification (HCPCS:87497)
• Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), agar dilution method (HCPCS:87181)
• Special stained specimen slides to examine tissue, each additional procedure (HCPCS:88341)
• Special stained specimen slides to examine tissue, initial procedure (HCPCS:88342)
• Detection test by multiplex amplified probe technique for severe acute respiratory syndrome coronavirus 2 (sars-cov-2) (covid-19), influenza virus types a and b, and respiratory syncytial virus (HCPCS:87637)
• Creatine kinase (cardiac enzyme) level, total (HCPCS:82550)
• Measurement of complement (immune system proteins), antigen, (HCPCS:86160)
• Special fluorescent and/or acid fast stain for microorganism (HCPCS:87206)
• Testing for presence of drug, by chemistry analyzers (HCPCS:80307)
• Blood potassium level (HCPCS:84132)
• Cell examination of specimen, selective cellular enhancement technique (HCPCS:88112)
• Lactate dehydrogenase (enzyme) level (HCPCS:83615)
• Phosphatase (enzyme) measurement, alkaline, isoenzymes (HCPCS:84080)
• Tuberculosis test, gamma interferon (HCPCS:86480)
• Alpha-fetoprotein (afp) level, serum (HCPCS:82105)
• Bilirubin level, direct (HCPCS:82248)
• Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision (HCPCS:G0145)
• Insertion of needle into vein for collection of blood sample (HCPCS:36415)
• Vitamin b-1 (thiamine) level (HCPCS:84425)
• Urine sodium level (HCPCS:84300)
• Albumin (protein) level (HCPCS:82040)
• Special stain for parasites (HCPCS:87209)
• Smear for parasites (HCPCS:87177)
• Stool calprotectin (protein) level (HCPCS:83993)
• Sex hormone binding globulin (protein) level (HCPCS:84270)
• Detection test by nucleic acid for neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique (HCPCS:87591)
• Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique (HCPCS:87491)
• Immunologic analysis technique on body fluid, other fluids with concentration (HCPCS:86335)
• Fungal culture, yeast (HCPCS:87106)
• Detection test by nucleic acid for strep (streptococcus, group a), amplified probe technique (HCPCS:87651)
• Protein measurement, body fluid (HCPCS:84166)
• Thyroglobulin (thyroid protein) antibody measurement (HCPCS:86800)
• Lipase (fat enzyme) level (HCPCS:83690)
• Prolactin (milk producing hormone) level (HCPCS:84146)
• Detection test by immunofluorescent technique for giardia (intestinal parasite) (HCPCS:87269)
• Detection test by immunofluorescent technique for cryptosporidium (parasite) (HCPCS:87272)
• Assessment of antibody to human leukocyte antigens (hla) with high definition qualitative panel for identification of antibody specificities, hla class i (HCPCS:86832)
• Assessment of antibody to human leukocyte antigens (hla) with high definition qualitative panel for identification of antibody specificities, hla class ii (HCPCS:86833)
• Red blood cell concentration measurement (HCPCS:85014)
• Concentration of specimen for infectious agents (HCPCS:87015)
• Red blood count, automated test (HCPCS:85045)
• Thyroglobulin (thyroid related hormone) level (HCPCS:84432)
• Homocysteine (amino acid) level (HCPCS:83090)
• Lipoprotein level, quantitation of lipoprotein particle number(s) (HCPCS:83704)
• Vitamin b-6 level (HCPCS:84207)
• Measure of severe acute respiratory syndrome coronavirus 2 (covid-19) antibody (HCPCS:86769)
• Syphilis detection test (HCPCS:86592)
• Measurement c-reactive protein for detection of infection or inflammation, high sensitivity (HCPCS:86141)
• Prealbumin (protein) level (HCPCS:84134)
• Phosphatase (enzyme) level, alkaline (HCPCS:84075)
• Blood count, hemoglobin (HCPCS:85018)
• Measurement of substance using immunoassay technique (HCPCS:83520)
• Procalcitonin (hormone) level (HCPCS:84145)
• Lithium level (HCPCS:80178)
• Liver enzyme (sgot), level (HCPCS:84450)
• Culture for acid-fast bacilli (HCPCS:87116)
• Testosterone (hormone) level, free (HCPCS:84402)
• Measurement of dna antibody, native or double stranded (HCPCS:86225)
• Dehydroepiandrosterone (dhea-s) hormone level (HCPCS:82627)
• Everolimus level (HCPCS:80169)
• Thyroxine (thyroid chemical), total (HCPCS:84436)
• Lamotrigine level (HCPCS:80175)
• Haptoglobin (serum protein) level (HCPCS:83010)
• Gonadotropin, follicle stimulating (reproductive hormone) level (HCPCS:83001)
• Digoxin level, total (HCPCS:80162)
• Vancomycin (antibiotic) level (HCPCS:80202)
• Carcinoembryonic antigen (cea) protein level (HCPCS:82378)
• Organic acid level (HCPCS:83921)
• Renin (kidney enzyme) level (HCPCS:84244)
• Urinalysis using microscope (HCPCS:81015)
• Measurement of antibody for rheumatoid arthritis assessment (HCPCS:86200)
• Blood group typing (abo) (HCPCS:86900)
• Ammonia level (HCPCS:82140)
• Screening test for pathogenic organisms (HCPCS:87081)
• Coagulation assessment blood test, plasma or whole blood (HCPCS:85730)
• Cyclosporine level (HCPCS:80158)
• Blood typing for rh (d) antigen (HCPCS:86901)
• Psa (prostate specific antigen) measurement, free (HCPCS:84154)
• Measurement of total estradiol (hormone) (HCPCS:82670)
• Gonadotropin, luteinizing (reproductive hormone) level (HCPCS:83002)
• Creatinine clearance measurement to test for kidney function (HCPCS:82575)
• Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous (HCPCS:G0328)
• Aldosterone hormone level (HCPCS:82088)
• Phenytoin level, total (HCPCS:80185)
• Bacterial culture, any source, except blood, anaerobic (HCPCS:87075)
• Immunologic analysis for detection of tumor antigen, quantitative; ca 125 (HCPCS:86304)
• Bacterial blood culture (HCPCS:87040)
• Ige (immune system protein) level (HCPCS:82785)
• Microsomal antibodies (autoantibody) measurement (HCPCS:86376)
• Troponin (protein) analysis, quantitative (HCPCS:84484)
• Kidney function blood test panel (HCPCS:80069)
• Pathology examination of tissue using a microscope, moderately high complexity (HCPCS:88307)
• Valproic acid level, free (HCPCS:80165)
• Calcium level, total (HCPCS:82310)
• Screening test for antibody to noninfectious agent (HCPCS:86255)
• Red blood cell sedimentation rate, to detect inflammation, non-automated (HCPCS:85651)
• Detection test by nucleic acid for hiv-1 virus, quantification (HCPCS:87536)
• Amylase (enzyme) level (HCPCS:82150)
• Sirolimus level (HCPCS:80195)
• Pathology examination of tissue using a microscope, moderately low complexity (HCPCS:88304)
• Immunologic analysis for detection of tumor antigen, quantitative; ca 19-9 (HCPCS:86301)
• Detection test by nucleic acid for trichomonas vaginalis (genital parasite), amplified probe technique (HCPCS:87661)
• Detection test by nucleic acid for human papillomavirus (hpv), high-risk types (HCPCS:87624)
• Stool analysis for blood, by fecal hemoglobin determination by immunoassay (HCPCS:82274)
• Detection test by immunoassay technique for helicobacter pylori (gi tract bacteria) in stool (HCPCS:87338)
• Immunologic analysis for detection of antigen or antibody (HCPCS:86331)
• Metanephrines level (HCPCS:83835)
• Dihydroxyvitamin d, 1, 25 level (HCPCS:82652)
• Cardiolipin antibody (tissue antibody) measurement (HCPCS:86147)
• Hepatitis b core antibody (igm) measurement (HCPCS:86705)
• Blood glucose (sugar) level (HCPCS:82947)
• Special stained specimen slides to identify organisms including interpretation and report (HCPCS:88312)
• Quantitation of therapeutic drug (HCPCS:80299)
• Somatomedin (growth factor) level (HCPCS:84305)
• Hepatitis b surface antibody measurement (HCPCS:86706)
• Detection test by immunoassay technique for hepatitis b surface antigen (HCPCS:87340)
• Analysis for antibody to aspergillus (fungus) (HCPCS:86606)
• Measurement of hepatitis a antibody (HCPCS:86708)
• Alpha-1-antitrypsin (protein) blood test, total (HCPCS:82103)
• Screening test for red blood cell antibodies (HCPCS:86850)
• Insulin measurement, total (HCPCS:83525)
• Fungal culture (mold or yeast) (HCPCS:87102)
• Triglycerides level (HCPCS:84478)
• Coagulation function measurement, d-dimer; quantitative (HCPCS:85379)
• Clotting factor x assessment test, diluted (HCPCS:85613)
• Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen) (HCPCS:87324)
• Measurement of substance using immunoassay technique, by radioimmunoassay (HCPCS:83519)
• Thyroid hormone, t3 measurement, reverse (HCPCS:84482)
• Vitamin e level (HCPCS:84446)
• C-peptide (protein) level (HCPCS:84681)
• Glutamyltransferase (liver enzyme) level (HCPCS:82977)
• Urine osmolality (concentration) measurement (HCPCS:83935)
• Automated urinalysis test (HCPCS:81003)
• Levetiracetam level (HCPCS:80177)
• Carbamazepine level, total (HCPCS:80156)
• Beta 2 glycoprotein 1 antibody (autoantibody) measurement (HCPCS:86146)
• Analysis for antibody to coccidioides (bacteria) (HCPCS:86635)
• Zinc level (HCPCS:84630)
• Measurement of antibody for assessment of autoimmune disorder, titer (HCPCS:86039)
• Detection test by nucleic acid for herpes simplex virus, amplified probe technique (HCPCS:87529)
• Detection test by nucleic acid for staphylococcus aureus (bacteria), amplified probe technique (HCPCS:87640)
• Microscopic genetic analysis of tumor, manual (HCPCS:88360)
• Lipoprotein (a) level (HCPCS:83695)
• Aldolase (enzyme) level (HCPCS:82085)
• Smear for infectious agents (HCPCS:87210)
• Blood osmolality (concentration) measurement (HCPCS:83930)
• Vitamin a level (HCPCS:84590)
• Thyroid stimulating immune globulins (thyroid related protein) level (HCPCS:84445)
• Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening (HCPCS:G0432)
• Lactic acid level (HCPCS:83605)
• Erythropoietin (protein) level (HCPCS:82668)
• Progesterone (reproductive hormone) level (HCPCS:84144)
• Chemical analysis using chromatography technique (HCPCS:82542)
• Clozapine level (HCPCS:80159)
• Gammaglobulin (immune system protein) measurement, immunoglobulin subclasses (HCPCS:82787)
• Topiramate level (HCPCS:80201)
• Detection test by nucleic acid for hepatitis c virus, amplified probe technique (HCPCS:87521)
• Body fluid cell count with cell identification (HCPCS:89051)
• Measurement of lacosamide (HCPCS:80235)
• Analysis using chemiluminescent technique (light and chemical )reaction (HCPCS:82397)
• Urine potassium level (HCPCS:84133)
• Urine phosphate level (HCPCS:84105)
• Oxcarbazepine level (HCPCS:80183)
• Acute hepatitis panel (HCPCS:80074)
• Gabapentin level (HCPCS:80171)
• Urine chloride level (HCPCS:82436)
• Detection test by nucleic acid for hepatitis c virus, quantification (HCPCS:87522)
• Detection test by nucleic acid for hepatitis b virus, quantification (HCPCS:87517)
• Uric acid level (HCPCS:84560)
• Analysis for antibody to epstein-barr virus (mononucleosis virus), viral capsid (HCPCS:86665)
• T cells count, total (HCPCS:86359)
• T cell count and ratio, including ratio (HCPCS:86360)
• Islet cell (pancreas) antibody measurement (HCPCS:86341)
• Culture for identification of yeast (HCPCS:87107)
• Hepatitis b core antibody measurement (HCPCS:86704)
• Citrate level (HCPCS:82507)
• Angiotensin l - converting enzyme (ace) level (HCPCS:82164)
• Phenytoin level, free (HCPCS:80186)
• Oxalate level (HCPCS:83945)
• Ceruloplasmin (protein) level (HCPCS:82390)
• Blood sodium level (HCPCS:84295)
• Ldl cholesterol level (HCPCS:83721)
• Urine sulfate (acid) level (HCPCS:84392)
• Body fluid ph level (HCPCS:83986)
• T cell count and ratio (HCPCS:86361)
• Confirmation test for antibody to borrelia burgdorferi (lyme disease bacteria) (HCPCS:86617)
• Coagulation assessment blood test, substitution, plasma fractions (HCPCS:85732)
• Platelet function test (HCPCS:85597)
• Phospholipid test (HCPCS:85598)
• Heparin neutralization test (HCPCS:85525)
• Phenobarbital level (HCPCS:80184)
• Total cell count for b cells (white blood cells) (HCPCS:86355)
• Transferrin (iron binding protein) level (HCPCS:84466)
• Detection test by immunoassay technique for other organism (HCPCS:87449)
• Evaluation of fine needle aspirate with interpretation and report (HCPCS:88173)
• Copper level (HCPCS:82525)
• Crystal identification from tissue or body fluid (HCPCS:89060)
• Red blood cell antibody detection test, direct (HCPCS:86880)
• Bacterial culture for anaerobic isolates (HCPCS:87076)
• Detection test by immunoassay technique for rotavirus (HCPCS:87425)
• Platelet aggregation function test (HCPCS:85576)
• Alpha-1-antitrypsin (protein) blood test, phenotype (HCPCS:82104)
• Cortisol (hormone) measurement, free (HCPCS:82530)
• Pregnenolone (reproductive hormone) level (HCPCS:84140)
• Glycated protein level (HCPCS:82985)
• Breath test analysis for helicobacter pylori (HCPCS:83013)
• Urea nitrogen level to assess kidney function, urine (HCPCS:84540)
• Thyroid hormone, t3 measurement, total (HCPCS:84480)
• Infrared analysis of stone (HCPCS:82365)
• Analysis for antibody to cytomegalovirus (cmv) (HCPCS:86644)
• Platelet count, automated test (HCPCS:85049)
• Detection test by immunoassay technique for histoplasma capsulatum (parasite) (HCPCS:87385)
• Identification of mycobacteria (tb or tb like organism) (HCPCS:87118)
• Identification of organisms by immunologic analysis, other than immunofluorescence method (HCPCS:87147)
• Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) (HCPCS:87184)
• Fungal culture (mold or yeast) of skin, hair, or nail (HCPCS:87101)
• Analysis for antibody to varicella-zoster virus (chicken pox) (HCPCS:86787)
• Creatine kinase (cardiac enzyme) level, isoenzymes (HCPCS:82552)
• Stool fat or lipids analysis, qualitative (HCPCS:82705)
• Fibrinogen (factor 1) activity measurement (HCPCS:85384)
• Tuberculosis test, enumeration of t-cells (HCPCS:86481)
• Analysis for antibody to rubella (german measles virus) (HCPCS:86762)
• Total cell count for natural killer cells (white blood cell) (HCPCS:86357)
• Intrinsic factor (stomach protein) antibody measurement (HCPCS:86340)
• Measurement of antibody to noninfectious agent (HCPCS:86256)
• Clotting factor viii (ahg) measurement (HCPCS:85240)
• Vitamin b-2 (riboflavin) level (HCPCS:84252)
• Measurement of dihydrotestosterone (HCPCS:82642)
• Cryoglobulin (protein) measurement (HCPCS:82595)
• Bilirubin level, total (HCPCS:82247)
• Catecholamines (organic nitrogen) level (HCPCS:82384)
• Analysis for antibody to helicobacter pylori (gastrointestinal bacteria) (HCPCS:86677)
• Analysis for antibody, treponema pallidum (HCPCS:86780)
• Molecular pathology procedure; physician interpretation and report (HCPCS:G0452)
• Analysis for antibody to herpes simplex virus, type 2 (HCPCS:86696)

The enumeration date for this NPI number is 7/22/2005 and was last updated on 11/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.