No Were there any nonexempt transactions with any party-in-interest? No Was this plan covered by a fidelity bond? No Were all the plan assets either distributed to participants or beneficiaries, transferred to another plan, or brought under the control of the PBGC?
No Has the plan failed to provide any benefit when due under the plan? No If this is an individual account plan, was there a blackout period? No If there was a blackout period, have you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR Service Providers.
There is no information on eligible indirect compensation for this plan. There are no service providers listed for this plan. Indirect Compensation. There are no service providers with indirect compensation listed for this plan. There are no service providers who failed or refused to provide information.
Termination Information on Accountants and Enrolled Actuaries. There is no termination information for this plan. No investments information available for this plan. Insurance Information. There are no insurance carriers listed for this plan.
For Enterprise Beacon. The offices are examples of subparts that could have their own NPIs if the main location determines that they should. Neither the pharmacy line of business nor the DME line of business represent legal entities; instead, both lines of business are part of an organization the "parent" that is a legal entity.
Each line of business represents a different Healthcare Provider Taxonomy or area of specialization that often submits its own electronic claims to health plans. The "parent"-we don't know who the parent is in this example-must ensure that each subpart that submits its own claims to health plans has its own NPI.
Provide organization name legal business name used to file tax returns with the IRS. The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon.
A field cannot contain all special characters. This data element may contain the same information as ''Provider first line location address''. This data element may contain the same information as ''Provider second line location address''. This data element may contain the same information as ''Provider location address City name''.
This data element may contain the same information as ''Provider location address State name''. This data element may contain the same information as ''Provider location address postal code''. This data element may contain the same information as ''Provider location address country code''.
Provider Business Mailing Address Telephone Number The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
Provider Business Mailing Address Fax Number The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. Provider Business Practice Location Address Telephone Number The telephone number associated with the location address of the provider being identified. Provider Business Practice Location Address Fax Number The fax number associated with the location address of the provider being identified.
The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. Most Relevant Information Provider Data.
Provider Practice Location. Copy Practice Location. Provider Mailing Address. Copy Mailing Address. Authorized Official. Entity Type. Code describing the type of health care provider that is being assigned an NPI. Is Organization Subpart. The "Is the organization a subpart? Provider Other Organization Name. Other name by which the organization provider is or has been known.
Code identifying the type of other name. The first line mailing address of the provider being identified. The second line mailing address of the provider being identified. The City name in the mailing address of the provider being identified. The State or Province name in the mailing address of the provider being identified.
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