| Name | Description | Type | Additional information |
|---|---|---|---|
| ID | integer |
None. |
|
| BILLING_NPI | integer |
None. |
|
| BILLING_PRVDR_NAME | string |
None. |
|
| SERVC_NPI | integer |
None. |
|
| SERVC_PRVDR_NAME | string |
None. |
|
| TAX_ID | string |
None. |
|
| OPRTNL_FLAG | string |
None. |
|
| PRVDR_CONTACT_NAME | string |
None. |
|
| PRVDR_PHONE | string |
None. |
|
| CONTACT_EMAIL | string |
None. |
|
| RequestedBillingNPI | Collection of integer |
None. |
|
| CREATED_DATE | date |
None. |
|
| STREET1 | string |
None. |
|
| STREET2 | string |
None. |
|
| STREET3 | string |
None. |
|
| CITY_TOWN_NAME | string |
None. |
|
| STATE_PRVNC_CODE | string |
None. |
|
| POSTAL_CODE | integer |
None. |
|
| MMIS_PRV_NO | integer |
None. |
|
| tax_id | string |
None. |
|
| prov_zip | integer |
None. |
|
| prvdr_rec_id | integer |
None. |
|
| type | string |
None. |
|
| report_month | integer |
None. |
|
| report_year | integer |
None. |
|
| mmis_prv_no | integer |
None. |