Provider

The 10-digit National Provider Identifier linked to the clinician or entity authoring a clinical note. Used to attribute documentation to a licensed provider in EHR and health information systems, supporting audit trails, co-signature workflows, and billing reconciliation.

The unique 10-digit National Provider Identifier assigned to a licensed nursing professional, such as an NP or CRNA. Used in claims submission, care team attribution, and credentialing systems to identify nurses rendering billable or supervised clinical services.

The 10-digit National Provider Identifier associated with the clinician or facility responsible for recording a clinical observation or measurement. Used in EHR and claims systems to attribute diagnostic findings and observation-status encounters to the correct billing provider.

The unique 10-digit National Provider Identifier assigned to an obstetrician or obstetric practice. Used in claims processing, prenatal care coordination, and maternity episode tracking to accurately identify providers delivering pregnancy, labor, and postpartum care services.

The unique 10-digit National Provider Identifier assigned to an oncologist or oncology practice. Used in claims adjudication, prior authorization, and cancer care coordination to identify providers delivering chemotherapy, radiation, immunotherapy, and other cancer treatment services.

A continuous process of monitoring and evaluating a credentialed provider professional performance to identify and address quality concerns between formal re-credentialing cycles, using data from quality metrics, peer review, patient complaints, and mortality and morbidity conferences. OPPE is required by Joint Commission standards for all credentialed medical staff members.

The 10-digit National Provider Identifier linked to the surgeon or surgical facility performing an operative procedure. Used in claims processing and surgical episode tracking to attribute inpatient and outpatient surgical interventions to the correct billing or rendering provider.

The unique 10-digit National Provider Identifier assigned to an ophthalmologist or eye care practice. Used in claims processing, vision benefit coordination, and referral management to accurately identify providers delivering medical and surgical eye care services.

The 10-digit National Provider Identifier of the clinician who placed a clinical service order, such as a lab test, imaging study, or medication. Used in EHR and claims systems to attribute ordering authority, support referral tracking, and meet regulatory documentation requirements.

The healthcare provider who orders a diagnostic test, durable medical equipment, home health service, or other clinical service for a patient, identified on claims and required for certain Medicare Part B services where ordering provider identity and enrollment status must be verified before payment. Ordering provider data is used in utilization analytics and fraud detection to flag providers ordering high volumes of tests from laboratories with financial relationships.

The 10-digit National Provider Identifier assigned to a healthcare organization, such as a hospital, clinic, or group practice. Used in claims submission, network contracting, and provider directory management to uniquely identify institutional entities billing for healthcare services.

The unique 10-digit National Provider Identifier assigned to an orthopedic surgeon or orthopedic practice. Used in claims adjudication, surgical episode management, and referral routing to identify providers delivering musculoskeletal and joint care services.

The unique 10-digit National Provider Identifier assigned to an otolaryngologist or ENT practice. Used in claims processing, referral management, and specialty care coordination to identify providers delivering ear, nose, throat, head, and neck care services.

The 10-digit National Provider Identifier associated with a provider in the context of tracking member out-of-pocket cost accumulation. Used in claims and benefit administration systems to attribute patient cost-sharing payments, such as deductibles and copays, to the rendering provider.

The 10-digit National Provider Identifier linked to the clinician or facility responsible for a documented clinical outcome or treatment result. Used in quality reporting, value-based care programs, and population health analytics to attribute patient outcomes to specific providers.

The 10-digit National Provider Identifier associated with the ordering or performing provider for a laboratory test panel. Used in claims adjudication and lab information systems to attribute grouped diagnostic test orders to the correct billing or rendering provider.

The unique 10-digit National Provider Identifier assigned to a pathologist or pathology practice. Used in claims processing, laboratory billing, and anatomic pathology reporting to identify the licensed specialist interpreting tissue samples, cytology, and laboratory specimens.

An erroneous application of the NPI standard. Patients do not hold NPIs, which are assigned only to healthcare providers. This field likely captures the treating provider's NPI linked to a patient encounter and should be validated against the NPPES registry.

An erroneous application of the NPI standard. Insurance payers and health plans are not assigned NPIs, which are reserved for healthcare providers. This field may intend to capture a payer-assigned plan or organization identifier used on claims submissions and EOB transactions.

An erroneous application of the NPI standard. Financial payment transactions do not carry NPIs. This field likely represents the rendering or billing provider NPI associated with a specific reimbursement transaction recorded in claims or remittance advice data.