CMS 1500 FORM Field 17 - Name of Referring Provider or Other Source

Field 17a - Other ID and 17b - NPI number


17a - The non-NPI ID number of the referring, ordering, or supervising provider is the unique identifier of the professional.

17b - The NPI number refers to the HIPAA National Provider Identifier number.

NUCC INSTRUCTIONS: 17a -The Other ID number of the referring, ordering, or supervising provider is reported in 17a in the shaded area. The qualifier indicating what the number represents is reported in the qualifier field to the immediate right of 17a.
The NUCC defines the following qualifiers used in 5010A1:
0B State License Number
1G Provider UPIN Number
G2 Provider Commercial Number
LU Location Number (This qualifier is used for Supervising Provider only.)
17b - Enter the NPI number of the referring, ordering, or supervising provider in Item Number 17b.

MEDICARE INSTRUCTIONS - 17a - Leave blank.

17b - Enter the NPI of the referring, ordering, or supervising physician or non-physician practitioner listed in item 17. All physicians and non-physician practitioners who order services or refer Medicare beneficiaries must report this data.
NOTE: Effective May 23, 2008, 17a is not to be reported but 17b MUST be reported when a service was ordered or referred by a physician.


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