Recent Updates
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Service Facility NPI
Updated on: Dec 07, 2022
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Service Facility Location Information
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Signature of Physician
Updated on: Dec 07, 2022
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Balance Due
Updated on: Dec 07, 2022
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Amount Paid
Updated on: Dec 07, 2022
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Total Charge
Updated on: Dec 07, 2022
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Accept Assignment
Updated on: Dec 07, 2022
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Patient Account Number
Updated on: Dec 07, 2022
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Federal Tax I.D. Number
Updated on: Dec 07, 2022
This Federal Tax I.D. number will be placed in Box 25 of the CMS 1500 form.
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Rendering Provider NPI
Updated on: Dec 07, 2022
This Rendering Provider ID will be placed in the shaded pink portion of the charge, in box 24J of the claim.