1649263294 JOHN I BARON HAS413 NPI

User Manual: HAS413

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1649263294
JOHN I BARON
National Provider Identifiers Registry
The Administrative Simplification provisions of the Health Insurance Portability
and Accountability Act of 1996 (HIPAA) mandated the adoption of standard
unique identifiers for health care providers and health plans. The purpose of these
provisions is to improve the efficiency and effectiveness of the electronic
transmission of health information. The Centers for Medicare & Medicaid Services
(CMS) has developed the National Plan and Provider Enumeration System
(NPPES) to assign these unique identifiers.
2018
1649263294 JOHN I BARON
NPI 1649263294 10-position all-numeric identification number
assigned by the NPS to uniquely identify a health
care provider.
Entity Type Individual Code describing the type of health care provider that
is being assigned an NPI. Codes are:
<ul>
<li>1 = (Person): individual human being who
furnishes health care;</li>
<li>2 = (Non-person): entity other than an
individual human being that furnishes health care
(for example, hospital, SNF, hospital subunit,
pharmacy, or HMO).</li>
</ul>
Is Sole Proprietor N Indicate whether provider is a sole proprietor.
<ul>
<li>A sole proprietor is the sole (the only) owner
of a business that is not incorporated; that
unincorporated business is a sole
proprietorship.</li>
<li>In a sole proprietorship, the sole proprietor
owns all of the assets of the business and is solely
liable for all of the debts of the business.</li>
<li>There is no difference between a sole
proprietorship and a sole proprietor; they are legally
a single entity: an individual.</li>
<li>In terms of NPI assignment, a sole proprietor
is an Entity type 1 (Individual) and is eligible for only
one NPI (the sole proprietorship business is not
eligible for its own NPI).</li>
<li>As an individual, a sole proprietorship cannot
be a subpart and cannot have subparts. (See NPI
Final Rule for information about subparts.)</li>
<li>A sole proprietorship may or may not have
employees.</li>
<li>Often, the IRS assigns an EIN to a sole
proprietorship in order to protect the sole
proprietor's SSN from disclosure in claims or on W-
2s. NPPES does not capture a sole proprietorship's
EIN.</li>
<li>Many types of health care providers could be
sole proprietorships (for example, group practices,
pharmacies, home health agencies).</li>
</ul>
Provider Last Name
(Legal Name)
BARON The last name of the provider (if an individual). If the
provider is an individual, this is the legal name. This
name must match the name on file with the Social
Security Administration (SSA). In addition, the date
of birth must match that on file with SSA. (First and
last names are required for initial applications.) The
First, Middle, Last and Credential(s) fields allow the
following special characters: ampersand,
apostrophe, colon, comma, forward slash, hyphen,
left and right parentheses, period, pound sign,
quotation mark, and semi-colon. A field cannot
contain all special characters.
Provider First Name JOHN The first name of the provider, if the provider is an
individual.
National Provider Identifiers Registry www.hipaaspace.com
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Provider Middle Name I The middle name of the provider, if the provider is
an individual.
Provider Credential
Text
MD The abbreviations for professional degrees or
credentials used or held by the provider, if the
provider is an individual. Examples are MD, DDS,
CSW, CNA, AA, NP, RNA, or PSY. These credential
designations will not be verified by NPS.
Provider First Line
Business Mailing
Address
19 WOODLAND ST The first line mailing address of the provider being
identified. This data element may contain the same
information as ''Provider first line location address''.
Provider Second Line
Business Mailing
Address
STE 47 The second line mailing address of the provider
being identified. This data element may contain the
same information as ''Provider second line location
address''.
Provider Business
Mailing Address City
Name
HARTFORD The City name in the mailing address of the provider
being identified. This data element may contain the
same information as ''Provider location address City
name''.
Provider Business
Mailing Address State
Name
CT The State or Province name in the mailing address
of the provider being identified. This data element
may contain the same information as ''Provider
location address State name''.
Provider Business
Mailing Address
Postal Code
06105-2372 The postal ZIP or zone code in the mailing address
of the provider being identified. NOTE: ZIP code
plus 4-digit extension, if available. This data element
may contain the same information as ''Provider
location address postal code''.
Provider Business
Mailing Address
Country Code
US The country code in the mailing address of the
provider being identified. This data element may
contain the same information as ''Provider location
address country code''.
Provider Business
Mailing Address
Telephone Number
860-525-4005 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 First Line
Business Practice
Location Address
7 ELM ST The first line location address of the provider being
identified. For providers with more than one physical
location, this is the primary location. This address
cannot include a Post Office box.
Provider Second Line
Business Practice
Location Address
STE 201 The second line location address of the provider
being identified. 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 City Name
ENFIELD The city name in the location address of the provider
being identified.
Provider Business
Practice Location
Address State Name
CT The State or Province name in the location address
of the provider being identified.
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Provider Business
Practice Location
Address Postal Code
06082-3669 The postal ZIP or zone code in the location address
of the provider being identified. NOTE: ZIP code
plus 4-digit extension, if available.
Provider Business
Practice Location
Address Country Code
US The country code in the location address of the
provider being identified.
Provider Business
Practice Location
Address Telephone
Number
860-741-6678 The telephone number associated with the location
address of the provider being identified.
Provider Business
Practice Location
Address Fax Number
860-741-6272 The fax number associated with the location
address of the provider being identified.
Provider Enumeration
Date
08/30/2005 The date the provider was assigned a unique
identifier (assigned an NPI).
Last Update Date 08/18/2009 The date that a record was last updated or changed.
Provider Gender Code M The code designating the provider's gender if the
provider is a person.
Provider Gender Male The provider's gender if the provider is a person.
Healthcare Provider
Taxonomy Code #1
207RC0000X The Health Care Provider Taxonomy code is a
unique alphanumeric code, ten characters in length.
The code set is structured into three distinct "Levels"
including Provider Type, Classification, and Area of
Specialization.
Healthcare Provider
Taxonomy 1
Cardiovascular Disease Healthcare Provider Taxonomy #1
Provider License
Number 1
030174 Certain taxonomy selections will require you to enter
your license number and the state where the license
was issued. 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. A field cannot
contain all special characters. DO NOT report the
Social Security Number (SSN), IRS Individual
Taxpayer Identification Number (ITIN) in this
section.
Provider License
Number State Code 1
CT Provider License Number State Code #1
Healthcare Provider
Primary Taxonomy
Switch 1
Y Primary Taxonomy:
<ul>
<li>X - The primary taxonomy switch is Not
Answered;</li>
<li>Y - The taxonomy is the primary taxonomy
(there can be only one per NPI record);</li>
<li>N - The taxonomy is not the primary
taxonomy.</li>
</ul>
National Provider Identifiers Registry www.hipaaspace.com
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Other Provider
Identifier 1
2083602 Other Provider Identifier #1
Other Provider
Identifier Type 1
OTHER Other Provider Identifier Type #1
Other Provider
Identifier Issuer 1
AETNA Other Provider Identifier Issuer #1
Other Provider
Identifier 2
628620 Other Provider Identifier #2
Other Provider
Identifier Type 2
OTHER Other Provider Identifier Type #2
Other Provider
Identifier State 2
CT Other Provider Identifier State #2
Other Provider
Identifier Issuer 2
CONNECTICARE Other Provider Identifier Issuer #2
Other Provider
Identifier 3
OV3354 Other Provider Identifier #3
Other Provider
Identifier Type 3
OTHER Other Provider Identifier Type #3
Other Provider
Identifier State 3
CT Other Provider Identifier State #3
Other Provider
Identifier Issuer 3
HEALTH NET Other Provider Identifier Issuer #3
Other Provider
Identifier 4
001301746 Other Provider Identifier #4
Other Provider
Identifier Type 4
MEDICAID Other Provider Identifier Type #4
Other Provider
Identifier State 4
CT Other Provider Identifier State #4
Other Provider
Identifier 5
00130174601 Other Provider Identifier #5
Other Provider
Identifier Type 5
OTHER Other Provider Identifier Type #5
Other Provider
Identifier Issuer 5
ANTHEM BCBS Other Provider Identifier Issuer #5
Other Provider
Identifier 6
010030174CT02 Other Provider Identifier #6
Other Provider
Identifier Type 6
OTHER Other Provider Identifier Type #6
Other Provider
Identifier Issuer 6
ANTHEM BCBS Other Provider Identifier Issuer #6
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Other Provider
Identifier 7
060052426 Other Provider Identifier #7
Other Provider
Identifier Type 7
OTHER Other Provider Identifier Type #7
Other Provider
Identifier Issuer 7
RAILROAD MEDICARE Other Provider Identifier Issuer #7
Other Provider
Identifier 8
0005252065 Other Provider Identifier #8
Other Provider
Identifier Type 8
OTHER Other Provider Identifier Type #8
Other Provider
Identifier Issuer 8
AETNA Other Provider Identifier Issuer #8
Other Provider
Identifier 9
010030174CT03 Other Provider Identifier #9
Other Provider
Identifier Type 9
OTHER Other Provider Identifier Type #9
Other Provider
Identifier Issuer 9
ANTHEM BCBS Other Provider Identifier Issuer #9
Other Provider
Identifier 10
HAS413 Other Provider Identifier #10
Other Provider
Identifier Type 10
OTHER Other Provider Identifier Type #10
Other Provider
Identifier State 10
CT Other Provider Identifier State #10
Other Provider
Identifier Issuer 10
OXFORD Other Provider Identifier Issuer #10
National Provider Identifiers Registry www.hipaaspace.com
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NPPES National Plan & Enumeration System
1-800-465-3203 (NPI Toll-Free)
1-800-692-2326 (NPI TTY)
NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059
Email: customerservice@npienumerator.com
National Provider Identifiers Registry www.hipaaspace.com
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For all questions regarding this bundle please
contact Support@HIPAASpace.com. Also
feel free to let us know about any suggestions
or concerns. All additional information as
well as customer support is available at
http://www.HIPAASpace.com.
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