Verification of Provider Information

The Verification of Provider Information screen displays information about the provider and service location associated with the incident. Users are able to modify the provider or service location information by clicking on the Select Provider/Location hyperlink and selecting a new provider and/or service location from the provider search pop-up window.

Note: The providers and service locations a user can select through the Select Provider/Location hyperlink will be limited based on the user's organizational scope and the individual selected (individual incidents only). For example, a user with a provider role will only be able to select service locations associated with that provider.

Field Name	Field Description
Select Provider/Location	Click the hyperlink to search for a different provider or service location if this information was recorded incorrectly in the first section.
MPI	This read-only field displays the provider's Master Provider Index (MPI) number.
Name	This read-only field displays the name of the provider associated to the MPI.
Service Location Provider Type	This read-only field displays the MPI provider type associated with the service location.
Service Location ID	This read-only field displays the provider's four-digit service location ID that corresponds to the site address of the service location.
Service Location Name	This read-only field displays the name of the provider's service location.
Phone	This read-only field displays the provider's telephone number.
Email	This read-only field displays the provider's e-mail address.
Address Line 1	This read-only field lists the address of the provider service location.
Address Line 2	This read-only field lists the address of the provider service location.
Address Line 3	This read-only field lists the address of the provider service location.
City	This read-only field displays the city corresponding to the above address.
County	This read-only field displays the county corresponding to the above address.
State	This read-only field displays the state corresponding to the above address.
Zip Code	This read-only field displays the zip code corresponding to the above address.