Provider Information

The Provider Information screen within the incident first section displays information about the provider and the provider service location pertaining to the incident.


Notes:

  • The first time a user accesses this screen they will see a Provider Search which allows the user to search for a provider and provider service locations/sites that they have access to based on their organizational scope and that have a relationship to the individual that the incident is being filed for (individual incidents only). Providers will only need to select a service location, as other parameters will be defaulted.
    • Once a provider or a site/location has been chosen, its information will appear in read-only mode on the Provider Information screen.
    • If the user would like to select a different provider or provider service location/site, they may do so by clicking the Select Provider/Location hyperlink.

Field Name

Field Description

Select Provider/Location

 Click the Select Provider/Location hyperlink to reopen the Provider Search to select a new provider and/or service location.

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 where the service is offered.

Service Location Name:

 This read-only field displays the Service Location Name for the selected provider.

Phone:

 This read-only field displays the provider's phone 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 additional address information of the provider service location.

Address Line 3:

 This read-only field lists the additional address information 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.