CMS-1500 Form Item 33: Billing Provider Information and Requirements
Last update :
Billing Provider Info & Ph.#
Enter the billing provider’s name, address, and telephone number Do not use slashes, hyphens, or spaces. Note: If services are rendered in the patient’s home or facility, enter the service location of the provider’s main office.
Enter the 10-digit NPI number of the billing provider.
Enter the 13-digit Group/Billing Provider ID number (Legacy #)
Item 33 - Enter the provider of service/supplier's billing name, address, ZIP Code, and telephone number. This is a required field. Item
33a Form CMS-1500 (08-05) - Effective May 23, 2007, and later, you MUST enter the NPI of the billing provider or group. The NPI may be reported on the Form CMS-1500 (08-05) as early as January 1, 2007. This is a required field. Item
33b Form CMS-1500 (08-05) - Enter the ID qualifier 1C followed by one blank space and then the PIN of the billing provider or group. Effective May 23, 2007, and later, 33b is not to be reported. Suppliers billing the DME MAC will use the National Supplier Clearinghouse (NSC) number in this item.