Npi Provider Data Fax Form Unitedn Healthcare Page 2
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3designate this with a “T” in the “Basis for
NPI” Column. Place the Tax ID in the “Level
Information” column and indicate whether
the Tax ID is a social security number or if it
is an employer identification number.
X = Taxonomy
NUCC Taxonomy Code
If the organization or sub-part was
enumerated by a NUCC Taxonomy code,
please provide the Taxonomy Code that the
NPI was based on and designate this with
an “X” in the “Basis for NPI” column. Place
the NUCC Taxonomy Code in the “Level
Information” column.
O= Other
Specify details for selecting ‘Other’
Provide any other basis for NPI in the “Basis
for NPI” column and designate as “O”, with
a description of the basis for that NPI in the
“Level Information” column.
This is intended for use by physicians and
M = Name
Provider Name
allied health professionals (people
providers). Insert the name in the “Level
Information” column.
NPI Collection Grid
In the grid below please insert your Organization or Sub-Part Name, NPI, and Taxonomy Code(s) associated with that NPI.
Please indicate the basis for that particular NPI with the appropriate letter from the grid above in the “Basis for NPI” column. Indicate the
appropriate 'Level Information'. If the number of NPI's exceeds this sheet, please instead access a formatted spreadsheet (NPI Tracking
Template) on to list your NPIs. It is found in the "UnitedHealthcare News" section.
NPI Number Organization / Sub-Part
Taxonomy Code
Basis
Level
NPI Issue
Name
(codes associated
For NPI
Information
Date
with each
MM/DD/YYYY
individual NPI)
Pg. 2
7/24/2008
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