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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICE SAH “A RESTATEMENT OF ISOLATED DEFICIENCIES WHICH CAUSEPROVIDER #NO HARM WITH ONLY A POTENTIAL FOR MINIMAL HARM FOR
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The 'name of provider or' refers to the individual or organization responsible for providing medical services or products.
Healthcare providers and organizations that deliver medical services are required to file the 'name of provider or'.
To fill out the 'name of provider or', include the full legal name of the provider or organization, address, and relevant identification numbers as per the form requirements.
The purpose of the 'name of provider or' is to clearly identify the healthcare provider or organization responsible for the services provided, ensuring accurate record-keeping and billing.
The information that must be reported includes the provider's name, address, National Provider Identifier (NPI), and any other identifiers as required by the filing entity.
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