npi
provider organization name
provider last name
provider first name
provider middle name
provider name prefix
provider name suffix
provider credential
provider other organization name
provider other organization name type code
provider other last name
provider other first name
provider other midedle name
provider other name prefix
provider other name suffix
provider other credential
provider last name type code
provider first line business mailing address
provider second line business mailing address
provider business mailing address city
provider business mailing address state
provider business mailing address postal code
provider business mailing address country
provider business mailing address phone
provider busines mailing address fax
provider first line business practice address
provider second line business practice address
provider business practice address city
provider business practice address postal code
provider business practice address state
provider business practice address country
provider business practice address phone
provider business practice address fax
authorized official last name
authorized official first name
authorized official middle name
authorized official title
authorized official phone
taxonomy code 1
taxonomy code 2
taxonomy code 3
taxonomy code 4
taxonomy code 5
taxonomy code 6
taxonomy code 7
taxonomy code 8
taxonomy code 9
taxonomy code 10
taxonomy code 11
taxonomy code 12
taxonomy code 13
taxonomy code 14
taxonomy code 15