Members Area Members Home Insurance Payors Patient Satisfaction Group Purchasing Partners NTENT News – COVID-19 Claims / Issue Escalation Calendar of Events Resources & Websites NTENT Group TIN Project Board Members Q&A Physician Change Request Member Number Last Name First Name Middle Suffix Specialty Ind NPI Group NPI Group Name Legal Name EMR Tax ID 1 Tax ID 1 Primary Address City State Zip County Telephone Fax 1900-04-08 00:00:00 1900-04-09 00:00:00 1900-04-10 00:00:00 1900-01-18 00:00:00 1900-01-19 00:00:00 UPIN Medical School Degree 1900-01-23 00:00:00 1900-01-24 00:00:00 Internship Internship Speciality Internship Start Internship Finish Residency Residency School 1900-03-31 00:00:00 Residency Finish Fellowship Fellowship Specialty 1900-04-02 00:00:00 Fellowship Finish Military Service Branch Military Start Military Finish Board Status Board Start Board Expires On Call Provider 1 On Call Provider 2 On Call Provider 3 Physician Preferred Email Physician Other Email Physician Cell Phone Office Manager Office Manager Phone Office Manager Email Billing Manager Billing Manager Email Alternate Contact Alternate Email Office Hours 2nd Address 2nd City 2nd State 2nd Zip 2nd Office Phone 2nd Office Fax 2nd Office Hours 3rd Address 3rd City 3rd State 3rd Zip 3rd Phone 3rd Fax 4th Address 4th City 4th State 4th Zip 5th Address 5th City 5th State 5th Zip Billing Address Bill City Bill St Bill zip Bill Phone Bill Fax Lic# 1900-03-03 00:00:00 DEA# 1900-03-05 00:00:00 Carrier Mal # Liability Limits 1900-03-09 00:00:00 1900-03-10 00:00:00 Premiums Claims HX Hospital Affiliation 1 Hospital Affiliation 1 Status 1900-04-26 00:00:00 Hospital Affiliation 2 Hospital Affiliation 2 Status Hospital Affiliation 2 Date Hospital Affiliation 3 Hospital Affiliation 3 Status Hospital Affiliation 3 Date Hospital Affiliation 4 Hospital Affiliation 5
