Loop 2010AA/FL 1

Table 5: Loop 2010AA/FL 1 Fields

Billing Provider Name, Street Address, City, State, ZIP, Telephone, and Fax	Source
The minimum entry is the provider name, city, state, and ZIP Code.	Provider records

Use the phone or fax numbers when reporting this FL and you must use a 9-digit ZIP Code. A Medicare edit to this FL prevents acceptance of a claim if there’s a Post Office (P.O.) Box on the address line for the billing provider. The location must be a physical address.

Note: When the Source column says you can find the information in the health care provider's records, this refers to the internal records belonging to the provider.