201012 DMIS ID Table Change Report
Army
Authorized Branch of
Facility Facility Facility Facility Facility 5- Facility 4- Health US DMIS Service Facility TRICARE Service/
DMIS Service Type Country State Digit ZIP Digit ZIP Service Flag Parent MEPRS Area Command Enrollment DHP Authority NPI 2 NPI 2 HIPAA
ID DCW ID MEPRS Unit ID Code Code DMIS Facility Name Facility Name Installation Name Code Code Facility City Name Code Code Region Code ID Parent ID Code Code Site (Y/N) Code Code Required NPI 2 Number Taxonomy
TO 0273 130O W3QM10 A CLINIC *LAWRENCE JOEL TMC-FT MCPHERSON *LAWRENCE JOEL TMC-FT MCPHERSON FT. MCPHERSON US GA ATLANTA 30330 18 Y 0047 0047 SRMC Y Y A Y 1861609513 261QM1100X
FROM 0273 130O W3QM10 A CLINIC *AHC FT. MCPHERSON *AHC FT. MCPHERSON FT. MCPHERSON US GA ATLANTA 30330 18 Y 0047 0047 SRMC Y Y A Y 1861609513 261QM1100X
TO 1519 123P W1MLAA A *INACT USA OCCUP HLTH CLIN-GOODFELLOW USA OCCUP HLTH CLIN-GOODFELLOW ST. LOUIS US MO ST. LOUIS 63120 17 Y 0075 0075 WRMC N Y *I Y 1114133923 261QM1100X
FROM 1519 123P W1MLAA A *CLINIC USA OCCUP HLTH CLIN-GOODFELLOW USA OCCUP HLTH CLIN-GOODFELLOW ST. LOUIS US MO ST. LOUIS 63120 17 Y 0075 0075 WRMC N Y *A Y 1114133923 261QM1100X
TO 6078 W2M5AA A CLINIC INTENSV OUTPT DAY TMT CLN-HOOD INTENSIVE OUTPNT DAY TREATMENT CLNC (IOP) FT. HOOD US TX FORT HOOD 76544 4752 18 Y 0110 0110 SRMC N Y A Y *1619287737 *261QM1100X
FROM 6078 W2M5AA A CLINIC INTENSV OUTPT DAY TMT CLN-HOOD INTENSIVE OUTPNT DAY TREATMENT CLNC (IOP) FT. HOOD US TX FORT HOOD 76544 4752 18 Y 0110 0110 SRMC N Y A Y * *
NEW 2004 A HOSP CARL VINSON VA MEDICAL CENTER CARL VINSON VA MEDICAL CENTER CARL VINSON VA MEDICAL CENTER US GA DUBLIN 31021 18 Y 0047 0047 SRMC N N B
Note: Asterisks indicate cells that were changed. Records for new DMIS IDs are listed at the end of this report. 1
12/10/2011
201012 DMIS ID Table Change Report
Navy
Authorized Branch of
Facility Facility Facility Facility Facility 5- Facility 4- Health US DMIS Service Facility TRICARE Service/
DMIS Service Type Country State Digit ZIP Digit ZIP Service Flag Parent MEPRS Area Command Enrollment DHP Authority NPI 2 NPI 2 HIPAA
ID DCW ID MEPRS Unit ID Code Code DMIS Facility Name Facility Name Installation Name Code Code Facility City Name Code Code Region Code ID Parent ID Code Code Site (Y/N) Code Code Required NPI 2 Number Taxonomy
No Changes
Note: Asterisks indicate cells that were changed. Records for new DMIS IDs are listed at the end of this report. 2
12/10/2011
201012 DMIS ID Table Change Report
Air Force
Authorized Branch of
Facility Facility Facility Facility Facility 5- Facility 4- Health US Service Facility TRICARE Service/
DMIS Service Type Country State Digit ZIP Digit ZIP Service Flag DMIS MEPRS Area Command Enrollment DHP Authority NPI 2 NPI 2 HIPAA
ID DCW ID MEPRS Unit ID Code Code DMIS Facility Name Facility Name Installation Name Code Code Facility City Name Code Code Region Code Parent ID Parent ID Code Code Site (Y/N) Code Code Required NPI 2 Number Taxonomy
TO 0120 5151 FFD5Z0 F HOSP *633rd MED GRP LANGLEY-EUSTIS *633rd MEDICAL GROUP *JOINT BASE LANGLEY-EUSTIS US VA HAMPTON 23665 17 Y 0120 0120 6011 ACC Y Y F Y 1609859891 2865M2000X
FROM 0120 5151 FFD5Z0 F HOSP *1st MED GRP-LANGLEY *1st MEDICAL GROUP *LANGLEY AFB US VA HAMPTON 23665 17 Y 0120 0120 6011 ACC Y Y F Y 1609859891 2865M2000X
TO 1783 F DENTAL *633 DENTAL SQ/SGD LANGLEY-EUST *633 DENTAL SQ/SGD *JOINT BASE LANGLEY-EUSTIS US VA HAMPTON 23665 17 Y 0120 0120 ACC N Y F
FROM 1783 F DENTAL *1 DENTAL SQ/SGD-LANGLEY *1 DENTAL SQ/SGD *LANGLEY AFB US VA HAMPTON 23665 17 Y 0120 0120 ACC N Y F
TO 7056 5152 F CLINIC *633rd ATH-JB LANGLEY-EUSTIS *633rd AIR TRANSPORTABLE HOSPITAL *JOINT BASE LANGLEY-EUSTIS US VA HAMPTON 23665 17 Y 0120 ACC N Y F
FROM 7056 5152 F CLINIC *1st ATH-LANGLEY *1st AIR TRANSPORTABLE HOSPITAL *LANGLEY AFB US VA HAMPTON 23665 17 Y 0120 ACC N Y F
Note: Asterisks indicate cells that were changed. Records for new DMIS IDs are listed at the end of this report. 3
12/10/2011
201012 DMIS ID Table Change Report
Other
Authorized Branch of
Facility Facility Facility Facility 5- Facility 4- Health US Service Facility TRICARE Service/
DMIS DCW MEPRS Service Facility Country State Digit ZIP Digit ZIP Service Flag DMIS MEPRS Area Command Enrollment DHP Authority NPI 2 NPI 2 HIPAA
ID ID Unit ID Code Type Code DMIS Facility Name Facility Name Installation Name Code Code Facility City Name Code Code Region Code Parent ID Parent ID Code Code Site (Y/N) Code Code Required NPI 2 Number Taxonomy
No Changes
Note: Asterisks indicate cells that were changed. Records for new DMIS IDs are listed at the end of this report. 4
12/10/2011