(a) What actions must be reported. Each Board of Medical Examiners must report to the NPDB any action based on reasons relating to a physician's or dentist's professional competence or professional conduct:

1. (1) Which revokes or suspends (or otherwise restricts) a physician's or dentist's license,
2. (2) Which censures, reprimands, or places on probation a physician or dentist, or
3. (3) Under which a physician's or dentist's license is surrendered.

(b) Information that must be reported. The Board must report the following information for each action:

1. (1) The physician's or dentist's name,
2. (2) The physician's or dentist's work address,
3. (3) The physician's or dentist's home address, if known,
4. (4) The physician's or dentist's Social Security number or Individual Tax Identification Number (ITIN), if known, and if obtained in accordance with section 7 of the Privacy Act of 1974 (5 U.S.C. 552a note),
5. (5) National Provider Identifier (NPI),
6. (6) The physician's or dentist's date of birth,
7. (7) Name of each professional school attended by the physician or dentist and year of graduation,
8. (8) For each professional license, the physician's or dentist's license number, the field of licensure and the name of the state or territory in which the license is held,
9. (9) The physician's or dentist's Drug Enforcement Administration registration number, if known,
10. (10) A description of the acts or omissions or other reasons for the action taken,
11. (11) A description of the Board action, the date the action was taken, its effective date and duration,
12. (12) Classification of the action in accordance with a reporting code adopted by the Secretary, and
13. (13) Other information as required by the Secretary from time to time after publication in the Federal Register and after an opportunity for public comment.