The report will provide the following information: (1) With respect to the physician, dentist, or other licensed health care practitioner for whose benefit the payment is made??? (i) Name; (ii) Work address; (iii) Home address, if known; (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act of 1974; (v) Date of birth; (vi) Name of each professional