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TMSIS Dataguide Medicaid.gov
Version 3.27.0

PROV-LEGAL-NAME

Data Element

DE Number

PRV023

System DE Number

PRV.002.023

File Name

PRV - PROVIDER

File Segment Number

PRV00002

File Segment Name

PROV-ATTRIBUTES-MAIN

Last updated

No Updates

Definition The name as it appears on the provider agreement between the state and the entity. Both persons and other entities can have a legal name.
Size X(100)
FLF Start Position 168
FLF Stop Position 267
Segment Key Field Identifier Not Applicable
Coding Requirements 1. Value must not contain a pipe or asterisk symbol
2. Value must be 100 characters or less
3. Mandatory
Valid Value Code Set Valid Value Code Valid Value Name Valid Value Description Effective Start Date Effective End Date
DE Number System DE Number DE Name File Segment Number File Segment Name