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Data Element
PRV097
PRV.007.097
No Updates
Definition | The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System. |
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Size | X(30) |
FLF Start Position | 22 |
FLF Stop Position | 51 |
Segment Key Field Identifier | 2 |
Coding Requirements | 1. Value must be 30 characters or less 2. Mandatory |
Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
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DE Number | System DE Number | DE Name | File Segment Number | File Segment Name |
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PRV019 | PRV.002.019 | SUBMITTING-STATE-PROV-ID | PRV00002 | PROV-ATTRIBUTES-MAIN |
PRV042 | PRV.003.042 | SUBMITTING-STATE-PROV-ID | PRV00003 | PROV-LOCATION-AND-CONTACT-INFO |
PRV063 | PRV.004.063 | SUBMITTING-STATE-PROV-ID | PRV00004 | PROV-LICENSING-INFO |
PRV075 | PRV.005.075 | SUBMITTING-STATE-PROV-ID | PRV00005 | PROV-IDENTIFIERS |
PRV087 | PRV.006.087 | SUBMITTING-STATE-PROV-ID | PRV00006 | PROV-TAXONOMY-CLASSIFICATION |
PRV109 | PRV.008.109 | SUBMITTING-STATE-PROV-ID | PRV00008 | PROV-AFFILIATED-GROUPS |
PRV118 | PRV.009.118 | SUBMITTING-STATE-PROV-ID | PRV00009 | PROV-AFFILIATED-PROGRAMS |
PRV128 | PRV.010.128 | SUBMITTING-STATE-PROV-ID | PRV00010 | PROV-BED-TYPE-INFO |