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TMSIS Dataguide Medicaid.gov
Version 3.36.0

PROV-ATTRIBUTES-MAIN

File Segment

File Segment Number

PRV00002

File Name

PRV - PROVIDER

Last updated

No Updates

Data Elements Reference
DE Number System DE Number Data Element Definition Valid Values
PRV016 PRV.002.016 RECORD-ID The Record ID represents the type of segment being reported. The Record ID communicates how the contents of a given row of data should be interpreted depending on which segment type the Record ID represents. Each type of segment collects different data elements so each segment type has a distinct layout. The first 3 characters identify the relevant file (e.g., ELG, PRV, CIP, etc.). The last 5 digits are the segment identifier padded with leading zeros (e.g., 00001, 00002, 00003, etc.). PRV016 Values
PRV017 PRV.002.017 SUBMITTING-STATE A code that uniquely identifies the U.S. State or Territory from which T-MSIS system data resources were received. PRV017 Values
PRV018 PRV.002.018 RECORD-NUMBER A sequential number assigned by the submitter to identify each record segment row in the submission file. The Record Number, in conjunction with the Record Identifier, uniquely identifies a single record within the submission file. N/A
PRV019 PRV.002.019 SUBMITTING-STATE-PROV-ID 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. N/A
PRV020 PRV.002.020 PROV-ATTRIBUTES-EFF-DATE The first calendar day on which all of the other data elements in the same segment were effective. N/A
PRV021 PRV.002.021 PROV-ATTRIBUTES-END-DATE The last calendar day on which all of the other data elements in the same segment were effective. N/A
PRV022 PRV.002.022 PROV-DOING-BUSINESS-AS-NAME The provider's name that is commonly used by the public when the "doing-business-as" name is different than the legal name. DBA is an abbreviation for "doing business as." Registering a DBA is required to operate a business under a name that differs from the company's legal name. If DBA name is the same as the legal name, do not populate DBA name. N/A
PRV023 PRV.002.023 PROV-LEGAL-NAME 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. N/A
PRV024 PRV.002.024 PROV-ORGANIZATION-NAME The name of the provider when the provider is an organization. If the provider organization name exceeds 60 characters submit only the first 60 characters of the name. Provider Organization Name should be same as provider last name when provider is an individual. N/A
PRV025 PRV.002.025 PROV-TAX-NAME The name that the provider entity uses on IRS filings. N/A
PRV026 PRV.002.026 FACILITY-GROUP-INDIVIDUAL-CODE A code to identify whether the Submitting State Provider Identifier is assigned to an individual, group, or a facility. PRV026 Values
PRV027 PRV.002.027 TEACHING-IND A code indicating if the provider's organization is a teaching facility. PRV027 Values
PRV028 PRV.002.028 PROV-FIRST-NAME Individual's first name; first name component of full name (e.g. First Name, Middle Initial, Last Name). N/A
PRV029 PRV.002.029 PROV-MIDDLE-INITIAL Individual's middle initial; middle initial component of full name (e.g. First Name, Middle Initial, Last Name). N/A
PRV030 PRV.002.030 PROV-LAST-NAME Individual's last name; last name component of full name (e.g. First Name, Middle Initial, Last Name). N/A
PRV031 PRV.002.031 SEX The individual's biological sex assigned at birth. PRV031 Values
PRV032 PRV.002.032 OWNERSHIP-CODE A code denoting the ownership interest and/or managing control information. The valid values list is a Medicare standard list. PRV032 Values
PRV033 PRV.002.033 PROV-PROFIT-STATUS A code denoting the profit status of the provider. PRV033 Values
PRV034 PRV.002.034 DATE-OF-BIRTH An individual's date of birth. N/A
PRV035 PRV.002.035 DATE-OF-DEATH The date an individual died on. N/A
PRV036 PRV.002.036 ACCEPTING-NEW-PATIENTS-IND An indicator to identify providers who are accepting new patients. PRV036 Values
PRV037 PRV.002.037 STATE-NOTATION A free text field for the submitting state to enter whatever information it chooses. N/A
Definition
A record to capture basic, generally static information about each provider. A provider is an individual person (medical or non-medical), a group of individuals, or an organization (e.g. institution, facility, agency, hospital, nursing facility, home health agency, school, or transportation organization) that delivers or facilitates health-related treatments, health care services, or living supports.

File Segment Length
1100