Segment
X12 EDI Release 00305
To specify the identifying characteristics of a provider
Elements
  • PRV011221Provider Code
    ID
    M必须(Mandatory)

    Code indentifying the type of provider

    Codes (25)
  • PRV02128Reference Number Qualifier
    ID
    M必须(Mandatory)

    Code qualifying the Reference Number.

    Codes (1082)
  • PRV03127Reference Number
    AN
    M必须(Mandatory)
    Min 1 / Max 30

    Reference number or identification number as defined for a particular Transaction Set, or as specified by the Reference Number Qualifier.

  • PRV04156State or Province Code
    ID
    O可选(Optional)
    Min 2 / Max 2

    Code (Standard State/Province) as defined by appropriate government agency.

  • PRV05559Agency Qualifier Code
    ID
    O可选(Optional)

    Code identifying the agency assigning the code values.

    Codes (93)
  • PRV061222Provider Specialty Code
    AN
    O可选(Optional)
    Min 1 / Max 3

    Code indicating the primary specialty of the provider, as defined by the receiver

  • PRV071223Provider Organization Code
    ID
    O可选(Optional)

    Code identifying the organizational structure of a provider

    Codes (8)