Segment
X12 EDI Release 00405
To specify the identifying characteristics of a provider
Elements
  • PRV011221Provider Code
    ID
    M必须(Mandatory)

    Code identifying the type of provider

    Codes (26)
  • PRV02128Reference Identification Qualifier
    ID
    O可选(Optional)

    Code qualifying the Reference Identification

    Codes (1690)
  • PRV03127Reference Identification
    AN
    O可选(Optional)
    Min 1 / Max 50

    Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier

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

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

  • PRV05C035Provider Specialty InformationO可选(Optional)
    12225591073
    • PRV05011222Provider Specialty Code
      AN
      M必须(Mandatory)
      Min 0 / Max 3

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

    • PRV0502559Agency Qualifier Code
      ID
      O可选(Optional)

      Code identifying the agency assigning the code values

      Codes (191)
    • PRV05031073Yes/No Condition or Response Code
      ID
      O可选(Optional)

      Code indicating a Yes or No condition or response

      Codes (4)
  • PRV061223Provider Organization Code
    ID
    O可选(Optional)

    Code identifying the organizational structure of a provider

    Codes (8)