Pa. Code tit. 28, pt. VI, ch. 913, subch. D, app B
Current through Register Vol. 54, No. 52, December 28, 2024
| DATA ELEMENT | DATA ELEMENT DESCRIPTION | POSITION | PICTURE | FORMAT | |
| FROM | TO | ||||
| 1 | Record Type | 1 | 9(1) | 1 = Physician Identifier record 2 = Facility Identifier record | |
| 2 | Identifier Type | 2 | 9(1) | 1 = Tax I.D. Number 2 = Medicare I.D. Number/Social Security Number 3 = Unique Number for Physician (only) | |
| 3 | Identifier Number | 3 | 20 | X(17) | Number identifying the physician or facility. Left justify. Blank fill right. |
| 4 | Physician/Facility Name | 21 | 65 | X(45) | The Name of the facility or the name of the physician. If name of the physician, place in order as follows: Last name followed by a space, first name followed by a space, middle initial. Blank fill right. |
| 5 | Physician/Facility Address | 66 | 150 | X(85) | Left justify. Blank fill right. (Include street address, city, state, zip.) |
Pa. Code tit. 28, pt. VI, ch. 913, subch. D, app B