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Segment
in
X12 Release 008010

PRV Provider Information

To specify the identifying characteristics of a provider
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1221
Provider Code
Identifier (ID)
Mandatory
1
3
1
Code identifying the type of provider
Codes (26)
02
Reference Identification Qualifier
Identifier (ID)
Conditional
2
3
1
Code identifying the Reference Identification
P0203
Codes (1904)
03
Reference Identification
String (AN)
Conditional
1
80
1
Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier
04
State or Province Code
Identifier (ID)
Optional
2
2
1
Code specifying the Standard State/Province as defined by appropriate government agency
05
Provider Specialty Information
Composite (composite)
Optional
1
01
Provider Specialty Code
String (AN)
Mandatory
1
3
-
Code indicating the primary specialty of the provider, as defined by the receiver
Codes (11)
02
Agency Qualifier Code
Identifier (ID)
Optional
2
2
-
Code identifying the agency assigning the code values
C035-02 qualifies C035-01.
Codes (206)
03
Yes/No Condition or Response Code
Identifier (ID)
Optional
1
1
-
Code indicating a Yes or No condition or response
C035-03 is the provider specialty certification indicator. A "Y" value indicates the provider is certified in the specialty indicated. An "N" value indicates the provider is not certified in the specialty indicated. A "U" value indicates that it is unknown whether the provider is certified in the specialty indicated.
Codes (9)
06
Provider Organization Code
Identifier (ID)
Optional
3
3
1
Code identifying the organizational structure of a provider
Codes (8)
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.