393-393 License Type 3 1 State, county, or municipality 1 Numeric O professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 394-394 Delimiter Use the ^ character value 1 Character R 395-414 License Or A data element to capture the 20 Character O license or accreditation number 3 issued to the provider by the licensing entity or accreditation body. 415-415 Delimiter Use the ^ character value 1 Character R 416-475 License issuing A free text field to capture the 60 Character O ID 3 identity of the entity issuing the license or accreditation. 476-476 Delimiter Use the ^ character value 1 Character R 477-484 License The beginning effective date of 8 Date O effective date 3 the license 485-485 Delimiter Use the ^ character value 1 Character R 486-493 License End The last date the license was 8 Date O date 3 active. (20991231 for open and unknown) 494-494 Delimiter Use the ^ character value 1 Character R 495-495 License Type 4 1 State, county, or municipality 1 Numeric O professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 496-496 Delimiter Use the ^ character value 1 Character R 497-516 License Or A data element to capture the 20 Character O license or accreditation number 4 issued to the provider by the licensing entity or accreditation body. 517-517 Delimiter Use the ^ character value 1 Character R 518-577 License issuing A free text field to capture the 60 Character O ID 4 identity of the entity issuing the license or accreditation.
393-393 License Type 3 1 State, county, or municipality professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 1 Numeric O 394-394 Delimiter Use the ^ character value 1 Character R 395-414 License Or 3 A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body. 20 Character O 415-415 Delimiter Use the ^ character value 1 Character R 416-475 License issuing ID 3 A free text field to capture the identity of the entity issuing the license or accreditation. 60 Character O 476-476 Delimiter Use the ^ character value 1 Character R 477-484 License effective date 3 The beginning effective date of the license 8 Date O 485-485 Delimiter Use the ^ character value 1 Character R 486-493 License End date 3 The last date the license was active. (20991231 for open and unknown) 8 Date O 494-494 Delimiter Use the ^ character value 1 Character R 495-495 License Type 4 1 State, county, or municipality professional or business license 2 DEA license 3 Professional society accreditation 4 CLIA accreditation 5 Other Blank (Space filled) if no additional license or accreditation 1 Numeric O 496-496 Delimiter Use the ^ character value 1 Character R 497-516 License Or 4 A data element to capture the license or accreditation number issued to the provider by the licensing entity or accreditation body. 20 Character O 517-517 Delimiter Use the ^ character value 1 Character R 518-577 License issuing ID 4 A free text field to capture the identity of the entity issuing the license or accreditation. 60 Character O