Report the Provider Entity Name Required when Provider ID does not 1 when Entity Name Provider (person). . This should only be PV 12 11/8/12 Text / Facility name PV034 = 2, 98% A1 Name Entity populated for facilities or groups. 3, 4, 5, 6, Limited punctuation may be 7, or 0 included. Required Lookup Report the value that defines the when PV 13 Entity Code 11/8/12 Table - tlkpEntityCode char[2] Provider entity code entity provider type. EXAMPLE: 12 98% A0 does not = Text = Acute Hospital 1 Value Description 01 Academic Institution 02 Foster Care 03 Ambulance Services 04 Hospital Based Clinic Stand-Alone, Walk-In/Urgent Care 05 Clinic 06 Other Clinic 07 Community Health Center - General Community Health Center - Urgent 08 Care 09 Government Agency 10 Health Care Corporation 11 Home Health Agency 12 Acute Hospital 13 Chronic Hospital 14 Rehabilitation Hospital 15 Psychiatric Hospital 16 DPH Hospital 17 State Hospital 18 Veterans Hospital
PV 12 Entity Name 11/8/12 Text Name Provider Entity / Facility name Report the Provider Entity Name when Provider ID does not 1 (person). . This should only be populated for facilities or groups. Limited punctuation may be included. Required when PV034 = 2, 3, 4, 5, 6, 7, or 0 98% A1 PV 13 Entity Code 11/8/12 Lookup Table - Text tlkpEntityCode char[2] Provider entity code Report the value that defines the entity provider type. EXAMPLE: 12 = Acute Hospital Required when does not = 1 98% A0 Value Description 01 Academic Institution 02 Foster Care 03 Ambulance Services 04 Hospital Based Clinic 05 Stand-Alone, Walk-In/Urgent Care Clinic 06 Other Clinic 07 Community Health Center - General 08 Community Health Center - Urgent Care 09 Government Agency 10 Health Care Corporation 11 Home Health Agency 12 Acute Hospital 13 Chronic Hospital 14 Rehabilitation Hospital 15 Psychiatric Hospital 16 DPH Hospital 17 State Hospital 18 Veterans Hospital
apcd-provider-file-submission-guide.docx