4 Other 5 Not Applicable Report the Provider ID for any affiliation the provider has with Provider Provider Affiliation another entity or parent company. If PV 56 6/24/10 Text ID Link to PV002 All 99% B Affiliation Code the provider is associated only with self, record the same value here as PV002. Report the telephone number of the Telephone number provider associated with the Provider associated with the PV 57 6/24/10 Numeric Telephone identification in PV002. Do not All 10% C Telephone provider identified in separate components with hyphens, spaces or other special characters. Delegated Report the value that defines the Lookup Provider Indicator - Delegated element. EXAMPLE: 1 = Yes, PV 58 11/8/12 Table - int[1] All 100% A2 Record Record provider record was sourced from Integer Flag the delegated provider’s system. Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable The APCD reserves this element for PV 59 Filler 11/8/12 Filler Filler char[0] Filler future use. Do not populate with any All 0% Z data. Required Lookup Report the value that defines the when PV 60 Office Type 11/8/12 Table - tlkpOfficeType int[1] Office Type Code provider's service setting. PV034 = 0, 98% A0 Integer EXAMPLE: 1 = Facility 1, 2, 3, 4, or 5 Code Description 1 Facility 2 Doctors office
4 Other 5 Not Applicable PV 56 Provider Affiliation 6/24/10 Text ID Link to PV002 Provider Affiliation Code Report the Provider ID for any affiliation the provider has with another entity or parent company. If the provider is associated only with self, record the same value here as PV002. All 99% B PV 57 Provider Telephone 6/24/10 Numeric Telephone Telephone number associated with the provider identified in Report the telephone number of the provider associated with the identification in PV002. Do not separate components with hyphens, spaces or other special characters. All 10% C PV 58 Delegated Provider Record Flag 11/8/12 Lookup Table - Integer int[1] Indicator - Delegated Record Report the value that defines the element. EXAMPLE: 1 = Yes, provider record was sourced from the delegated provider’s system. All 100% A2 Value Description 1 Yes 2 No 3 Unknown 4 5 Not Applicable PV 59 Filler 11/8/12 Filler Filler char[0] Filler The APCD reserves this element for future use. Do not populate with any data. All 0% Z PV 60 Office Type 11/8/12 Lookup Table - Integer tlkpOfficeType int[1] Office Type Code Report the value that defines the provider's service setting. EXAMPLE: 1 = Facility Required when PV034 = 0, 1, 2, 3, 4, or 5 98% A0 Code Description 1 Facility 2 Doctors office
apcd-provider-file-submission-guide.docx