Other; any type of entity not 0 otherwise defined that performs health care services. Report the SSN of the individual Required Provider's Social provider in PV002. Do not zero-fill. PV 35 SSN Id 11/8/12 Numeric ID Tax char[9] when 98% A1 Security Number Do not report any value here if not PV034 = 1 available or not applicable. Report the Medicare ID (OSCAR, Required Provider's Medicare Certification, Other, Unspecified, when Medicare PV 36 6/24/10 Text ID Medicare Number, other than NSC or PIN) of the provider or entity PV034 = 0, 90% B ID UPIN in PV002. Do not report UPIN here, 1, 2, 3, 4, see PV004. or 5 Report the date the provider or facility becomes eligible / contracted Century Year to perform services for plan Full Date PV 37 Begin Date 11/8/12 Month Day - int[8] Provider Start Date members in CCYYMMDD Format. All 98% A2 - Integer CCYYMMDD Do not report any value here for providers that do not render services. Report the Date the provider or facility is no longer eligible to perform services for plan members / insureds Century Year in CCYYMMDD Format. Do not Full Date PV 38 End Date Day - int[8] Provider End Date report any value here for providers All 98% B - Integer CCYYMMDD that are still actively eligible to provide services, or Providers who do not render services (i.e., Parent Organizations). External External Code Required National Provider Report the NPI of the Provider / National Code Source 3 - when PV 39 int[10] Identification (NPI) Clinician / Facility / Organization 98% A Provider ID Source 3 National Provider = 0, 1, 2, 3, of the Provider defined in this record. - Integer ID 4, or 5 Required External External Code National National Provider Report the Secondary or Other NPI when Code Source 3 - PV 40 Provider ID int[10] Identification (NPI) of the Provider / Clinician / Facility / PV034 = 0, 1% B Source 3 National Provider 2 of the Provider Organization defined in this record. 1, 2, 3, 4, - Integer ID or 5
0 Other; any type of entity not otherwise defined that performs health care services. PV 35 SSN Id 11/8/12 Numeric ID Tax char[9] Provider's Social Security Number Report the SSN of the individual provider in PV002. Do not zero-fill. Do not report any value here if not available or not applicable. Required when PV034 = 1 98% A1 PV 36 Medicare ID 6/24/10 Text ID Medicare Provider's Medicare Number, other than UPIN Report the Medicare ID (OSCAR, Certification, Other, Unspecified, NSC or PIN) of the provider or entity in PV002. Do not report UPIN here, see PV004. Required when PV034 = 0, 1, 2, 3, 4, or 5 90% B PV 37 Begin Date 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Provider Start Date Report the date the provider or facility becomes eligible / contracted to perform services for plan members in CCYYMMDD Format. Do not report any value here for providers that do not render services. All 98% A2 PV 38 End Date Full Date - Integer Century Year Day - CCYYMMDD int[8] Provider End Date Report the Date the provider or facility is no longer eligible to perform services for plan members / insureds in CCYYMMDD Format. Do not report any value here for providers that are still actively eligible to provide services, or Providers who do not render services (i.e., Parent Organizations). All 98% B PV 39 National Provider ID External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Provider Report the NPI of the Provider / Clinician / Facility / Organization defined in this record. Required when = 0, 1, 2, 3, 4, or 5 98% A PV 40 National Provider ID 2 External Code Source 3 - Integer External Code Source 3 - National Provider ID int[10] National Provider Identification (NPI) of the Provider Report the Secondary or Other NPI of the Provider / Clinician / Facility / Organization defined in this record. Required when PV034 = 0, 1, 2, 3, 4, or 5 1% B
apcd-provider-file-submission-guide.docx