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Dental Service Providers File Submission

Maine

Versions: 2010-03-16• v1.2Compare Versions


Name:Dental Service Providers File Submission
State:Maine
Definition:Not Provided
Version2010-03-16

File Specification for Dental Service Providers File Submission

Data Element ID Data Element Description Type Format Length
Multiple versionsDCSP001 Provider ID# Provider ID# integer
Multiple versionsDCSP002 Payer Payer varchar 6
Multiple versionsDCSP003 Service Provider Number Service Provider Number varchar 30
Multiple versionsDCSP004 Service Provider Tax ID Number Service Provider Tax ID Number varchar 10
Multiple versionsDCSP005 Service Provider Entity Type Qualifier Service Provider Entity Type Qualifier varchar 1
Multiple versionsDCSP006 Service Provider First Name Service Provider First Name varchar 25
Multiple versionsDCSP007 Service Provider Middle Name Service Provider Middle Name varchar 25
Multiple versionsDCSP008 Service Provider Last Name or Organization Name Service Provider Last Name or Organization Name varchar 60
Multiple versionsDCSP009 Service Provider Suffix Service Provider Suffix varchar 10
Multiple versionsDCSP010 Service Provider Specialty Service Provider Specialty varchar 10
Multiple versionsDCSP011 Service Provider City Name Service Provider City Name varchar 30
Multiple versionsDCSP012 Service Provider State or Province Service Provider State or Province varchar 2
Multiple versionsDCSP013 Service Provider ZIP Code Service Provider ZIP Code varchar 11
Multiple versionsDCSP014 Data Processing Center Code Data Processing Center Code integer
Multiple versionsDCSP015 Taxonomy Code Taxonomy Code varchar 10
Multiple versionsDCSP016 INDIVIDUAL Eliminated 04//01/2007 integer 1
Multiple versionsDCSP017 National Provider Identifier National Provider Identifier varchar 20

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Data Element ID Data Element Code Value
DCSP016 INDIVIDUAL 0 Release(default)
1 Withhold
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