| Name: | Dental Service Providers File Submission |
|---|---|
| State: | Maine |
| Definition: | Not Provided |
| Version | 2010-03-16 |
| Data Element ID | Data Element | Description | Type | Format | Length |
|---|---|---|---|---|---|
 DCSP001 |
Provider ID# | Provider ID# | integer | ||
| DCSP002 |
Payer | Payer | varchar | 6 | |
| DCSP003 |
Service Provider Number | Service Provider Number | varchar | 30 | |
| DCSP004 |
Service Provider Tax ID Number | Service Provider Tax ID Number | varchar | 10 | |
| DCSP005 |
Service Provider Entity Type Qualifier | Service Provider Entity Type Qualifier | varchar | 1 | |
| DCSP006 |
Service Provider First Name | Service Provider First Name | varchar | 25 | |
| DCSP007 |
Service Provider Middle Name | Service Provider Middle Name | varchar | 25 | |
| DCSP008 |
Service Provider Last Name or Organization Name | Service Provider Last Name or Organization Name | varchar | 60 | |
| DCSP009 |
Service Provider Suffix | Service Provider Suffix | varchar | 10 | |
| DCSP010 |
Service Provider Specialty | Service Provider Specialty | varchar | 10 | |
| DCSP011 |
Service Provider City Name | Service Provider City Name | varchar | 30 | |
| DCSP012 |
Service Provider State or Province | Service Provider State or Province | varchar | 2 | |
| DCSP013 |
Service Provider ZIP Code | Service Provider ZIP Code | varchar | 11 | |
| DCSP014 |
Data Processing Center Code | Data Processing Center Code | integer | ||
| DCSP015 |
Taxonomy Code | Taxonomy Code | varchar | 10 | |
| DCSP016 |
INDIVIDUAL | Eliminated 04//01/2007 | integer | 1 | |
| DCSP017 |
National Provider Identifier | National Provider Identifier | varchar | 20 |
| Data Element ID | Data Element | Code | Value |
|---|---|---|---|
| DCSP016 | INDIVIDUAL | 0 | Release(default) |
| 1 | Withhold |
Agency for Healthcare Research and Quality • 5600 Fishers Lane, Rockville, MD 20857 • Telephone: (301) 427-1364
