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Provider state license number

MP018A, Oregon

Versions: September 27, 2011 - v2011.1.1• June 25, 2012 - v2013.0.0• June 27, 2013 - v2014.0.0• 2015.0.1Compare Versions


Name:Provider state license number
Data Element ID:MP018A
Description:Prefix with two-character state of licensure. Example: ORLL12345
State:Oregon
Data Type:Text
Length:15
Threshold:TBD
Required:Yes
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File Specification for Multiple versionsMedical Providers File Submission - September 27, 2011 - v2011.1.1

Data Element ID Data Element Description Type Format Length
Multiple versionsMP003 Provider ID Identifier for the provider as assigned by the reporting entity Text 30
Multiple versionsMP004 Provider Tax ID Tax ID of the provider (example: 1234567890) Text 9
Multiple versionsMP006 Provider first name First name of the provider (example: John); null if provider is an organization entity Text 25
Multiple versionsMP007 Provider middle initial Middle initial of the provider (example: M); null if provider is an organization entity Text 1
Multiple versionsMP008 Provider last name Last name of the provider or organization entity name Text 100
Multiple versionsMP010 Provider specialty Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP010A Provider second specialty Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP010B Provider third specialty Required if available. Report the HIPAA-compliant health care provider taxonomy code. The reference code set is extensive and is published semi-annually; version 11.0 (effective January 1, 2011) is freely available at the National Uniform Claims Committee's web site: http://www.nucc.org/. To access the taxonomy files, point to the Code Sets menu, then point to the Taxonomy menu, and then click on either PDF (if you want a PDF file) or CSV (if you want a comma-delimited text file). Text 10
Multiple versionsMP011A Provider street address1 First line of physical address of practice. Example: 123 Main Street Text 50
Multiple versionsMP011B Provider street address2 Required if available. Second line of physical address of practice. Example: Bldg A, Suite 100 Text 50
Multiple versionsMP011 Provider city Physical address of practice. Example: Grants Pass Text 30
Multiple versionsMP012 Provider state Physical address of practice. Example: OR Text 2
Multiple versionsMP013 Provider ZIP Physical address of practice. Examples: 97209-1234 or 97209 Text 10
Multiple versionsMP017 Provider DEA number Required if available. Text 12
Multiple versionsMP018 Provider NPI NPI of the provider (example: 1234567890) Text 10
Multiple versionsMP018A Provider state license number Prefix with two-character state of licensure. Example: ORLL12345 Text 15
Multiple versionsQC004 Provider Medicaid number Required (if available) for participants in Q-Corp initiative. Text 12
Multiple versionsQC006 Provider CMS UPIN Required (if available) for participants in Q-Corp initiative. Text 12
Multiple versionsQC011 Provider DOB Required for participants in Q-Corp initiative. Date 8
Multiple versionsQC021 Provider is PCP Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC022 Provider is OBGYN Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC023 Provider is Mental Health Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC024 Provider is Eye Care Provider Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC025 Provider is Dentist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC026 Provider is Nephrologist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC027 Provider is Chem. Dep Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC028 Provider is Nurse Practitioner Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC029 Provider is Phys Assist Required for HEDIS processing for participants in Q- Corp initiative. Text 1
Multiple versionsQC030 Provider can prescribe Rx Required for HEDIS processing for participants in Q- Corp initiative. Text 1

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