***DRAFT***

September 3, 1998

Provider/Organization

Periodic Data Elements

IX. PROVIDER/ORGANIZATION PERIODIC DATA ELEMENTS [Data reported annually.]:

Item

FN-11

Source

Other

¬ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ Committee Recommendation ¾ ¾ ¾ ¾ ¾ ¾ ¾ ¾ ®

#

Data Element

Document

Name

Definition

Workgroup Comments

1

Organization Identifier

EE #34

FN-10 p.149

  Federal ID Number or National Provider ID Number  

2

Provider Identification

EE #35

FN-10 p.132

  Federal ID Number or National Provider ID Number  

3

Reporting Year

FN-10 p.137

Basis for Reporting Year The fiscal year for which data are reported. (mm/yyyy; mm/yyyy)