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Data Element Name:  Other/Emergency Department Physician 3 State License Number
Format-Length:  A/N - 8 Required For:  ED, IP
Effective Date:  1/1/94 Revision Date:  September 2003

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element


Version 4050R 2310C REF01 128 0B State License Number Qualifier
REF02 127 Other Physician State License Number

Paper Form Locator Code Qualifier
Institutional - UB-04 78-79 N/A


The professional license number, issued by the New York State Department of Education, used to identify the physician or other health care professional (other than the Attending Physician or Operating Physician) who was involved in the patient's care or treatment (i.e., consulting physician, second operating physician, nurse/midwife).

For emergency department visits, if there is more than one physician or health care professional responsible for the care of the patient, then additional physician or health care processional's license numbers should be reported here. When reporting multiple providers of care, report the state license numbers in the order in which the care was provided.

Data users will need to note that hospital policy may dictate which physician license number will be used for this data element. In some instances hospital policy may dictate that an attending physician or chief of service may be assigned to any number of patients who may not have a primary care giver.

Codes and Values:

  1. The first two positions of this field indicate the type of license held (see License Code Description in Appendix J).

  2. Must be valid numerically for each range of entry.

  3. Must be a valid professional license number issued by the New York State Department of Education preceded by a valid license category code.

  4. If the Other Physician or health care professional does not possess a valid New York State License Number, the License Number of the Operating Physician, Attending Physician, or Chief of Service should be reported.

Edit Applications:

  1. Must be a valid entry, if reported.
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