FHIR IG analytics| Package | hl7.fhir.us.davinci-deqm.r4 |
| Resource Type | Bundle |
| Id | Bundle-single-gaps-closed-indv-report02.json |
| FHIR Version | R4 |
No resources found
No resources found
No narrative content found in resource
FHIR
FHIRsmith{
"resourceType": "Bundle",
"id": "single-gaps-closed-indv-report02",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-bundle-deqm"
]
},
"identifier": {
"system": "urn:ietf:rfc:3986",
"value": "urn:uuid:e2eaf470-f7ca-453f-8fd7-232a07f1b63c"
},
"type": "document",
"timestamp": "2020-07-07T13:08:53+00:00",
"entry": [
{
"fullUrl": "http://example.org/fhir/gaps/Composition/gaps-composition03",
"resource": {
"resourceType": "Composition",
"id": "gaps-composition03",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-composition-deqm"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Composition_gaps-composition03\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Composition gaps-composition03</b></p><a name=\"gaps-composition03\"> </a><a name=\"hcgaps-composition03\"> </a><a name=\"gaps-composition03-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-gaps-composition-deqm.html\">DEQM Gaps In Care Composition Profile</a></p></div><p><b>status</b>: Final</p><p><b>type</b>: <span title=\"Codes:{http://loinc.org 96315-7}\">Gaps in care report</span></p><p><b>date</b>: 2020-07-07 13:08:53+0000</p><p><b>author</b>: <a href=\"Organization-gaps-organization-reportingvendor.html\">Organization GapsReportingVendor01</a></p><p><b>title</b>: Care Gap Report for patient gaps-patient01</p></div>"
},
"status": "final",
"type": {
"coding": [
{
"system": "http://loinc.org",
"code": "96315-7",
"display": "Gaps in care report"
}
]
},
"subject": {
"reference": "Patient/gaps-patient01"
},
"date": "2020-07-07T13:08:53+00:00",
"author": [
{
"reference": "Organization/gaps-organization-reportingvendor"
}
],
"title": "Care Gap Report for patient gaps-patient01",
"section": [
{
"title": "Colorectal Cancer Screening",
"focus": {
"reference": "MeasureReport/gaps-indv-measurereport04"
},
"entry": [
{
"reference": "DetectedIssue/gaps-detectedissue04"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/DetectedIssue/gaps-detectedissue04",
"resource": {
"resourceType": "DetectedIssue",
"id": "gaps-detectedissue04",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/gaps-detectedissue-deqm"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"DetectedIssue_gaps-detectedissue04\"> </a><p class=\"res-header-id\"><b>Generated Narrative: DetectedIssue gaps-detectedissue04</b></p><a name=\"gaps-detectedissue04\"> </a><a name=\"hcgaps-detectedissue04\"> </a><a name=\"gaps-detectedissue04-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-gaps-detectedissue-deqm.html\">DEQM Gaps In Care Detected Issue Profile</a></p></div><p><b>DEQM Gap Status Modifier Extension</b>: <span title=\"Codes:{http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status closed-gap}\">Closed Gap</span></p><p><b>status</b>: Final</p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/v3-ActCode CAREGAP}\">Caregap</span></p><p><b>patient</b>: <a href=\"Patient-gaps-patient01.html\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</a></p><h3>Evidences</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Detail</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"MeasureReport-gaps-indv-measurereport04.html\">MeasureReport: extension = Proportion,urn:oid:2.16.840.1.113883.3.2074.1#0015HQN9BD3304E,->Organization GapsReportingVendor01; status = complete; type = individual; measure = http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130-FHIR|8.0.000; date = 2020-07-07 13:08:52+0000; period = 2020-01-01 --> 2020-12-31; improvementNotation = Increased score indicates improvement</a></td></tr></table></div>"
},
"modifierExtension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-gapStatus",
"valueCodeableConcept": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-status",
"code": "closed-gap"
}
]
}
}
],
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "CAREGAP",
"display": "Caregap"
}
]
},
"patient": {
"reference": "Patient/gaps-patient01"
},
"evidence": [
{
"detail": [
{
"reference": "MeasureReport/gaps-indv-measurereport04"
}
]
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/MeasureReport/gaps-indv-measurereport04",
"resource": {
"resourceType": "MeasureReport",
"id": "gaps-indv-measurereport04",
"meta": {
"profile": [
"http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/indv-measurereport-deqm"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"MeasureReport_gaps-indv-measurereport04\"> </a><p class=\"res-header-id\"><b>Generated Narrative: MeasureReport gaps-indv-measurereport04</b></p><a name=\"gaps-indv-measurereport04\"> </a><a name=\"hcgaps-indv-measurereport04\"> </a><a name=\"gaps-indv-measurereport04-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-indv-measurereport-deqm.html\">DEQM Individual MeasureReport Profile</a></p></div><p><b>DEQM Measure Scoring Extension</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring proportion}\">Proportion</span></p><p><b>DEQM Certification Identifier Extension</b>: <code>urn:oid:2.16.840.1.113883.3.2074.1</code>/0015HQN9BD3304E</p><p><b>DEQM Reporting Vendor Extension</b>: <a href=\"Organization-gaps-organization-reportingvendor.html\">Organization GapsReportingVendor01</a></p><p><b>status</b>: Complete</p><p><b>type</b>: Individual</p><p><b>measure</b>: <a href=\"http://hl7.org/fhir/us/cqfmeasures/STU5/Measure-EXM130-FHIR.html\">EXM130 - Colorectal Cancer Screening Measureversion: null8.0.000)</a></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</a></p><p><b>date</b>: 2020-07-07 13:08:52+0000</p><p><b>reporter</b>: <a href=\"Organization-gaps-organization-reportingvendor.html\">Organization GapsReportingVendor01</a></p><p><b>period</b>: 2020-01-01 --> 2020-12-31</p><p><b>improvementNotation</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-improvement-notation increase}\">Increased score indicates improvement</span></p><blockquote><p><b>group</b></p><blockquote><p><b>id</b></p>group-exm130</blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-population initial-population}\">Initial Population</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-population numerator}\">Numerator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-population denominator}\">Denominator</span></p><p><b>count</b>: 1</p></blockquote><blockquote><p><b>population</b></p><p><b>code</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-population denominator-exclusion}\">Denominator Exclusion</span></p><p><b>count</b>: 0</p></blockquote><p><b>measureScore</b>: 1.0</p></blockquote><p><b>evaluatedResource</b>: </p><ul><li><a href=\"Encounter-gaps-encounter03.html\">Encounter: status = finished; class = ambulatory (ActCode#AMB); type = Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.; period = 2020-07-06 07:07:00+0000 --> 2020-07-06 10:11:00+0000</a></li><li><a href=\"Patient-gaps-patient01.html\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</a></li><li><a href=\"Procedure-gaps-procedure02.html\">Procedure Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps</a></li></ul></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-measureScoring",
"valueCodeableConcept": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-scoring",
"code": "proportion"
}
]
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-certificationIdentifier",
"valueIdentifier": {
"system": "urn:oid:2.16.840.1.113883.3.2074.1",
"value": "0015HQN9BD3304E"
}
},
{
"url": "http://hl7.org/fhir/us/davinci-deqm/StructureDefinition/extension-reportingVendor",
"valueReference": {
"reference": "Organization/gaps-organization-reportingvendor"
}
}
],
"status": "complete",
"type": "individual",
"measure": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130-FHIR|8.0.000",
"subject": {
"reference": "Patient/gaps-patient01"
},
"date": "2020-07-07T13:08:52+00:00",
"reporter": {
"reference": "Organization/gaps-organization-reportingvendor"
},
"period": {
"start": "2020-01-01",
"end": "2020-12-31"
},
"improvementNotation": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
"code": "increase"
}
]
},
"group": [
{
"id": "group-exm130",
"population": [
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "initial-population",
"display": "Initial Population"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "numerator",
"display": "Numerator"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator",
"display": "Denominator"
}
]
},
"count": 1
},
{
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/measure-population",
"code": "denominator-exclusion",
"display": "Denominator Exclusion"
}
]
},
"count": 0
}
],
"measureScore": {
"value": 1
}
}
],
"evaluatedResource": [
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "initial-population"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "denominator"
}
],
"reference": "Encounter/gaps-encounter03"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "initial-population"
},
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "denominator"
}
],
"reference": "Patient/gaps-patient01"
},
{
"extension": [
{
"url": "http://hl7.org/fhir/StructureDefinition/cqf-criteriaReference",
"valueString": "numerator"
}
],
"reference": "Procedure/gaps-procedure02"
}
]
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Encounter/gaps-encounter03",
"resource": {
"resourceType": "Encounter",
"id": "gaps-encounter03",
"meta": {
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Encounter_gaps-encounter03\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Encounter gaps-encounter03</b></p><a name=\"gaps-encounter03\"> </a><a name=\"hcgaps-encounter03\"> </a><a name=\"gaps-encounter03-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/qicore/STU6/StructureDefinition-qicore-encounter.html\">QICore Encounter</a></p></div><p><b>status</b>: Finished</p><p><b>class</b>: <a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html#v3-ActCode-AMB\">ActCode AMB</a>: ambulatory</p><p><b>type</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 99202}\">Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.</span></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</a></p><p><b>period</b>: 2020-07-06 07:07:00+0000 --> 2020-07-06 10:11:00+0000</p></div>"
},
"status": "finished",
"class": {
"system": "http://terminology.hl7.org/CodeSystem/v3-ActCode",
"code": "AMB",
"display": "ambulatory"
},
"type": [
{
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "99202",
"display": "Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter."
}
]
}
],
"subject": {
"reference": "Patient/gaps-patient01"
},
"period": {
"start": "2020-07-06T07:07:00-00:00",
"end": "2020-07-06T10:11:00-00:00"
}
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Procedure/gaps-procedure02",
"resource": {
"resourceType": "Procedure",
"id": "gaps-procedure02",
"meta": {
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
]
},
"text": {
"status": "extensions",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Procedure_gaps-procedure02\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Procedure gaps-procedure02</b></p><a name=\"gaps-procedure02\"> </a><a name=\"hcgaps-procedure02\"> </a><a name=\"gaps-procedure02-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/qicore/STU6/StructureDefinition-qicore-procedure.html\">QICore Procedure</a></p></div><p><b>QICore Not Done Recorded</b>: 2020-07-06 09:00:00+0000</p><p><b>status</b>: Completed</p><p><b>code</b>: <span title=\"Codes:{http://www.ama-assn.org/go/cpt 45384}\">Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps</span></p><p><b>subject</b>: <a href=\"Patient-gaps-patient01.html\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</a></p><p><b>performed</b>: 2020-07-06 08:00:00+0000 --> 2020-07-06 09:00:00+0000</p></div>"
},
"extension": [
{
"url": "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-recorded",
"valueDateTime": "2020-07-06T09:00:00-00:00"
}
],
"status": "completed",
"code": {
"coding": [
{
"system": "http://www.ama-assn.org/go/cpt",
"code": "45384",
"display": "Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps"
}
]
},
"subject": {
"reference": "Patient/gaps-patient01"
},
"performedPeriod": {
"start": "2020-07-06T08:00:00-00:00",
"end": "2020-07-06T09:00:00-00:00"
}
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Patient/gaps-patient01",
"resource": {
"resourceType": "Patient",
"id": "gaps-patient01",
"meta": {
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Patient_gaps-patient01\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Patient gaps-patient01</b></p><a name=\"gaps-patient01\"> </a><a name=\"hcgaps-patient01\"> </a><a name=\"gaps-patient01-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/qicore/STU6/StructureDefinition-qicore-patient.html\">QICore Patient</a></p></div><p style=\"border: 1px #661aff solid; background-color: #e6e6ff; padding: 10px;\">Parker Susan Female, DoB: 1965-01-01 ( Medical Record Number: 999995992 (use: usual, ))</p><hr/><table class=\"grid\"><tr><td style=\"background-color: #f3f5da\" title=\"Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The ethnicity codes used to represent these concepts are based upon the [CDC ethnicity and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html) which includes over 900 concepts for representing race and ethnicity of which 43 reference ethnicity. The ethnicity concepts are grouped by and pre-mapped to the 2 OMB ethnicity categories: - Hispanic or Latino - Not Hispanic or Latino.\">US Core Ethnicity Extension:</td><td colspan=\"3\"><ul><li>ombCategory: CDC Race and Ethnicity 2135-2: Hispanic or Latino</li><li>text: Hispanic or Latino</li></ul></td></tr><tr><td style=\"background-color: #f3f5da\" title=\"Concepts classifying the person into a named category of humans sharing common history, traits, geographical origin or nationality. The race codes used to represent these concepts are based upon the [CDC Race and Ethnicity Code Set Version 1.0](http://www.cdc.gov/phin/resources/vocabulary/index.html#3) which includes over 900 concepts for representing race and ethnicity of which 921 reference race. The race concepts are grouped by and pre-mapped to the 5 OMB race categories:\n\n - American Indian or Alaska Native\n - Asian\n - Black or African American\n - Native Hawaiian or Other Pacific Islander\n - White.\">US Core Race Extension:</td><td colspan=\"3\"><ul><li>ombCategory: CDC Race and Ethnicity 2028-9: Asian</li><li>text: Asian</li></ul></td></tr></table></div>"
},
"extension": [
{
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2028-9",
"display": "Asian"
}
},
{
"url": "text",
"valueString": "Asian"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-race"
},
{
"extension": [
{
"url": "ombCategory",
"valueCoding": {
"system": "urn:oid:2.16.840.1.113883.6.238",
"code": "2135-2",
"display": "Hispanic or Latino"
}
},
{
"url": "text",
"valueString": "Hispanic or Latino"
}
],
"url": "http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity"
}
],
"identifier": [
{
"use": "usual",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "MR",
"display": "Medical Record Number"
}
]
},
"system": "http://hospital.smarthealthit.org",
"value": "999995992"
}
],
"name": [
{
"family": "Susan",
"given": [
"Parker"
]
}
],
"gender": "female",
"birthDate": "1965-01-01"
}
},
{
"fullUrl": "http://example.org/fhir/gaps/Organization/gaps-organization-reportingvendor",
"resource": {
"resourceType": "Organization",
"id": "gaps-organization-reportingvendor",
"meta": {
"profile": [
"http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-organization"
]
},
"text": {
"status": "generated",
"div": "<div xmlns=\"http://www.w3.org/1999/xhtml\"><a name=\"Organization_gaps-organization-reportingvendor\"> </a><p class=\"res-header-id\"><b>Generated Narrative: Organization gaps-organization-reportingvendor</b></p><a name=\"gaps-organization-reportingvendor\"> </a><a name=\"hcgaps-organization-reportingvendor\"> </a><a name=\"gaps-organization-reportingvendor-en-US\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\"/><p style=\"margin-bottom: 0px\">Profile: <a href=\"http://hl7.org/fhir/us/qicore/STU6/StructureDefinition-qicore-organization.html\">QICore Organization</a></p></div><p><b>identifier</b>: Tax ID number/123446789 (use: official, )</p><p><b>active</b>: true</p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/organization-type pay}\">Payer</span></p><p><b>name</b>: GapsReportingVendor01</p><p><b>telecom</b>: ph: (+1) 401-545-1212</p><p><b>address</b>: 13 Drive Street Cityplace MA 01101 USA </p></div>"
},
"identifier": [
{
"use": "official",
"type": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/v2-0203",
"code": "TAX",
"display": "Tax ID number"
}
]
},
"system": "urn:oid:2.16.840.1.113883.4.4",
"value": "123446789",
"assigner": {
"display": "www.irs.gov"
}
}
],
"active": true,
"type": [
{
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/organization-type",
"code": "pay",
"display": "Payer"
}
]
}
],
"name": "GapsReportingVendor01",
"telecom": [
{
"system": "phone",
"value": "(+1) 401-545-1212"
}
],
"address": [
{
"line": [
"13 Drive Street"
],
"city": "Cityplace",
"state": "MA",
"postalCode": "01101",
"country": "USA"
}
]
}
}
]
}