IC-1
type: Organization
node role: treeRoot
id:
  v: IC-1
meta:
  last updated:
    v: 2025-11-27T20:27:11.000-06:00
  profile:
    v: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-pas-insurer-organization-profile
    link: https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-pas-insurer-organization-profile
text:
  status:
    v: generated
  div: Aetna Life and Casualty P O Box 1458 Carrollton, TX 75006 US Phone: 9726621350 Phone: 9876543211
identifier:
  extension:
    url:
      v: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment
    value: string
      v: Aetna Life and Casualty
  extension:
    url:
      v: http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction
    value: CodeableConcept
  system:
    v: http://hl7.org/fhir/sid/us-npi
  value:
    v: 0
identifier:
  type:
    coding:
      system:
        v: http://terminology.hl7.org/CodeSystem/v2-0203
      code:
        v: TIN
      display:
        v: Tax Identification Number
  system:
    v: http://terminology.hl7.org/NamingSystem/USEIN
  value:
    v: 12345
identifier:
  type:
    coding:
      system:
        v: http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType
      code:
        v: payerid
      display:
        v: Payer ID
  value:
    v: 11223344
active:
  v: true
type:
  coding:
    system:
      v: https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98
    code:
      v: 93
    display:
      v: Insurance Institute
  text:
    v: Insurance Institute
name:
  v: Aetna Life and Casualty
telecom:
  system:
    v: phone
  value:
    v: 9726621350
  use:
    v: work
telecom:
  system:
    v: phone
  value:
    v: 9876543211
  use:
    v: mobile
address:
  line:
    v: P O Box 1458
  city:
    v: Carrollton
  state:
    v: TX
  postal code:
    v: 75006
  country:
    v: US

v: TX

v: Texas