| Parent File | Name | Number | Package |
|---|---|---|---|
| FEE BASIS INVOICE(#162.5) | LINE ITEM RENDERING PROV | 162.579 | Fee Basis |
| Field # | Name | Loc | Type | Details |
|---|---|---|---|---|
| .01 | LINE ITEM NUMBER | 0;1 | NUMBER |
|
| .02 | RENDERING PROV NAME | 0;2 | FREE TEXT |
|
| .03 | RENDERING PROV NPI | 0;3 | FREE TEXT |
|
| .04 | RENDERING PROV TAXONOMY CODE | 0;4 | FREE TEXT |
|