Form CMS-10419 Research Template

Research Payment Template

Submission File Specification
DE #
Data Element Name
Definition / Description
Submission File Information (this section contains data elements which are reported once per submission file)
1

Data Type

Publicly
Displayed

Required?

Field Size

Validation

Free form text

Yes

≤ 100 Char

Match the name
on file for
associated
Registration ID

Yes

System generated

System generated

Yes

System
generated

Match the
Registration ID
on file

No

Applicable Manufacturer or
Textual proper name of either the Submitting Applicable Manufacturer or Submitting Applicable Group Text
Applicable GPO Submitting File Purchasing Organization (GPO) .
Name
If this file is a single Applicable Manufacturer/GPO's set of payment(s) and/or transfer(s) of value
records, this Applicable Manufacturer/GPO name will be used for all records in the file.

Format

If this file contains a Consolidated Report, this Applicable Manufacturer/GPO Name will be used as the
Consolidated Reporter and the Applicable Manufacturer/GPO Names and OPEN PAYMENTS system
IDs of the sub-companies making the payments/transfers of value will be recorded with every payment
or transfer of value record in the file.
2

Applicable Manufacturer or
Applicable GPO
Submitting File Registration ID

OPEN PAYMENTS system generated identifier used to identify the Applicable Manufacturer or GPO
(populated only with CMS provided identifier).
If this file is a single Applicable Manufacturer/GPO's set of payment/transfer of value records, this
Applicable Manufacturer/GPO ID will be used for all records in the file.
If this file contains a Consolidated Report, this Applicable Manufacturer/GPO ID will be used as the
Consolidated Reporter and the Applicable Manufacturer/GPO Names and OPEN PAYMENTS System
IDs of the sub-companies making the payments/transfers of value will be recorded with every
payment/transfer of value record in the file.

3

Consolidated Report Indicator

Indicator showing if this submission file constitutes a Consolidated Report.

Boolean

"Y" = Yes;
"N" = No

Yes

1 Char

Limited to
characters Y or
N

No

4

Resubmission File Indicator

Indicator showing if this submission file contains payment(s) and/or transfer(s) of value that are
amended or corrected versions of previously submitted records.

Boolean

"Y" = Yes;
"N" = No

Yes

1 Char

Limited to
characters Y or
N

No

5

Original File Submission ID

OPEN PAYMENTS system generated identifier used to identify the original file submission. This data

system generated

system generated

Yes IF

system
generated

Matches
Original File
Submission ID
on file for
associated
Registration ID

No

will be reported to the submitter after a successful submission and should only be reported back in a
resubmission for file identification purposes.

Line 4
Resubmission File Indicator
= "Y"

Submission Record Information (all sections from here to end of template contain data elements that are reported once per payment/transfer of value)
Recipient Demographic Information
6
Recipient Type

Indicator showing if recipient of the payment or transfer of value is a physician covered recipient,
teaching hospital covered recipient, non-covered recipient entity or non-covered recipient individual.
Standardized list of covered Teaching Hospital names and information will be provided.

Text

"1" = Covered Recipient Physician
or
"2" = Covered Recipient Teaching
Hospital
or
"3" = Non-covered Recipient Entity
or
"4" = Non-covered Recipient
Individual

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

Yes

1 Char

Yes

1

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DE #
7

Data Element Name
Non-covered Recipient Entity
Name

Definition / Description
The name of the Non-covered Recipient Entity receiving the payment or transfer of value.

Data Type
Text

Format
Free form text

Required?

Field Size

Yes IF

≤ 100 Char

Validation

Publicly
Displayed
Yes

Line 6 =
"3" Non-covered Recipient
Entity
8

Covered Recipient Teaching
Hospital Name

The name of Teaching Hospital receiving the payment or transfer of value.

Text

Text of Standardized Selection from
approved list of Teaching Hospitals

Standardized list of covered Teaching Hospital names and information will be provided.

9

Covered Recipient Teaching
Hospital Tax ID Number (TIN)

Tax Identification number of Teaching Hospital receiving the payment or transfer of value.

Covered Recipient Physician First Textual first name, as listed in the National Plan & Provider Enumeration System (NPPES) of the
Name
physician (covered recipient) receiving the payment or transfer of value.

≤ 100 Char

Matches the
hospital name
provided in list
for a given TIN

Yes

9 Char

Matches a TIN
provided on
teaching
hospital list

No

≤ 20 Char

Validation by
CMS

Yes

Line 6
Recipient Type = "2"
Covered Recipient Teaching
Hospital
Text

XXXXXXXXX

Standardized list of covered Teaching Hospital names and information will be provided.

10

Yes IF

Yes IF
Line 6
Recipient Type = "2"
Covered Recipient Teaching
Hospital

Text

Free form text

Yes IF
Line 6
Recipient Type = "1"
Covered Recipient
Physician

11

Covered Recipient Physician
Middle Name

Textual middle initial or middle name, as listed in the National Plan & Provider Enumeration System
(NPPES) of the physician (covered recipient) receiving the payment or transfer of value.

12

Covered Recipient Physician Last Textual last name, as listed in the National Plan & Provider Enumeration System (NPPES) of the
Name
physician (covered recipient) receiving the payment or transfer of value.

Text

Free form text

No

≤ 20 Char

Text

Free form text

Yes IF

≤ 35 Char

Yes

Validation by
CMS

Yes

Line 6
Recipient Type = "1"
Covered Recipient
Physician
13

Covered Recipient Physician
Name Suffix

Name suffix, as listed in the National Plan & Provider Enumeration System (NPPES) of the physician
Text
(covered recipient) receiving the payment or transfer of value chosen from a constrained list of values
(Examples: Jr., Sr, III).

Free form text

14

Recipient Business Street
Address Line 1

The first line of the primary business street address of the physician or teaching hospital or noncovered recipient entity receiving the payment or transfer of value.

Two line address format;
First line contains building number,
street name, street identifier

15

Recipient Business Street
Address Line 2

The second line of the primary business street address of the physician or teaching hospital or noncovered recipient entity receiving the payment or transfer of value.

Text

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

No

≤ 5 Char

Yes

Yes IF

≤ 55 Char

Yes

≤ 55 Char

Yes

Line 6, "Covered Recipient
Indicator" =
"1," Covered Recipient
Physician, OR
"2," Covered Recipient
Teaching Hospital OR
"3" Non-covered Recipient
Entity
No

2

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DE #
16

Data Element Name
Recipient City

Definition / Description

Data Type

The primary business address city of the physician or teaching hospital or non-covered recipient entity Text
receiving the payment or transfer of value.

Format
Free form text

Required?

Field Size

Yes IF

≤ 40 Char

Validation

Publicly
Displayed
Yes

Line 6, "Covered Recipient
Indicator" =
"1," Covered Recipient
Physician, OR "2," "Covered
Recipient Teaching Hospital
OR "3" Non-covered
Recipient Entity
17

18

19

Recipient State

Recipient Zip Code

Recipient Country

The state or territory abbreviation of the primary business address of the physician or teaching hospital Enumeration
or non-covered recipient entity receiving the payment or transfer of value if the primary business
address is in the United States.

2 character U.S. state or territory
alpha abbreviation

The 9 digit zip code for the primary business location of the physician or teaching hospital or nonText
covered recipient entity receiving the payment or transfer of value if the primary practice address is in
the United States.

9 digit numeric zip code

The business address country of the physician or teaching hospital or non-covered recipient entity
receiving the payment or transfer of value.

Free form text

Text

Yes IF

2 Char

Limited to list of
state
abbreviations
and territories
per US Postal
Service

Yes

≤ 9 Char

Either exactly 5
or exactly 9
numeric digits

Yes

Recipient Country Line 19
is the United States

Yes IF
Recipient Country Line 19 is
the United States
Yes IF

≤ 40 Char

Yes

Yes

Line 6, "Covered Recipient
Indicator" =
"1," Covered Recipient
Physician, OR "2," "Covered
Recipient Teaching Hospital
OR "3" = Non-covered
Recipient Entity
20

Recipient Province

The business address province of the physician or teaching hospital or non-covered recipient entity
receiving the payment or transfer of value if the primary practice address is outside the United States
and if applicable.

Text

Free form text

No

≤ 20 Char

21

Recipient Postal Code

The international postal code for the primary business location of the physician or teaching hospital or Text
non-covered recipient entity receiving the payment or transfer of value if the primary business address
is outside the United States.

Alphanumeric

Yes IF

≤ 20 Char

Proper length
and format
validated for
each country

Yes

Recipient Country Line 19 is
outside the United States
AND Line 6 = "1," OR "2,"
OR "3"

22

Recipient Email Address

The primary email address for physician or teaching hospital or non-covered recipient entity to be used Text
for communication purposes.

Email Address

No

≤ 100 Char

Proper email
format enforced

No

23

Covered Recipient Physician or
Teaching Hospital NPI

Individual NPI for Physician (not NPI of any group physician belonging to) or NPI of Teaching Hospital;
required, if applicable.

Text

Numeric digits only

No

10 Char

Validation by
CMS

No

24

Covered Recipient Physician
Primary Type

Primary type of medicine practiced by the covered recipient physician.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

Yes IF

1 Char

Limited to
numeric
characters 1
through 6

Yes

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

Line 6
Recipient Type = "1"
Covered Recipient
Physician

3

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DE #
25

Data Element Name
Covered Recipient Physician
Specialty

Definition / Description
Physician's single specialty chosen from the standardized "provider taxonomy" code list.

Data Type
Text

Format
Text from Standardized Selection

Publicly
Displayed

Required?

Field Size

Validation

Yes IF

10 Char

Validation by
CMS

Yes

≤ 20 Char per
comma
separated item

Proper length
and format
validated for
each state

Yes, for the
State
AND
No, for the
License #

1 Char

Allowed values
limited to "1",
"2", "3", or "4"

Yes

Validation by
CMS

Yes

Line 6
Recipient Type = "1"
Covered Recipient
Physician
26

Covered Recipient Physician
License State and License
Number

Paired state and official state license number of the covered recipient physician; the pairing includes
Alphanumeric
the 2 letter state abbreviation, followed by a hyphen, followed by the state license number and may
include up to 5 "Physician License State and License Number" pairs, if a physician is licensed in multiple
states.

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXXX

Yes IF
Line 6
Recipient Type = "1"
Covered Recipient
Physician

Associated Drug, Device, Biological, or Medical Supply Information
27

Product Indicator

Indicator allows the Applicable Manufacturer or GPO to select whether the payment or other transfer
of value is associated with ONLY covered drugs, devices, biologicals or medical supplies("Covered"),
ONLY non-covered drugs, devices, biologicals or medical supplies ("Non-covered"), neither covered or
non-covered drugs, devices, biologicals or medical supplies("None"), or both covered and/or noncovered drugs, devices, biologicals or medical supplies ("Covered" or "Combination").

Enumeration

"1" = "Covered"
"2" = "Non-covered"
"3" = "None"
"4" = "Combination"

Yes

If the payment or other transfer of value is associated with both covered drugs, devices, biologicals or
medical supplies AND non-covered drugs, devices, biologicals or medical supplies, the Applicable
Manufacturer must choose either "Covered" or "Combination", where:
(1) “Covered” represents covered ≥ 1 AND non-covered product ≥ 0 AND that "Combination" is not
selected
OR
(2) “Combination” to represent covered ≥ 1 AND non-covered product ≥ 1 AND that "Covered" is not
selected.

28

Name of Associated Drug or
Biological

If the payment or other transfer of value is associated with at least one (1) covered drug or biological Text
that has a marketed name, report the marketed name (or names up to 5) of only the covered drugs or
biologicals.

Maximum of 5 comma separated
covered drugs or biologicals

If the payment or other transfer of value is associated with at least one (1) covered drug or biological
that does not have a marketed name, report the name as it is registered on clinicaltrials.gov.
A standardized list based on validated industry lists (drug names, etc.) will be available for guidance.

29

NDC of Associated Covered Drug The National Drug Code (NDC), if any, of the drug or biological associated with the payment or other
or Biological
transfer of value (if applicable; up to 5 NDCs). If no NDC for any named covered drug or biological in
line 28, enter, "null."

Alphanumeric

Maximum of 5 comma
separated NDCs

Yes IF
≤ 100 Char per
"Product Indicator" line 27
comma
is "1" = "Covered" OR is "2" separated item
= "Combination" AND
there is not at least 1
covered device or medical
supply provided in line 30
"Name of Associated
Covered Device or Medical
Supply"

No

12 Char per
Number of
comma
NDCs is same as
separated item
number of
names (line 28)

Yes

If more than one NDC provided, order must match order of named covered drugs or biologicals in line
28, "Name of Associated Covered Drug or Biological;" if no NDC for any named drug or biological, enter
"null."

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

4

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DE #
30

Data Element Name
Name of Associated Covered
Device or Medical Supply

Definition / Description

Data Type

If the payment or other transfer of value is associated with at least one (1) covered device or medical Text
supply that has a marketed name, report the marketed name (or names up to 5) of only the covered
device or medical supply. Applicable Manufacturer or GPO may provide either (1) the marketed name
under which the device or medical supply is or was marketed OR (2) the Therapeutic Area or Product
Category.

Format

Required?

Maximum of 5 comma separated
covered devices or medical supplies

Yes IF

A list of Therapeutic Area or Product Category will be available for guidance.

Field Size

≤ 100 Char per
comma
"Product Indicator" line 27 separated item
is "1" = "Covered" OR is "2"
= "Combination" AND
there is not at least 1
covered drug or biological
provided in line 28 "Name
of Associated Covered Drug
or Biological"

Validation
Validation by
CMS

Publicly
Displayed
Yes

Transfer of Value (Research Payment) Information
31

Applicable Manufacturer or
Textual proper name of either the Applicable Manufacturer or Applicable GPO making the payment or Text
Applicable GPO Making Payment transfer of value being reported in this record.
Name
If this file contains a single Applicable Manufacturer/GPO's set of payment(s) and/or transfer(s) of
value records, this data element will be blank since it was reported in data element #1.

Free form text

32

Applicable Manufacturer or
OPEN PAYMENTS System generated alphanumeric identifier for this Applicable Manufacturer or GPO
Applicable GPO
issued during the registration process.
Making Payment Registration ID

Alphanumeric string

System generated

33

Resubmitted Payment Record ID This data element will be blank for initial file submissions.

Alphanumeric string

System generated

Yes IF

≤ 100 Char

Yes

Yes

10 Char

No

Yes IF

6 Char

No

12 Char

Yes

Line 3
Consolidated Report
Indicator = "Y"

For resubmission files - this data element will either be blank (indicating an omitted record is being
submitted in the Resubmission file) or will contain the original payment/transfer of value record ID
(indicating which record is to be corrected). The original payment/transfer of value record ID is
provided by the Open Payments System.

Line 4
Resubmission File Indicator
= "Y"
and
Record is not being
submitted as an omission
from the original
submission

34

Total Amount of Research
Payment (U.S. Dollars)

U.S. dollar amount of payment to recipient (manufacturer must convert to dollar currency, if
necessary).

Monetary amount (USD) in
#####.## format

Yes

34 A

Date of Payment

If reporting a singular payment, report the actual date the payment was issued.

Date

YYYYMMDD

Enumeration

"1" = Cash or cash equivalent;
"2" = In-kind items and services;
"3" = Stock, stock option, or any
other ownership interest;
"4" = Dividend, profit or other return
on investment

Yes

8 Char

Is within correct
reporting year

Yes

Limited to
numeric
characters 1
through 4

Yes

If reporting EITHER a series of payments or an aggregated set of payments, record the date of the first
payment to the covered recipient in this reporting year.
35

Form of Payment or Transfer of The method of payment used to pay the covered recipient or to make the transfer of value.
Value

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

Yes

1 Char

5

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DE #
36

Data Element Name
Expenditure Category

Definition / Description
Contextual category for this research payment or transfer of value. There can be multiple contextual
categories for this research reported; however, for every Expenditure Category reported, an
Expenditure Category percentage must also be reported.

Data Type

Format

Required?

Field Size

Validation

Publicly
Displayed

Enumeration

Format: X-XXX
"1" = Professional Salary Support;
"2" = Medical Research Writing or
Publication;
"3" = Patient Care;
"4" = Non-patient Care;
"5" = Overhead;
"6" = Other

No

≤ 5 Char

Yes

Boolean

"Y" = Yes;
"N" = No

Yes

1 Char

Yes

"1" = R &D on New Product
"2" = Clinical Investigation on New
Product
"3" = No Delay Requested

Yes

1 Char

Yes

Yes IF

≤ 500 Char

Yes

Category and percent represented as a single number for the category followed by the 2 or 3 digit
percentage value (eg. 1-90 or 1-100)

Research Related Information
37

Pre-clinical Research Indicator

Indicator showing if payment or transfer of value is related to research, which is pre-clinical.

38

Delay in Publication of Research Indicator showing if an Applicable Manufacturer/GPO is requesting a delay in publication of a payment Enumeration
Payment Indicator
or other transfer of value when the payment or transfer of value is made in connection with: (1)
research on or development of a new product (drug, device, biological, or medical supply) or (2) clinical
investigation regarding a new product (drug, device, biological, or medical supply).
Applicable Manufacturers/GPOs not requesting a delay in publication of a payment or other transfer of
value should select (3) not requesting a delay in publication to indicate that no delay is requested.
CMS will display payments or other transfers of value no later than four years after the initial request
for delay in publication of the [payment or transfer of value. Further details regarding notification to
CMS of FDA approval will be forthcoming in guidance.

39

Name of Study

The textual name of the study for which the Covered Recipient is receiving this payment or transfer of Text
value.

Free form text

Line 37
Pre-clinical Research
Indicator = "N"
40
41

Context of Research
ClinicalTrials.Gov Identifier

Textual description of research context or research objectives.
Identifier assigned if research study is registered on clinicaltrials.gov.

42

Research Information Link

43

Principal Investigator Covered
Recipient Physician Indicator

Text
Alphanumeric

Free form text
11 character alphanumeric, first 3
characters alpha

No
No

≤ 500 Char
11 Char

Yes
Yes

Optional link to information relevant to the research study for which this payment or transfer of value Web URL
is being reported (there can be a maximum of five links reported).

Free form text

No

≤ 2083 Char

Yes

Indicator showing the Principal Investigator of the research study is a covered recipient physician.

"Y" = Yes;
"N" = No

Yes

1 Char

Yes

Yes
IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 20 Char

Yes

Boolean

If there are multiple Principal Investigators, indicate "Yes" if at least one (1) is a covered recipient
physician and provide the identifiers (data elements 45-60) for each Principal Investigator (up to 5),
who is a covered recipient physician .

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
44

Principal Investigator First Name Textual first name of the Principal Investigator(s) of the research study, if the Principal Investigator is a Text
Covered Recipient Physician.

Free form text

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

6

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DE #

Data Element Name

45

Principal Investigator Middle
Name

46

Definition / Description
Textual middle initial or middle name of the Principal Investigator of the research study, if the
Principal Investigator is a Covered Recipient Physician.

Data Type

Format

Required?

Field Size

Validation

Publicly
Displayed

Text

Free form text

No

≤ 20 Char

Yes

Principal Investigator Last Name Textual last name of the Principal investigator of the research study, if the Principal Investigator is a
Covered Recipient Physician.

Text

Free form text

Yes
IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 35 Char

Yes

47

Principal Investigator Name
Suffix

Suffix of the Principal Investigator of the research study chosen from a constrained list of values
(Examples: Jr., Sr, III), if the Principal Investigator is a Covered Recipient Physician.

Text

Free form text

No

≤ 5 Char

Yes

48

Principal Investigator Business
Street Address Line 1

The first line of the primary business street address of the Principal Investigator of the research study,
if the Principal Investigator is a Covered Recipient Physician.

Text

Two line address format;
First line contains building number,
street name, street identifier

Yes
IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 55 Char

Yes

No

≤ 55 Char

Yes

Yes IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 40 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).
49

Principal Investigator Business
Street Address Line 2

The second line of the primary business street address of the Principal investigator of the research
study.

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

50

Principal Investigator City

The primary business address city of the Principal investigator of the research study.

Text

Free form text

51

Principal Investigator State

The primary business address state or territory abbreviation of the Principal investigator of the
research study, if the primary practice address is in the United States.

Enumeration

2 character U.S. state or territory
alpha abbreviation

Yes IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"
AND
Recipient Country, Line 53
is the United States

2 Char

52

Principal Investigator Zip Code

The 9 digit zip code of the primary business address location of the Principal investigator of the
research study, if the primary practice address is in the United States.

Text

9 digit numeric zip code

Yes IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"
AND
Recipient Country, Line 53
is the United States

≤ 9 Char

Yes

53

Principal Investigator Country

The primary business address country name of the Principal investigator of the research study.

Text

Free form text

Yes IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 40 Char

Yes

54

Principal Investigator Province

The primary business address province name of the Principal investigator of the research study, if the
primary practice address is outside the United States.

Text

Free form text

No

≤ 20 Char

Yes

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

Limited to list of
state
abbreviations
and territories
per US Postal
Service

Yes

7

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DE #
55

Data Element Name
Principal Investigator Postal
Code

Definition / Description
The international postal code of the primary business location of the Principal investigator of the
research study if the primary practice address is outside the United States.

Data Type
Text

Format
Alphanumeric

Required?
Yes IF

Field Size

Validation

≤ 20 Char

Publicly
Displayed
Yes

Recipient Country Line 53 is
outside the United States
56

Principal Investigator Physician
Primary Type

Primary type of medicine practiced by the Principal Investigator.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

10 digit Numeric

Numeric digits only

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).

57

Principal Investigator NPI

Individual NPI for Physician (not NPI of any group physician belonging to) required, if applicable.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).

58

Principal Investigator Specialty

Principal Investigator's single specialty chosen from "provider taxonomy" code list.

Principal Investigator License
State and License Number

1 Char

Allowed values
limited to "1",
"2", "3", "4",
"5", or "6"

Yes

Yes IF

10 Char

Validation by
CMS

No

the Physician has an NPI

Text

Text from Standardized Selection

Yes
IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

10 Char

Validation by
CMS

Yes

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXX

Yes
IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

≤ 20 Char per
comma
separated item

Proper length
and format
validated for
each state

Yes, for the
State
AND
No, for the
License #

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).
59

Yes IF
Line 43, "Principal
Investigator Physician
Covered Recipient
Indicator" = "Y"

Paired state and state license number of the Principal Investigator, who is a physician covered
Alphanumeric
recipient; the pairing includes the 2 letter state abbreviation, followed by a hyphen, followed by the
state license number and may include up to 5 "Physician License State and License Number" pairs. If a
Principal investigator is licensed in multiple states, provide only one state and license number pair.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45 and 47-60).

Multiple Principal Investigators:
For lines 60-123, when indicating multiple Principal Investigators, include the First
Name, Last Name, Business Address, Physician Primary Type, NPI (if applicable),
Physician Specialty, and Licence State and License Number for each Principal
Investigator added as required in lines 44-59.
60

Principal Investigator First Name Textual first name of the Principal Investigator(s) of the research study; required, if the Principal
Investigator is a Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 35 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
61

Principal Investigator Middle
Name

Textual middle initial or middle name of the Principal Investigator of the research study, if the
Principal Investigator is a Covered Recipient Physician.

62

Principal Investigator Last Name Textual last name of the Principal investigator of the research study; required if, the Principal
Investigator is a Covered Recipient Physician.

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

8

Research Payment Template

DE #

Data Element Name

Definition / Description

Data Type

Format

Required?

Field Size

Validation

Publicly
Displayed

63

Principal Investigator Name
Suffix

Suffix of the Principal Investigator of the research study chosen from a constrained list of values
(Examples: Jr., Sr, III), if the Principal Investigator is a Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 5 Char

Yes

64

Principal Investigator Business
Street Address Line 1

The first line of the primary business street address of the Principal Investigator of the research study,
if the Principal Investigator is a Covered Recipient Physician.

Text

Two line address format;
First line contains building number,
street name, street identifier

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
65

Principal Investigator Business
Street Address Line 2

The second line of the primary business street address of the Principal investigator of the research
study.

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

66

Principal Investigator City

The primary business address city of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

67

Principal Investigator State

The primary business address state or territory abbreviation of the Principal investigator of the
research study, if the primary practice address is in the United States.

Enumeration

2 character U.S. state or territory
alpha abbreviation

No unless indicating
multiple Principal
Investigators

2 Char

Yes

68

Principal Investigator Zip Code

The 9 digit zip code of the primary business address location of the Principal investigator of the
research study, if the primary practice address is in the United States.

Text

9 digit numeric zip code

No unless indicating
multiple Principal
Investigators

≤ 9 Char

Yes

69

Principal Investigator Country

The primary business address country name of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

70

Principal Investigator Province

The primary business address province name of the Principal investigator of the research study, if the
primary practice address is outside the United States.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

71

Principal Investigator Postal
Code

The international postal code of the primary business location of the Principal investigator of the
research study if the primary practice address is outside the United States.

Text

Alphanumeric

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

72

Principal Investigator Physician
Primary Type

Primary type of medicine practiced by the Principal Investigator.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

No unless indicating
multiple Principal
Investigators

1 Char

Yes

10 digit Numeric

Numeric digits only

No unless indicating
multiple Principal
Investigators

10 Char

No

Text

Text from Standardized Selection

No unless indicating
multiple Principal
Investigators

10 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

73

Principal Investigator NPI

Individual NPI for Physician (not NPI of any group physician belonging to) required, if applicable.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

74

Principal Investigator Specialty

Principal Investigator's single specialty chosen from "provider taxonomy" list.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

9

Research Payment Template

DE #
75

Data Element Name
Principal Investigator License
State and License Number

Definition / Description

Data Type

Validation

Publicly
Displayed

Required?

Field Size

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXX

No unless indicating
multiple Principal
Investigators

≤ 20 Char per
comma
separated item

No

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Paired state and state license number of the Principal Investigator, who is a physician covered
Alphanumeric
recipient; the pairing includes the 2 letter state abbreviation, followed by a hyphen, followed by the
state license number and may include up to 5 "Physician License State and License Number" pairs. If a
Principal investigator is licensed in multiple states, provide only one state and license number pair.

Format

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
76

Principal Investigator First Name Textual first name of the Principal Investigator(s) of the research study, if the Principal Investigator is a Text
Covered Recipient Physician.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

77

Principal Investigator Middle
Name

Textual middle initial or middle name of the Principal Investigator of the research study, if the
Principal Investigator is a Covered Recipient Physician.

78

Principal Investigator Last Name Textual last name of the Principal investigator of the research study, if the Principal Investigator is a
Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 35 Char

Yes

79

Principal Investigator Name
Suffix

Suffix of the Principal Investigator of the research study chosen from a constrained list of values
(Examples: Jr., Sr, III), if the Principal Investigator is a Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 5 Char

Yes

80

Principal Investigator Business
Street Address Line 1

The first line of the primary business street address of the Principal Investigator of the research study,
if the Principal Investigator is a Covered Recipient Physician.

Text

Two line address format;
First line contains building number,
street name, street identifier

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
81

Principal Investigator Business
Street Address Line 2

The second line of the primary business street address of the Principal investigator of the research
study.

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

82

Principal Investigator City

The primary business address city of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

83

Principal Investigator State

The primary business address state or territory abbreviation of the Principal investigator of the
research study, if the primary practice address is in the United States.

Enumeration

2 character U.S. state or territory
alpha abbreviation

No unless indicating
multiple Principal
Investigators

2 Char

Yes

84

Principal Investigator Zip Code

The 9 digit zip code of the primary business address location of the Principal investigator of the
research study, if the primary practice address is in the United States.

Text

9 digit numeric zip code

No unless indicating
multiple Principal
Investigators

≤ 9 Char

Yes

85

Principal Investigator Country

The primary business address country name of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

86

Principal Investigator Province

The primary business address province name of the Principal investigator of the research study, if the
primary practice address is outside the United States.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

10

Research Payment Template

DE #

Data Element Name

Definition / Description

Data Type

Format

Required?

Field Size

Validation

Publicly
Displayed

87

Principal Investigator Postal
Code

The international postal code of the primary business location of the Principal investigator of the
research study if the primary practice address is outside the United States.

Text

Alphanumeric

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

88

Principal Investigator Physician
Primary Type

Primary type of medicine practiced by the Principal Investigator.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

No unless indicating
multiple Principal
Investigators

1 Char

Yes

10 digit Numeric

Numeric digits only

No unless indicating
multiple Principal
Investigators

10 Char

No

Text

Text from Standardized Selection

No unless indicating
multiple Principal
Investigators

10 Char

Yes

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXX

No unless indicating
multiple Principal
Investigators

≤ 20 Char per
comma
separated item

No

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

89

Principal Investigator NPI

Individual NPI for Physician (not NPI of any group physician belonging to) required, if applicable.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

90

Principal Investigator Specialty

Principal Investigator's single specialty chosen from "provider taxonomy" list.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

91

Principal Investigator License
State and License Number

Paired state and state license number of the Principal Investigator, who is a physician covered
Alphanumeric
recipient; the pairing includes the 2 letter state abbreviation, followed by a hyphen, followed by the
state license number and may include up to 5 "Physician License State and License Number" pairs. If a
Principal investigator is licensed in multiple states, provide only one state and license number pair.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

92

Principal Investigator First Name Textual first name of the Principal Investigator(s) of the research study, if the Principal Investigator is a Text
Covered Recipient Physician.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

93

Principal Investigator Middle
Name

Textual middle initial or middle name of the Principal Investigator of the research study, if the
Principal Investigator is a Covered Recipient Physician.

94

Principal Investigator Last Name Textual last name of the Principal investigator of the research study, if the Principal Investigator is a
Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 35 Char

Yes

95

Principal Investigator Name
Suffix

Suffix of the Principal Investigator of the research study chosen from a constrained list of values
(Examples: Jr., Sr, III), if the Principal Investigator is a Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 5 Char

Yes

96

Principal Investigator Business
Street Address Line 1

The first line of the primary business street address of the Principal Investigator of the research study,
if the Principal Investigator is a Covered Recipient Physician.

Text

Two line address format;
First line contains building number,
street name, street identifier

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

11

Research Payment Template

DE #

Data Element Name

Definition / Description

Data Type

Format

Required?

Field Size

Validation

Publicly
Displayed

97

Principal Investigator Business
Street Address Line 2

The second line of the primary business street address of the Principal investigator of the research
study.

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

98

Principal Investigator City

The primary business address city of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

99

Principal Investigator State

The primary business address state or territory abbreviation of the Principal investigator of the
research study, if the primary practice address is in the United States.

Enumeration

2 character U.S. state or territory
alpha abbreviation

No unless indicating
multiple Principal
Investigators

2 Char

Yes

100

Principal Investigator Zip Code

The 9 digit zip code of the primary business address location of the Principal investigator of the
research study, if the primary practice address is in the United States.

Text

9 digit numeric zip code

No unless indicating
multiple Principal
Investigators

≤ 9 Char

Yes

101

Principal Investigator Country

The primary business address country name of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

102

Principal Investigator Province

The primary business address province name of the Principal investigator of the research study, if the
primary practice address is outside the United States.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

103

Principal Investigator Postal
Code

The international postal code of the primary business location of the Principal investigator of the
research study if the primary practice address is outside the United States.

Text

Alphanumeric

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

104

Principal Investigator Physician
Primary Type

Primary type of medicine practiced by the Principal Investigator.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

No unless indicating
multiple Principal
Investigators

1 Char

Yes

10 digit Numeric

Numeric digits only

No unless indicating
multiple Principal
Investigators

10 Char

No

Text

Text from Standardized Selection

No unless indicating
multiple Principal
Investigators

10 Char

Yes

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXX

No unless indicating
multiple Principal
Investigators

≤ 20 Char per
comma
separated item

No

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

105

Principal Investigator NPI

Individual NPI for Physician (not NPI of any group physician belonging to) required, if applicable.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

106

Principal Investigator Specialty

Principal Investigator's single specialty chosen from "provider taxonomy" list.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

107

Principal Investigator License
State and License Number

Paired state and state license number of the Principal Investigator, who is a physician covered
Alphanumeric
recipient; the pairing includes the 2 letter state abbreviation, followed by a hyphen, followed by the
state license number and may include up to 5 "Physician License State and License Number" pairs. If a
Principal investigator is licensed in multiple states, provide only one state and license number pair.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

12

Research Payment Template

DE #
108

Data Element Name

Definition / Description

Data Type

Validation

Publicly
Displayed

Required?

Field Size

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

Principal Investigator First Name Textual first name of the Principal Investigator(s) of the research study, if the Principal Investigator is a Text
Covered Recipient Physician.

Format

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
109

Principal Investigator Middle
Name

Textual middle initial or middle name of the Principal Investigator of the research study, if the
Principal Investigator is a Covered Recipient Physician.

110

Principal Investigator Last Name Textual last name of the Principal investigator of the research study, if the Principal Investigator is a
Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 35 Char

Yes

111

Principal Investigator Name
Suffix

Suffix of the Principal Investigator of the research study chosen from a constrained list of values
(Examples: Jr., Sr, III), if the Principal Investigator is a Covered Recipient Physician.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 5 Char

Yes

112

Principal Investigator Business
Street Address Line 1

The first line of the primary business street address of the Principal Investigator of the research study,
if the Principal Investigator is a Covered Recipient Physician.

Text

Two line address format;
First line contains building number,
street name, street identifier

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
113

Principal Investigator Business
Street Address Line 2

The second line of the primary business street address of the Principal investigator of the research
study.

Text

Two line address format;
Second line contains suite number,
apartment number, post office box
number or other qualifying
information

No unless indicating
multiple Principal
Investigators

≤ 55 Char

Yes

114

Principal Investigator City

The primary business address city of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

115

Principal Investigator State

The primary business address state or territory abbreviation of the Principal investigator of the
research study, if the primary practice address is in the United States.

Enumeration

2 character U.S. state or territory
alpha abbreviation

No unless indicating
multiple Principal
Investigators

2 Char

Yes

116

Principal Investigator Zip Code

The 9 digit zip code of the primary business address location of the Principal investigator of the
research study, if the primary practice address is in the United States.

Text

9 digit numeric zip code

No unless indicating
multiple Principal
Investigators

≤ 9 Char

Yes

117

Principal Investigator Country

The primary business address country name of the Principal investigator of the research study.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 40 Char

Yes

118

Principal Investigator Province

The primary business address province name of the Principal investigator of the research study, if the
primary practice address is outside the United States.

Text

Free form text

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

119

Principal Investigator Postal
Code

The international postal code of the primary business location of the Principal investigator of the
research study if the primary practice address is outside the United States.

Text

Alphanumeric

No unless indicating
multiple Principal
Investigators

≤ 20 Char

Yes

120

Principal Investigator Physician
Primary Type

Primary type of medicine practiced by the Principal Investigator.

Enumeration

"1" = Medical Doctor (MD);
"2" = Doctor of Osteopathy (DO);
"3" = Doctor of Dentistry (DDS);
"4" = Doctor of Podiatric Medicine
(DPM);
"5" = Doctor of Optometry (OD);
"6" = Chiropractor (DCP)

No unless indicating
multiple Principal
Investigators

1 Char

Yes

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

13

Research Payment Template

DE #
121

Data Element Name
Principal Investigator NPI

Definition / Description
Individual NPI for Physician (not NPI of any group physician belonging to) required, if applicable.

Data Type

Format

Principal Investigator Specialty

Principal Investigator's single specialty chosen from "provider taxonomy" list.

Principal Investigator License
State and License Number

Validation

Publicly
Displayed

Numeric digits only

No unless indicating
multiple Principal
Investigators

10 Char

No

Text

Text from Standardized Selection

No unless indicating
multiple Principal
Investigators

10 Char

Yes

Maximum of 5 comma
separated pairs of the state
and license number; AAXXXXXXXXXXXXXXXX

No unless indicating
multiple Principal
Investigators

≤ 20 Char per
comma
separated item

No

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
123

Field Size

10 digit Numeric

If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).
122

Required?

Paired state and state license number of the Principal Investigator, who is a physician covered
Alphanumeric
recipient; the pairing includes the 2 letter state abbreviation, followed by a hyphen, followed by the
state license number and may include up to 5 "Physician License State and License Number" pairs. If a
Principal investigator is licensed in multiple states, provide only one state and license number pair.
If the Principal Investigator is the same as the Covered Recipient Physician receiving the payment
(identified in data elements 10-13), it is not necessary to duplicate the information for the Principal
Investigator fields (Data Elements 45-60).

INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW

14