Implementation Guide
25.0.0 - R4 APIs

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: PAS Insurer Organization Example - JSON Representation

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{
  "resourceType" : "Organization",
  "id" : "IC-1",
  "meta" : {
    "lastUpdated" : "2025-11-27T20:27:11.000-06:00",
    "profile" : [
      🔗 "https://docs.mydata.athenahealth.com/fhir-r4/StructureDefinition/athena-pas-insurer-organization-profile"
    ]
  },
  "text" : {
    "status" : "generated",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\"><table width=\"100%\"><tbody><tr><td width=\"25%\">Aetna Life and Casualty</td><td width=\"42%\">P O Box 1458 Carrollton, TX 75006 US Phone: 9726621350 Phone: 9876543211</td></tr></tbody></table></div>"
  },
  "identifier" : [
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment",
          "valueString" : "Aetna Life and Casualty"
        },
        {
          "url" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction",
                "code" : "TX ",
                "display" : "Texas"
              }
            ]
          }
        }
      ],
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "0"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/v2-0203",
            "code" : "TIN",
            "display" : "Tax Identification Number"
          }
        ]
      },
      "system" : "http://terminology.hl7.org/NamingSystem/USEIN",
      "value" : "12345"
    },
    {
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/carin-bb/CodeSystem/C4BBIdentifierType",
            "code" : "payerid",
            "display" : "Payer ID"
          }
        ]
      },
      "value" : "11223344"
    }
  ],
  "active" : true,
  "type" : [
    {
      "coding" : [
        {
          "system" : "https://valueset.x12.org/x217/005010/request/2010A/NM1/1/01/00/98",
          "code" : "93",
          "display" : "Insurance Institute"
        }
      ],
      "text" : "Insurance Institute"
    }
  ],
  "name" : "Aetna Life and Casualty",
  "telecom" : [
    {
      "system" : "phone",
      "value" : "9726621350",
      "use" : "work"
    },
    {
      "system" : "phone",
      "value" : "9876543211",
      "use" : "mobile"
    }
  ],
  "address" : [
    {
      "line" : [
        "P O Box 1458"
      ],
      "city" : "Carrollton",
      "state" : "TX",
      "postalCode" : "75006",
      "country" : "US"
    }
  ]
}