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: PAS Insurer Organization Example - XML Representation

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