# Submit Claim Requestor Example - Da Vinci Prior Authorization Support (PAS) FHIR IG v2.2.0-ballot

## Example Organization: Submit Claim Requestor Example

Language: en

Profile: [PAS Requestor Organization](StructureDefinition-profile-requestor.md)

**identifier**: [United States National Provider Identifier](http://terminology.hl7.org/6.2.0/NamingSystem-npi.html)/8189991234

**active**: true

**type**: X3

**name**: DR. JOE SMITH CORPORATION

**address**: 111 1ST STREET SAN DIEGO CA 92101 US 



## Resource Content

```json
{
  "resourceType" : "Organization",
  "id" : "UMOExample",
  "meta" : {
    "profile" : [
      "http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor"
    ]
  },
  "language" : "en",
  "identifier" : [
    {
      "system" : "http://hl7.org/fhir/sid/us-npi",
      "value" : "8189991234"
    }
  ],
  "active" : true,
  "type" : [
    {
      "coding" : [
        {
          "system" : "https://codesystem.x12.org/005010/98",
          "code" : "X3"
        }
      ]
    }
  ],
  "name" : "DR. JOE SMITH CORPORATION",
  "address" : [
    {
      "line" : ["111 1ST STREET"],
      "city" : "SAN DIEGO",
      "state" : "CA",
      "postalCode" : "92101",
      "country" : "US"
    }
  ]
}

```
