{"identifier":"ee58c0ab-f42d-4638-a74b-4283564e39e8","data":{"title":"Opt Out Affidavits Data Dictionary","fields":[{"name":"First_Name","label":"First Name","description":"First Name of the Opt Out Provider"},{"name":"Last_Name","label":"Last Name","description":"Last Name of the Opt Out Provider"},{"name":"NPI","label":"NPI","description":"National Provider Identifier (NPI) number of the Opt Out Provider"},{"name":"Specialty","label":"Specialty","description":"Specialty of the Opt Out Provider"},{"name":"Opt_Out_Effective_Date","label":"Opt Out Effective Date","description":"Date from which the Provider\u0027s Opt Out Status is effective"},{"name":"Opt_Out_End_Date","label":"Opt Out End Date","description":"Date on which the Provider\u0027s Opt Out Status ends"},{"name":"First_Line_Street_Address","label":"First Line Street Address","description":"Provider\u0027s Street Address"},{"name":"Second_Line_Street_Address","label":"Second Line Street Address","description":"Provider\u0027s Street Address"},{"name":"City_Name","label":"City Name","description":"Provider\u0027s City"},{"name":"State_Code","label":"State Code","description":"Provider\u0027s State Abbreviation"},{"name":"Zip_Code","label":"Zip Code","description":"Provider\u0027s Zip Code"},{"name":"Eligible_to_Order_and_Refer","label":"Eligible to Order and Refer","description":"Flag indicating whether the Provider is eligible to Order and Refer"}]}}