<participant typeCode=“LOC”>

<associatedEntity classCode="SDLOC">
  <id root="2.16.840.1.113883.3.249.5.1" extension="T2OR1234" assigningAuthorityName="CMS-CMMI"/>
  <code code="394730007" displayName="healthcare related organization" codeSystem="2.16.840.1.113883.6.96" codeSystemName="SNOMED-CT"/>
  <addr>
    <streetAddressLine>202 Burlington Rd.</streetAddressLine>
    <city>Bedford</city>
    <state>MA</state>
    <postalCode>01730</postalCode>
    <country>US</country>
  </addr>
</associatedEntity>

</participant>