PROVIDER TYPE CODE DESCRIPTION OF PROVIDER TYPE …

PROVIDER TYPE CODE DESCRIPTION OF PROVIDER TYPE

01

INPATIENT FACILITY

01

01

01

01

01

01

01

01

01

01

01

01

01

01

01

01

01

02

AMBULATORY SURGICAL CENTER

03

EXTENDED CARE FACILITY

03

03

03

03

03

03

03

03

03

03

03

03

04

REHABILITATION FACILITY

05

HOME HEALTH

05

05

05

05

05

05

05

05

SPECIALITY CODE

DESCRIPTION OF PROVIDER SPECIALITY

010

ACUTE CARE HOSPITAL

011

PRIVATE PSYCHIATRIC HOSPITAL

012

INPATIENT MEDICAL REHAB HOSPITAL

013

RESIDENTIAL TREATMENT FACILITY (JCAHO

014

INPATIENT MEDICAL REHAB UNIT

015

CHILDREN'S SPECIALITY

016

EMERGENCY ROOM ARRANGEMENT 1

017

EMERGENCY ROOM ARRANGEMENT 2

018

EXTENDED ACUTE PSYCH INPATIENT UNIT

019

INPATIENT DRUG & ALCOHOL HOSPITAL

021

SHORT PROCEDURE UNIT

022

PRIVATE PSYCHIATRIC UNIT

023

PUBLIC PSYCHIATRIC HOSPITAL

183

HOSPITAL BASED MEDICAL CLINIC

441

DRUG AND ALCOHOL REHAB UNIT

340

PROGRAM EXCEPTION

220

HEARING AID DISPENSER

370

TOBACCO CESSATION

020

AMBULATORY SURGICAL CENTER

030

NURSING FACILITY

031

COUNTY NURSING FACILITY

032

ICF/MR 8 BEDS OR LESS

033

ICF/MR 9 BEDS OR MORE

036

RESPITE CARE

037

STATE LTC UNIT

038

STATE MENTAL RETARDATION CENTER

039

ICF/ORC

040

SPECIAL REHAB NURSING FACILITY

362

ATTENDANT CARE/PERSONAL ASSISTANCE

382

INP. FACILITY BASED LTC EXT. CARE FACILITY

410

ADULT DAY CARE

430

HOMEMAKER SERVICES

041

COMPREHENSIVE OUTPATIENT REHAB FACILITY

025

PERSONAL EMERGENCY RESPONSE SYSTEM

050

HOME HEALTH SERVICES

051

PRIVATE DUTY NURSING

250

DME / MEDICAL SUPPLIES

340

PROGRAM EXCEPTION

361

PERSONAL CARE - AGENCY

362

ATTENDANT CARE/PERSONAL ASSISTANCE

410

ADULT DAY CARE

430

HOMEMAKER SERVICES

05

05

06

HOSPICE

07

CAPITATION

07

07

07

08

CLINIC

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

08

09

CERTIFIED REGISTERED NURSE

09

09

09

09

09

09

09

09

09

512

RESPITE CARE - HOME BASED

370

TOBACCO CESSATION

060

HOSPICE

070

LTC CAP

071

MANAGED CARE ORGANIZATION, PHYSICAL

072

MANAGED CARE ORGANIZATION, BEHAVIORAL

073

PCCM

074

MOBILE MENTAL HEALTH TREATMENT

076

PEER SPECIALIST

080

FEDERALLY QUALIFIED HEALTH CENTER

081

RURAL HEALTH CLINIC

082

INDEPENDENT MEDICAL / SURGICAL CLINIC

083

FAMILY PLANNING CLINIC

084

METHADONE MAINTENANCE

086

DENTAL CLINIC

110

PSYCHIATRIC OUTPATIENT

123

PSYCHIATRIC REHABILITATION

184

OUTPATIENT DRUG AND ALCOHOL

340

PROGRAM EXCEPTION

370

TOBACCO CESSATION

800

FQHC THERAPEUTIC STAFF SUPPORT

801

FQHC MOBILE THERAPY

802

FQHC BEHAVIORAL SPECIALIST CONSULTANT

FQHC SUMMER THERAPEUTIC ACTIVITY PROGRAM

803

(STAP)

804

RHC THERAPEUTIC STAFF SUPPORT

805

RHC MOBILE THERAPY

806

RHC BEHAVIORAL SPECIALIST CONSULTANT

807

RHC SUMMER THERAPEUTIC ACTIVITY PROGRAM

808

PSYCH OUTPT THERAPEUTIC STAFF SUPPORT

809

PSYCH OUTPT MOBILE THERAPY

810

PSYCH OUTPT BEHAVIORAL SPECIALIST

811

PSYCHIATRIC OUTPATIENT (STAP)

090

PEDIATRIC

091

OBSTETRICS / GYNECOLOGY

092

FAMILY HEALTH

093

NURSE PRACTITIONER (PRIMARY CARE)

094

FAMILY HOME HEALTH

095

ADULT HEALTH

096

SCHOOL NURSE

097

FAMILY PLANNING

098

GERONTOLOGY

099

EMERGENCY

09

09

09

09

09

09

09

09

09

09

09

09

09

09

09

09

09

09

09

11

MENTAL HEALTH / SUBSTANCE ABUSE

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

11

101

NEONATAL

103

ADULT PSYCH MENTAL HEALTH

104

ADULT ACUTE CARE

105

PEDIATRIC ACUTE CHRONIC

106

PEDIATRIC CRITICAL CARE

107

ADULT CARDIOPULMONARY

108

ADULT SURGICAL

109

ADULT RENAL METABOLIC

292

ADULT CRITICAL CARE

293

ADULT NEUROSCIENCE

294

ADULT ONCOLOGY

295

ADULT PERIOPERATIVE

297

PEDIATRIC ONCOLOGY

298

PERINATAL

299

WOMEN'S HEALTH

370

TOBACCO CESSATION

548

THERAPEUTIC STAFF SUPPORT

549

MOBILE THERAPY

559

BEHAVIORAL SPECIALIST CONSULTANT

076

PEER SPECIALIST

110

PSYCHIATRIC OUTPATIENT

111

COMMUNITY MENTAL HEALTH

112

OUTPATIENT PRACTITIONER-MH

113

PARTIAL PSYCH HOSPITALIZATION CHILDREN

114

PARTIAL PSYCH HOSPITALIZATION ADULT

115

FAMILY BASED MENTAL HEALTH

116

LICENSED CLINICAL SOCIAL WORKER

117

LICENSED SOCIAL WORKER

118

MENTAL HEALTH CRISIS INTERVENTION

119

MENTAL HEALTH - OMHSAS

122

MARRIAGE AND FAMILY COUNSELOR

123

PSYCHIATRIC REHABILITATION

124

MENTAL ILLNESS/SUBSTANCE ABUSE

125

MENTAL ILLNESS/SUBSTANCE ABUSE

126

BEHAVIORAL SUPPORT

127

D & A OUTPATIENT

128

D & A INTENSIVE OUTPATIENT

129

D & A PARTIAL HOSPITALIZATION

131

D & A HALFWAY HOUSE

132

D & A MEDICALLY MONITORED DETOXIFICATION

D & A MEDICALLY MONITORED RESIDENTIAL,

133

SHORT TERM

11 11 11 11

11 11

11 11

11 11

11 11

11 11

11

11

11

11

11

12

SCHOOL CORPORATION

12

14

PODIATRIST

15

CHIROPRACTOR

16

NURSE

16

16

16

16

17

THERAPIST

17

17

17

17

17

17

17

D & A MEDICALLY MONITORED RESIDENTIAL, LONG

134

TERM

137

CARN-AP (CERTD ADDICTIONS RN-ADVANCED

184

OUTPATIENT DRUG AND ALCOHOL

340

PROGRAM EXCEPTION

PART PSYCH HOSP CHILD THERAPEUTIC STAFF

442

SUPPORT

443

PART PSYCH HOSP CHILD MOBILE THERAPY

PART PSYCH HOSP CHILD BEHAV SPECIALIST

444

CONSULTANT

445

PART PSYCH HOSP CHILD (STAP)

PART PSYCH HOSP ADULT THERAPEUTIC STAFF

446

SUPPORT

447

PART PSYCH HOSP ADULT MOBILE THERAPY

PART PSYCH HOSP ADULT BEHAV SPECIALIST

448

CONSULTANT

449

PART PSYCH HOSP ADULT (STAP)

FAMILY BASED MNTL HLTH THERAPEUTIC STAFF

450

SUPPORT

451

FAMILY BASED MNTL HLTH MOBILE THERAPY

FAMILY BASED MNTL HLTH BEHAV SPECIALIST

452

CONSULTANT

453

FAMILY BASED MNTL HLTH (STAP)

548

THERAPEUTIC STAFF SUPPORT

549

MOBILE THERAPY

559

BEHAVIORAL SPECIALIST CONSULTANT

120

TEACHING INSTITUTE

121

TEACHING INSTITUTE - DENTAL

140

PODIATRIST

150

CHIROPRACTOR

160

REGISTERED NURSE

161

LICENSED PRACTICAL NURSE

162

PSYCHIATRIC NURSE

340

PROGRAM EXCEPTION

572

EARLY INTERVENTION SERVICES

170

PHYSICAL THERAPIST

171

OCCUPATIONAL THERAPIST

172

RESPIRATORY THERAPIST

173

SPEECH/HEARING THERAPIST

174

ART THERAPIST

175

MUSIC THERAPIST

176

PHYSICAL THERAPY / EARLY INTERVENTION (EI)

177

OCCUPATIONAL THERAPY / EARLY INTERVENTION

17

17

18

OPTOMETRIST

19

PSYCHOLOGIST

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

19

20

AUDIOLOGIST

20

20

21

CASE MANAGER

21

21

21

21

21

21

21

21

21

22

DEPARTMENT OF HEALTH

22

22

178

SPEECH/HEARING THERAPY / EARLY INTERVENTION

340

PROGRAM EXCEPTION

180

OPTOMETRIST

190

GENERAL PSYCHOLOGIST

191

CLINICAL NEUROPSYCHOLOGIST

192

CLINICAL HEALTH PSYCHOLOGIST

194

SCHOOL PSYCHOLOGIST

195

CLINICAL PSYCHOLOGIST

196

CLINICAL CHILD PSYCHOLOGIST

197

COUNSELING PSYCHOLOGIST

198

INDUSTRIAL ORGANIZATIONAL PSYCHOLOGIST

199

BEHAVIORAL PSYCHOLOGIST

201

FORENSIC PSYCHOLOGIST

202

FAMILY PSYCHOLOGIST

204

CLINICAL GEROPSYCHOLOGIST

TRTMT OF ALCOL AND OTHER PSYCAV SBSTC USE

206

DSORDRS

207

COGNITIVE THERAPIST

208

BEHAVIORAL THERAPIST CONSULTANT

340

PROGRAM EXCEPTION

370

TOBACCO CESSATION

548

THERAPEUTIC STAFF SUPPORT

549

MOBILE THERAPY

559

BEHAVIORAL SPECIALIST CONSULTANT

572

EARLY INTERVENTION SERVICES

200

AUDIOLOGIST

220

HEARING AID DISPENSER

572

EARLY INTERVENTION SERVICES

076

PEER SPECIALIST

138

D & A TARGETED CASE MANAGEMENT

MEDICAL ASSISTANCE CASE MANAGEMENT FOR

211

HIV & AIDS

MEDICAL ASSISTANCE CASE MANAGEMENT FOR

212

UNDER 21

213

EARLY INTERVENTION CASE MANAGEMENT

215

MH CASE MANAGEMENT - ADMINISTRATIVE

216

LICENSED SOCIAL WORKER , EI

218

MR TARGETED CASE MANAGEMENT

221

MH TARGETED CASE MGT, RESOURCE

222

MH TARGETED CASE MANAGEMENT, INTENSIVE

225

ENVIRONMENTAL INVESTIGATION

226

NEWBORN HEARING SCREENING

227

NEWBORN SCREENING

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