PROVIDER TYPE CODE PROVIDER SPECIALTY CODE …

PROVIDER TYPE CODE

010-Behavioral Health & Social Service Providers

PROVIDER SPECIALTY CODE 074-Clinical Neuropsychologist

152-Counselor 155-Counselor, Addiction 177-Counselor, Licensed Associate

Professional (LAPC) 190-Counselor, Licensed Professional

Clinical (LPCC) 194-Counselor, Professional 403-Marriage & Family Therapist 191-Licensed Independent Clinical Social

Worker (LICSW, LCSW) 050-Psychologist

425-Social Worker (LSW)

TAXONOMY CODE 103G00000X 101Y00000X 101YA0400X

101YP2500X

101YP2500X

101YP2500X 106H00000X

1041C0700X

103T00000X 104100000X

011-Chiropractic Providers

047-Chiropractor

111N00000X

012-Dental Providers

019-Dentists 062-Endodontics 001-General Practice 212-Oral Maxillofacial Surgery 064-Orthodontics

063-Pedodontics (Pediatric Dentistry)

065-Periodontics 066-Prosthodontics

122300000X 1223E0200X 1223G0001X 1223S0112X 1223X0400X

1223P0221X

1223P0300X 1223P0700X

013-Dietary & Nutritional Service Providers

056-Licensed Registered Dietician

015-Eye & Vision Service Providers

411-Optician 088-Optometrist

016-Nursing Service Providers

130-Licensed Practical Nurse 127-Licensed Vocational Nurse

129-Registered Nurse

133V00000X

156FX1800X 152W00000X

164W00000X 164X00000X 163W00000X

017-Other Service Providers

335-Case Manager/Care Coordinator 468-County Social Service Office 339-Lodging

393-Provide Meals

171M00000X 171M00000X no taxonomy code

required no taxonomy code

required

018-Pharmacy Service Providers

253-Pharmacist

183500000X

058-Adult Medicine 003-Allergy & Immunology 436 -Anatomic Pathology

005-Anesthesiology 006-Cardiovascular Disease 078-Clinical & Laboratory Dermatological

Immunology 083-Clinical Biochemical Genetics

084-Clinical Cardiac Electrophysiology

020-Physicians (Allopathic & Osteopathic)

085-Clinical Cytogenetic 405-Clinical Genetics (MD) 118-Clinical Molecular Genetics

021-Clinical Pathology 136 -Clinical Pathology/Laboratory

Medicine 133-Clinical Pharmacology 101-Colon and Rectal Surgery 206-Critical Care Medicine

007-Dermatology 260-Dermatopathology 167-Diagnostic Radiology 270-Emergency Medicine 093-Emergency Medical Services 168-Endocrinology, Diabetes &

Metabolism 301-Facial Plastic Surgery

173-Family Medicine 302-Foot & Ankle Surgery

010-Gastroenterology 001-General Practice 307-Gynecologic Oncology 179-Hematology/Oncology

207QA0505X 207K00000X 207ZP0101X 207L00000X 207RC0000X

207NI0002X

207SG0202X

207RC0001X

207SC0300X 207SG0201X 207SG0203X 207ZC0006X

207ZP0105X

208U00000X 208C00000X 207RC0200X 207N00000X 207ND0900X 2085R0202X 207P00000X 207PE0004X

207RE0101X

207YS0123X 207Q00000X 207XX0004X 207RG0100X 208D00000X 207VX0201X 207RH0003X

340-Hepatology

344-Hospitalist

183-Immunopathology

471-Independent Medical Examiner

185-Infectious Diseases

011-Internal Medicine

188-Interventional Cardiology

375-Legal Medicine

404-Maternal & Fetal Medicine

105-Nephrology

014-Neurological Surgery

013-Neurology

203-Neuropathology

204-Neuroradiology

103-Nuclear Medicine

Nuclear Radiology

211-Obstetrics

016-Obstetrics & Gynecology

018-Ophthalmology

212-Oral Maxillofacial Surgery

214-Orthopedic Hand Surgery

020-Orthopaedic Surgery

020-Physicians (Allopathic

217-Otolarynology

& Osteopathic)

219-Pain Medicine

108-Pediatric Allergy & Immunology

412-Pediatric Anesthesiology

221-Pediatric Cardiology

222-Pediatric Dermatology

223-Pediatric Developmental & Behavioral

Pediatrics

225-Pediatric Emergency Medicine

226-Pediatric Endocrinology

227-Pediatric Gastroenterology

228-Pediatric Hematology-Oncology

229-Pediatric Infectious Disease

231-Pediatric Medical Toxicology

232-Pediatric Nephrology

233-Pediatric Neurodevelopment

Disabilities

237-Pediatric Orthopedics Surgery

140-Pediatric Otolaryngology

238-Pediatric Pathology

240-Pediatric Pulmonology

241-Pediatric Radiology

242-Pediatric Rehab Medicine

243-Pediatric Rheumatology

207RI0008X 208M00000X 207ZI0100X 202C00000X 207RI0200X 207R00000X 207RI0011X 209800000X 207VM0101X 207RN0300X 207T00000X 2084N0400X 207ZN0500X 2085N0700X 207U00000X 2085N0904X 207VX0000X 207V00000X 207W00000X 204E00000X 207XS0106X 207X00000X 207Y00000X 208VP0000X 2080P0201X 207LP3000X 2080P0202X 207NP0225X

2080P0006X

207PP0204X 2080P0205X 2080P0206X 2080P0207X 2080P0208X 2080T0002X 2080P0210X

2080P0008X

207XP3100X 207YP0228X 207ZP0213X 2080P0214X 2085P0229X 2081P0010X 2080P0216X

244-Pediatric Sports Medicine 245-Pediatric Surgery 246-Pediatric Urology 049-Pediatrics 012-Phlebology

025-Physical Medicine & Rehabilitation

024-Plastic Surgery 256-Plastic Surgery Hand Surgery

257-Preventative Medicine/OccupationalEnvironmental Medicine

020-Physicians (Allopathic & Osteopathic)

414-Procedural Dermatology 121-Psychiatry

142-Psychiatry ? Child/Adolescent 029-Pulmonary Diseases Radiation Oncology 267-Rheumatology 275-Surgery 276-Surgical Oncology 278-Therapeutic Radiology 033-Thoracic Surgery 279-Transplant Surgery 034-Urology

189-Vascular and Interventional Radiology

289-Vascular Surgery

2080S0010X 2086S0120X 2088P0231X 208000000X 202K00000X

208100000X

208200000X 2082S0105X

2083P0500X

207NS0135X 2084P0800X 2084P0804X 207RP1001X 2085R001X 207RR0500X 208600000X 2086X0206X 2085R0203X 208G00000X 204F00000X 208800000X

2085R0204X

2086S0129X

021-Podiatric Medicine &Surgery Service Providers

120-Podiatrist

022-Respiratory, Developmental, Rehabilitative & Restorative Service

Providers

126-Occupational Therapy 114-Orthotist

123-Physical Therapist 115-Prosthetist

349-Respiratory Therapist, Certified

430-Respiratory Therapist, Registered

213E00000X

225X00000X 222Z00000X 225100000X 224P00000X 227800000X 227900000X

023-Speech, Language & Hearing Service Providers

087-Audiologist 272-Speech-Language Pathologist

231H00000X 235Z00000X

034-Transportation Services

483-Air Carrier 132-Ambulance

385-Bus 387-Private Vehicle 388-Secured Medical Transport (Van)

389-Taxi 390-Train 484-Transportation Broker

485-Advanced Practice Midwife

341-Certified Registered Nurse Anesthetist

036-Clinical Nurse Specialist 431-Nurse Practitioner; Adult Health

055-Nurse Practitioner;-Advanced Practice

036-Physician Assistants &Advanced Practice Nursing Providers

432-Nurse Practitioner; Family 466 -Nurse Practitioner; Neonatal; Critical

Care 434 -Nurse Practitioner; OB/GYN

435-Nurse Practitioner; Pediatrics

469-Nurse Practitioner; Primary Care

467-Nurse Practitioner; Psychiatric/Mental

Health

470-Nurse Practitioner, Women's Health

255-Physician Assistant

344800000X 341600000X 347B00000X 347C00000X 343800000X 344600000X 347D00000X 347E00000X

367A00000X

367500000X

364S00000X 363LA2200X

363L00000X

363LF0000X

363LN0005X

363LX0001X 363LP0200X 363LP2300X

363LP0808X

363LW0102X

363A00000X

039-Developmental Disabilities

335-Case Manager/Care Coordinator 380-Congregate Care (DD) 374-Day Support (DD) 373-Extended Services (DD)

379-Family Support Services (DD) 377-Ind Supp Lvg Arrangement (DD)

372-Infant Development (DD) 381-Minimally Suprvsd Lvg Arrngmnt (DD) 382-Supported Living Arrangement (DD) 376-Transitional Comm Living Facility (DD)

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048-Qualified Service Providers

323-Adult Day Care (QSP)

318-Adult Family Foster Care (QSP) 146-Attendant Care (QSP)

312-Case Management ? Assment (QSP) 313-Case Management ? Other (QSP) 309-Chore Labor (QSP) 308-Chore ? Snow Removal (QSP)

153-Chore Emrgncy Rspns Sys Comp (QSP) 321-Environmental Modifications (QSP) 394-Extended Personal Care (QSP) 319-Family Home Care (QSP) 112-Family Personal Care (QSP)

317-Higher Lvl Case Mgmt ? Assmnt (QSP) 316-Higher Lvl Case Mgmt ? Other (QSP)

330-Home Delivered Meals (QSP) 180-Homemaker (QSP)

310-Installation ERS (QSP) 205-Non-Med Transport (Carrier-bus, taxi)

(QSP) 327-Non-Med Transport (Escort) (QSP) 326-Non-Med Transport (local-round trip)

(QSP) 325-Non-Med Transport (out of town)

(QSP) 396-Nurse Education Care (QSP)

209-Nurse Management (QSP)

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048-Qualified Service Providers

320-Personal Care ? Assisted Living (QSP) 251-Personal Care ? Daily Rate (QSP) 399-Personal Care ? Unit Rate (QSP) 324-Residential Service (QSP) 081-Respite Care (QSP) 306-Respite Care, Institutional (QSP) 125-Specialized Equipment (QSP)

285-TBI Case Management Other (QSP) 286-TBI Case Management Team Meeting

(QSP) 287-TBI Supportive Employment (QSP) 314-Tech Depd Case Mgmt ? Other (QSP) 315-Tech Depd Case Mgmt ? Asmt (QSP)

329-Transitional Living (QSP)

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