155-Counselor, Addiction 177-Counselor, Licensed Associate Professional (LAPC) 425-Social Worker (LSW) 212-Oral Maxillofacial Surgery
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1 PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE 074-Clinical Neuropsychologist 103G00000X 152-Counselor 101Y00000X 155-Counselor, Addiction 101YA0400X 177-Counselor, Licensed Associate Professional (LAPC) 101YP2500X 190-Counselor, Licensed Professional 010-Behavioral Health & 101YP2500X Clinical (LPCC) Social Service 194-Counselor, Professional 101YP2500X 403-Marriage & Family Therapist 106H00000X 191-Licensed Independent Clinical Social Worker (LICSW, LCSW) 1041C0700X 050-Psychologist 103T00000X 425-Social Worker (LSW) X 011-Chiropractic 047-Chiropractor 111N00000X 012-Dental 019-Dentists 062-Endodontics 001-General Practice 212-Oral Maxillofacial Surgery 064-Orthodontics 063-Pedodontics (Pediatric Dentistry) 065-Periodontics 066-Prosthodontics X 1223E0200X 1223G0001X 1223S0112X 1223X0400X 1223P0221X 1223P0300X 1223P0700X 013-Dietary & Nutritional Service 056-Licensed Registered Dietician 133V00000X 015-Eye & Vision Service 411-Optician 088-Optometrist 156FX1800X 152W00000X 016-Nursing Service 130-Licensed Practical Nurse 127-Licensed Vocational Nurse 129-Registered Nurse 164W00000X 164X00000X 163W00000X
2 017-Other Service 335-Case Manager/Care Coordinator 468-County Social Service Office 339-Lodging 393-Provide Meals 171M00000X 171M00000X 018-Pharmacy Service 253-Pharmacist X 058-Adult Medicine 207QA0505X 003-Allergy & Immunology 207K00000X 436 -Anatomic Pathology 207ZP0101X 005-Anesthesiology 207L00000X 006-Cardiovascular Disease 207RC0000X 078-Clinical & Laboratory Dermatological Immunology 207NI0002X 083-Clinical Biochemical Genetics 207SG0202X 020-Physicians (Allopathic & Osteopathic) 084-Clinical Cardiac Electrophysiology 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 207RC0001X 207SC0300X 207SG0201X 207SG0203X 207ZC0006X 207ZP0105X 208U00000X 208C00000X 207RC0200X 207N00000X 207ND0900X 2085R0202X 207P00000X 207PE0004X 207RE0101X 207YS0123X 207Q00000X 207XX0004X 207RG0100X 208D00000X 207VX0201X 207RH0003X
3 020-Physicians (Allopathic & Osteopathic) 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 217-Otolarynology 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 X 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
4 020-Physicians (Allopathic & Osteopathic) 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/Occupational- Environmental Medicine 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 X 202K00000X X X 2082S0105X 2083P0500X 207NS0135X 2084P0800X 2084P0804X 207RP1001X 2085R001X 207RR0500X X 2086X0206X 2085R0203X 208G00000X 204F00000X X 2085R0204X 2086S0129X 021-Podiatric Medicine &Surgery Service 120-Podiatrist 213E00000X 022-Respiratory, Developmental, Rehabilitative & Restorative Service 126-Occupational Therapy 114-Orthotist 123-Physical Therapist 115-Prosthetist 349-Respiratory Therapist, Certified 430-Respiratory Therapist, Registered 225X00000X 222Z00000X X 224P00000X X X 023-Speech, Language & Hearing Service 087-Audiologist 272-Speech-Language Pathologist 231H00000X 235Z00000X
5 034-Transportation Services 483-Air Carrier 132-Ambulance 385-Bus 387-Private Vehicle 388-Secured Medical Transport (Van) 389-Taxi 390-Train 484-Transportation Broker X X 347B00000X 347C00000X X X 347D00000X 347E00000X 485-Advanced Practice Midwife 341-Certified Registered Nurse Anesthetist 036-Clinical Nurse Specialist 431-Nurse Practitioner; Adult Health 055-Nurse Practitioner;-Advanced Practice 367A00000X X 364S00000X 363LA2200X 363L00000X 036-Physician Assistants &Advanced Practice Nursing 432-Nurse Practitioner; Family 363LF0000X 466 -Nurse Practitioner; Neonatal; Critical Care 363LN0005X 434 -Nurse Practitioner; OB/GYN 363LX0001X 435-Nurse Practitioner; Pediatrics 363LP0200X 469-Nurse Practitioner; Primary Care 363LP2300X 467-Nurse Practitioner; Psychiatric/Mental Health 363LP0808X 470-Nurse Practitioner, Women's Health 255-Physician Assistant 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)
6 048-Qualified Service 323-Adult Day Care 318-Adult Family Foster Care 146-Attendant Care 312-Case Management Assment 313-Case Management Other 309-Chore Labor 308-Chore Snow Removal 153-Chore Emrgncy Rspns Sys Comp 321-Environmental Modifications 394-Extended Personal Care 319-Family Home Care 112-Family Personal Care 317-Higher Lvl Case Mgmt Assmnt 316-Higher Lvl Case Mgmt Other 330-Home Delivered Meals 180-Homemaker 310-Installation ERS 205-Non-Med Transport (Carrier-bus, taxi) 327-Non-Med Transport (Escort) 326-Non-Med Transport (local-round trip) 325-Non-Med Transport (out of town) 396-Nurse Education Care 209-Nurse Management
7 048-Qualified Service 320-Personal Care Assisted Living 251-Personal Care Daily Rate 399-Personal Care Unit Rate 324-Residential Service 081-Respite Care 306-Respite Care, Institutional 125-Specialized Equipment 285-TBI Case Management Other 286-TBI Case Management Team Meeting 287-TBI Supportive Employment 314-Tech Depd Case Mgmt Other 315-Tech Depd Case Mgmt Asmt 329-Transitional Living
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