PROVIDER TYPE CODE PROVIDER SPECIALTY CODE …

1 PROVIDER TYPE CODEPROVIDER SPECIALTY CODETAXONOMY CODE074- clinical Neuropsychologist103G00000X152- counselor 101Y00000X155- counselor , Addiction101YA0400X177- counselor , Licensed Associate Professional (LAPC)101YP2500X190- counselor , Licensed Professional clinical (LPCC)101YP2500X194- counselor , Professional101YP2500X403-Marriage & Family Therapist106H00000X191-Licensed Independent clinical Social Worker (LICSW, LCSW)1041C0700X 050-Psychologist103T00000X425-Social Worker (LSW)104100000X011-Chiropractic Providers047-Chiropractor111N00000X019-D entists122300000X062-Endodontics1223E020 0X001-General Practice1223G0001X212-Oral Maxillofacial Surgery1223S0112X064-Orthodontics1223X04 00X063-Pedodontics (Pediatric Dentistry)1223P0221X065-Periodontics1223 P0300X066-Prosthodontics1223P0700X013-Di etary & Nutritional Service Providers056-Licensed Registered Dietician133V00000X411-Optician156FX1800 X088-Optometrist152W00000X130-Licensed Practical Nurse164W00000X127-Licensed Vocational Nurse164X00000X129-Registered Nurse163W00000X010-Behavioral Health & Social Service Providers015-Eye & Vision Service Providers016-Nursing Service Providers012-Dental Providers335-Case Manager/Care Coordinator 171M00000X468-County Social Service Office171M00000X339-Lodgingno taxonomy code required393-Provide Mealsno taxonomy code required018-Pharmacy Service Providers253-Pharmacist183500000X058-Adu lt Medicine207QA0505X003-Allergy & Immunology207K00000X436 -Anatomic Pathology207ZP0101X005-Anesthesiology207 L00000X006-Cardiovascular

2 Disease207RC0000X078- clinical & Laboratory Dermatological Immunology207NI0002X083- clinical Biochemical Genetics207SG0202X084- clinical Cardiac Electrophysiology207RC0001X085- clinical Cytogenetic207SC0300X405- clinical Genetics (MD)207SG0201X118- clinical Molecular Genetics207SG0203X021- clinical Pathology207ZC0006X136 - clinical Pathology/Laboratory Medicine207ZP0105X133- clinical Pharmacology208U00000X101-Colon and Rectal Surgery208C00000X206-Critical Care Medicine207RC0200X007-Dermatology207N000 00X260-Dermatopathology207ND0900X167-Dia gnostic Radiology2085R0202X270-Emergency Medicine207P00000X093-Emergency Medical Services207PE0004X168-Endocrinology, Diabetes & Metabolism207RE0101X301-Facial Plastic Surgery207YS0123X173-Family Medicine207Q00000X302-Foot & Ankle Surgery207XX0004X010-Gastroenterology207 RG0100X001-General Practice208D00000X307-Gynecologic Oncology207VX0201X179-Hematology/Oncolog y207RH0003X020-Physicians (Allopathic & Osteopathic)

3 017-Other Service Providers340-Hepatology207RI0008X344-Hos pitalist208M00000X183-Immunopathology207 ZI0100X471-Independent Medical Examiner202C00000X185-Infectious Diseases207RI0200X011-Internal Medicine207R00000X188-Interventional Cardiology207RI0011X375-Legal Medicine209800000X404-Maternal & Fetal Medicine207VM0101X105-Nephrology207RN030 0X014-Neurological Surgery207T00000X013-Neurology2084N0400X 203-Neuropathology207ZN0500X204-Neurorad iology2085N0700X103-Nuclear Medicine207U00000 XNuclear Radiology2085N0904X211-Obstetrics207VX00 00X016-Obstetrics & Gynecology207V00000X018-Ophthalmology207 W00000X212-Oral Maxillofacial Surgery204E00000X214-Orthopedic Hand Surgery207XS0106X020-Orthopaedic Surgery207X00000X217-Otolarynology207Y00 000X219-Pain Medicine208VP0000X108-Pediatric Allergy & Immunology2080P0201X412-Pediatric Anesthesiology207LP3000X221-Pediatric Cardiology2080P0202X222-Pediatric Dermatology207NP0225X223-Pediatric Developmental & Behavioral Pediatrics2080P0006X225-Pediatric Emergency Medicine207PP0204X226-Pediatric Endocrinology2080P0205X227-Pediatric Gastroenterology2080P0206X228-Pediatric Hematology-Oncology2080P0207X229-Pediatr ic Infectious Disease2080P0208X231-Pediatric Medical Toxicology2080T0002X232-Pediatric Nephrology2080P0210X233-Pediatric Neurodevelopment Disabilities2080P0008X237-Pediatric Orthopedics Surgery207XP3100X140-Pediatric Otolaryngology207YP0228X238-Pediatric Pathology207ZP0213X240-Pediatric Pulmonology2080P0214X241-Pediatric Radiology2085P0229X242-Pediatric Rehab Medicine2081P0010X243-Pediatric Rheumatology2080P0216X020-Physicians (Allopathic &)

4 Osteopathic)244-Pediatric Sports Medicine2080S0010X245-Pediatric Surgery2086S0120X246-Pediatric Urology2088P0231X049-Pediatrics208000000 X012-Phlebology202K00000X025-Physical Medicine & Rehabilitation208100000X024-Plastic Surgery208200000X256-Plastic Surgery Hand Surgery2082S0105X257-Preventative Medicine/Occupational-Environmental Medicine2083P0500X414-Procedural Dermatology207NS0135X121-Psychiatry2084P 0800X142-Psychiatry Child/Adolescent2084P0804X029-Pulmonary Diseases207RP1001 XRadiation Oncology2085R001X267-Rheumatology207RR05 00X275-Surgery208600000X276-Surgical Oncology2086X0206X278-Therapeutic Radiology2085R0203X033-Thoracic Surgery208G00000X279-Transplant Surgery204F00000X034-Urology208800000X18 9-Vascular and Interventional Radiology2085R0204X289-Vascular Surgery2086S0129X021-Podiatric Medicine

5 &Surgery Service Providers120-Podiatrist213E00000X126-Occ upational Therapy225X00000X114-Orthotist222Z00000X 123-Physical Therapist225100000X115-Prosthetist224P00 000X349-Respiratory Therapist, Certified227800000X430-Respiratory Therapist, Registered227900000X087-Audiologist 231H00000X272-Speech-Language Pathologist235Z00000X020-Physicians (Allopathic & Osteopathic)022-Respiratory, Developmental, Rehabilitative & Restorative Service Providers023-Speech, Language & Hearing Service Providers483-Air Carrier344800000X132-Ambulance 341600000X385-Bus347B00000X387-Private Vehicle347C00000X388-Secured Medical Transport (Van)343800000X389-Taxi344600000X390-Tra in347D00000X484-Transportation Broker347E00000X485-Advanced Practice Midwife367A00000X341-Certified Registered Nurse Anesthetist367500000X036- clinical Nurse Specialist364S00000X431-Nurse Practitioner; Adult Health363LA2200X055-Nurse Practitioner;-Advanced Practice 363L00000X432-Nurse Practitioner; Family363LF0000X466 -Nurse Practitioner; Neonatal; Critical Care363LN0005X434 -Nurse Practitioner; OB/GYN363LX0001X435-Nurse Practitioner; Pediatrics363LP0200X469-Nurse Practitioner; Primary Care363LP2300X467-Nurse Practitioner.

6 Psychiatric/Mental Health363LP0808X470-Nurse Practitioner, Women's Health363LW0102X255-Physician Assistant363A00000X335-Case Manager/Care Coordinatorno taxonomy code required380-Congregate Care (DD)no taxonomy code required374-Day Support (DD)no taxonomy code required373-Extended Services (DD)no taxonomy code required379-Family Support Services (DD)no taxonomy code required377-Ind Supp Lvg Arrangement (DD)no taxonomy code required372-Infant Development (DD)no taxonomy code required381-Minimally Suprvsd Lvg Arrngmnt (DD)no taxonomy code required382-Supported Living Arrangement (DD)no taxonomy code required376-Transitional Comm Living Facility (DD)no taxonomy code required034-Transportation Services036-Physician Assistants &Advanced Practice Nursing Providers039-Developmental Disabilities323-Adult Day Care (QSP)no taxonomy code required318-Adult Family Foster Care (QSP)no taxonomy code required146-Attendant Care (QSP)no taxonomy code required312-Case Management Assment (QSP)no taxonomy code required313-Case Management Other (QSP)no taxonomy code required309-Chore Labor (QSP)no taxonomy code required308-Chore Snow Removal (QSP)no taxonomy code required153-Chore Emrgncy Rspns Sys Comp (QSP)no taxonomy code required321-Environmental Modifications (QSP)no taxonomy code required394-Extended Personal Care (QSP)no taxonomy code required319-Family Home Care (QSP)no taxonomy code required112-Family Personal Care (QSP)

7 No taxonomy code required317-Higher Lvl Case Mgmt Assmnt (QSP)no taxonomy code required316-Higher Lvl Case Mgmt Other (QSP)no taxonomy code required330-Home Delivered Meals (QSP)no taxonomy code required180-Homemaker (QSP)no taxonomy code required310-Installation ERS (QSP)no taxonomy code required205-Non-Med Transport (Carrier-bus, taxi) (QSP)no taxonomy code required327-Non-Med Transport (Escort) (QSP)no taxonomy code required326-Non-Med Transport (local-round trip) (QSP)no taxonomy code required325-Non-Med Transport (out of town) (QSP)no taxonomy code required396-Nurse Education Care (QSP)no taxonomy code required209-Nurse Management (QSP)no taxonomy code required048-Qualified Service Providers320-Personal Care Assisted Living (QSP)no taxonomy code required251-Personal Care Daily Rate (QSP)no taxonomy code required399-Personal Care Unit Rate (QSP)no taxonomy code required324-Residential Service (QSP)no taxonomy code required081-Respite Care (QSP)no taxonomy code required306-Respite Care, Institutional (QSP)no taxonomy code required125-Specialized Equipment (QSP)no taxonomy code required285-TBI Case Management Other (QSP)no taxonomy code required286-TBI Case Management Team Meeting (QSP)no taxonomy code required287-TBI Supportive Employment (QSP)no taxonomy code required314-Tech Depd Case Mgmt Other (QSP)no taxonomy code required315-Tech Depd Case Mgmt Asmt (QSP)no taxonomy code required329-Transitional Living (QSP)no taxonomy code required048-Qualified Service Providers