PROVIDER TYPE CODE PROVIDER SPECIALTY CODE …

1 PROVIDER TYPE CODEPROVIDER SPECIALTY CODETAXONOMY CODE335-Case Manager/Care Coordinator 171M00000X468-County Social Service Office171M00000X339-Lodgingno taxonomy code required393-Provide Mealsno taxonomy code required035-Case Management251B00000X357-Community/Behavi oral Health251S00000X060-Early Intervention; PROVIDER Agency252Y00000X082-Home Health Agency251E00000X454- Hospice Care, Community Based251G00000X453-Human Service Center251S00000X397-Local Education Agency (LEA)/Special Education251300000X358-PACE251T00000X261 -Public Health or Welfare251K00000X026-Adolescent and Children Mental Health261QM0855X070-Adult Mental Health261QM0850X089-Ambulatory Surgical Center 261QA1903X071-Augmentative Communication261QA3000X359-Clinic/Center 261Q00000X040-Community Health Centers261QC1500X437-Dental Clinic261QD0000x271-Emergency Care261QE0002X300-End-Stage Renal Disease Treatment (ESRD)261QE0700X299-Endoscopy261QE0800X0 15-Family Planning Non-Surgical261QF0050X361-Federally Qualified Health Center261QF0400X332-Hearing & Speech261QH0700X186-Infusion Therapy261QI0500X395-Magnetic Resonance Imaging (MRI)261QM1200X360-Mental Health (Incl.)

2 Comm Mntl Hlth)261QM0801X406-Migrant Health261QM1000X408-Occupational Medicine261QX0100X017-Other Service Providers025-Agenices026-Ambulatory Health Care Facilities107-Oncology261QX0200X409-Onco logy, Radiation261QX0203X410-Ophthalmologic Surgery261QS0132X212- oral maxillofacial Surgery261QS0112X218-Pain Management261QP3300X110-Physical Therapy261QP2000X048-Podiatric 261QP1100X413-Primary Care261QP2300X416-Public Health, State or Local261QP0905X030-Radiology261QR0200X41 7-Radiology, Mammography261QR0206X418-Radiology, Mobile261QR0208X419-Radiology, Mobile Mammography261QR0207X420-Rehabilitation2 61QR0400X422-Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)261QR0401X364-Rehabilitation, Substance Use Disorder Unit261QR0405X423-Rehabilitation, Cardiac Facilities261QR0404X268-Rural Health Clinic261QR1300X424-Sleep Disorder Diagnostic261QS1200X426-Student Health261QS1000X288-Urgent Care Center261QU0200X362-Psychiatric Unit; Hospital Unit273R00000X363-Rehabilitation Unit.

3 Hospital Unit273Y00000X364-Rehabilitation, Substance Use Disorder Unit276400000X196-Swingbed (Medicare Defined)275N00000X156-Chronic Disease Hospital281P00000X111-Critical Access: Hospital282NC0060X091-General Acute Care Hospital282N00000X192-Long Term Care Hospital282E00000X131-Psychiatric Hospital283Q00000X421-Rehabilitation Hospital283X00000X027-Hospital Units028-Hospitals026-Ambulatory Health Care Facilities054-Clinical Medical Lab291U00000X366-Physiological Lab (Ind Physiological Lab)293D00000X030-Managed Care Organizations367-Health Maintenance Organization302R00000X371-Alzheimer/Deme ntia/Dementia Care311500000X440 -Basic Care in a Nursing Facility311Z00000X370-Custodial Care Facility311Z00000X438 -Gero Psych Nursing Home314000000X369-Intermediate Care Facility-MR315P00000X439-Non Gero Psych Nursing Home 314000000X269-Skilled Nursing Facility314000000X258-Psychiatric Residential Treatment Facility323P00000X264-RTF, Emotionally Disturbed Children322D00000X265-RTF, Mental Retardation and/or DD320600000X266-RTF, Physical Disabilities320700000X274-Substance Abuse Disorder Treatment Facility324500000X427-Substance Abuse Treatment.

4 Children3245S0500X472-Clinic Pharmacy333600000X473-Community/Retail Pharmacy3336C0003X474-Compounding Pharmacy3336C0004X113-Durable Medical Equipment & Medical Suppliers332B00000X384-Eyewear Supplier332H00000X383-Hearing Aid Equipment332S00000X475-Home Infusion Therapy Pharmacy3336H0001X486-Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy332800000X033-Suppliers032-Resid ential Treatment Facilities031-Nursing & Custodial Care Facilities029-Laboratories476-Institutio nal Pharmacy3336I0012X477-Long Term Care Pharmacy3336L0003X478-Mail Order Pharmacy3336M0002X479-Managed Care Organization Pharmacy3336M0003X480-Non-Pharmacy Dispensing Site332900000X481-Nuclear Pharmacy3336N0007X128-Pharmacy333600000X 116-Portable X-Ray Supplier335V00000X347-Prosthetic/Orthoti c Supplier335E00000X482- SPECIALTY Pharmacy3336S0011X483-Air Carrier344800000X132-Ambulance 341600000X385-Bus347B00000X387-Private Vehicle347C00000X388-Secured Medical Transport (Van)343800000X389-Taxi344600000X390-Tra in347D00000X484-Transportation Broker347E00000X335-Case Manager/Care Coordinatorno taxonomy code required380-Congregate Care (DD)no taxonomy code required374-Day Support (DD)

5 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 Services039-Developmental Disabilities033-Suppliers079-Basic Care Facility311Z00000X370-Custodial Care Facility311Z00000X132-Ambulance 341600000X359-Clinic/Center261Q00000X300 -End Stage Renal Dialysis (ESRD) Treatment261QE0700X091-General Acute Care Hospital282N00000X323-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)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 required048-Qualified Service Providers047-Indian Health Services043-Basic Care310-Installation ERS (QSP)

6 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 required249-Personal Care (QSP)no taxonomy code required320-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