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ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual...

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE 010-Behavioral Health & Social Service Providers 566-Assistant Behavior Analyst 106E00000X 010-Behavioral Health & Social Service Providers 567-Behavior Analyst 103K00000X 010-Behavioral Health & Social Service Providers 488-Behavior Modification Specialist 174400000X 010-Behavioral Health & Social Service Providers 568-Behavior Technician 106S00000X 010-Behavioral Health & Social Service Providers 074-Clinical Neuropsychologist 103G00000X 010-Behavioral Health & Social Service Providers 155-Counselor, Addiction (LAC) 101YA0400X 010-Behavioral Health & Social Service Providers 177-Counselor, Licensed Associate Professional (LAPC) 101YP2500X 010-Behavioral Health & Social Service Providers 190-Counselor, Licensed Professional Clinical (LPCC) 101YP2500X 010-Behavioral Health & Social Service Providers 580-Counselor (Mental Health) 101YM0800X (MCO only) 010-Behavioral Health & Social Service Providers 194-Counselor, Professional (LPC) 101YP2500X 010-Behavioral Health & Social Service Providers 425-Licensed Master Social Worker (LMSW) 104100000X 010-Behavioral Health & Social Service Providers 191-Licensed Clinical Social Worker (LCSW) 1041C0700X 010-Behavioral Health & Social Service Providers 625-Licensed Baccalaureate Social Worker (LBSW) 104100000X 010-Behavioral Health & Social Service Providers 403-Marriage & Family Therapist 106H00000X 010-Behavioral Health & Social Service Providers 492-Mental Health Technician 247200000X 010-Behavioral Health & Social Service Providers 050-Psychologist 103T00000X 010-Behavioral Health & Social Service Providers 543-Psychologist, Clinical 103TC0700X 1 10/19/2020
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Page 1: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

010-Behavioral Health & Social

Service Providers

566-Assistant Behavior Analyst 106E00000X

010-Behavioral Health & Social

Service Providers

567-Behavior Analyst 103K00000X

010-Behavioral Health & Social

Service Providers

488-Behavior Modification Specialist 174400000X

010-Behavioral Health & Social

Service Providers

568-Behavior Technician 106S00000X

010-Behavioral Health & Social

Service Providers

074-Clinical Neuropsychologist 103G00000X

010-Behavioral Health & Social

Service Providers

155-Counselor, Addiction (LAC) 101YA0400X

010-Behavioral Health & Social

Service Providers

177-Counselor, Licensed Associate Professional (LAPC) 101YP2500X

010-Behavioral Health & Social

Service Providers

190-Counselor, Licensed Professional Clinical (LPCC) 101YP2500X

010-Behavioral Health & Social

Service Providers

580-Counselor (Mental Health) 101YM0800X (MCO only)

010-Behavioral Health & Social

Service Providers

194-Counselor, Professional (LPC) 101YP2500X

010-Behavioral Health & Social

Service Providers

425-Licensed Master Social Worker (LMSW) 104100000X

010-Behavioral Health & Social

Service Providers

191-Licensed Clinical Social Worker (LCSW) 1041C0700X

010-Behavioral Health & Social

Service Providers

625-Licensed Baccalaureate Social Worker (LBSW) 104100000X

010-Behavioral Health & Social

Service Providers

403-Marriage & Family Therapist 106H00000X

010-Behavioral Health & Social

Service Providers

492-Mental Health Technician 247200000X

010-Behavioral Health & Social

Service Providers

050-Psychologist 103T00000X

010-Behavioral Health & Social

Service Providers

543-Psychologist, Clinical 103TC0700X

1 10/19/2020

Page 2: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

010-Behavioral Health & Social

Service Providers

523-Psychologist, Clinical Child & Adolescent 103TC2200X

011-Chiropractic Providers 047-Chiropractor 111N00000X

012-Dental Providers 610-Dental Hygienist 124Q00000X (MCO only)

012-Dental Providers 498-Dental Public Health 1223D0001X

012-Dental Providers 019-Dentists 122300000X

012-Dental Providers 062-Endodontics 1223E0200X

012-Dental Providers 001-General Practice 1223G0001X

012-Dental Providers 538-Oral and Maxillofacial Pathology 1223P0106X

012-Dental Providers 212-Oral and Maxillofacial Surgery 1223S0112X

012-Dental Providers 064-Orthodontics 1223X0400X

012-Dental Providers 515-Orthodontics & Dentofacial Orthopedics 1223X0400X

012-Dental Providers 063-Pedodontics (Pediatric Dentistry) 1223P0221X

012-Dental Providers 065-Periodontics 1223P0300X

012-Dental Providers 066-Prosthodontics 1223P0700X

013-Dietary & Nutritional

Service Providers

056-Licensed Registered Dietician 133V00000X

013-Dietary & Nutritional

Service Providers

598-Nutrition, Education 133NN1002X (MCO only)

013-Dietary & Nutritional

Service Providers

599-Nutritionist 133N00000X (MCO only)

2 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

014-Emergency Medical

Service Providers

572-Emergency Medical Technician, Paramedic 146L00000X

015-Eye & Vision Service

Providers

608-Ocularist 156FX1700X (MCO only)

015-Eye & Vision Service

Providers

411-Optician 156FX1800X

015-Eye & Vision Service

Providers

088-Optometrist 152W00000X

015-Eye & Vision Service

Providers

617-Optometrist; Corneal and Contact Management 152WC0802X

016-Nursing Service Providers 130-Licensed Practical Nurse 164W00000X

016-Nursing Service Providers 127-Licensed Vocational Nurse 164X00000X

016-Nursing Service Providers 129-Registered Nurse 163W00000X

016-Nursing Service Providers 582-Registered Nurse; Diabetes Educator 163WD0400X (MCO only)

017-Other Service Providers 574-Acupuncturist 171100000X (MCO only)

017-Other Service Providers 335-Case Manager/Care Coordinator 171M00000X

017-Other Service Providers 585-Genetic Counselor, MS 170300000X (MCO only)

017-Other Service Providers 588-Health Educator 174H00000X (MCO only)

017-Other Service Providers 593-Midwife 176B00000X (MCO only)

017-Other Service Providers 594-Naturopath 175F00000X (MCO only)

018-Pharmacy Service

Providers

253-Pharmacist 183500000X

018-Pharmacy Service

Providers

493-Pharmacy Technician 183700000X

3 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

019-Technologist, Technician,

and Other Technical Service

Providers

579-Surgical Assistant 246ZC0007X (MCO only)

019-Technologist, Technician,

and Other Technical Service

Providers

602-Radiologic Technologist 247100000X (MCO only)

019-Technologist, Technician,

and Other Technical Service

Providers

611-Orthopedic Assistant 246ZX2200X (MCO only)

019-Technologist, Technician,

and Other Technical Service

Providers

613-Surgical - Specialist/Technologist Other 246ZS0410X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

058-Adult Medicine 207QA0505X

020-Physicians (Allopathic &

Osteopathic)

615-Advanced Heart Failure and Transplant Cardiology 207RA0001X

020-Physicians (Allopathic &

Osteopathic)

003-Allergy & Immunology 207K00000X

020-Physicians (Allopathic &

Osteopathic)

436 -Anatomic Pathology 207ZP0101X

020-Physicians (Allopathic &

Osteopathic)

259 -Anatomic Pathology & Clinical Pathology 207ZP0102X

020-Physicians (Allopathic &

Osteopathic)

005-Anesthesiology 207L00000X

020-Physicians (Allopathic &

Osteopathic)

573 Anesthesiology; Critical Care Medicine 207LC0200X

020-Physicians (Allopathic &

Osteopathic)

624-Anesthesiology; Pain Medicine 207LP2900X

020-Physicians (Allopathic &

Osteopathic)

563-Blood Banking & Transfusion Medicine 207ZB0001X

020-Physicians (Allopathic &

Osteopathic)

006-Cardiovascular Disease 207RC0000X

020-Physicians (Allopathic &

Osteopathic)

078-Clinical & Laboratory Dermatological Immunology 207NI0002X

020-Physicians (Allopathic &

Osteopathic)

083-Clinical Biochemical Genetics 207SG0202X

020-Physicians (Allopathic &

Osteopathic)

084-Clinical Cardiac Electrophysiology 207RC0001X

4 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

085-Clinical Cytogenetic 207SC0300X

020-Physicians (Allopathic &

Osteopathic)

109-Clinical Genetics (MD) 207SG0201X

020-Physicians (Allopathic &

Osteopathic)

118-Clinical Molecular Genetics 207SG0203X

020-Physicians (Allopathic &

Osteopathic)

534-Clinical Neurophysiology 2084N0600X

020-Physicians (Allopathic &

Osteopathic)

021-Clinical Pathology 207ZC0006X

020-Physicians (Allopathic &

Osteopathic)

136 -Clinical Pathology/Laboratory Medicine 207ZP0105X

020-Physicians (Allopathic &

Osteopathic)

133-Clinical Pharmacology 208U00000X

020-Physicians (Allopathic &

Osteopathic)

101-Colon and Rectal Surgery 208C00000X

020-Physicians (Allopathic &

Osteopathic)

206-Critical Care Medicine 207RC0200X

020-Physicians (Allopathic &

Osteopathic)

007-Dermatology 207N00000X

020-Physicians (Allopathic &

Osteopathic)

260-Dermatopathology 207ND0900X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

167-Diagnostic Radiology 2085R0202X

020-Physicians (Allopathic &

Osteopathic)

270-Emergency Medicine 207P00000X

020-Physicians (Allopathic &

Osteopathic)

571-Emergency Medicine; Hospice and Palliative Medicine 207PH00020X

020-Physicians (Allopathic &

Osteopathic)

605-Emergency Medicine; Sports Medicine 207PS0010X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

093-Emergency Medical Services 207PE0004X

020-Physicians (Allopathic &

Osteopathic)

168-Endocrinology, Diabetes & Metabolism 207RE0101X

5 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

301-Facial Plastic Surgery 207YS0123X

020-Physicians (Allopathic &

Osteopathic)

173-Family Medicine 207Q00000X

020-Physicians (Allopathic &

Osteopathic)

562 -Family Medicine; Addiction Medicine 207QA0401X

020-Physicians (Allopathic &

Osteopathic)

586-Family Medicine;Geriatric Medicine 207QG0300X

020-Physicians (Allopathic &

Osteopathic)

590-Family Medicine; Hospice & Palliative Medicine 207QH0002X

020-Physicians (Allopathic &

Osteopathic)

578-Family Medicine; Obesity Medicine 207QB0002X

020-Physicians (Allopathic &

Osteopathic)

603-Family Medicine; Sleep Medicine 207QS1201X

020-Physicians (Allopathic &

Osteopathic)

520-Family Medicine; Sports Medicine 207QS0010X

020-Physicians (Allopathic &

Osteopathic)

565-Female Pelvic Medicine and Reconstructive Surgery 207VF0040X

020-Physicians (Allopathic &

Osteopathic)

302-Foot & Ankle Surgery 207XX0004X

020-Physicians (Allopathic &

Osteopathic)

490-Forensic Psychiatry 2084F0202X

020-Physicians (Allopathic &

Osteopathic)

010-Gastroenterology 207RG0100X

020-Physicians (Allopathic &

Osteopathic)

001-General Practice 208D00000X

020-Physicians (Allopathic &

Osteopathic)

175-Geriatric Psychiatry 2084P0805X

020-Physicians (Allopathic &

Osteopathic)

307-Gynecologic Oncology 207VX0201X

020-Physicians (Allopathic &

Osteopathic)

553-Gynecology 207VG0400X

020-Physicians (Allopathic &

Osteopathic)

178-Hematology 207RH0000X

6 10/19/2020

Page 7: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

179-Hematology/Oncology 207RH0003X

020-Physicians (Allopathic &

Osteopathic)

340-Hepatology 207RI0008X

020-Physicians (Allopathic &

Osteopathic)

545-Hospice and Palliative Medicine 207VH0002X

020-Physicians (Allopathic &

Osteopathic)

344-Hospitalist 208M00000X

020-Physicians (Allopathic &

Osteopathic)

183-Immunopathology 207ZI0100X

020-Physicians (Allopathic &

Osteopathic)

471-Independent Medical Examiner 202C00000X

020-Physicians (Allopathic &

Osteopathic)

185-Infectious Diseases 207RI0200X

020-Physicians (Allopathic &

Osteopathic)

011-Internal Medicine 207R00000X

020-Physicians (Allopathic &

Osteopathic)

652-Internal Medicine;Addiction Medicine 207RA0401X

020-Physicians (Allopathic &

Osteopathic)

587-Internal Medicine; Geriatric Medicine 207RG0300X

020-Physicians (Allopathic &

Osteopathic)

591-Internal Medicine; Hospice & Palliative Medicine 207RH0002X

020-Physicians (Allopathic &

Osteopathic)

614-Internal Medicine; Sleep Medicine 207RS0012X

020-Physicians (Allopathic &

Osteopathic)

639-Internal Medicine; Sports Medicine 207RS0010X

020-Physicians (Allopathic &

Osteopathic)

188-Interventional Cardiology 207RI0011X

020-Physicians (Allopathic &

Osteopathic)

524-Interventional Pain Medicine 208VP0014X

020-Physicians (Allopathic &

Osteopathic)

375-Legal Medicine 209800000X

020-Physicians (Allopathic &

Osteopathic)

404-Maternal & Fetal Medicine 207VM0101X

7 10/19/2020

Page 8: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

595-Medical Genetics; Neuromusculoskeletal Medicine & OMM 204D00000X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

529-Medical Oncology 207RX0202X

020-Physicians (Allopathic &

Osteopathic)

502-Neonatal-Perinatal Medicine 2080N0001X

020-Physicians (Allopathic &

Osteopathic)

105-Nephrology 207RN0300X

020-Physicians (Allopathic &

Osteopathic)

014-Neurological Surgery 207T00000X

020-Physicians (Allopathic &

Osteopathic)

013-Neurology 2084N0400X

020-Physicians (Allopathic &

Osteopathic)

522-Neurology with Special Qualifications in Child Neurology 2084N0402X

020-Physicians (Allopathic &

Osteopathic)

653-Neuromusculoskeletal Medicine, Sports Medicine 204C00000X

020-Physicians (Allopathic &

Osteopathic)

203-Neuropathology 207ZN0500X

020-Physicians (Allopathic &

Osteopathic)

204-Neuroradiology 2085N0700X

020-Physicians (Allopathic &

Osteopathic)

103-Nuclear Medicine 207U00000X

020-Physicians (Allopathic &

Osteopathic)

597-Nuclear Medicine; Nuclear Cardiology 207UN0901X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

495-Nuclear Radiology 2085N0904X

020-Physicians (Allopathic &

Osteopathic)

211-Obstetrics 207VX0000X

020-Physicians (Allopathic &

Osteopathic)

016-Obstetrics & Gynecology 207V00000X

020-Physicians (Allopathic &

Osteopathic)

533-Occupational Medicine 2083X0100X

020-Physicians (Allopathic &

Osteopathic)

018-Ophthalmology 207W00000X

8 10/19/2020

Page 9: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

616-Ophthalmology; Retina Specialist 207WX0107X

020-Physicians (Allopathic &

Osteopathic)

212-Oral Maxillofacial Surgery 204E00000X

020-Physicians (Allopathic &

Osteopathic)

214-Orthopedic Hand Surgery 207XS0106X

020-Physicians (Allopathic &

Osteopathic)

020-Orthopaedic Surgery 207X00000X

020-Physicians (Allopathic &

Osteopathic)

526-Orthopeadic Surgery, Sports Medicine 207XX0005X

020-Physicians (Allopathic &

Osteopathic)

632-Orthopaedic Trauma 207XX0801X

020-Physicians (Allopathic &

Osteopathic)

217-Otolarynology 207Y00000X

020-Physicians (Allopathic &

Osteopathic)

549-Otolaryngology/Facial Plastic Surgery 207YX0905X

020-Physicians (Allopathic &

Osteopathic)

219-Otolaryngology; Pain Medicine 208VP0000X

020-Physicians (Allopathic &

Osteopathic)

022-Pathology 207ZP0101X

020-Physicians (Allopathic &

Osteopathic)

631-Pathology; Cytopathology 207ZC0500X

020-Physicians (Allopathic &

Osteopathic)

581-Pathology; Dermatopathology 207ZD0900X

020-Physicians (Allopathic &

Osteopathic)

560-Pathology; Hematology 207ZH0000X

020-Physicians (Allopathic &

Osteopathic)

564-Pediatric Adolescent Medicine 2080A0000X

020-Physicians (Allopathic &

Osteopathic)

108-Pediatric Allergy & Immunology 2080P0201X

020-Physicians (Allopathic &

Osteopathic)

412-Pediatric Anesthesiology 207LP3000X

020-Physicians (Allopathic &

Osteopathic)

221-Pediatric Cardiology 2080P0202X

9 10/19/2020

Page 10: ND Medicaid - Individual Provider Type, Specialty and ...Jul 28, 2020  · ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values PROVIDER TYPE CODE PROVIDER SPECIALTY

ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

514-Pediatric Critical Care Medicine 2080P0203X

020-Physicians (Allopathic &

Osteopathic)

222-Pediatric Dermatology 207NP0225X

020-Physicians (Allopathic &

Osteopathic)

223-Pediatric Developmental & Behavioral Pediatrics 2080P0006X

020-Physicians (Allopathic &

Osteopathic)

225-Pediatric Emergency Medicine; Emergency Medicine 207PP0204X

020-Physicians (Allopathic &

Osteopathic)

561-Pediatric Emergency Medicine; Pediatrics 2080P0204X

020-Physicians (Allopathic &

Osteopathic)

226-Pediatric Endocrinology 2080P0205X

020-Physicians (Allopathic &

Osteopathic)

227-Pediatric Gastroenterology 2080P0206X

020-Physicians (Allopathic &

Osteopathic)

228-Pediatric Hematology-Oncology 2080P0207X

020-Physicians (Allopathic &

Osteopathic)

542-Pediatric Hospice and Palliative Medicine 2080H0002X

020-Physicians (Allopathic &

Osteopathic)

229-Pediatric Infectious Disease 2080P0208X

020-Physicians (Allopathic &

Osteopathic)

231-Pediatric Medical Toxicology 2080T0002X

020-Physicians (Allopathic &

Osteopathic)

232-Pediatric Nephrology 2080P0210X

020-Physicians (Allopathic &

Osteopathic)

233-Pediatric Neurodevelopment Disabilities 2080P0008X

020-Physicians (Allopathic &

Osteopathic)

634-Pediatric Ophthalomology and Strabismus Specialist 207WX0110X

020-Physicians (Allopathic &

Osteopathic)

237-Pediatric Orthopedics Surgery 207XP3100X

020-Physicians (Allopathic &

Osteopathic)

140-Pediatric Otolaryngology 207YP0228X

020-Physicians (Allopathic &

Osteopathic)

238-Pediatric Pathology 207ZP0213X

10 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

240-Pediatric Pulmonology 2080P0214X

020-Physicians (Allopathic &

Osteopathic)

241-Pediatric Radiology 2085P0229X

020-Physicians (Allopathic &

Osteopathic)

242-Pediatric Rehab Medicine 2081P0010X

020-Physicians (Allopathic &

Osteopathic)

558-Pediatric Sleep Medicine 2080S0012X

020-Physicians (Allopathic &

Osteopathic)

243-Pediatric Rheumatology 2080P0216X

020-Physicians (Allopathic &

Osteopathic)

244-Pediatric Sports Medicine 2080S0010X

020-Physicians (Allopathic &

Osteopathic)

245-Pediatric Surgery 2086S0120X

020-Physicians (Allopathic &

Osteopathic)

246-Pediatric Urology 2088P0231X

020-Physicians (Allopathic &

Osteopathic)

049-Pediatrics 208000000X

020-Physicians (Allopathic &

Osteopathic)

247-Perinatology 163WP1700X

020-Physicians (Allopathic &

Osteopathic)

012-Phlebology 202K00000X

020-Physicians (Allopathic &

Osteopathic)

025-Physical Medicine & Rehabilitation 208100000X

020-Physicians (Allopathic &

Osteopathic)

532-Physical Medicine & Rehabilitation; Pain Medicine 2081P2900X

020-Physicians (Allopathic &

Osteopathic)

548-Physical Medicine & Rehabilitation; Sports Medicine 2081S0010X

020-Physicians (Allopathic &

Osteopathic)

636-Physical Medicine & Rehabilitation; Spinal Cord Injury

Medicine

2081P0004X

020-Physicians (Allopathic &

Osteopathic)

525-Plastic and Reconstructive Surgery 2086S0122X

020-Physicians (Allopathic &

Osteopathic)

024-Plastic Surgery 208200000X

11 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

256-Plastic Surgery Hand Surgery 2082S0105X

020-Physicians (Allopathic &

Osteopathic)

257-Preventative Medicine; Occupational-Environmental

Medicine

2083P0500X

020-Physicians (Allopathic &

Osteopathic)

654-Preventive Medicine; Undersea and Hyperbaric Medicine 2083P0011X

020-Physicians (Allopathic &

Osteopathic)

414-Procedural Dermatology 207NS0135X

020-Physicians (Allopathic &

Osteopathic)

121-Psychiatry 2084P0800X

020-Physicians (Allopathic &

Osteopathic)

142-Psychiatry – Child/Adolescent 2084P0804X

020-Physicians (Allopathic &

Osteopathic)

640-Psychiatry & Neurology;Behavioral Neurology &

Neuropsychiatry

2084B0040X

020-Physicians (Allopathic &

Osteopathic)

612-Psychiatry & Neurology; Neurocritical Care 2084A2900X

020-Physicians (Allopathic &

Osteopathic)

630-Psychiatry & Neurology;Neuromuscular Medicine 2084N0008X

020-Physicians (Allopathic &

Osteopathic)

570-Psychiatry & Neurology; Pain Medicine 2084P2900X

020-Physicians (Allopathic &

Osteopathic)

618-Psychiatry & Neurology; Psychosomatic Medicine 2084P0015X

020-Physicians (Allopathic &

Osteopathic)

569-Public Health & General Preventative Medicine 2083P0901X

020-Physicians (Allopathic &

Osteopathic)

029-Pulmonary Diseases 207RP1001X

020-Physicians (Allopathic &

Osteopathic)

583-Radiology; Diagnostic Ultrasound 2085U0001X (MCO only)

020-Physicians (Allopathic &

Osteopathic)

497-Radiation Oncology 2085R0001X

020-Physicians (Allopathic &

Osteopathic)

530-Reproductive Endocrinology 207VE0102X

020-Physicians (Allopathic &

Osteopathic)

267-Rheumatology 207RR0500X

12 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

020-Physicians (Allopathic &

Osteopathic)

521-Sleep Medicine 2084S0012X

020-Physicians (Allopathic &

Osteopathic)

273-Sports Medicine 207QS0010X

020-Physicians (Allopathic &

Osteopathic)

275-Surgery 208600000X

020-Physicians (Allopathic &

Osteopathic)

546-Surgery of the Hand 2086S0105X

020-Physicians (Allopathic &

Osteopathic)

539-Surgical Critical Care 2086S0102X

020-Physicians (Allopathic &

Osteopathic)

276-Surgical Oncology 2086X0206X

020-Physicians (Allopathic &

Osteopathic)

278-Therapeutic Radiology 2085R0203X

020-Physicians (Allopathic &

Osteopathic)

033-Thoracic Surgery 208G00000X

020-Physicians (Allopathic &

Osteopathic)

279-Transplant Surgery 204F00000X

020-Physicians (Allopathic &

Osteopathic)

633-Trauma Surgery 2086S0127X

020-Physicians (Allopathic &

Osteopathic)

638-Undersea and Hyperbaric Medicine 207PE0005X

020-Physicians (Allopathic &

Osteopathic)

034-Urology 208800000X

020-Physicians (Allopathic &

Osteopathic)

189-Vascular and Interventional Radiology 2085R0204X

020-Physicians (Allopathic &

Osteopathic)

552-Vascular Neurology 2084V0102X

020-Physicians (Allopathic &

Osteopathic)

289-Vascular Surgery 2086S0129X

021-Podiatric Medicine &

Surgery Service Providers

120-Podiatrist 213E00000X

13 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

021-Podiatric Medicine &

Surgery Service Providers

540-Surgery, Foot 213ES0131X

021-Podiatric Medicine &

Surgery Service Providers

541-Surgery, Foot & Ankle 213ES0103X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

576-Athletic Trainer 2255A2300X (MCO only)

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

592-Massage Therapist 225700000X (MCO only)

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

126-Occupational Therapy 225X00000X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

600-Occupational Therapy Assistant 224Z00000X (MCO only)

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

114-Orthotist 222Z00000X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

123-Physical Therapist 225100000X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

601-Physical Therapy Assistant 225200000X (MCO only)

14 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

115-Prosthetist 224P00000X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

607-Recreation Therapist 225800000X (MCO only)

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

349-Respiratory Therapist, Certified 227800000X

022-Respiratory,

Developmental, Rehabilitative

& Restorative Service

Providers

430-Respiratory Therapist, Registered 227900000X

023-Speech, Language &

Hearing Service Providers

087-Audiologist 231H00000X

023-Speech, Language &

Hearing Service Providers

577-Audiologist - Hearing Aid Fitter 237600000X (MCO only)

023-Speech, Language &

Hearing Service Providers

272-Speech-Language Pathologist 235Z00000X

023-Speech, Language &

Hearing Service Providers

512-Hearing Instrument Specialist 237700000X

024-Student, Health Care 606-Student in an Organized Health Care Education/Training

Program

390200000X (MCO only)

034-Transportation Services 626-Chaperone A taxonomy code is not required for this

provider type/specialty combination

034-Transportation Services 387-Private Vehicle 347C00000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

485-Advanced Practice Midwife 367A00000X

15 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

036-Physician Assistants

&Advanced Practice Nursing

Providers

609-Anesthesiologist Assistant 367H00000X (MCO only)

036-Physician Assistants

&Advanced Practice Nursing

Providers

341-Certified Registered Nurse Anesthetist 367500000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

036-Clinical Nurse Specialist 364S00000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

550 -Clinical Nurse Specialist, Adult Health 364SA2200X

036-Physician Assistants

&Advanced Practice Nursing

Providers

619-Clinical Nurse Specialist, Family Health 364SF0001X

036-Physician Assistants

&Advanced Practice Nursing

Providers

559-Clinical Nurse Specialist, Oncology 364SX0200X

036-Physician Assistants

&Advanced Practice Nursing

Providers

537-Clinical Nurse Specialist, Psychiatric/Mental Health 364SP0808X

036-Physician Assistants

&Advanced Practice Nursing

Providers

547-Clinical Nurse Specialist, Psychiatric/Mental Health, Adult 364SP0809X

036-Physician Assistants

&Advanced Practice Nursing

Providers

629-Clinical Nurse Specialist, Psychiatric/Mental Health, Child

& Adolescent

364SP0807X

16 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

036-Physician Assistants

&Advanced Practice Nursing

Providers

516-Nurse Practitioner, Acute Care 363LA2100X

036-Physician Assistants

&Advanced Practice Nursing

Providers

431-Nurse Practitioner, Adult Health 363LA2200X

036-Physician Assistants

&Advanced Practice Nursing

Providers

055-Nurse Practitioner, Advanced Practice 363L00000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

596-Nurse Practitioner; Critical Care Medicine 363LC0200X (MCO only)

036-Physician Assistants

&Advanced Practice Nursing

Providers

432-Nurse Practitioner, Family 363LF0000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

551-Nurse Practitioner, Gerontology 363LG0600X

036-Physician Assistants

&Advanced Practice Nursing

Providers

531-Nurse Practitioner, Neonatal 363LN0000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

466 -Nurse Practitioner, Neonatal; Critical Care 363LN0005X

036-Physician Assistants

&Advanced Practice Nursing

Providers

434 -Nurse Practitioner, OB/GYN 363LX0001X

17 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

036-Physician Assistants

&Advanced Practice Nursing

Providers

536-Nurse Practitioner, Occupational Health 363LX0106X

036-Physician Assistants

&Advanced Practice Nursing

Providers

435-Nurse Practitioner, Pediatrics 363LP0200X

036-Physician Assistants

&Advanced Practice Nursing

Providers

635-Nurse Practitioner, Pediatrics, Critical Care 363LP0222X

036-Physician Assistants

&Advanced Practice Nursing

Providers

535-Nurse Practitioner, Perinatal 363LP1700X

036-Physician Assistants

&Advanced Practice Nursing

Providers

469-Nurse Practitioner, Primary Care 363LP2300X

036-Physician Assistants

&Advanced Practice Nursing

Providers

467-Nurse Practitioner, Psychiatric/Mental Health 363LP0808X

036-Physician Assistants

&Advanced Practice Nursing

Providers

470-Nurse Practitioner, Women's Health 363LW0102X

036-Physician Assistants

&Advanced Practice Nursing

Providers

255-Physician Assistant 363A00000X

036-Physician Assistants

&Advanced Practice Nursing

Providers

518-Physician Assistant, Medical 363AM0700X

18 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

036-Physician Assistants

&Advanced Practice Nursing

Providers

519-Physican Assistant, Surgical 363AS0400X

036-Physician Assistants

&Advanced Practice Nursing

Providers

121-Psychiatry 2084P0800X

048-Qualified Service

Providers

323-Adult Day Care (QSP) 3747P1801X

048-Qualified Service

Providers

318-Adult Family Foster Care (QSP) 3747P1801X

048-Qualified Service

Providers

146-Attendant Care (QSP) 3747A0650X

048-Qualified Service

Providers

309-Chore Labor (QSP) 372500000X

048-Qualified Service

Providers

308-Chore – Snow Removal (QSP) 372500000X

048-Qualified Service

Providers

637-Companionship 372600000X

048-Qualified Service

Providers

394-Extended Personal Care (QSP) 3747A0650X

048-Qualified Service

Providers

319-Family Home Care (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

112-Family Personal Care (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

317-Higher Lvl Case Mgmt – Assmnt (QSP) 171M00000X

048-Qualified Service

Providers

316-Higher Lvl Case Mgmt – Other (QSP) 171M00000X

19 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

048-Qualified Service

Providers

330-Home Delivered Meals (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

180-Homemaker (QSP) 376J00000X

048-Qualified Service

Providers

327-Non-Med Transport (Escort) (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

326-Non-Med Transport (local-round trip) (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

325-Non-Med Transport (out of town) (QSP) A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

396-Nurse Education Care (QSP) 163WC1500X

048-Qualified Service

Providers

209-Nurse Management (QSP) 163WC1500X

048-Qualified Service

Providers

251-Personal Care – Daily Rate (QSP) 3747P1801X

048-Qualified Service

Providers

399-Personal Care – Unit Rate (QSP) 3747P1801X

048-Qualified Service

Providers

387-Private Vehicle A taxonomy code is not required for this

provider type/specialty combination

048-Qualified Service

Providers

081-Respite Care (QSP) 3747P1801X

048-Qualified Service

Providers

513-Supervision 372600000X

048-Qualified Service

Providers

314-Tech Depd Case Mgmt – Other (QSP) 171M00000X

20 10/19/2020

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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values

PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE

048-Qualified Service

Providers

315-Tech Depd Case Mgmt – Asmt (QSP) 171M00000X

049-1915i State Plan

Amendment Services

641-Care Coordination 171M00000X

049-1915i State Plan

Amendment Services

642-Supported Employment 171M00000X

049-1915i State Plan

Amendment Services

643-Pre-Vocational 171M00000X

049-1915i State Plan

Amendment Services

644-Education 171M00000X

049-1915i State Plan

Amendment Services

086-Respite 171M00000X

049-1915i State Plan

Amendment Services

645-Training & Support for Unpaid Caregivers 171M00000X

049-1915i State Plan

Amendment Services

646-Peer Support 175T00000X

049-1915i State Plan

Amendment Services

387-Private Vehicle 347C00000X

049-1915i State Plan

Amendment Services

647-Family Peer Support 175T00000X

049-1915i State Plan

Amendment Services

648-Benefits Planning 171M00000X

049-1915i State Plan

Amendment Services

649-Community Transition Service 171M00000X

049-1915i State Plan

Amendment Services

650-Housing Supports 171M00000X

21 10/19/2020


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