taxonomy provider provider type provider provider specialty ic … · 2019-07-17 · clinic/center...

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TennCare Taxonomy Crosswalk 7/17/2019 TAXONOMY Grouping 1 TAXONOMY Grouping 2 TAXONOMY Grouping 3 DESCRIPTION TAXONOMY Provider Type Provider Type Description Provider Specialty Provider Specialty Description iC Fund Code Healthcare Prov Non-individual Hospital Units Epilepsy Unit Epilepsy Unit**** 273100000X 01 Inpatient Facility 010 Acute Care Y N Non-individual Hospital Units Medicare Defined Swing Bed Unit Medicare Defined Swing Bed Unit 275N00000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Chronic Disease Hospital Chronic Disease Hospital 281P00000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Chronic Disease Hospital Children 281PC2000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Long Term Care Hospital Long Term Care Hospital 282E00000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals General Acute Care Hospital General Acute Care Hospital 282N00000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals General Acute Care Hospital Women 282NW0100X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Special Hospital Special Hospital 284300000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Military Hospital Military Hospital 286500000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Military Hospital Community Health^^^^ 2865C1500X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Military Hospital Military General Acute Care Hospital 2865M2000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Military Hospital Military General Acute Care Hospital. Operational (Transportable) 2865X1600X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospitals Christian Science Sanitorium Christian Science Sanitorium 287300000X 01 Inpatient Facility 010 Acute Care Y Y Non-individual Hospital Units Psychiatric Unit Psychiatric Unit 273R00000X 01 Inpatient Facility 011 Psychiatric Y Y Non-individual Hospitals Psychiatric Hospital Psychiatric Hospital 283Q00000X 01 Inpatient Facility 011 Psychiatric Y Y Non-individual Hospital Units Rehabilitation Unit Rehabilitation Unit 273Y00000X 01 Inpatient Facility 012 Rehabilitation Y Y Non-individual Hospital Units Rehabilitation, Substance Use Disorder Unit Rehabilitation, Substance Use Disorder Unit 276400000X 01 Inpatient Facility 012 Rehabilitation Y Y Non-individual Hospitals Rehabilitation Hospital Rehabilitation Hospital 283X00000X 01 Inpatient Facility 012 Rehabilitation Y Y Non-individual Hospitals Rehabilitation Hospital Children 283XC2000X 01 Inpatient Facility 012 Rehabilitation Y Y Page 1 of 80

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Page 1: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

TAXONOMY

Grouping 1

TAXONOMY

Grouping 2

TAXONOMY

Grouping 3DESCRIPTION TAXONOMY

Provider

Type

Provider Type

Description

Provider

Specialty

Provider Specialty

Description

iC Fund

Code

Healthcare

Prov

Non-individual Hospital Units Epilepsy Unit Epilepsy Unit**** 273100000X 01 Inpatient Facility 010 Acute Care Y N

Non-individual Hospital Units Medicare Defined

Swing Bed Unit

Medicare Defined

Swing Bed Unit 275N00000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Chronic Disease

Hospital

Chronic Disease

Hospital 281P00000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Chronic Disease

Hospital Children 281PC2000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Long Term Care

Hospital

Long Term Care

Hospital 282E00000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals General Acute

Care Hospital

General Acute Care

Hospital 282N00000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals General Acute

Care Hospital Women 282NW0100X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Special Hospital Special Hospital 284300000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Military Hospital Military Hospital 286500000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Military Hospital Community

Health^^^^2865C1500X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Military Hospital Military General

Acute Care Hospital 2865M2000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Military Hospital

Military General

Acute Care Hospital.

Operational

(Transportable)

2865X1600X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospitals Christian Science

Sanitorium

Christian Science

Sanitorium 287300000X 01 Inpatient Facility 010 Acute Care Y Y

Non-individual Hospital Units Psychiatric Unit Psychiatric Unit 273R00000X 01 Inpatient Facility 011 Psychiatric Y Y

Non-individual Hospitals Psychiatric

Hospital Psychiatric Hospital 283Q00000X 01 Inpatient Facility 011 Psychiatric Y Y

Non-individual Hospital Units Rehabilitation

Unit Rehabilitation Unit 273Y00000X 01 Inpatient Facility 012 Rehabilitation Y Y

Non-individual Hospital Units

Rehabilitation,

Substance Use

Disorder Unit

Rehabilitation,

Substance Use

Disorder Unit

276400000X 01 Inpatient Facility 012 Rehabilitation Y Y

Non-individual Hospitals Rehabilitation

Hospital

Rehabilitation

Hospital 283X00000X 01 Inpatient Facility 012 Rehabilitation Y Y

Non-individual Hospitals Rehabilitation

Hospital Children 283XC2000X 01 Inpatient Facility 012 Rehabilitation Y Y

Page 1 of 80

Page 2: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Residential

Treatment

Facilities

Psychiatric

Residential

Treatment Facility

Psychiatric

Residential

Treatment Facility

323P00000X 01 Inpatient Facility 013Residential Treatment

CenterN Y

Non-individual

Residential

Treatment

Facilities

Psychiatric

Residential

Treatment Facility

Psychiatric

Residential

Treatment Facility

323P00000X 01 Inpatient Facility 013Residential Treatment

CenterN Y

Non-individual Hospitals General Acute

Care Hospital

General Acute Care

Hospital 282N00000X 01 Inpatient Facility 014 Critical Access Y Y

Non-individual Hospitals General Acute

Care Hospital Critical Access 282NC0060X 01 Inpatient Facility 014 Critical Access Y Y

Non-individual Hospitals General Acute

Care Hospital Children 282NC2000X 01 Inpatient Facility 015 Children's Specialty Y Y

Non-individual Hospitals General Acute

Care Hospital

General Acute Care

Hospital 282N00000X 01 Inpatient Facility 016 Emergency N Y

Non-individual Hospitals General Acute

Care Hospital Rural 282NR1301X 01 Inpatient Facility 017 Acute Care - Rural Y Y

Non-individual Hospitals General Acute

Care Hospital Rural 282NR1301X 01 Inpatient Facility 017 Acute Care - Rural Y Y

Non-individual Hospitals Psychiatric

Hospital Psychiatric Hospital 283Q00000X 01 Inpatient Facility 018

Mental Health Inpatient

Hospitals Under 21N Y

Non-individual Hospitals Psychiatric

Hospital

Psychiatric

Hospital 283Q00000X 01 Inpatient Facility 018

Mental Health

Inpatient Hospitals

Under 21

N Y

Non-individual Hospitals Psychiatric

Hospital

Psychiatric

Hospital 283Q00000X 01 Inpatient Facility 019

Mental Health

Inpatient Hospitals

Over 65

Y Y

Non-individual Hospitals Hospital

Religious

Nonmedical Health

Care Institution

282J00000X 01 Inpatient Facility 682Religious Nonmedical

Health Care InstitutionN N

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Military and U.S.

Coast Guard

Ambulatory

Procedure

261QM1101X 02Ambulatory Surgical

Center (ASC)020

Ambulatory Surgical

Center (ASC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Oral and

Maxillofacial

Surgery

261QS0112X 02Ambulatory Surgical

Center (ASC)020

Ambulatory Surgical

Center (ASC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Ophthalmologic

Surgery 261QS0132X 02

Ambulatory Surgical

Center (ASC)020

Ambulatory Surgical

Center (ASC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Ambulatory Surgery 261QA1903X 02Ambulatory Surgical

Center (ASC)675

Ambulatory Surgical

Center (ASC)Y Y

Page 2 of 80

Page 3: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Nursing &

Custodial Care

Facilities

Intermediate Care

Facility, Mental

Illness

Intermediate Care

Facility, Mental

Illness

310500000X 03 Extended Care Facility 030 Nursing Facility - ICF Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Nursing

Facility/Intermedi

ate Care Facility

Nursing

Facility/Intermediate

Care Facility

313M00000X 03 Extended Care Facility 030 Nursing Facility - ICF Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Intermediate Care

Facility, Mentally

Retarded

Intermediate Care

Facility, Mentally

Retarded

315P00000X 03 Extended Care Facility 031 ICF/MR N Y

Non-individual

Nursing &

Custodial Care

Facilities

Nursing

Facility/Intermedi

ate Care Facility

Nursing

Facility/Intermediate

Care Facility

313M00000X 03 Extended Care Facility 032Pediatric Nursing

FacilityN Y

Non-individual

Nursing &

Custodial Care

Facilities

Skilled Nursing

Facility

Skilled Nursing

Facility 314000000X 03 Extended Care Facility 033

Residential Care

Facility N Y

Non-individual

Nursing &

Custodial Care

Facilities

Skilled Nursing

Facility

Skilled Nursing

Facility 314000000X 03 Extended Care Facility 034

Skilled Nursing Facility

(SNF) - OtherN Y

Non-individual

Nursing &

Custodial Care

Facilities

Alzheimer Center

(Dementia Center)

Alzheimer Center

(Dementia Center) 311500000X 03 Extended Care Facility 035

Skilled Nursing Facility

(SNF)Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Skilled Nursing

Facility

Skilled Nursing

Facility 314000000X 03 Extended Care Facility 035

Skilled Nursing Facility

(SNF) Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Skilled Nursing

Facility

Nursing Care,

Pediatric 3140N1450X 03 Extended Care Facility 035

Skilled Nursing Facility

(SNF) Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Christian Science

Facility

Christian Science

Facility 317400000X 03 Extended Care Facility 035

Skilled Nursing Facility

(SNF) Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Skilled Nursing

Facility

Skilled Nursing

Facility 314000000X 03 Extended Care Facility 036

Respite Care - Facility

Based N Y

Non-individual Respite Care

FacilityRespite Care Respite Care 385H00000X 03 Extended Care Facility 036

Respite Care - Facility

Based N Y

Non-individual Respite Care

FacilityRespite Care Respite Care Camp 385HR2050X 03 Extended Care Facility 036

Respite Care - Facility

Based N Y

Non-individual Respite Care

FacilityRespite Care

Respite Care, Mental

Illness, Child 385HR2055X 03 Extended Care Facility 036

Respite Care - Facility

Based N Y

Page 3 of 80

Page 4: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Respite Care

FacilityRespite Care

Respite Care, Mental

Retardation and/or

Developmental

Disabilities

385HR2060X 03 Extended Care Facility 036Respite Care - Facility

Based N Y

Non-individual Respite Care

FacilityRespite Care

Respite Care,

Physical Disabilities,

Child

385HR2065X 03 Extended Care Facility 036Respite Care - Facility

Based N Y

Non-individual

Nursing &

Custodial Care

Facilities

Assisted Living

Facility

Assisted Living

Facility 310400000X 03 Extended Care Facility 037 Assisted Living N N

Non-individual

Nursing &

Custodial Care

Facilities

Assisted Living

Facility

Assisted Living,

Mental Illness 3104A0625X 03 Extended Care Facility 037 Assisted Living N N

Non-individual

Nursing &

Custodial Care

Facilities

Assisted Living

Facility

Assisted Living,

Behavioral

Disturbances

3104A0630X 03 Extended Care Facility 037 Assisted Living N N

Non-individual

Nursing &

Custodial Care

Facilities

Custodial Care

Facility

Custodial Care

Facility 311Z00000X 03 Extended Care Facility 037 Assisted Living N N

Non-individual

Nursing &

Custodial Care

Facilities

Custodial Care

Facility Adult Care Home 311ZA0620X 03 Extended Care Facility 037 Assisted Living N N

Non-individual

Nursing &

Custodial Care

Facilities

Intermediate Care

Facility, Mentally

Retarded

Intermediate Care

Facility, Mentally

Retarded

315P00000X 03 Extended Care Facility 038 ICF/MR - Other N Y

Non-individual

Nursing &

Custodial Care

Facilities

Nursing

Facility/Intermedi

ate Care Facility

Nursing

Facility/Intermediate

Care Facility

313M00000X 03 Extended Care Facility 039Nursing Facility - ICF -

OtherN Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Rehabilitation 261QR0400X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Rehabilitation,

Comprehensive

Outpatient

Rehabilitation

Facility (CORF)

261QR0401X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Rehabilitation,

Cardiac Facilities 261QR0404X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Rehabilitation,

Substance Use

Disorder

261QR0405X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Page 4 of 80

Page 5: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Residential

Treatment

Facilities

Residential

Treatment

Facility, Mental

Retardation and/or

Developmental

Disabilities

Residential

Treatment Facility,

Mental Retardation

and/or

Developmental

Disabilities

320600000X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Residential

Treatment

Facilities

Residential

Treatment

Facility, Physical

Disabilities

Residential

Treatment Facility,

Physical Disabilities

320700000X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Residential

Treatment

Facilities

Community Based

Residential

Treatment

Facility, Mental

Illness

Community Based

Residential

Treatment Facility,

Mental Illness

320800000X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Residential

Treatment

Facilities

Community Based

Residential

Treatment

Facility, Mental

Retardation and/or

Developmental

Disabilities

Community Based

Residential

Treatment Facility,

Mental Retardation

and/or

Developmental

Disabilities

320900000X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Residential

Treatment

Facilities

Substance Abuse

Rehabilitation

Facility

Substance Abuse

Rehabilitation

Facility

324500000X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual

Residential

Treatment

Facilities

Substance Abuse

Rehabilitation

Facility

Substance Abuse

Treatment, Children 3245S0500X 04 Rehabilitation Facility 040 Rehabilitation Facility Y Y

Non-individual Agencies Home Health Home Health 251E00000X 05 Home Health Agency 050 Home Health Agency Y Y

Non-individual Agencies Home Health Home Health 251E00000X 05 Home Health Agency 051Specialized Home

Nursing ServicesN Y

Non-individual Agencies Voluntary or

Charitable

Voluntary or

Charitable 251V00000X 05 Home Health Agency 052 Voluntary or Charitable N Y

Non-individual Agencies Home Health Home Health 251E00000X 05 Home Health Agency 210Care Coordinator for

Pregnant WomenN Y

Non-individual Agencies Home Health Home Health 251E00000X 05 Home Health Agency 211 HIV Case Manager N Y

Non-individual Agencies Home Infusion Home Infusion 251F00000X 05 Home Health Agency 998Specialty not yet

definedN N

Page 5 of 80

Page 6: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Agencies Hospice Care,

Community Based

Hospice Care,

Community Based 251G00000X 06 Hospice 060 Hospice Y Y

Non-individual

Nursing &

Custodial Care

Facilities

Hospice, Inpatient Hospice, Inpatient 315D00000X 06 Hospice 060 Hospice Y Y

Non-individual Managed Care

Organizations

Health

Maintenance

Organization

Health Maintenance

Organization 302R00000X 07 Capitation Provider 071

Manager Care

Organization (MCO)N Y

Non-individual Managed Care

Organizations

Preferred Provider

Organization

Preferred Provider

Organization 305R00000X 07 Capitation Provider 071

Manager Care

Organization (MCO)N Y

Non-individual Managed Care

OrganizationsPoint of Service Point of Service 305S00000X 07 Capitation Provider 071

Manager Care

Organization (MCO)N Y

Non-individual Agencies

Program of All-

Inclusive Care for

the Elderly

(PACE) Provider

Organization

Program of All-

Inclusive Care for

the Elderly (PACE)

Provider

Organization

251T00000X 07 Capitation Provider 071Manager Care

Organization (MCO)N Y

Non-individual Managed Care

Organizations

Health

Maintenance

Organization

Health Maintenance

Organization 302R00000X 07 Capitation Provider 072

Behavioral Health

Organization (BHO)N Y

Non-individual Managed Care

Organizations

Health

Maintenance

Organization

Health Maintenance

Organization 302R00000X 07 Capitation Provider 073

Dental Benefit Manager

(DBM)N Y

Non-individual Managed Care

Organizations

Health

Maintenance

Organization

Health Maintenance

Organization 302R00000X 07 Capitation Provider 074

Prescription Benefit

Manager (PBM)N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Student Health 261QS1000X 07 Capitation Provider 120 Teaching Institute N N

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Federally Qualified

Health Center

(FQHC)

261QF0400X 08 Clinic 080Federally Qualified

Health Clinic (FQHC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Rural Health 261QR1300X 08 Clinic 081Rural Health Clinic

(RHC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Clinic/Center 261Q00000X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Augmentative

Communication 261QA3000X 08 Clinic 082 Medical Clinic Y Y

Page 6 of 80

Page 7: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Critical Access

Hospital 261QC0050X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Developmental

Disabilities 261QD1600X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Emergency Care 261QE0002X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Endoscopy 261QE0800X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Genetics 261QG0250X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Lithotripsy 261QL0400X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Migrant Health 261QM1000X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Military/U.S. Coast

Guard Outpatient 261QM1100X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Military Outpatient

Operational

(Transportable)

Component

261QM1102X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Military Ambulatory

Procedure Visits

Operational

(Transportable)

261QM1103X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Magnetic Resonance

Imaging (MRI) 261QM1200X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Multi-Specialty 261QM1300X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Medical Specialty 261QM2500X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Methadone 261QM2800X 08 Clinic 082 Medical Clinic Y Y

Page 7 of 80

Page 8: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Podiatric 261QP1100X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Primary Care 261QP2300X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Prison Health 261QP2400X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Pain 261QP3300X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Recovery Care 261QR0800X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Research 261QR1100X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Sleep Disorder

Diagnostic 261QS1200X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Urgent Care 261QU0200X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center VA 261QV0200X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Occupational

Medicine 261QX0100X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Oncology 261QX0200X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Oncology, Radiation 261QX0203X 08 Clinic 082 Medical Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Ambulatory Family

Planning Facility 261QA0005X 08 Clinic 083 Family Planning Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Ambulatory Fertility

Facility 261QA0006X 08 Clinic 083 Family Planning Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Family Planning,

Non-Surgical 261QF0050X 08 Clinic 083 Family Planning Clinic Y Y

Page 8 of 80

Page 9: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Public Health, State

or Local 261QP0905X 08 Clinic 083 Family Planning Clinic Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Nurse Practitioner 363L00000X 08 Clinic 084Nurse Practitioner

ClinicN Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Public Health,

Federal 261QP0904X 08 Clinic 085 EPSDT Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Dental 261QD0000X 08 Clinic 086 Dental Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Infusion Therapy 261QI0500X 08 Clinic 087 Therapy Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Physical Therapy 261QP2000X 08 Clinic 087 Therapy Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Health Service 261QH0100X 08 Clinic 088 Pediatric Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Adolescent and

Children Mental

Health

261QM0855X 08 Clinic 088 Pediatric Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Medically Fragile

Infants and Children

Day Care

261QM3000X 08 Clinic 088 Pediatric Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Health Service 261QH0100X 08 Clinic 089 Tuberculosis Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Health Service 261QH0100X 08 Clinic 181 Maternity N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Health Service 261QH0100X 08 Clinic 182 Speech/Hearing Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Hearing and Speech 261QH0700X 08 Clinic 182 Speech/Hearing Clinic N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Health Service 261QH0100X 08 Clinic 183Early Intervention

ServicesN Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Rural Health 261QR1300X 08 Clinic 184Hospital Based Rural

Health ClinicN Y

Page 9 of 80

Page 10: TAXONOMY Provider Provider Type Provider Provider Specialty iC … · 2019-07-17 · Clinic/Center Amputee 261QA0900X 08 Clinic 082 Medical Clinic Y Y Non-individual Ambulatory Health

TennCare Taxonomy Crosswalk 7/17/2019

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Rural Health 261QR1300X 08 Clinic 185Free Standing Rural

Health ClinicY Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Community Health 261QC1500X 08 Clinic 186 Community Health Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Corporate Health 261QC1800X 08 Clinic 186 Community Health Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Pediatrics 363LP0200X 09 Advance Practice Nurse 090Pediatric Nurse

PractitionerN Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Pediatrics, Critical

Care 363LP0222X 09 Advance Practice Nurse 090

Pediatric Nurse

PractitionerN Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Pediatrics 364SP0200X 09 Advance Practice Nurse 090

Pediatric Nurse

PractitionerN Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Obstetrics &

Gynecology 363LX0001X 09 Advance Practice Nurse 091

Obstetric Nurse

PractitionerN Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Family 363LF0000X 09 Advance Practice Nurse 092Family Nurse

PractitionerY Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Nurse Practitioner 363L00000X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Acute Care 363LA2100X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Adult Health 363LA2200X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Critical Care

Medicine 363LC0200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Community Health 363LC1500X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Gerontology 363LG0600X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Neonatal 363LN0000X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Neonatal, Critical

Care 363LN0005X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Psychiatric/Mental

Health 363LP0808X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Perinatal 363LP1700X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Primary Care 363LP2300X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner School 363LS0200X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Women's Health 363LW0102X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Occupational Health 363LX0106X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Clinical Nurse

Specialist 364S00000X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Acute Care 364SA2100X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Adult Health 364SA2200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Critical Care

Medicine 364SC0200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Community

Health/Public Health 364SC1501X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Chronic Care 364SC2300X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Emergency 364SE0003X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Ethics 364SE1400X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Family Health 364SF0001X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Gerontology 364SG0600X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Home Health 364SH0200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Holistic 364SH1100X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Informatics 364SI0800X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Long-Term Care 364SL0600X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Medical-Surgical 364SM0705X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Neonatal 364SN0000X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Neuroscience 364SN0800X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health, Child &

Adolescent

364SP0807X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health 364SP0808X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health, Adult 364SP0809X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health, Child &

Family

364SP0810X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health, Chronically

Ill

364SP0811X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health, Community 364SP0812X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist

Psychiatric/Mental

Health,

Geropsychiatric

364SP0813X 09 Advance Practice Nurse 093Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Perinatal 364SP1700X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Perioperative 364SP2800X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Rehabilitation 364SR0400X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist School 364SS0200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Transplantation 364ST0500X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Women's Health 364SW0102X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Occupational Health 364SX0106X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Oncology 364SX0200X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Clinical Nurse

Specialist Oncology, Pediatrics 364SX0204X 09 Advance Practice Nurse 093

Nurse Practitioner

(Other)Y Y

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Anesthetist,

Certified

Registered

Nurse Anesthetist,

Certified Registered 367500000X 09 Advance Practice Nurse 094

Certified Registered

Nurse Anesthetist

(CRNA)

Y Y

Individual or

Groups (of

Individuals)

Other Service

Providers

Midwife,

Certified Midwife, Certified 176B00000X 09 Advance Practice Nurse 095

Certified Nurse

MidwifeY Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Midwife,

Certified Nurse

Midwife, Certified

Nurse 367A00000X 09 Advance Practice Nurse 095

Certified Nurse

MidwifeY Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Nurse Practitioner 363L00000X 09 Advance Practice Nurse 210Care Coordinator for

Pregnant WomenN Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Practitioner Nurse Practitioner 363L00000X 09 Advance Practice Nurse 211 HIV Case Manager N Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Assistant,

Podiatric Assistant, Podiatric 211D00000X 10 Mid-Level Practitioner 100 Physician Assistant N Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Physician

Assistant Physician Assistant 363A00000X 10 Mid-Level Practitioner 100 Physician Assistant Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Physician

Assistant Medical 363AM0700X 10 Mid-Level Practitioner 100 Physician Assistant Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Physician

Assistant Surgical 363AS0400X 10 Mid-Level Practitioner 100 Physician Assistant Y Y

Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Nurse Anesthetist,

Certified

Registered

Nurse Anesthetist,

Certified Registered 367500000X 10 Mid-Level Practitioner 101

Anesthesiology

AssistantY Y

Page 16 of 80

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Individual or

Groups (of

Individuals)

Physician

Assistants &

Advanced

Practice Nursing

Providers

Anesthesiologist

Assistant

Anesthesiologist

Assistant 367H00000X 10 Mid-Level Practitioner 101

Anesthesiology

AssistantY Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Mental Health

(Including

Community Mental

Health Center)

261QM0801X 11 Mental Health Provider 110Outpatient Mental

Health ClinicY Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Mental Health

(Including

Community Mental

Health Center)

261QM0801X 11 Mental Health Provider 111Community Mental

Health Center (CMHC)Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Adult Mental Health 261QM0850X 11 Mental Health Provider 111Community Mental

Health Center (CMHC)Y Y

Non-individual Agencies Community/Beha

vioral Health***&

Community/Behavio

ral Health***&251S00000X 11 Mental Health Provider 111

Community Mental

Health Center (CMHC)Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychoanalyst** Psychoanalyst** 102L00000X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Psychologist& 103T00000X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&

Addiction

(Substance Use

Disorder)

103TA0400X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&Adult Development

& Aging 103TA0700X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&Cognitive &

Behavioral+ 103TB0200X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Counseling 103TC1900X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Educational^ 103TE1000X 11 Mental Health Provider 112 Psychologist Y Y

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Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Exercise & Sports 103TE1100X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Family 103TF0000X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Forensic 103TF0200X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Health** 103TH0004X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Health Service 103TH0100X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Men & Masculinity^ 103TM1700X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&

Mental Retardation

& Developmental

Disabilities

103TM1800X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&Prescribing

(Medical)**103TP0016X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Psychoanalysis 103TP0814X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Psychotherapy^ 103TP2700X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&Group

Psychotherapy+ 103TP2701X 11 Mental Health Provider 112 Psychologist Y Y

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Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Rehabilitation 103TR0400X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& School 103TS0200X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Women^ 103TW0100X 11 Mental Health Provider 112 Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Clinical

Neuropsychologis

t+

Clinical

Neuropsychologist+ 103G00000X 11 Mental Health Provider 113 Clinical Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Clinical

Neuropsychologis

t+

Clinical^ (use

103G00000X) 103GC0700X 11 Mental Health Provider 113 Clinical Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Psychologist& 103T00000X 11 Mental Health Provider 113 Clinical Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Clinical 103TC0700X 11 Mental Health Provider 113 Clinical Psychologist Y Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist&Clinical Child &

Adolescent+103TC2200X 11 Mental Health Provider 113 Clinical Psychologist Y Y

Individual or

Groups (of

Individuals)

Other Service

Providers

Sleep Specialist,

PhD

Sleep Specialist,

PhD*****173F00000X 11 Mental Health Provider 113 Clinical Psychologist Y N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Psychologist& Psychologist& 103T00000X 11 Mental Health Provider 114Health Service Provider

in Psychology (HSPP)N Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Social Worker Clinical 1041C0700X 11 Mental Health Provider 115Certified Clinical

Social WorkerY Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Social Worker Social Worker 104100000X 11 Mental Health Provider 116 Certified Social Worker Y Y

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Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Social Worker School 1041S0200X 11 Mental Health Provider 116 Certified Social Worker Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Psychiatric/Mental

Health 163WP0808X 11 Mental Health Provider 117 Psychiatric Nurse N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Mental Health

(Including

Community Mental

Health Center)

261QM0801X 11 Mental Health Provider 118Mental Health -

DMHSASN Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Marriage &

Family Therapist

Marriage & Family

Therapist 106H00000X 11 Mental Health Provider 119

Marriage and Family

CounselorN Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor Counselor 101Y00000X 11 Mental Health Provider 121Licensed Practical

CounselorN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor Mental Health 101YM0800X 11 Mental Health Provider 121Licensed Practical

CounselorN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor Pastoral 101YP1600X 11 Mental Health Provider 121Licensed Practical

CounselorN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor Professional 101YP2500X 11 Mental Health Provider 121Licensed Practical

CounselorN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor School 101YS0200X 11 Mental Health Provider 121Licensed Practical

CounselorN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Behavioral

Analyst

Classification

Behavioral Analyst

Classification103K00000X 11 Mental Health Provider 122 Behavioral Analyst N Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Assistant

Behavior AnalystBehavior Analyst 106E00000X 11 Mental Health Provider 122 Behavior Analyst N Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Behavior

TechnicianBehavior Technician 106S00000X 11 Mental Health Provider 122 Behavior Analyst N Y

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Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Mental Health

(Including

Community Mental

Health Center)

261QM0801X 11 Mental Health Provider 210Care Coordinator for

Pregnant WomenN Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

Mental Health

(Including

Community Mental

Health Center)

261QM0801X 11 Mental Health Provider 211 HIV Case Manager N Y

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor

Addiction

(Substance Use

Disorder)

101YA0400X 11 Mental Health Provider 212 Addiction Counselor N Y

Individual or

Groups (of

Individuals)

Other Service

Providers

Genetic

Counselor, MS

Genetic Counselor,

MS 170300000X 11 Mental Health Provider 357 Genetics N N

Non-individual Agencies

Day Training,

Developmentally

Disabled Services

Day Training,

Developmentally

Disabled Services

251C00000X 11 Mental Health Provider 493DDSD-Supportive

Living ArrangementsN N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Poetry TherapistPoetry

Therapist****102X00000X 11 Mental Health 617 Poetry Therapist N N

Non-individual Agencies Local Education

Agency (LEA)

Local Education

Agency (LEA) 251300000X 12 School Corporation 120 School Corporation Y N

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Student Health 261QS1000X 12 School Corporation 120 Teaching Institute Y N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 13 Public Health Agency 130

County Health

DepartmentY N

Non-individual Agencies

Early

InterventionProvi

der Agency

Early Intervention

Provider

Agency****

252Y00000X 13 Public Health Agency 183Early Intervention

ServicesN N

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Podiatrist 213E00000X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist General Practice^^^

(use 213E00000X)213EG0000X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Public Medicine 213EP0504X 14 Podiatrist 140 Podiatrist Y Y

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Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Primary Podiatric

Medicine 213EP1101X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Radiology 213ER0200X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Sports Medicine 213ES0000X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Foot & Ankle

Surgery 213ES0103X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Podiatric

Medicine &

Surgery Service

Providers

Podiatrist Foot Surgery 213ES0131X 14 Podiatrist 140 Podiatrist Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Chiropractor 111N00000X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor

Independent Medical

Examiner** 111NI0013X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Internist 111NI0900X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Neurology 111NN0400X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Nutrition 111NN1001X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Pediatric***** 111NP0017X 15 Chiropractor 150 Chiropractor Y N

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Radiology 111NR0200X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Rehabilitation 111NR0400X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Sports Physician 111NS0005X 15 Chiropractor 150 Chiropractor Y Y

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TennCare Taxonomy Crosswalk 7/17/2019

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Thermography 111NT0100X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor

Occupational

Medicine 111NX0100X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Orthopedic 111NX0800X 15 Chiropractor 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Psychiatric/Mental

Health, Child &

Adolescent

163WP0807X 16 Nurse 117 Psychiatric Nurse N N

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Psychiatric/Mental

Health, Adult 163WP0809X 16 Nurse 117 Psychiatric Nurse N N

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Registered Nurse 163W00000X 16 Nurse 160 Registered Nurse (RN) N Y

Individual or

Groups (of

Individuals)

Nursing Service

Providers

Licensed Practical

Nurse

Licensed Practical

Nurse 164W00000X 16 Nurse 161

Licensed Practical

Nurse (LPN)N Y

Individual or

Groups (of

Individuals)

Nursing Service

Providers

Licensed

Vocational Nurse

Licensed Vocational

Nurse 164X00000X 16 Nurse 161

Licensed Practical

Nurse (LPN)N Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Registered Nurse 163W00000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Addiction

(Substance Use

Disorder)

163WA0400X 16 Nurse 162Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Administrator 163WA2000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Critical Care

Medicine 163WC0200X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Case Management 163WC0400X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse College Health 163WC1400X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Community Health 163WC1500X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Page 23 of 80

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Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Continuing

Education/Staff

Development

163WC1600X 16 Nurse 162Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Continence Care 163WC2100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Cardiac

Rehabilitation 163WC3500X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Diabetes Educator 163WD0400X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Dialysis, Peritoneal 163WD1100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Emergency 163WE0003X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Enterostomal

Therapy 163WE0900X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Flight 163WF0300X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse General Practice 163WG0000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Gastroenterology 163WG0100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Gerontology 163WG0600X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Home Health 163WH0200X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Hemodialysis 163WH0500X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Hospice 163WH1000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Infusion Therapy 163WI0500X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Page 24 of 80

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Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Lactation Consultant 163WL0100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Maternal Newborn 163WM0102X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Medical-Surgical 163WM0705X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Nurse Massage

Therapist (NMT) 163WM1400X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Neonatal Intensive

Care 163WN0002X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Neonatal, Low Risk 163WN0003X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Nephrology 163WN0300X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Neuroscience 163WN0800X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Nutrition Support 163WN1003X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Pain Management 163WP0000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Pediatrics 163WP0200X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Pediatric Oncology 163WP0218X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Ambulatory Care 163WP2201X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Registered Nurse

First Assistant 163WR0006X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Rehabilitation 163WR0400X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Page 25 of 80

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Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Reproductive

Endocrinology/Infert

ility

163WR1000X 16 Nurse 162Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Plastic Surgery 163WS0121X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse School 163WS0200X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Urology 163WU0100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Wound Care 163WW0000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Women's Health

Care, Ambulatory 163WW0101X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Obstetric, High-Risk 163WX0002X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Obstetric, Inpatient 163WX0003X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Occupational Health 163WX0106X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Oncology 163WX0200X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse

Otorhinolaryngology

& Head-Neck 163WX0601X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Orthopedic 163WX0800X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Ophthalmic 163WX1100X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Ostomy Care 163WX1500X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Christian Science

Practitioner/Nurse

Christian Science

Practitioner/Nurse 374T00000X 16 Nurse 162

Registered Nurse

Clinical (RNC)Y Y

Page 26 of 80

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Non-individual Agencies Nursing Care Nursing Care 251J00000X 16 Nurse 163 Skilled Nursing Agency N N

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Perinatal 163WP1700X 16 Nurse 210

Care Coordinator for

Pregnant WomenN Y

Individual or

Groups (of

Individuals)

Nursing Service

ProvidersRegistered Nurse Infection Control 163WI0600X 16 Nurse 211 HIV Case Manager N Y

Individual or

Groups (of

Individuals)

Other Service

ProvidersAcupuncturist Acupuncturist 171100000X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Other Service

Providers

Mechanotherapist

** Mechanotherapist** 172M00000X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Physical Therapist 225100000X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Cardiopulmonary 2251C2600X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Ergonomics 2251E1200X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Electrophysiology,

Clinical 2251E1300X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Geriatrics 2251G0304X 17 Therapist 170 Physical Therapist Y Y

Page 27 of 80

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Hand 2251H1200X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Human Factors 2251H1300X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Neurology 2251N0400X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Pediatrics 2251P0200X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Sports 2251S0007X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapist Orthopedic 2251X0800X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Rehabilitation

Practitioner

Rehabilitation

Practitioner 225400000X 17 Therapist 170 Physical Therapist Y Y

Individual or

Groups (of

Individuals)

Other Service

ProvidersReflexologist Reflexologist***** 173C00000X 17 Therapist 170 Physical Therapist Y N

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist

Occupational

Therapist 225X00000X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist Ergonomics 225XE1200X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist Hand 225XH1200X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist Human Factors 225XH1300X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist Neurorehabilitation 225XN1300X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist Pediatrics 225XP0200X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapist

Rehabilitation,

Driver 225XR0403X 17 Therapist 171 Occupational Therapist Y Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapist

Environmental

Modification

Specialization

225XE0001X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Restorative

Service Providers

Occupational

Therapist 225XF0002X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental

Rehabilitative and

Restorative

Service Providers

Type,

Occupational

Therapist

Gerontology

Specialization225XG0600X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapist

Low Vision

Specialization225XL0004X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapist

Mental Health

Specialization225XM0800X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapist

Physical

Rehabilitation 225XP0019X 17 Therapist 171 Occupational Therapist Y Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Respiratory

Therapist, Certified 227800000X 17 Therapist 172 Respiratory Therapist N Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Critical Care 2278C0205X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Emergency Care 2278E0002X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Educational 2278E1000X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Geriatric Care 2278G0305X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

General Care 2278G1100X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Home Health 2278H0200X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Pulmonary

Diagnostics 2278P1004X 17 Therapist 172 Respiratory Therapist N Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Pulmonary

Rehabilitation 2278P1005X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Pulmonary Function

Technologist 2278P1006X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Palliative/Hospice 2278P3800X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Neonatal/Pediatrics 2278P3900X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

Patient Transport 2278P4000X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Certified

SNF/Subacute Care 2278S1500X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Respiratory

Therapist, Registered 227900000X 17 Therapist 172 Respiratory Therapist N Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Critical Care 2279C0205X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Emergency Care 2279E0002X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Educational 2279E1000X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Geriatric Care 2279G0305X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

General Care 2279G1100X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Home Health 2279H0200X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Pulmonary

Diagnostics 2279P1004X 17 Therapist 172 Respiratory Therapist N Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Pulmonary

Rehabilitation 2279P1005X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Pulmonary Function

Technologist 2279P1006X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Palliative/Hospice 2279P3800X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Neonatal/Pediatrics 2279P3900X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

Patient Transport 2279P4000X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Respiratory

Therapist,

Registered

SNF/Subacute Care 2279S1500X 17 Therapist 172 Respiratory Therapist N Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Clinical Exercise

Physiologist

Clinical Exercise

Physiologist 224Y00000X 17

Clinical Exercise

Physiologist172 Respiratory Therapist N N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Speech-Language

Pathologist

Speech-Language

Pathologist 235Z00000X 17 Therapist 173

Speech/Hearing

TherapistY Y

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Occupational

Therapy Assistant

Occupational

Therapy Assistant 224Z00000X 17 Therapist 174

Occupational Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapy Assistant

Environmental

Modification

Specialization

224ZE0001X 17 Assistant Therapist 174Occupational Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapy Assistant

Feeding, Eating &

Swallowing

Specialization

224ZF0002X 17 Assistant Therapist 174Occupational Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapy Assistant

Low Vision

Specialization224ZL0004X 17 Assistant Therapist 174

Occupational Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Occupational

Therapy Assistant

Driving &

Community Mobility

Specialization

224ZR0403X 17 Assistant Therapist 174Occupational Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Physical Therapy

Assistant

Physical Therapy

Assistant 225200000X 17 Therapist 175

Physical Therapy

AssistantN Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Optometrist 152W00000X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Corneal and Contact

Management 152WC0802X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Low Vision

Rehabilitation 152WL0500X 18 Optometrist 180 Optometrist Y Y

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TennCare Taxonomy Crosswalk 7/17/2019

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Pediatrics 152WP0200X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Sports Vision 152WS0006X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Vision Therapy 152WV0400X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Optometrist Occupational Vision 152WX0102X 18 Optometrist 180 Optometrist Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist

Technician/Technolo

gist 156F00000X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Contact Lens 156FC0800X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Contact Lens Fitter 156FC0801X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Ophthalmic 156FX1100X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist

Ophthalmic

Assistant 156FX1101X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Optometric Assistant 156FX1201X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist

Optometric

Technician 156FX1202X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Ocularist 156FX1700X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Optician 156FX1800X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Orthoptist 156FX1900X 19 Optician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Audiologist Audiologist 231H00000X 20 Audiologist 200 Audiologist Y Y

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TennCare Taxonomy Crosswalk 7/17/2019

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Audiologist

Assistive

Technology

Practitioner

231HA2400X 20 Audiologist 251 Assistive Technology N N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Audiologist Assistive

Technology Supplier 231HA2500X 20 Audiologist 621

Assistive Technology

SupplierN N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Audiologist-

Hearing Aid Fitter

Audiologist-Hearing

Aid Fitter 237600000X 20 Audiologist 625

Audiologist-Hearing

Aid Fitter N N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)210

Care Coordinator for

Pregnant WomenN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)211 HIV Case Manager N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Case

Manager/Care

Coordinator

Case Manager/Care

Coordinator 171M00000X 21

Case Manager

(Targeted)213 E.I. Case Management N N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)213 E.I. Case Manager N N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)214

High Risk Pregnant

WomenN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)215 TB Case Management N N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)216

OJA Targeted Case

ManagementN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)217

Child Welfare Targeted

Case ManagementN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)218 DDSD/ICFMR Waiver N N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)219

TCM 1st Time

Mothers/InfantsN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)221

MH Case Mgmt All

AgesN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)222

MH Case Mgmt, Over

21, PublicN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)223

MH Case Mgmt, Over

21, ContractedN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)224

MH Case Mgmt, Over

21, PrivateN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)225

MH Case Mgmt, Under

21, PublicN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)226

MH Case Mgmt, Under

21, ContractedN N

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TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)227

MH Case Mgmt, Under

21, PrivateN N

Non-individual Agencies Case Management Case Management 251B00000X 21Case Manager

(Targeted)228

Advantage Case

ManagerN N

Non-individual Agencies Supports

Brokerage Supports Brokerage 251X00000X 21

Case Manager

(Targeted)228

Advantage Case

ManagerN N

Non-individual Suppliers Hearing Aid

Equipment

Hearing Aid

Equipment 332S00000X 22 Hearing Aid Dealer 220 Hearing Aid Dealer N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Nutritionist Nutritionist 133N00000X 23 Nutritionist 210Care Coordinator for

Pregnant WomenN Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Nutritionist Nutritionist 133N00000X 23 Nutritionist 211 HIV Case Manager N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietary Manager Dietary Manager 132700000X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Nutritionist Nutritionist 133N00000X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Nutritionist Nutrition, Education 133NN1002X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietitian,

Registered Dietitian, Registered 133V00000X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietitian,

Registered Nutrition, Pediatric 133VN1004X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietitian,

Registered Nutrition, Renal 133VN1005X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietitian,

Registered Nutrition, Metabolic 133VN1006X 23 Nutritionist 230 Nutritionist N Y

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Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 136A00000X 23 Nutritionist 230 Nutritionist N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 133VN1101X 23

Gerontological

Nutrition677

Gerontological

NutritionN Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 133VN1201X 23

Obesity and Weight

Management 678

Obesity and Weight

Management N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 133VN1301X 23 Oncology Nutrition 679 Oncology Nutrition N Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 133VN1401X 23

Pediatric Critial Care

Nutrition680

Pediatric Critial Care

NutritionN Y

Individual or

Groups (of

Individuals)

Dietary &

Nutritional

Service Providers

Dietetic

Technician,

Registered

Dietetic Technician,

Registered 133VN1501X 23

Sports Dietetics

Nutrition681

Sports Dietetics

NutritionN Y

Non-individual Suppliers

Military/U.S.

Coast Guard

Pharmacy

Military/U.S. Coast

Guard Pharmacy 332000000X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers

Department of

Veterans Affairs

(VA) Pharmacy

Department of

Veterans Affairs

(VA) Pharmacy

332100000X 24 Pharmacy 240 Pharamacy Y Y

Non-individual Suppliers

Indian Health

Service/Tribal/Ur

ban Indian Health

(I/T/U) Pharmacy

Indian Health

Service/Tribal/Urban

Indian Health

(I/T/U) Pharmacy

332800000X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Pharmacy 333600000X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Clinic Pharmacy 3336C0002X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Community/Retail

Pharmacy 3336C0003X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Compounding

Pharmacy 3336C0004X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Home Infusion

Therapy Pharmacy 3336H0001X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Institutional

Pharmacy 3336I0012X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Long Term Care

Pharmacy 3336L0003X 24 Pharmacy 240 Pharmacy Y Y

Page 39 of 80

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TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Suppliers Pharmacy Mail Order

Pharmacy 3336M0002X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy

Managed Care

Organization

Pharmacy

3336M0003X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Nuclear Pharmacy 3336N0007X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Specialty Pharmacy 3336S0011X 24 Pharmacy 240 Pharmacy Y Y

Non-individual Suppliers Pharmacy Pharmacy 333600000X 24 Pharmacy 250DME/Medical Supply

DealerN Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Durable Medical

Equipment &

Medical Supplies

332B00000X 25DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Customized

Equipment 332BC3200X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Dialysis Equipment

& Supplies 332BD1200X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Nursing Facility

Supplies 332BN1400X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Parenteral & Enteral

Nutrition 332BP3500X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Oxygen Equipment

& Supplies 332BX2000X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Eyewear Supplier

(Equipment, not

the service)

Eyewear Supplier

(Equipment, not the

service)

332H00000X 25DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers Medical Foods

Supplier

Medical Foods

Supplier 335G00000X 25

Medical Foods

Supplier/DME250 DME/Medical Supplier Y Y

Non-individual Suppliers Portable X-Ray

Supplier

Portable X-Ray

Supplier 335V00000X 25

DME/Medical Supply

Dealer250

DME/Medical Supply

DealerY Y

Non-individual Suppliers

Durable Medical

Equipment &

Medical Supplies

Durable Medical

Equipment &

Medical Supplies

332B00000X 25DME/Medical Supply

Dealer251 Assistive Technology N Y

Page 40 of 80

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Non-individual Suppliers Prosthetic/Orthoti

c Supplier

Prosthetic/Orthotic

Supplier 335E00000X 25

DME/Medical Supply

Dealer277 Prosthesis Y Y

Non-individual Transportation

ServicesAmbulance Ambulance 341600000X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

ServicesAmbulance Land Transport 3416L0300X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

ServicesAmbulance Water Transport 3416S0300X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

Services

Military/U.S.

Coast Guard

Transport

Military/U.S. Coast

Guard Transport 341800000X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

Services

Military/U.S.

Coast Guard

Transport

Military or U.S.

Coast Guard

Ambulance, Ground

Transport

3418M1110X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

Services

Military/U.S.

Coast Guard

Transport

Military or U.S.

Coast Guard

Ambulance, Water

Transport

3418M1130X 26 Transportation Provider 260 Ambulance Y N

Non-individual Transportation

ServicesAmbulance Air Transport 3416A0800X 26 Transportation Provider 261 Air Ambulance Y N

Non-individual Transportation

Services

Military/U.S.

Coast Guard

Transport

Military or U.S.

Coast Guard

Ambulance, Air

Transport

3418M1120X 26 Transportation Provider 261 Air Ambulance Y N

Non-individual Transportation

ServicesBus Bus 347B00000X 26 Transportation Provider 262 Bus Y N

Non-individual Transportation

ServicesTaxi Taxi 344600000X 26 Transportation Provider 263 Taxi Y N

Individual or

Groups (of

Individuals)

Other Service

ProvidersDriver Driver 172A00000X 26 Transportation Provider 264

Common Carrier

(Ambulatory)Y N

Non-individual Transportation

Services

Non-emergency

Medical Transport

(VAN)

Non-emergency

Medical Transport

(VAN)

343900000X 26 Transportation Provider 264Common Carrier

(Ambulatory)Y N

Individual or

Groups (of

Individuals)

Other Service

ProvidersFuneral Director Funeral Director 176P00000X 26 Transportation Provider 265

Common Carrier (Non-

ambulatory)N N

Non-individual Transportation

Services

Non-emergency

Medical Transport

(VAN)

Non-emergency

Medical Transport

(VAN)

343900000X 26 Transportation Provider 265Common Carrier (Non-

Ambulatory)Y N

Non-individual Transportation

ServicesTrain Train 347D00000X 26 Transportation Provider 265

Common Carrier (Non-

Ambulatory)Y N

Non-individual Transportation

Services

Transportation

Broker

Transportation

Broker 347E00000X 26 Transportation Provider 265

Common Carrier (Non-

Ambulatory)Y N

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TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Transportation

ServicesAir Carrier Air Carrier 344800000X 26 Transportation Provider 265

Common Carrier (Non-

Ambulatory)y N

Non-individual Transportation

ServicesPrivate Vehicle Private Vehicle 347C00000X 26 Transportation Provider 266 Family Member Y N

Non-individual Transportation

Services

Non-emergency

Medical Transport

(VAN)

Non-emergency

Medical Transport

(VAN)

343900000X 26 Transportation Provider 267 Volunteer Y N

Non-individual Transportation

Services

Secured Medical

Transport (VAN)

Secured Medical

Transport (VAN) 343800000X 26 Transportation Provider 268

Secured Medical

Transport (VAN)y N

Individual or

Groups (of

Individuals)

Dental Providers Dentist Endodontics 1223E0200X 27 Dentist 270 Endodontist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Dentist 122300000X 27 Dentist 271General Dentistry

PractitionerY Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Dental Public Health 1223D0001X 27 Dentist 271General Dentistry

PractitionerY Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist General Practice 1223G0001X 27 Dentist 271General Dentistry

PractitionerY Y

Individual or

Groups (of

Individuals)

Dental Providers Denturist Denturist 122400000X 27 Dentist 271General Dentistry

PractitionerY Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist

Oral and

Maxillofacial

Surgery

1223S0112X 27 Dentist 272 Oral Surgeon Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist

Orthodontics and

Dentofacial

Orthopedics

1223X0400X 27 Dentist 273 Orthodontist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Pediatric Dentistry 1223P0221X 27 Dentist 274 Pediatric Dentist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Periodontics 1223P0300X 27 Dentist 275 Periodontist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist

Oral and

Maxillofacial

Pathology

1223P0106X 27 Dentist 276 Oral Pathologist N Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Prosthodontics 1223P0700X 27 Dentist 278 Prosthodontist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist

Oral and

Maxillofacial

Radiology

1223X0008X 27 Dentist 341 Radiologist N N

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Individual or

Groups (of

Individuals)

Dental Providers Dentist Dentist

Anesthesiologist1223D0004X 27 Dentist 669

Anesthesiologist -

OtherN Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Orafacial Pain 1223X2210X 27 Dentist 676 Orafacial Pain Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Oral Medicinist 125Q00000X 27 Oral Medicinise 683 Oral Medicinist Y Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist Dentist Therapist 125J00000X 27 Dental Therapist 999 Miscellaneous N N

Individual or

Groups (of

Individuals)

Dental Providers Dentist Advanced Practice

Dental Therapist125K00000X 27

Advanced Dental

Therapist999 Miscellaneous N N

Individual or

Groups (of

Individuals)

Dental Providers Dentist Oral Medicinist 125Q00000X 27 Oral Medicine 999 Miscellaneous N N

Non-individual Laboratories

Military Clinical

Medical

Laboratory

Military Clinical

Medical Laboratory 291900000X 28 Laboratory 280 Independent Lab Y Y

Non-individual LaboratoriesClinical Medical

Laboratory

Clinical Medical

Laboratory 291U00000X 28 Laboratory 280 Independent Lab Y Y

Non-individual Laboratories Dental Laboratory Dental Laboratory 292200000X 28 Laboratory 280 Independent Lab Y Y

Non-individual LaboratoriesPhysiological

Laboratory

Physiological

Laboratory 293D00000X 28 Laboratory 280 Independent Lab Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Radiology, Mobile 261QR0208X 28 Laboratory 281 Mobile Lab N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Radiology 261QR0200X 29 X-Ray Clinic 290Freestanding X-Ray

ClinicY Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Radiology, Mobile

Mammography 261QR0207X 29 X-Ray Clinic 291 Mobile X-Ray Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Radiology, Mobile 261QR0208X 29 X-Ray Clinic 291 Mobile X-Ray Clinic Y Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Radiology,

Mammography 261QR0206X 29 X-Ray Clinic 292 Mammography N Y

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center

End-Stage Renal

Disease (ESRD)

Treatment

261QE0700X 30End-Stage Renal

Disease (RSD) Clinic300

Free-standing Renal

Dialysis ClinicY Y

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Individual or

Groups (of

Individuals)

Chiropractic

ProvidersChiropractor Chiropractor 111N00000X 31 Physician 150 Chiropractor Y Y

Individual or

Groups (of

Individuals)

Eye and Vision

Services

Providers

Technician/Techn

ologist Optician 156FX1800X 31 Physician 190 Optician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Pediatrics

Child Abuse

Pediatrics

Specialization

2080C0008X 31Case Manager

(Targeted)217

Child Welfare Targeted

Case ManagementY Y

Individual or

Groups (of

Individuals)

Dental Providers Dentist

Oral and

Maxillofacial

Surgery

1223S0112X 31 Physician 272 Oral Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Allergy &

Immunology

Allergy &

Immunology207K00000X 31 Physician 310 Allergist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Allergy &

ImmunologyAllergy 207KA0200X 31 Physician 310 Allergist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Allergy &

Immunology

Clinical &

Laboratory

Immunology

207KI0005X 31 Physician 310 Allergist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineAllergy &

Immunology 207RA0201X 31 Physician 310 Allergist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Anesthesiology Anesthesiology 207L00000X 31 Physician 311 Anesthesiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

AnesthesiologyCritical Care

Medicine207LC0200X 31 Physician 311 Anesthesiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Anesthesiology

Hospice and

Palliative

Medicine**

207LH0002X 31 Physician 311 Anesthesiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Anesthesiology Pain Medicine 207LP2900X 31 Physician 311 Anesthesiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

AnesthesiologyPediatric

Anesthesiology207LP3000X 31 Physician 311 Anesthesiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine

Advanced Heart

Failure and

Transplant

Caridology

207RA0001X 31 Physician 312 Cardiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineCardiovascular

Disease  207RC0000X 31 Physician 312 Cardiologist Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineInterventional

Cardiology207RI0011X 31 Physician 312 Cardiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Cardiology 2080P0202X 31 Physician 312 Cardiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine

Advanced Heart

Failure and

Transplant

Caridology

207RA00001X 31 Physician 312 Cardiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Vascular Surgery 2086S0129X 31 Physician 313 Cardiovascular Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology  Dermatology  207N00000X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology 

MOHS-

Micrographic

Surgery## 

207ND0101X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology  Family Medicine+  207ND0900X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology 

Clinical &

Laboratory

Dermatological

Immunology 

207NI0002X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology Pediatric

Dermatology 207NP0225X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Dermatology 

Procedural

Dermatology (title

change from

Dermatological

Surgery effective

20080401)## 

207NS0135X 31 Physician 314 Dermatologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine 

Emergency

Medicine 207P00000X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine 

Emergency Medical

Services 207PE0004X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine 

Undersea and

Hyperbaric

Medicine 

207PE0005X 31 Physician 315Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine 

Hospice and

Palliative

Medicine** 

207PH0002X 31 Physician 315Emergency Medicine

PractitionerY Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine 

Pediatric Emergency

Medicine 207PP0204X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine Sports Medicine  207PS0010X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Emergency

Medicine Medical Toxicology  207PT0002X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Emergency

Medicine 2080P0204X 31 Physician 315

Emergency Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Family Medicine+  207Q00000X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Adolescent Medicine 207QA0000X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Adult Medicine 207QA0505X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+ 

Bariatric

Medicine**** 207QB0002X 31 Physician 316 Family Practitioner Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+ 

Hospice and

Palliative

Medicine**

207QH0002X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Sports Medicine  207QS0010X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians  

Family MedicineSleep Medicine

Specialization207QS1201X 31 Physician 316 Family Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Gastroenterology 207RG0100X 31 Physician 317 Gastroenterologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Hepatology 207RI0008X 31 Physician 317 Gastroenterologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric

Gastroenterology 2080P0206X 31 Physician 317 Gastroenterologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Aerospace Medicine 2083A0100X 31 Physician 318 General Practitioner Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Clinical Informatics 2083C0008X 31 Physician 318 Clinical informatics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Undersea and

Hyperbaric Medicine 2083P0011X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Preventive

Medicine/Occupatio

nal Environmental

Medicine

2083P0500X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Public Health &

General Preventive

Medicine

2083P0901X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Sports Medicine 2083S0010X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Medical Toxicology 2083T0002X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Occupational

Medicine 2083X0100X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

General Practice General Practice 208D00000X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Hospitalist  Hospitalist  208M00000X 31 Physician 318 General Practitioner Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Oral &

Maxillofacial

Surgery

Oral & Maxillofacial

Surgery204E00000X 31 Physician 319 General Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Transplant

Surgery Transplant Surgery 204F00000X 31 Physician 319 General Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Surgery 208600000X 31 Physician 319 General Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery

Hospice and

Palliative

Medicine**

2086H0002X 31 Physician 319 General Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Surgical Critical

Care 2086S0102X 31 Physician 319 General Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Trauma Surgery## 2086S0127X 31 Physician 319 General Surgeon Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Geriatric Medicine 207QG0300X 31 Physician 320 Geriatric Practitioner N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

SurgeryHand Surgery 207XS0106X 31 Physician 321 Hand Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Plastic Surgery Surgery of the Hand 2082S0105X 31 Physician 321 Hand Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Surgery of the Hand 2086S0105X 31 Physician 321 Hand Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Internal Medicine 207R00000X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineAdolescent

Medicine 207RA0000X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineBariatric

Medicine**** 207RB0002X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineClinical Cardiac

Electrophysiology207RC0001X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineCritical Care

Medicine207RC0200X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Geriatric Medicine 207RG0300X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine

Hospice and

Palliative

Medicine**

207RH0002X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine

Clinical &

Laboratory

Immunology 

207RI0001X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineMagnetic Resonance

Imaging (MRI)207RM1200X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Sports Medicine 207RS0010X 31 Physician 322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Sleep Medicine 207RS0012X 31 Physician 322 Internist Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineTransplant

Hepatology****207RT0003X 31 Physician 322 Internist Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Internal Medicine Hypertension

Specialist 207RH0005X 31

Hpertension Specialist

Physician322 Internist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Neonatal-Perinatal

Medicine2080N0001X 31 Physician 323 Neonatologist N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Nephrology 207RN0300X 31 Physician 324 Nephrologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Nephrology 2080P0210X 31 Physician 324 Nephrologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Neurological

Surgery

Neurological

Surgery207T00000X 31 Physician 325 Neurological Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Neuromuscular

Medicine**** 2084N0008X 31 Physician 326 Neurologist Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Neurology# 2084N0400X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Neurology with

Special

Qualifications in

Child Neurology#

2084N0402X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Clinical

Neurophysiology# 2084N0600X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Neurodevelopmental

Disabilities 2084P0005X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Psychosomatic

Medicine** 2084P0015X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Pain Medicine 2084P2900X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Sports Medicine 2084S0010X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Sleep Medicine 2084S0012X 31 Physician 326 Neurologist Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Vascular Neurology# 2084V0102X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Psychiatry &

Neurology

Behavioral

Neurology &

Neuropsychiatry

Speciality

2084B0040X 31 Physician 326 Neurologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Psychiatry &

Neurology Neurocritcal Care 2084A2900X 31 Other 326 Neurocritcal Care N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Neuromusculoskel

etal Medicine,

Sports Medicine

Neuromusculoskelet

al Medicine, Sports

Medicine

204C00000X 31 Physician 327Nuclear Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Nuclear Medicine Nuclear Medicine 207U00000X 31 Physician 327Nuclear Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Nuclear Medicine Nuclear Cardiology 207UN0901X 31 Physician 327Nuclear Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Nuclear MedicineNuclear Imaging &

Therapy207UN0902X 31 Physician 327

Nuclear Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Nuclear MedicineIn Vivo & In Vitro

Nuclear Medicine207UN0903X 31 Physician 327

Nuclear Medicine

PractitionerY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Obstetrics &

Gynecology207V00000X 31 Physician 328

Obstetrician/Gynecolog

istY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Bariatric

Medicine****207VB0002X 31 Physician 328 Obstretrician/Gyn Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Critical Care

Medicine207VC0200X 31 Physician 328

Obstetrician/Gynecolog

istY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Reproductive

Endocrinology207VE0102X 31 Physician 328

Obstetrician/Gynecolog

istY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Hospice and

Palliative

Medicine**

207VH0002X 31 Physician 328Obstetrician/Gynecolog

istY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Obstetrics &

Gynecology

Female Pelvic

Medicine and

Reconstructive

Surgery

207VF0040X 31 Physician 328Obstetrician/Gynecolog

istY Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineHematology &

Oncology207RH0003X 31 Physician 329

Oncologist (including

Hematology)N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207W00000X 31 Physician 330 Glaucoma Specialist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0107X 31 Physician 330 Retina Specialist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0108X 31 Physician 330Uveitis and Ocular

Inflammatory DiseaseY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0109X 31 Physician 330 Neuro Opthamologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0110X 31 Physician 330

Opthamologist

Pediatric Strabismus

Specialist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology

Ophthalmic Plastic

and Reconstructive

Surgery

207WX0200X 31 Physician 330 Opthamologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0009X 31 Physician 330 Opthamologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

SurgeryOrthopaedic Surgery 207X00000X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

Surgery

Pediatric

Orthopaedic Surgery207XP3100X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

Surgery

Adult Reconstructive

Orthopaedic Surgery207XS0114X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

Surgery

Orthopaedic Surgery

of the Spine207XS0117X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

Surgery

Foot and Ankle

Orthopaedics207XX0004X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

SurgerySports Medicine 207XX0005X 31 Physician 331 Orthopedic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Orthopaedic

SurgeryOrthopaedic Trauma 207XX0801X 31 Physician 331 Orthopedic Surgeon Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Otolaryngology Otolaryngology 207Y00000X 31 Physician 332

Otologist,

Laryngologist,

Rhinologist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

OtolaryngologyPediatric

Otolaryngology207YP0228X 31 Physician 332

Otologist,

Laryngologist,

Rhinologist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Otolaryngology Sleep Medicine  207YS0012X 31 Physician 332

Otologist,

Laryngologist,

Rhinologist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Otolaryngology Otolaryngic Allergy 207YX0602X 31 Physician 332

Otologist,

Laryngologist,

Rhinologist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

OtolaryngologyOtology &

Neurotology207YX0901X 31 Physician 332

Otologist,

Laryngologist,

Rhinologist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Independent

Medical

Examiner** 

Independent Medical

Examiner** 202C00000X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -

Blood Banking &

Transfusion

Medicine

207ZB0001X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Cytopathology 207ZC0500X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Clinical Informatics 207ZC0008X 31 Physician 333 Clinical Informatics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Dermatopathology 207ZD0900X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Forensic Pathology 207ZF0201X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Immunopathology 207ZI0100X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -Medical

Microbiology 207ZM0300X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Neuropathology 207ZN0500X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -Molecular Genetic

Pathology 207ZP0007X 31 Physician 333 Pathologist Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Anatomic Pathology 207ZP0101X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Chemical Pathology 207ZP0104X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Pediatric Pathology 207ZP0213X 31 Physician 333 Pathologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Pediatric Surgery 2086S0120X 31 Physician 334 Pediatric Surgeon N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Maternal & Fetal

Medicine207VM0101X 31 Physician 335

Maternal Fetal

MedicineN Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Physical Medicine &

Rehabilitation 208100000X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Brain Injury

Medicine2081P0301X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Hospice and

Palliative

Medicine**

2081H0002X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Neuromuscular

Medicine**** 2081N0008X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Spinal Cord Injury

Medicine 2081P0004X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation

Pediatric

Rehabilitation

Medicine

2081P0010X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation Pain Medicine 2081P2900X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Physical Medicine

& Rehabilitation Sports Medicine 2081S0010X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pain Medicine - Pain Medicine 208VP0000X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pain Medicine -Interventional Pain

Medicine 208VP0014X 31 Physician 336

Physical Medicine and

Rehabilitation

Practitioner

Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

OtolaryngologyFacial Plastic

Surgery207YS0123X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Otolaryngology

Plastic Surgery

within the Head &

Neck

207YX0007X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

OtolaryngologyOtolaryngology/Faci

al Plastic Surgery207YX0905X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Plastic Surgery Plastic Surgery 208200000X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Plastic Surgery

Plastic Surgery

Within the Head and

Neck

2082S0099X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery

Plastic and

Reconstructive

Surgery

2086S0122X 31 Physician 337 Plastic Surgeon Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Colon & Rectal

Surgery

Colon & Rectal

Surgery 208C00000X 31 Physician 338 Proctologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Bariatric

Medicine**** 2084B0002X 31 Physician 339 Psychiatry Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Brain Injury

Medicine2084P0301X 31 Physician 339 Psychiatry Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Forensic Psychiatry# 2084F0202X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Hospice and

Palliative

Medicine**

2084H0002X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Psychiatry# 2084P0800X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Addiction

Psychiatry# 2084P0802X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Child & Adolescent

Psychiatry#2084P0804X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Geriatric Psychiatry# 2084P0805X 31 Physician 339 Psychiatrist Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Psychiatry &

Neurology

Behavioral

Neurology &

Neuropsychiatry

Speciality

2084B0040X 31 Physician 339 Psychiatrist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Pulmonary Disease 207RP1001X 31 Physician 340Pulmonary Disease

SpecialistY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -

Diagnostic

Neuroimaging** 2084D0003X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Body Imaging 2085B0100X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -Diagnostic

Neuroimaging** 2085D0003X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -

Hospice and

Palliative

Medicine**

2085H0002X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Neuroradiology 2085N0700X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Nuclear Radiology 2085N0904X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Pediatric Radiology 2085P0229X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -Diagnostic

Radiology 2085R0202X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -

Vascular &

Interventional

Radiology

2085R0204X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Radiological Physics 2085R0205X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -Diagnostic

Ultrasound 2085U0001X 31 Physician 341 Radiologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Thoracic Surgery

(Cardiothoracic

Vascular Surgery)

Thoracic Surgery

(Cardiothoracic

Vascular Surgery)

208G00000X 31 Physician 342 Thoracic Surgeon Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Urology Urology 208800000X 31 Physician 343 Urologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Urology Pediatric Urology 2088P0231X 31 Physician 343 Urologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Urology

Female Pelvic

Medicine and

Reconstructive

Surgery

2088F0040X 31 Physician 343 Urologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine

Endocrinology,

Diabetes &

Metabolism

207RE0101X 31 Physician 344 General Internist N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

PeditricsPreventative

Medicine2083B0002X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

PeditricsPreventative

Medicine2080B0002X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatrics 208000000X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Adolescent Medicine 2080A0000X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics

Hospice and

Palliative

Medicine**

2080H0002X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics

Clinical &

Laboratory

Immunology

2080I0007X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics

Developmental –

Behavioral

Pediatrics

2080P0006X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Neurodevelopmental

Disabilities 2080P0008X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Critical

Care Medicine 2080P0203X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric

Endocrinology 2080P0205X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Infectious

Diseases 2080P0208X 31 Physician 345 General Pediatrician Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric

Pulmonology 2080P0214X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric

Rheumatology 2080P0216X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Sports Medicine 2080S0010X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Sleep Medicine 2080S0012X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Medical Toxicology 2080T0002X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Transplant

Hepatology****2080T0004X 31 Physician 345 General Pediatrician Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology -Therapeutic

Radiology 2085R0203X 31 Physician 347 Radiation Therapist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Neuromusculoskel

etal Medicine &

OMM

Neuromusculoskelet

al Medicine & OMM204D00000X 31 Physician 348

Osteopathic

Manipulative MedicineY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics

Pediatric

Hematology-

Oncology

2080P0207X 31 Physician 349 Pediatric Oncology N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Rheumatology 207RR0500X 31 Physician 350 Rheumatologist N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Radiology - Radiation Oncology 2085R0001X 31 Physician 351 Radiation Oncology Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Surgery Surgical Oncology## 2086X0206X 31 Physician 352 Surgical Oncology N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

GynecologyGynecology 207VG0400X 31 Physician 353 Gynecologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

Gynecology

Gynecologic

Oncology207VX0201X 31 Physician 353 Gynecologist Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Obstetrics &

GynecologyObstetrics 207VX0000X 31 Physician 354 Obstetrician Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -Clinical

Pathology**** 207ZC0006X 31 Physician 355 Pathology - Clinical Y N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -Anatomic Pathology

& Clinical Pathology 207ZP0102X 31 Physician 355 Pathology - Clinical Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology -

Clinical

Pathology/Laborator

y Medicine

207ZP0105X 31 Physician 355 Pathology - Clinical Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Anesthesiology Addiction Medicine 207LA0401X 31 Physician 356 Addiction Medicine N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Family

Medicine+  Addiction Medicine 207QA0401X 31 Physician 356 Addiction Medicine N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Addiction Medicine  207RA0401X 31 Physician 356 Addiction Medicine N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Psychiatry &

Neurology -Addiction Medicine  2084A0401X 31 Physician 356 Addiction Medicine N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics - Clinical Cytogenetic 207SC0300X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics -Clinical Genetics

(M.D.)207SG0201X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics -Clinical Biochemical

Genetics207SG0202X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics -Clinical Molecular

Genetics207SG0203X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics -Ph.D. Medical

Genetics207SG0205X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Medical Genetics -Molecular Genetic

Pathology207SM0001X 31 Physician 357 Genetics N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Hematology 207RH0000X 31 Physician 358 Hematology N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pathology - Hematology 207ZH0000X 31 Physician 358 Hematology N Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Infectious Disease 207RI0200X 31 Physician 359 Infectious Diseases N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal Medicine Medical Oncology 207RX0202X 31 Physician 365 Oncologist N Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Allergy &

ImmunologyAllergy 207KA0200X 31 Physician 366 Allergist - Pediatric Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Pediatrics Pediatric Allergy &

Immunology 2080P0201X 31 Physician 366 Allergist - Pediatric Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Anesthesiology Anesthesiology 207L00000X 31 Physician 495Anesthesiologist -

OtherN Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Clinical

Pharmacology 

Clinical

Pharmacology  208U00000X 31 Physician 520 Clinical Pharmacology N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersLegal Medicine Legal Medicine 173000000X 31 Physician 530 Legal Medicine N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Legal Medicine Legal Medicine 209800000X 31 Physician 530 Legal Medicine N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Phlebology** Phlebology** 202K00000X 31 Physician 540 Phlebology N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Addiction Medicine 2083A0300X 31 Physician 671 Addiction Medicine Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineCardiovascular

Disease  207RA0002X 31 Physician 672

Adult Congenital Heart

DiseaseY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0120X 31 Physician 673

Opthamologist Cornea

& External Diseases

Specialist

Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Public Health &

General Preventive

Medicine

203BP0901N 31 Physician 674

Public Health &

GeneralPreventive

Medicine

Y Y

Individual or

Groups (of

Individuals)

Group   Multi-Specialty Multi-Specialty 193200000X 32 Group/Multi-Specialty 082 Medical Clinic Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 150 Chiropractor Y N

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Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 190 Optician Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 272 Oral Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 310 Allergist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 311 Anesthesiologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 312 Cardiologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 313 Cardiovascular Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 314 Dermatologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 315Emergency Medicine

PractitionerY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 316 Family Practitioner Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 317 Gastroenterologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 318 General Practitioner Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 319 General Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 320 Geriatric Practitioner Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 321 Hand Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 322 Internist Y N

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Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 323 Neonatologist N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 324 Nephrologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 325 Neurological Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 326 Neurologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 327Nuclear Medicine

PractitionerY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 328Obstetrician/Gynecolog

istY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 329Oncologist (including

Hematology)N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 330 Opthamologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 331 Orthopedic Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 332

Otologist,

Laryngologist,

Rhinologist

Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 333 Pathologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 334 Pediatric Surgeon N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 335Maternal Fetal

MedicineY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 336

Physical Medicine and

Rehabilitation

Practitioner

Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 337 Plastic Surgeon Y N

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Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 338 Proctologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 339 Psychiatrist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 340Pulmonary Disease

SpecialistY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 341 Radiologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 342 Thoracic Surgeon Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 343 Urologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 344 General Internist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 345 General Pediatrician Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 347 Radiation Therapist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 348Osteopathic

Manipulative MedicineY N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 349 Pediatric Oncology N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 350 Rheumatologist N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 351 Radiation Oncology Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 352 Surgical Oncology Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 353 Gynecologist Y N

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Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 354 Obstetrician Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 355 Pathology - Clinical Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 356 Addiction Medicine N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 357 Genetics N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 358 Hematology N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 359 Infectious Diseases N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 365 Oncologist Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 366 Allergist - Pediatric Y N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 495Anesthesiologist -

OtherN N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 520 Clinical Pharmacology N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 530 Legal Medicine N N

Individual or

Groups (of

Individuals)

Group   Single Specialty Single Specialty 193400000X 33 Group/Single-Specialty 540 Phlebology N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -Addiction Medicine 2083A0300X 33 Group/Single-Specialty 671 Addiction Medicine Y Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Internal MedicineCardiovascular

Disease  207RA0002X 33 Group/Single-Specialty 672

Adult Congenital Heart

DiseaseY Y

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Ophthalmology Ophthalmology 207WX0120X 33 Group/Single-Specialty 673

Opthamologist Cornea

& External Diseases

Specialist

Y Y

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Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians 

Preventive

Medicine -

Public Health &

General Preventive

Medicine

203BP0901N 33 Group/Single-Specialty 674

Public Health &

GeneralPreventive

Medicine

Y Y

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersChore Provider Chore Provider 372500000X 36 Personal Care Services 360

Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Day

Training/Habilitat

ion Specialist

Day

Training/Habilitation

Specialist

373H00000X 36 Personal Care Services 360Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersTechnician

Personal Care

Attendant 3747P1801X 36 Personal Care Services 360

Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersDoula Doula 374J00000X 36 Personal Care Services 360

Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Religious

Nonmedical

Practitioner

Religious

Nonmedical

Practitioner

374K00000X 36 Personal Care Services 360Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Home Health

Aide Home Health Aide 374U00000X 36 Personal Care Services 360

Personal Care -

IndividualN N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersNurse's Aide Nurse's Aide 376K00000X 36 Personal Care Services 360

Personal Care -

IndividualN N

Non-individual Agencies Nursing Care Nursing Care 251J00000X 36 Personal Care Services 361 Personal Care - Agency N N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 37 Room and Board 370 Room and Board N N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Day

Training/Habilitat

ion Specialist

Day

Training/Habilitation

Specialist

373H00000X 38 Respite Care 380Respite Care -

Community BasedN N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Day

Training/Habilitat

ion Specialist

Day

Training/Habilitation

Specialist

373H00000X 38 Respite Care 381Respite Care - Home

BasedN N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 39 Direct Support Services 390

Habilitation Training

SpecialistN N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 39 Direct Support Services 391 Agency Companion N N

Individual or

Groups (of

Individuals)

Emergency

Medical Service

Providers

Personal

Emergency

Response

Attendant

Personal Emergency

Response Attendant 146D00000X 39 Direct Support Services 392 Daily Living Supports N N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 39 Direct Support Services 392 Daily Living Supports N N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersTechnician

Attendant Care

Provider 3747A0650X 39 Direct Support Services 392 Daily Living Supports N N

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TennCare Taxonomy Crosswalk 7/17/2019

Non-individual Agencies Foster Care

Agency

Foster Care

Agency*****253J00000X 39 Direct Support Services 392 Daily Living Supports N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Prevention

Professional

Prevention

Professional405300000X 39 Direct Support Services 511 Direct Support Services N N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 40

Specialized Foster

Care/MR400

Specialized Foster

Care/MRN N

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Adult Day Care 261QA0600X 41 Adult Day Care 410 Adult Day Care N N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersAdult Companion Adult Companion 372600000X 41 Adult Day Care 410 Adult Day Care N N

Individual or

Groups (of

Individuals)

Behavioral Health

& Social Service

Providers

Counselor Counselor 101Y00000X 42Employee Training

Specialist420

Employee Training

SpecialistN N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersHomemaker Homemaker 376J00000X 43 Homemaker Services 430 Homemaker Services N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersContractor Contractor 171W00000X 44

Architectural

Modification440

Architectural

ModificationN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersContractor Home Modifications 171WH0202X 44

Architectural

Modification440

Architectural

ModificationN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersContractor

Vehicle

Modifications 171WV0202X 44

Architectural

Modification440

Architectural

ModificationN N

Non-individual

Residential

Treatment

Facilities

Psychiatric

Residential

Treatment Facility

Psychiatric

Residential

Treatment Facility

323P00000X 45

Residential Behavior

Management Services

(RBMS)

450RBMS Room and

BoardN Y

Non-individual

Residential

Treatment

Facilities

Residential

Treatment

Facility,

Emotionally

Disturbed

Children

Residential

Treatment Facility,

Emotionally

Disturbed Children

322D00000X 45

Residential Behavior

Management Services

(RBMS)

451RBMS Therapeutic

Foster CareN Y

Non-individual Other Service

Providers meals meals 174200000X 46

Advantage Home

Delivered Meal460

Advantage Home

Delivered MealN N

Non-individual Suppliers Home Delivered

Meals

Home Delivered

Meals 332U00000X 46

Advantage Home

Delivered Meal460

Advantage Home

Delivered MealN N

Non-individual

Ambulatory

Health Care

Facilities

Clinic/Center Birthing 261QB0400X 47Free Standing Birthing

Center470

Free Standing Birthing

CenterN Y

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Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Day

Training/Habilitat

ion Specialist

Day

Training/Habilitation

Specialist

373H00000X 48 DDSD-NFM 480 DDSD-NFM N N

Non-individual Agencies Public Health or

Welfare

Public Health or

Welfare 251K00000X 49

DDSD-Supportive

Living Arrangements493

DDSD-Supportive

Living ArrangementsN N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Mastectomy Fitter

ClassificationMastectomy Fitter 224900000X 50 Submitter Only 277 Prosthesis N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service Providers

Pedorthist Pedorthist 224L00000X 50 Submitter Only 277 Prosthesis N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersLodging Lodging 177F00000X 50 Submitter Only 500 State Agency N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersLodging Lodging 177F00000X 50 Submitter Only 501 TPL Carrier N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersLodging Lodging 177F00000X 50 Submitter Only 502 Insurance Carrier N N

Individual or

Groups (of

Individuals)

AgenciesIn Home

Supportive Care Agencies 253Z00000X 51 HCBS Facility 510

HCBS - MR Waiver

FacilityN N

Individual or

Groups (of

Individuals)

Pharmacy Service

Providers

Pharmacy

Technician

Pharmacy

Technician 183700000X 52 Techinician 248 Pharmacy Technician N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Orthotist Orthotist 222Z00000X 52 Techinician 277 Prothesis / Orthotics N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Prosthetist Prosthetist 224P00000X 52 Techinician 277 Prothesis / Orthotics N N

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Orthotics/Prosthet

ics Fitter

Orthotics/Prosthetics

Fitter 225000000X 52 Techinician 277 Prothesis / Orthotics N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Pathology Phlebotomy 246RP1900X 52 Techinician 540 Phlebology N N

Individual or

Groups (of

Individuals)

Dental ProvidersDental Laboratory

Technician

Dental Laboratory

Technician 126900000X 52 Techinician 552

Dental Laboratory

TechinicianY N

Individual or

Groups (of

Individuals)

Emergency

Medical Service

Providers

Emergency

Medical

Technician, Basic

Emergency Medical

Technician, Basic 146N00000X 52 Techinician 560

Emergency Medical

Technician, BasicN N

Individual or

Groups (of

Individuals)

Emergency

Medical Service

Providers

Emergency

Medical

Technician,

Intermediate

Emergency Medical

Technician,

Intermediate

146M00000X 52 Techinician 561

Emergency Medical

Technician,

Intermediate

N N

Individual or

Groups (of

Individuals)

Emergency

Medical Service

Providers

Emergency

Medical

Technician,

Paramedic

Emergency Medical

Technician,

Paramedic

146L00000X 52 Techinician 562Emergency Medical

Technician, ParamedicN N

Individual or

Groups (of

Individuals)

Nursing Service

Providers

Licensed

Psychiatric

Technician

Licensed Psychiatric

Technician 167G00000X 52 Techinician 570

Licensed Psychiatric

TechinicianN N

Individual or

Groups (of

Individuals)

Nursing Service

Related ProvidersTechnician Technician 374700000X 52 Techinician 580 Nurse Technician N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Health

Information

Technician, Health

Information 247000000X 52 Techinician 641

Specialist/Technologist,

Health Information /

Coding Specialist

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Health

Information

Assistant Record

Technician 2470A2800X 52 Techinician 641

Specialist/Technologist,

Health Information /

Coding Specialist

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Pathology

Technician,

Pathology 246R00000X 52 Techinician 643 Pathology N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Cardiology

Technician,

Cardiology 246W00000X 52 Techinician 644 Cardiology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other Biomedical

Engineering 2472B0301X 52 Techinician 645

Biomedical

Engineering N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Pathology

Clinical Laboratory

Director, Non

physician**

247ZC0005X 52 Techinician 646Clinical Laboratory

Director, Non physicianN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Pathology Histology 246RH0600X 52 Techinician 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician,

Pathology Medical Laboratory 246RM2200X 52 Techinician 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other Darkroom 2472D0500X 52 Techinician 998Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other EEG 2472E0500X 52 Techinician 998Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other Renal Dialysis 2472R0900X 52 Techinician 998Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other Veterinary 2472V0600X 52 Techinician 998Specialty not yet

definedN N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Technician, Other Technician, Other 247200000X 52 Techinician 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Mammography 2471M2300X 53 Technologist 292 Mammography N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Pulmonary

Function

Technologist

Pulmonary Function

Technologist 225B00000X 53 Technologist 340

Pulmonary Disease

SpecialistN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Radiation Therapy 2471R0002X 53 Technologist 347 Radiation Therapist N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Perfusionist** Perfusionist** 242T00000X 53 Technologist 630 Perfusionist N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Radiologic

Technologist 247100000X 53 Technologist 631

Radiologic

Technologist N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Bone Densitometry 2471B0102X 53 Technologist 632 Bone Densitometry N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Cardiovascular-

Interventional

Technology

2471C1101X 53 Technologist 633

Cardiac/Cardiovascular-

Interventional

Technology

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Cardiac-

Interventional

Technology

2471C1106X 53 Technologist 633

Cardiac/Cardiovascular-

Interventional

Technology

N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Computed

Tomography 2471C3401X 53 Technologist 634 Computed Tomography N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Magnetic Resonance

Imaging 2471M1202X 53 Technologist 635

Magnetic Resonance

Imaging N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Nuclear Medicine

Technology 2471N0900X 53 Technologist 636

Nuclear Medicine

Technology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Quality Management 2471Q0001X 53 Technologist 637 Quality Management N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Radiography 2471C3402X 53 Technologist 638 Radiography N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist Sonography 2471S1302X 53 Technologist 639 Sonography / Vascular N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Vascular

Sonography 2471V0105X 53 Technologist 639 Sonography / Vascular N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiologic

Technologist

Vascular-

Interventional

Technology

2471V0106X 53 Technologist 640Vascular-Interventional

Technology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Surgical Assistant 246ZC0007X 53 Technologist 647 Certified First Assistant N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Radiology

Practitioner

Assistant

Radiology

Practitioner

Assistant

243U00000X 54 Assistant 282Radiology Practitioner

AssistantsN N

Individual or

Groups (of

Individuals)

Dental Providers Dental Assistant Dental Assistant 126800000X 54 Assistant 550 Dental Assistant Y N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Specialist/Technol

ogist Audiology Assistant 2355A2700X 54 Assistant 627 Audiology Assistant N N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Specialist/Technol

ogist

Speech-Language

Assistant 2355S0801X 54 Assistant 628

Speech-Language

Assistant N N

Individual or

Groups (of

Individuals)

Dental Providers Dental Hygienist Dental Hygienist 124Q00000X 55 Dental Hygienist 551 Dental Hygienist Y N

Individual or

Groups (of

Individuals)

Nursing Service

Related Providers

Nursing Home

Administrator

Nursing Home

Administrator 376G00000X 56 Administrator 581

Nursing Home

AdministratorN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersHomeopath Homeopath 175L00000X 57 Homeopath 590 Homeopath N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersInterpreter Interpreter 171R00000X 58 Interpreter 591 Interpreter N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Medical Genetics,

Ph.D. Medical

Genetics

Medical Genetics,

Ph.D. Medical

Genetics

170100000X 59Medical Genetics, Non-

physician357 Genetics N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersMidwife, Lay Midwife, Lay 175M00000X 60 Midwife, Lay 592 Non-certified Midwife N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Military Health

Care Provider

Military Health Care

Provider 171000000X 61

Military Health Care

Provider593

Military Health Care

ProviderN N

Individual or

Groups (of

Individuals)

Other Service

Providers

Military Health

Care Provider

Independent Duty

Corpsman 1710I1002X 61

Military Health Care

Provider594

Independent Duty

Corpsman N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Military Health

Care Provider

Independent Duty

Medical Technicians 1710I1003X 61

Military Health Care

Provider595

Independent Duty

Medical Technicians N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Electrodiagnostic

Medicine

Electrodiagnostic

Medicine 204R00000X 61

Electrodiagnostic

Medicine Specialist667

Neurophysiologic Tech

SpecialistN N

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Individual or

Groups (of

Individuals)

Other Service

ProvidersNaprapath** Naprapath** 172P00000X 62 Naprapath 596 Naprapath N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersNaturopath Naturopath 175F00000X 63 Naturopath 597 Naturopath N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersSpecialist Graphics Designer 1744G0900X 64 Specialist 598 Graphic Designer N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersSpecialist

Prosthetics Case

Management 1744P3200X 64 Specialist 599

Prosthetics Case

ManagerN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersSpecialist

Research Data

Abstracter/Coder 1744R1103X 64 Specialist 600

Research Data

Abstractor/CoderN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersSpecialist Research Study 1744R1102X 64 Specialist 601 Research Study N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Specialist/Technol

ogist Athletic Trainer 2255A2300X 64 Specialist 623 Athletic Trainer N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Specialist/Technol

ogist Rehabilitation, Blind 2255R0406X 64 Specialist 624 Rehabilitation, Blind N N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Hearing

Instrument

Specialist

Hearing Instrument

Specialist 237700000X 64 Specialist 626

Hearing Instrument

Specialist N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist

Cardiovascular

Specialist/Technolog

ist Cardiovascular 246X00000X 64 Specialist 633

Cardiac/Cardiovascular-

Interventional

Technology

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist

Cardiovascular

Cardiovascular

Invasive Specialist 246XC2901X 64 Specialist 633

Cardiac/Cardiovascular-

Interventional

Technology

N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist

Cardiovascular

Vascular Specialist 246XC2903X 64 Specialist 639 Sonography / Vascular N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist

Cardiovascular

Sonography 246XS1301X 64 Specialist 639 Sonography / Vascular N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Health

Information

Specialist/Technolog

ist, Health

Information

246Y00000X 64 Specialist 641

Specialist/Technologist,

Health Information /

Coding Specialist

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Health

Information

Coding Specialist,

Hospital Based 246YC3301X 64 Specialist 641

Specialist/Technologist,

Health Information /

Coding Specialist

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Health

Information

Coding Specialist,

Physician Office

Based

246YC3302X 64 Specialist 641

Specialist/Technologist,

Health Information /

Coding Specialist

N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Health

Information

Registered Record

Administrator 246YR1600X 64 Specialist 642

Registered Record

Administrator N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology

Specialist/Technolog

ist, Pathology 246Q00000X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Blood Banking 246QB0000X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Chemistry 246QC1000X 64 Specialist 643 Pathology N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Cytotechnology 246QC2700X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Hematology 246QH0000X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology

Hemapheresis

Practitioner 246QH0401X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Histology 246QH0600X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Immunology 246QI0000X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology

Laboratory

Management 246QL0900X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology

Laboratory

Management,

Diplomate

246QL0901X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology

Medical

Technologist 246QM0706X 64 Specialist 643 Pathology N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Pathology Microbiology 246QM0900X 64 Specialist 643 Pathology N N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Art, Medical 246ZA2600X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Biomedical

Engineering 246ZB0301X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Biomedical

Photographer 246ZB0302X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Biochemist 246ZB0500X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Biostatistician 246ZB0600X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other EEG 246ZE0500X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Electroneurodiagnost

ic 246ZE0600X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Graphics Methods 246ZG0701X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Geneticist, Medical

(PhD) 246ZG1000X 64 Specialist 998

Specialty not yet

definedN N

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Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Illustration, Medical 246ZI1000X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Nephrology 246ZN0300X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Surgical

Technologist246ZS0410X 64 Specialist 998

Specialty not yet

definedN N

Individual or

Groups (of

Individuals)

Other Service

ProvidersSpecialist Specialist 174400000X 64 Specialist 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Specialist/Technol

ogist

Specialist/Technolog

ist 225500000X 64 Specialist 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Speech, Language

and Hearing

Service Providers

Specialist/Technol

ogist

Specialist/Technolog

ist 235500000X 64 Specialist 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other

Specialist/Technolog

ist, Other 246Z00000X 64 Specialist 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Pharmacist 183500000X 65 Pharmacist 241 Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Ambulatory Care 1835P2201X 65 Pharmacist 241 Pharmacist N Y

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist

General Practice^^

(use 183500000X)1835G0000X 65 Pharmacist 241 Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Critical Care 1835C0205X 65 Pharmacist 241 Critical Care Y Y

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Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Pediatrics 1835P0200X 65 Pharmacist 241 Pediatircs Y Y

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Geriatric 1835G0303X 65 Pharmacist 242 Geriatric Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Nuclear 1835N0905X 65 Pharmacist 243 Nuclear Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Nutrition Support 1835N1003X 65 Pharmacist 244

Nutrition Support

PharmacistN N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Oncology 1835X0200X 65 Pharmacist 245 Oncology Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Pharmacotherapy 1835P1200X 65 Pharmacist 246

Pharmacology

PharmacistN N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist Psychiatric 1835P1300X 65 Pharmacist 247 Psychiatric Pharmacist N N

Individual or

Groups (of

Individuals)

Pharmacy Service

ProvidersPharmacist

Pharmacist Clinician

(PhC)/ Clinical

Pharmacy

Specialist*****

1835P0018X 65 Pharmacist 520 Clinical Pharmacology N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Anaplastologist Anaplastologist 229N00000X 66 Anaplastologist 277 Prosthesis / Orthotics N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Art Therapist Art Therapist 221700000X 67Therapist - Non-

Certified610 Art Therapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Dance Therapist Dance Therapist 225600000X 67Therapist - Non-

Certified611 Dance Therapist N N

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Developmental

Therapist**

Developmental

Therapist** 222Q00000X 67

Therapist - Non-

Certified612

Developmental

TherapistN N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Kinesiotherapist Kinesiotherapist 226300000X 67Therapist - Non-

Certified613 Kinesiotherapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Massage

Therapist Massage Therapist 225700000X 67

Therapist - Non-

Certified614 Massage Therapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Music Therapist Music Therapist 225A00000X 67Therapist - Non-

Certified615 Music Therapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Recreation

Therapist Recreation Therapist 225800000X 67

Therapist - Non-

Certified616 Recreation Therapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Recreation

Therapist

Recreational

Therapist Assistant226000000X 67

Recreational Therapist

Assistant616 Recreation Therapist N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Rehabilitation

Counselor

Assistive

Technology

Practitioner

225CA2400X 68 Counselor 251 Assistive Technology N N

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Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Rehabilitation

Counselor

Rehabilitation

Counselor 225C00000X 68 Counselor 620

Rehabilitation

Counselor N N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Rehabilitation

Counselor

Assistive

Technology Supplier 225CA2500X 68 Counselor 621

Assistive Technology

SupplierN N

Individual or

Groups (of

Individuals)

Respiratory,

Developmental,

Rehabilitative and

Restorative

Service

Providers+&

Rehabilitation

Counselor

Orientation and

Mobility Training

Provider

225CX0006X 68 Counselor 622

Orientation and

Mobility Training

Provider

N N

Individual or

Groups (of

Individuals)

Other Service

Providers

Lactation

Consultant, Non-

RN

Lactation

Consultant, Non-RN 174N00000X 68

Lactation Consultant,

Non-RN Counselor665

Lactation Non-RN

CounselorN N

Individual or

Groups (of

Individuals)

Other Service

Providers Clinical Ethicist Clinical Ethicist 174V00000X 68

Clinical Ethicist

Counselor666 Ethics Case consultant N N

Individual or

Groups (of

Individuals)

Student, Health

Care

Student in an

Organized Health

Care

Education/Trainin

g Program

Student in an

Organized Health

Care

Education/Training

Program

390200000X 69 Student, Health Care 629

Student in an

Organized Health Care

Education/Training

Program

N N

Non-individual Managed Care

Organizations

Exclusive

Provider

Organization

Exclusive Provider

Organization 302F00000X 70

Non-capitation

Provider071

Manager Care

Organization (MCO)N N

Non-individual Suppliers Blood Bank Blood Bank 331L00000X 71 Blood Bank 660 Blood Bank N N

Non-individual Suppliers Eye Bank Eye Bank 332G00000X 72 Eye Bank 661 Eye Bank N N

Non-individual Suppliers Non-Pharmacy

Dispensing Site

Non-Pharmacy

Dispensing Site 332900000X 73

Non-Pharmacy

Dispensing Site 662

Non-Pharmacy

Dispensing Site N N

Non-individual Suppliers

Organ

Procurement

Organization

Organ Procurement

Organization 335U00000X 74

Organ Procurement

Organization 663

Organ Procurement

Organization N N

Non-individual Suppliers

Emergency

Response System

Companies

Emergency

Response System

Companies****

333300000X 75Emergency Response

System Companies664

Emergency Response

System CompaniesN N

Individual or

Groups (of

Individuals)

Other Service

Providers

Community

Health Worker

Community Health

Worker****172V00000X 99 Other 187

Community Health -

Non-ProfessionalN N

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Individual or

Groups (of

Individuals)

Other Service

Providers

Health Educator (Weight Watchers)

Health Educator 174H00000X 99 other 511 Health Educator N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersVeterinarian Veterinarian 174M00000X 99 Other 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Other Service

ProvidersVeterinarian Medical Research 174MM1900X 99 Other 999 Miscelleneous N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Other Service

ProvidersPeer Specialist 175T00000X N Other N Miscelleneous N N

Individual or

Groups (of

Individuals)

Technologists,

Technicians &

Other Technical

Service Providers

Specialist/Technol

ogist, Other Orthopedic Assitant 246ZX2200X N Other N Miscelleneous N N

Individual or

Groups (of

Individuals)

Allopathic &

Osteopathic

Physicians

Neurocritcal Care Orthopedic Assitant 2084A2900X N Other N Miscelleneous N N

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