Taxonomy Codes

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Health Care Provider Taxonomy Code Set

From www.wpc-edi.com/codes/taxonomy

The Health Care Provider Taxonomy code set is a collection of unique alphanumeric codes, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.

The Health Care Provider Taxonomy code set allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one value associated to them. When determining what value or valuess to associate with a provider, the user needs to review the requirements of the trading partner with which the value(s) are being used.

Level I, Provider Type
A major grouping of service(s) or occupation(s) of health care providers. For example: Allopathic & Osteopathic Physicians, Dental Providers, Hospitals, etc.

Level II, Classification
A more specific service or occupation related to the Provider Type. For example, the Classification for Allopathic & Osteopathic Physicians is based upon the General Specialty Certificates as issued by the appropriate national boards. The following boards will however, have their general certificates appear as Level III areas of specialization strictly due to display limitations of the code set: Medical Genetics, Preventive Medicine, Psychiatry & Neurology, Radiology, Surgery, Otolaryngology, Pathology.

Level III, Area of Specialization
A more specialized area of the Classification in which a provider chooses to practice or make services available. For example, the Area of Specialization for provider type Allopathic & Osteopathic Physicians is based upon the Subspecialty Certificates as issued by the appropriate national boards.

The Health Care Provider Taxonomy code set Levels are organized to allow for drilling down to the provider's most specific level of specialization. The ten digit codes for each provider category are unique and contain no embedded logic. The codes and categories are to be used exactly as they are assigned in the Taxonomy list. At no time should codes be separated to form new codes. See "How do I request a change?" if you identify a need for a provider category.

Level I



Level II




Level III
Code
Definition
Group

A business entity under which one or more individuals practice. A group does not require multiple professional providers. A single provider group is a valid group and would be identified by the business entity name, for instance - John Doe, PC. [7/1/2003: new]

Multi-Specialty
193200000X
A business group of one or more individual practitioners, who practice with different areas of specialization. [7/1/2003: new]

Single Specialty
193400000X
A business group of one or more individual practitioners, all of who practice with the same area of specialization. [7/1/2003: new]
Chiropractic Providers



Chiropractor
111N00000X
A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems.


Independent Medical Examiner
111NI0013X
A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practitioners to clarify clinical, disability, liability or other case issues. Source: American Board of Independent Medical Examiners [1/1/2007: new]


Internist
111NI0900X
Definition to come...


Neurology
111NN0400X
Definition to come...


Nutrition
111NN1001X
Definition to come...


Occupational Medicine
111NX0100X
Definition to come...


Orthopedic
111NX0800X
Definition to come...


Pediatric Chiropractor
111NP0017X
The Pediatric Chiropractor is a chiropractor with specialized, advanced training and certification in the evaluation, care and management of health and wellness conditions of infancy, childhood and adolescence. This specialist provides primary, comprehensive, therapeutic and preventative chiropractic health care for newborns through adolescents. Source: Council on Chiropractic Pediatrics, American Chiropractic Association, 2007 [1/1/2008: new]


Radiology
111NR0200X
Definition to come...


Rehabilitation
111NR0400X
Rehabilitation is the discipline focused on restoring a patient's functional abilities to pre-injury or pre-disease status. Functional abilities are defined as those activities in one's daily life, work, or sports and recreational activities that an individual participates in. Relevant impairments (e.g. strength, endurance, flexibility, motor control, etc.) are often intermediate goals of rehabilitation, but the final goal of successful care is return to participation in activities in which the patient was successful before the onset of the injury or disease. Essential to a rehabilitation approach is a focus on patient-centered outcomes such as independence and self-management or self-care skills. Source: The American Chiropractic Association (ACA) and the ACA Council on Physiological Therapeutics [7/1/2006: new]


Sports Physician
111NS0005X
Definition to come...


Thermography
111NT0100X
Definition to come...
Dietary & Nutritional Service Providers

Broad category defining practitioners who help prevent and treat illness by promoting healthy eating habits, scientifically evaluating diets and suggesting modifications. They may also assess the nutritional needs of patients, develop and implement nutritional care plans.

Dietary Manager 132700000X A dietary manager is a trained food services professional who is charged with maintaining cost/profit objectives, purchasing foods and services for the department and supervising staff.. Dietary managers are trained to understand the basic nutritional needs of clients and work in partnership with dietitians, who offer specialized nutritional expertise. The CDM certified dietary manager designation is an advanced professional credential awarded to dietary managers who have completed specific course work, have passed the national credentialing exams (including a sanitation and safety exam) and have applied for certification.

Dietetic Technician, Registered 136A00000X A person trained in food and nutrition who is an integral part of health care and foodservice management teams. A dietetic technician, registered (DTR) has successfully completed at least a two-year associate’s degree at a US regionally accredited college or university; a dietetic technician program approved by The American Dietetic Association, including 450 hours of supervised practice experience; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. Source: The American Dietetic Association. Becoming a Dietetic Technician, Registered -- a food and nutrition practitioner. Chicago, IL: The American dietetic association, July 1997.

Dietitian, Registered 133V00000X A registered dietician (RD) is a food and nutrition expert who has successfully completed a minimum of a bachelor’s degree at a US regionally accredited university or college and course work approved by The American Dietetic Association (ADA); an ADA-accredited or approved, supervised practice program, typically 6 to 12 months in length; a national examination administered by the Commission on Dietetic Registration; and continuing professional educational requirements to maintain registration. Source: The American Dietetic Association. Becoming a Registered Dietitian -- a food and nutrition expert. Chicago, IL: The American Dietetic Association, July 1997.


Nutrition, Metabolic 133VN1006X Definition to come...


Nutrition, Pediatric 133VN1004X Definition to come...


Nutrition, Renal 133VN1005X Definition to come...

Nutritionist 133N00000X A specialist in adapting and applying food and nutrient knowledge to the solution of food and nutritional problems, the control of disease, and the promotion of health. Nutritionists perform research, instruct groups and individuals about nutritional requirements, and assist people in developing meal patterns that meet their nutritional needs; (2) A nutritionist is someone who has completed undergraduate and/or graduate training in the discipline of nutrition without necessarily meeting the academic and experience requirements to qualify for the Registered Dietitian designation. Source: (1) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.


Nutrition, Education 133NN1002X Definition to come...
Other Service Providers



Acupuncturist 171100000X An acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long, fine needles inserted into specific points in order to treat painful conditions or produce anesthesia.

Case Manager/Care Coordinator 171M00000X sists an individual in gaining access to needed medical, social, educational, and/or other services. The person has the ability to provide an assessment and review of completed plan of care on a periodic basis. This person is also able to take collaborative action to coordinate the services with other providers and monitor the enrollee’s progress toward the cost-effective achievement of objectives specified in the plan of care. Credentials may vary from an experience in the fields of psychology, social work, rehabilitation, nursing or a closely related human service field, to a related Assoc of Arts Degree or to nursing credentials. Some states may require certification in case management. Source: CMS State Medicaid Manual Section 4442.3 [7/1/2006: new]

Homeopath 175L00000X A provider who is educated and trained in a system of therapeutics in which diseases are treated by drugs which are capable of producing in healthy persons symptoms like those of the disease to be treated. Treatment requires administering a drug in minute doses. Source: Dorland’s Illustrated Medical Dictionary. 26th edition. Philadelphia: W.B. Saunders Company, 1981.

Mechanotherapist 172M00000X A practitioner of mechanotherapy examines patients by verbal inquiry, examination of the musculoskeletal system by hand, and visual inspection and observation. In the treatment of patients, mechanotherapists employ the techniques of advised or supervised exercise; electrical neuromuscular stimulation; massage or manipulation; or air, water, heat, cold, sound, or infrared ray therapy. Source: Summarized from Ohio Revised Code 4731.15 [1/1/2007: new]

Midwife 176B00000X A Midwife is a trained professional with special expertise in supporting women to maintain a healthy pregnancy birth, offering expert individualized care, education, counseling, and support to a woman and her newborn throughout the childbearing cycle. A Midwife is a skilled and independent practitioner who has undergone formalized training. Midwives are not required to be nurses and may be trained via multiple routes of education (apprenticeship, workshop, formal classes, or programs, etc., usually a combination). The educational background requirements and licensing requirements vary by state. The Midwife may or may not be certified by a state or national organization. Source: The National Uniform Claim Committee [7/1/2007: title changed, defintion changed, source changed]

Midwife, Lay 175M00000X A person qualified by experience and limited specialized training to provide obstetric and neo-natal care in the management of women having normal pregnancy, labor and childbirth. The lay midwife is licensed in some states.

Military Health Care Provider 171000000X Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. [7/1/2005: new]


Independent Duty Corpsman 1710I1002X A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new]


Independent Duty Medical Technicians 1710I1003X An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. Source: Air Force Surgeon General Office [7/1/2005: new]

Naprapath 172P00000X Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connective tissue specialists. Education and training are defined through individual states’ licensing/certification requirements. Source: National Uniform Claim Committee [1/1/2007: new]

Naturopath 175F00000X Diagnoses, treats, and cares for patients, using system of practice that bases treatment of physiological functions and abnormal conditions on natural laws governing human body: Utilizes physiological, psychological, and mechanical methods, such as air, water, light, heat, earth, phototherapy, food and herb therapy, psychotherapy, electrotherapy, physiotherapy, minor and orificial surgery, mechanotherapy, naturopathic corrections and manipulation, and natural methods or modalities, together with natural medicines, natural processed foods, and herbs and nature's remedies. Excludes major surgery, therapeutic use of x ray and radium, and use of drugs, except those assimilable substances containing elements or compounds which are components of body tissues and are physiologically compatible to body processes for maintenance of life. Source: The Federal Dictionary of Occupational Titles, U.S. Department of Labor, Washington, D.C., section #079, 101-014 [7/1/2007: definition changed, source added]
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