nd medicaid - individual provider type, specialty and ...jul 28, 2020 · nd medicaid - individual...
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ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
010-Behavioral Health & Social
Service Providers
566-Assistant Behavior Analyst 106E00000X
010-Behavioral Health & Social
Service Providers
567-Behavior Analyst 103K00000X
010-Behavioral Health & Social
Service Providers
488-Behavior Modification Specialist 174400000X
010-Behavioral Health & Social
Service Providers
568-Behavior Technician 106S00000X
010-Behavioral Health & Social
Service Providers
074-Clinical Neuropsychologist 103G00000X
010-Behavioral Health & Social
Service Providers
155-Counselor, Addiction (LAC) 101YA0400X
010-Behavioral Health & Social
Service Providers
177-Counselor, Licensed Associate Professional (LAPC) 101YP2500X
010-Behavioral Health & Social
Service Providers
190-Counselor, Licensed Professional Clinical (LPCC) 101YP2500X
010-Behavioral Health & Social
Service Providers
580-Counselor (Mental Health) 101YM0800X (MCO only)
010-Behavioral Health & Social
Service Providers
194-Counselor, Professional (LPC) 101YP2500X
010-Behavioral Health & Social
Service Providers
425-Licensed Master Social Worker (LMSW) 104100000X
010-Behavioral Health & Social
Service Providers
191-Licensed Clinical Social Worker (LCSW) 1041C0700X
010-Behavioral Health & Social
Service Providers
625-Licensed Baccalaureate Social Worker (LBSW) 104100000X
010-Behavioral Health & Social
Service Providers
403-Marriage & Family Therapist 106H00000X
010-Behavioral Health & Social
Service Providers
492-Mental Health Technician 247200000X
010-Behavioral Health & Social
Service Providers
050-Psychologist 103T00000X
010-Behavioral Health & Social
Service Providers
543-Psychologist, Clinical 103TC0700X
1 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
010-Behavioral Health & Social
Service Providers
523-Psychologist, Clinical Child & Adolescent 103TC2200X
011-Chiropractic Providers 047-Chiropractor 111N00000X
012-Dental Providers 610-Dental Hygienist 124Q00000X (MCO only)
012-Dental Providers 498-Dental Public Health 1223D0001X
012-Dental Providers 019-Dentists 122300000X
012-Dental Providers 062-Endodontics 1223E0200X
012-Dental Providers 001-General Practice 1223G0001X
012-Dental Providers 538-Oral and Maxillofacial Pathology 1223P0106X
012-Dental Providers 212-Oral and Maxillofacial Surgery 1223S0112X
012-Dental Providers 064-Orthodontics 1223X0400X
012-Dental Providers 515-Orthodontics & Dentofacial Orthopedics 1223X0400X
012-Dental Providers 063-Pedodontics (Pediatric Dentistry) 1223P0221X
012-Dental Providers 065-Periodontics 1223P0300X
012-Dental Providers 066-Prosthodontics 1223P0700X
013-Dietary & Nutritional
Service Providers
056-Licensed Registered Dietician 133V00000X
013-Dietary & Nutritional
Service Providers
598-Nutrition, Education 133NN1002X (MCO only)
013-Dietary & Nutritional
Service Providers
599-Nutritionist 133N00000X (MCO only)
2 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
014-Emergency Medical
Service Providers
572-Emergency Medical Technician, Paramedic 146L00000X
015-Eye & Vision Service
Providers
608-Ocularist 156FX1700X (MCO only)
015-Eye & Vision Service
Providers
411-Optician 156FX1800X
015-Eye & Vision Service
Providers
088-Optometrist 152W00000X
015-Eye & Vision Service
Providers
617-Optometrist; Corneal and Contact Management 152WC0802X
016-Nursing Service Providers 130-Licensed Practical Nurse 164W00000X
016-Nursing Service Providers 127-Licensed Vocational Nurse 164X00000X
016-Nursing Service Providers 129-Registered Nurse 163W00000X
016-Nursing Service Providers 582-Registered Nurse; Diabetes Educator 163WD0400X (MCO only)
017-Other Service Providers 574-Acupuncturist 171100000X (MCO only)
017-Other Service Providers 335-Case Manager/Care Coordinator 171M00000X
017-Other Service Providers 585-Genetic Counselor, MS 170300000X (MCO only)
017-Other Service Providers 588-Health Educator 174H00000X (MCO only)
017-Other Service Providers 593-Midwife 176B00000X (MCO only)
017-Other Service Providers 594-Naturopath 175F00000X (MCO only)
018-Pharmacy Service
Providers
253-Pharmacist 183500000X
018-Pharmacy Service
Providers
493-Pharmacy Technician 183700000X
3 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
019-Technologist, Technician,
and Other Technical Service
Providers
579-Surgical Assistant 246ZC0007X (MCO only)
019-Technologist, Technician,
and Other Technical Service
Providers
602-Radiologic Technologist 247100000X (MCO only)
019-Technologist, Technician,
and Other Technical Service
Providers
611-Orthopedic Assistant 246ZX2200X (MCO only)
019-Technologist, Technician,
and Other Technical Service
Providers
613-Surgical - Specialist/Technologist Other 246ZS0410X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
058-Adult Medicine 207QA0505X
020-Physicians (Allopathic &
Osteopathic)
615-Advanced Heart Failure and Transplant Cardiology 207RA0001X
020-Physicians (Allopathic &
Osteopathic)
003-Allergy & Immunology 207K00000X
020-Physicians (Allopathic &
Osteopathic)
436 -Anatomic Pathology 207ZP0101X
020-Physicians (Allopathic &
Osteopathic)
259 -Anatomic Pathology & Clinical Pathology 207ZP0102X
020-Physicians (Allopathic &
Osteopathic)
005-Anesthesiology 207L00000X
020-Physicians (Allopathic &
Osteopathic)
573 Anesthesiology; Critical Care Medicine 207LC0200X
020-Physicians (Allopathic &
Osteopathic)
624-Anesthesiology; Pain Medicine 207LP2900X
020-Physicians (Allopathic &
Osteopathic)
563-Blood Banking & Transfusion Medicine 207ZB0001X
020-Physicians (Allopathic &
Osteopathic)
006-Cardiovascular Disease 207RC0000X
020-Physicians (Allopathic &
Osteopathic)
078-Clinical & Laboratory Dermatological Immunology 207NI0002X
020-Physicians (Allopathic &
Osteopathic)
083-Clinical Biochemical Genetics 207SG0202X
020-Physicians (Allopathic &
Osteopathic)
084-Clinical Cardiac Electrophysiology 207RC0001X
4 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
085-Clinical Cytogenetic 207SC0300X
020-Physicians (Allopathic &
Osteopathic)
109-Clinical Genetics (MD) 207SG0201X
020-Physicians (Allopathic &
Osteopathic)
118-Clinical Molecular Genetics 207SG0203X
020-Physicians (Allopathic &
Osteopathic)
534-Clinical Neurophysiology 2084N0600X
020-Physicians (Allopathic &
Osteopathic)
021-Clinical Pathology 207ZC0006X
020-Physicians (Allopathic &
Osteopathic)
136 -Clinical Pathology/Laboratory Medicine 207ZP0105X
020-Physicians (Allopathic &
Osteopathic)
133-Clinical Pharmacology 208U00000X
020-Physicians (Allopathic &
Osteopathic)
101-Colon and Rectal Surgery 208C00000X
020-Physicians (Allopathic &
Osteopathic)
206-Critical Care Medicine 207RC0200X
020-Physicians (Allopathic &
Osteopathic)
007-Dermatology 207N00000X
020-Physicians (Allopathic &
Osteopathic)
260-Dermatopathology 207ND0900X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
167-Diagnostic Radiology 2085R0202X
020-Physicians (Allopathic &
Osteopathic)
270-Emergency Medicine 207P00000X
020-Physicians (Allopathic &
Osteopathic)
571-Emergency Medicine; Hospice and Palliative Medicine 207PH00020X
020-Physicians (Allopathic &
Osteopathic)
605-Emergency Medicine; Sports Medicine 207PS0010X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
093-Emergency Medical Services 207PE0004X
020-Physicians (Allopathic &
Osteopathic)
168-Endocrinology, Diabetes & Metabolism 207RE0101X
5 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
301-Facial Plastic Surgery 207YS0123X
020-Physicians (Allopathic &
Osteopathic)
173-Family Medicine 207Q00000X
020-Physicians (Allopathic &
Osteopathic)
562 -Family Medicine; Addiction Medicine 207QA0401X
020-Physicians (Allopathic &
Osteopathic)
586-Family Medicine;Geriatric Medicine 207QG0300X
020-Physicians (Allopathic &
Osteopathic)
590-Family Medicine; Hospice & Palliative Medicine 207QH0002X
020-Physicians (Allopathic &
Osteopathic)
578-Family Medicine; Obesity Medicine 207QB0002X
020-Physicians (Allopathic &
Osteopathic)
603-Family Medicine; Sleep Medicine 207QS1201X
020-Physicians (Allopathic &
Osteopathic)
520-Family Medicine; Sports Medicine 207QS0010X
020-Physicians (Allopathic &
Osteopathic)
565-Female Pelvic Medicine and Reconstructive Surgery 207VF0040X
020-Physicians (Allopathic &
Osteopathic)
302-Foot & Ankle Surgery 207XX0004X
020-Physicians (Allopathic &
Osteopathic)
490-Forensic Psychiatry 2084F0202X
020-Physicians (Allopathic &
Osteopathic)
010-Gastroenterology 207RG0100X
020-Physicians (Allopathic &
Osteopathic)
001-General Practice 208D00000X
020-Physicians (Allopathic &
Osteopathic)
175-Geriatric Psychiatry 2084P0805X
020-Physicians (Allopathic &
Osteopathic)
307-Gynecologic Oncology 207VX0201X
020-Physicians (Allopathic &
Osteopathic)
553-Gynecology 207VG0400X
020-Physicians (Allopathic &
Osteopathic)
178-Hematology 207RH0000X
6 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
179-Hematology/Oncology 207RH0003X
020-Physicians (Allopathic &
Osteopathic)
340-Hepatology 207RI0008X
020-Physicians (Allopathic &
Osteopathic)
545-Hospice and Palliative Medicine 207VH0002X
020-Physicians (Allopathic &
Osteopathic)
344-Hospitalist 208M00000X
020-Physicians (Allopathic &
Osteopathic)
183-Immunopathology 207ZI0100X
020-Physicians (Allopathic &
Osteopathic)
471-Independent Medical Examiner 202C00000X
020-Physicians (Allopathic &
Osteopathic)
185-Infectious Diseases 207RI0200X
020-Physicians (Allopathic &
Osteopathic)
011-Internal Medicine 207R00000X
020-Physicians (Allopathic &
Osteopathic)
652-Internal Medicine;Addiction Medicine 207RA0401X
020-Physicians (Allopathic &
Osteopathic)
587-Internal Medicine; Geriatric Medicine 207RG0300X
020-Physicians (Allopathic &
Osteopathic)
591-Internal Medicine; Hospice & Palliative Medicine 207RH0002X
020-Physicians (Allopathic &
Osteopathic)
614-Internal Medicine; Sleep Medicine 207RS0012X
020-Physicians (Allopathic &
Osteopathic)
639-Internal Medicine; Sports Medicine 207RS0010X
020-Physicians (Allopathic &
Osteopathic)
188-Interventional Cardiology 207RI0011X
020-Physicians (Allopathic &
Osteopathic)
524-Interventional Pain Medicine 208VP0014X
020-Physicians (Allopathic &
Osteopathic)
375-Legal Medicine 209800000X
020-Physicians (Allopathic &
Osteopathic)
404-Maternal & Fetal Medicine 207VM0101X
7 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
595-Medical Genetics; Neuromusculoskeletal Medicine & OMM 204D00000X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
529-Medical Oncology 207RX0202X
020-Physicians (Allopathic &
Osteopathic)
502-Neonatal-Perinatal Medicine 2080N0001X
020-Physicians (Allopathic &
Osteopathic)
105-Nephrology 207RN0300X
020-Physicians (Allopathic &
Osteopathic)
014-Neurological Surgery 207T00000X
020-Physicians (Allopathic &
Osteopathic)
013-Neurology 2084N0400X
020-Physicians (Allopathic &
Osteopathic)
522-Neurology with Special Qualifications in Child Neurology 2084N0402X
020-Physicians (Allopathic &
Osteopathic)
653-Neuromusculoskeletal Medicine, Sports Medicine 204C00000X
020-Physicians (Allopathic &
Osteopathic)
203-Neuropathology 207ZN0500X
020-Physicians (Allopathic &
Osteopathic)
204-Neuroradiology 2085N0700X
020-Physicians (Allopathic &
Osteopathic)
103-Nuclear Medicine 207U00000X
020-Physicians (Allopathic &
Osteopathic)
597-Nuclear Medicine; Nuclear Cardiology 207UN0901X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
495-Nuclear Radiology 2085N0904X
020-Physicians (Allopathic &
Osteopathic)
211-Obstetrics 207VX0000X
020-Physicians (Allopathic &
Osteopathic)
016-Obstetrics & Gynecology 207V00000X
020-Physicians (Allopathic &
Osteopathic)
533-Occupational Medicine 2083X0100X
020-Physicians (Allopathic &
Osteopathic)
018-Ophthalmology 207W00000X
8 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
616-Ophthalmology; Retina Specialist 207WX0107X
020-Physicians (Allopathic &
Osteopathic)
212-Oral Maxillofacial Surgery 204E00000X
020-Physicians (Allopathic &
Osteopathic)
214-Orthopedic Hand Surgery 207XS0106X
020-Physicians (Allopathic &
Osteopathic)
020-Orthopaedic Surgery 207X00000X
020-Physicians (Allopathic &
Osteopathic)
526-Orthopeadic Surgery, Sports Medicine 207XX0005X
020-Physicians (Allopathic &
Osteopathic)
632-Orthopaedic Trauma 207XX0801X
020-Physicians (Allopathic &
Osteopathic)
217-Otolarynology 207Y00000X
020-Physicians (Allopathic &
Osteopathic)
549-Otolaryngology/Facial Plastic Surgery 207YX0905X
020-Physicians (Allopathic &
Osteopathic)
219-Otolaryngology; Pain Medicine 208VP0000X
020-Physicians (Allopathic &
Osteopathic)
022-Pathology 207ZP0101X
020-Physicians (Allopathic &
Osteopathic)
631-Pathology; Cytopathology 207ZC0500X
020-Physicians (Allopathic &
Osteopathic)
581-Pathology; Dermatopathology 207ZD0900X
020-Physicians (Allopathic &
Osteopathic)
560-Pathology; Hematology 207ZH0000X
020-Physicians (Allopathic &
Osteopathic)
564-Pediatric Adolescent Medicine 2080A0000X
020-Physicians (Allopathic &
Osteopathic)
108-Pediatric Allergy & Immunology 2080P0201X
020-Physicians (Allopathic &
Osteopathic)
412-Pediatric Anesthesiology 207LP3000X
020-Physicians (Allopathic &
Osteopathic)
221-Pediatric Cardiology 2080P0202X
9 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
514-Pediatric Critical Care Medicine 2080P0203X
020-Physicians (Allopathic &
Osteopathic)
222-Pediatric Dermatology 207NP0225X
020-Physicians (Allopathic &
Osteopathic)
223-Pediatric Developmental & Behavioral Pediatrics 2080P0006X
020-Physicians (Allopathic &
Osteopathic)
225-Pediatric Emergency Medicine; Emergency Medicine 207PP0204X
020-Physicians (Allopathic &
Osteopathic)
561-Pediatric Emergency Medicine; Pediatrics 2080P0204X
020-Physicians (Allopathic &
Osteopathic)
226-Pediatric Endocrinology 2080P0205X
020-Physicians (Allopathic &
Osteopathic)
227-Pediatric Gastroenterology 2080P0206X
020-Physicians (Allopathic &
Osteopathic)
228-Pediatric Hematology-Oncology 2080P0207X
020-Physicians (Allopathic &
Osteopathic)
542-Pediatric Hospice and Palliative Medicine 2080H0002X
020-Physicians (Allopathic &
Osteopathic)
229-Pediatric Infectious Disease 2080P0208X
020-Physicians (Allopathic &
Osteopathic)
231-Pediatric Medical Toxicology 2080T0002X
020-Physicians (Allopathic &
Osteopathic)
232-Pediatric Nephrology 2080P0210X
020-Physicians (Allopathic &
Osteopathic)
233-Pediatric Neurodevelopment Disabilities 2080P0008X
020-Physicians (Allopathic &
Osteopathic)
634-Pediatric Ophthalomology and Strabismus Specialist 207WX0110X
020-Physicians (Allopathic &
Osteopathic)
237-Pediatric Orthopedics Surgery 207XP3100X
020-Physicians (Allopathic &
Osteopathic)
140-Pediatric Otolaryngology 207YP0228X
020-Physicians (Allopathic &
Osteopathic)
238-Pediatric Pathology 207ZP0213X
10 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
240-Pediatric Pulmonology 2080P0214X
020-Physicians (Allopathic &
Osteopathic)
241-Pediatric Radiology 2085P0229X
020-Physicians (Allopathic &
Osteopathic)
242-Pediatric Rehab Medicine 2081P0010X
020-Physicians (Allopathic &
Osteopathic)
558-Pediatric Sleep Medicine 2080S0012X
020-Physicians (Allopathic &
Osteopathic)
243-Pediatric Rheumatology 2080P0216X
020-Physicians (Allopathic &
Osteopathic)
244-Pediatric Sports Medicine 2080S0010X
020-Physicians (Allopathic &
Osteopathic)
245-Pediatric Surgery 2086S0120X
020-Physicians (Allopathic &
Osteopathic)
246-Pediatric Urology 2088P0231X
020-Physicians (Allopathic &
Osteopathic)
049-Pediatrics 208000000X
020-Physicians (Allopathic &
Osteopathic)
247-Perinatology 163WP1700X
020-Physicians (Allopathic &
Osteopathic)
012-Phlebology 202K00000X
020-Physicians (Allopathic &
Osteopathic)
025-Physical Medicine & Rehabilitation 208100000X
020-Physicians (Allopathic &
Osteopathic)
532-Physical Medicine & Rehabilitation; Pain Medicine 2081P2900X
020-Physicians (Allopathic &
Osteopathic)
548-Physical Medicine & Rehabilitation; Sports Medicine 2081S0010X
020-Physicians (Allopathic &
Osteopathic)
636-Physical Medicine & Rehabilitation; Spinal Cord Injury
Medicine
2081P0004X
020-Physicians (Allopathic &
Osteopathic)
525-Plastic and Reconstructive Surgery 2086S0122X
020-Physicians (Allopathic &
Osteopathic)
024-Plastic Surgery 208200000X
11 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
256-Plastic Surgery Hand Surgery 2082S0105X
020-Physicians (Allopathic &
Osteopathic)
257-Preventative Medicine; Occupational-Environmental
Medicine
2083P0500X
020-Physicians (Allopathic &
Osteopathic)
654-Preventive Medicine; Undersea and Hyperbaric Medicine 2083P0011X
020-Physicians (Allopathic &
Osteopathic)
414-Procedural Dermatology 207NS0135X
020-Physicians (Allopathic &
Osteopathic)
121-Psychiatry 2084P0800X
020-Physicians (Allopathic &
Osteopathic)
142-Psychiatry – Child/Adolescent 2084P0804X
020-Physicians (Allopathic &
Osteopathic)
640-Psychiatry & Neurology;Behavioral Neurology &
Neuropsychiatry
2084B0040X
020-Physicians (Allopathic &
Osteopathic)
612-Psychiatry & Neurology; Neurocritical Care 2084A2900X
020-Physicians (Allopathic &
Osteopathic)
630-Psychiatry & Neurology;Neuromuscular Medicine 2084N0008X
020-Physicians (Allopathic &
Osteopathic)
570-Psychiatry & Neurology; Pain Medicine 2084P2900X
020-Physicians (Allopathic &
Osteopathic)
618-Psychiatry & Neurology; Psychosomatic Medicine 2084P0015X
020-Physicians (Allopathic &
Osteopathic)
569-Public Health & General Preventative Medicine 2083P0901X
020-Physicians (Allopathic &
Osteopathic)
029-Pulmonary Diseases 207RP1001X
020-Physicians (Allopathic &
Osteopathic)
583-Radiology; Diagnostic Ultrasound 2085U0001X (MCO only)
020-Physicians (Allopathic &
Osteopathic)
497-Radiation Oncology 2085R0001X
020-Physicians (Allopathic &
Osteopathic)
530-Reproductive Endocrinology 207VE0102X
020-Physicians (Allopathic &
Osteopathic)
267-Rheumatology 207RR0500X
12 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
020-Physicians (Allopathic &
Osteopathic)
521-Sleep Medicine 2084S0012X
020-Physicians (Allopathic &
Osteopathic)
273-Sports Medicine 207QS0010X
020-Physicians (Allopathic &
Osteopathic)
275-Surgery 208600000X
020-Physicians (Allopathic &
Osteopathic)
546-Surgery of the Hand 2086S0105X
020-Physicians (Allopathic &
Osteopathic)
539-Surgical Critical Care 2086S0102X
020-Physicians (Allopathic &
Osteopathic)
276-Surgical Oncology 2086X0206X
020-Physicians (Allopathic &
Osteopathic)
278-Therapeutic Radiology 2085R0203X
020-Physicians (Allopathic &
Osteopathic)
033-Thoracic Surgery 208G00000X
020-Physicians (Allopathic &
Osteopathic)
279-Transplant Surgery 204F00000X
020-Physicians (Allopathic &
Osteopathic)
633-Trauma Surgery 2086S0127X
020-Physicians (Allopathic &
Osteopathic)
638-Undersea and Hyperbaric Medicine 207PE0005X
020-Physicians (Allopathic &
Osteopathic)
034-Urology 208800000X
020-Physicians (Allopathic &
Osteopathic)
189-Vascular and Interventional Radiology 2085R0204X
020-Physicians (Allopathic &
Osteopathic)
552-Vascular Neurology 2084V0102X
020-Physicians (Allopathic &
Osteopathic)
289-Vascular Surgery 2086S0129X
021-Podiatric Medicine &
Surgery Service Providers
120-Podiatrist 213E00000X
13 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
021-Podiatric Medicine &
Surgery Service Providers
540-Surgery, Foot 213ES0131X
021-Podiatric Medicine &
Surgery Service Providers
541-Surgery, Foot & Ankle 213ES0103X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
576-Athletic Trainer 2255A2300X (MCO only)
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
592-Massage Therapist 225700000X (MCO only)
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
126-Occupational Therapy 225X00000X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
600-Occupational Therapy Assistant 224Z00000X (MCO only)
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
114-Orthotist 222Z00000X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
123-Physical Therapist 225100000X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
601-Physical Therapy Assistant 225200000X (MCO only)
14 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
115-Prosthetist 224P00000X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
607-Recreation Therapist 225800000X (MCO only)
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
349-Respiratory Therapist, Certified 227800000X
022-Respiratory,
Developmental, Rehabilitative
& Restorative Service
Providers
430-Respiratory Therapist, Registered 227900000X
023-Speech, Language &
Hearing Service Providers
087-Audiologist 231H00000X
023-Speech, Language &
Hearing Service Providers
577-Audiologist - Hearing Aid Fitter 237600000X (MCO only)
023-Speech, Language &
Hearing Service Providers
272-Speech-Language Pathologist 235Z00000X
023-Speech, Language &
Hearing Service Providers
512-Hearing Instrument Specialist 237700000X
024-Student, Health Care 606-Student in an Organized Health Care Education/Training
Program
390200000X (MCO only)
034-Transportation Services 626-Chaperone A taxonomy code is not required for this
provider type/specialty combination
034-Transportation Services 387-Private Vehicle 347C00000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
485-Advanced Practice Midwife 367A00000X
15 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
036-Physician Assistants
&Advanced Practice Nursing
Providers
609-Anesthesiologist Assistant 367H00000X (MCO only)
036-Physician Assistants
&Advanced Practice Nursing
Providers
341-Certified Registered Nurse Anesthetist 367500000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
036-Clinical Nurse Specialist 364S00000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
550 -Clinical Nurse Specialist, Adult Health 364SA2200X
036-Physician Assistants
&Advanced Practice Nursing
Providers
619-Clinical Nurse Specialist, Family Health 364SF0001X
036-Physician Assistants
&Advanced Practice Nursing
Providers
559-Clinical Nurse Specialist, Oncology 364SX0200X
036-Physician Assistants
&Advanced Practice Nursing
Providers
537-Clinical Nurse Specialist, Psychiatric/Mental Health 364SP0808X
036-Physician Assistants
&Advanced Practice Nursing
Providers
547-Clinical Nurse Specialist, Psychiatric/Mental Health, Adult 364SP0809X
036-Physician Assistants
&Advanced Practice Nursing
Providers
629-Clinical Nurse Specialist, Psychiatric/Mental Health, Child
& Adolescent
364SP0807X
16 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
036-Physician Assistants
&Advanced Practice Nursing
Providers
516-Nurse Practitioner, Acute Care 363LA2100X
036-Physician Assistants
&Advanced Practice Nursing
Providers
431-Nurse Practitioner, Adult Health 363LA2200X
036-Physician Assistants
&Advanced Practice Nursing
Providers
055-Nurse Practitioner, Advanced Practice 363L00000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
596-Nurse Practitioner; Critical Care Medicine 363LC0200X (MCO only)
036-Physician Assistants
&Advanced Practice Nursing
Providers
432-Nurse Practitioner, Family 363LF0000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
551-Nurse Practitioner, Gerontology 363LG0600X
036-Physician Assistants
&Advanced Practice Nursing
Providers
531-Nurse Practitioner, Neonatal 363LN0000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
466 -Nurse Practitioner, Neonatal; Critical Care 363LN0005X
036-Physician Assistants
&Advanced Practice Nursing
Providers
434 -Nurse Practitioner, OB/GYN 363LX0001X
17 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
036-Physician Assistants
&Advanced Practice Nursing
Providers
536-Nurse Practitioner, Occupational Health 363LX0106X
036-Physician Assistants
&Advanced Practice Nursing
Providers
435-Nurse Practitioner, Pediatrics 363LP0200X
036-Physician Assistants
&Advanced Practice Nursing
Providers
635-Nurse Practitioner, Pediatrics, Critical Care 363LP0222X
036-Physician Assistants
&Advanced Practice Nursing
Providers
535-Nurse Practitioner, Perinatal 363LP1700X
036-Physician Assistants
&Advanced Practice Nursing
Providers
469-Nurse Practitioner, Primary Care 363LP2300X
036-Physician Assistants
&Advanced Practice Nursing
Providers
467-Nurse Practitioner, Psychiatric/Mental Health 363LP0808X
036-Physician Assistants
&Advanced Practice Nursing
Providers
470-Nurse Practitioner, Women's Health 363LW0102X
036-Physician Assistants
&Advanced Practice Nursing
Providers
255-Physician Assistant 363A00000X
036-Physician Assistants
&Advanced Practice Nursing
Providers
518-Physician Assistant, Medical 363AM0700X
18 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
036-Physician Assistants
&Advanced Practice Nursing
Providers
519-Physican Assistant, Surgical 363AS0400X
036-Physician Assistants
&Advanced Practice Nursing
Providers
121-Psychiatry 2084P0800X
048-Qualified Service
Providers
323-Adult Day Care (QSP) 3747P1801X
048-Qualified Service
Providers
318-Adult Family Foster Care (QSP) 3747P1801X
048-Qualified Service
Providers
146-Attendant Care (QSP) 3747A0650X
048-Qualified Service
Providers
309-Chore Labor (QSP) 372500000X
048-Qualified Service
Providers
308-Chore – Snow Removal (QSP) 372500000X
048-Qualified Service
Providers
637-Companionship 372600000X
048-Qualified Service
Providers
394-Extended Personal Care (QSP) 3747A0650X
048-Qualified Service
Providers
319-Family Home Care (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
112-Family Personal Care (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
317-Higher Lvl Case Mgmt – Assmnt (QSP) 171M00000X
048-Qualified Service
Providers
316-Higher Lvl Case Mgmt – Other (QSP) 171M00000X
19 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
048-Qualified Service
Providers
330-Home Delivered Meals (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
180-Homemaker (QSP) 376J00000X
048-Qualified Service
Providers
327-Non-Med Transport (Escort) (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
326-Non-Med Transport (local-round trip) (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
325-Non-Med Transport (out of town) (QSP) A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
396-Nurse Education Care (QSP) 163WC1500X
048-Qualified Service
Providers
209-Nurse Management (QSP) 163WC1500X
048-Qualified Service
Providers
251-Personal Care – Daily Rate (QSP) 3747P1801X
048-Qualified Service
Providers
399-Personal Care – Unit Rate (QSP) 3747P1801X
048-Qualified Service
Providers
387-Private Vehicle A taxonomy code is not required for this
provider type/specialty combination
048-Qualified Service
Providers
081-Respite Care (QSP) 3747P1801X
048-Qualified Service
Providers
513-Supervision 372600000X
048-Qualified Service
Providers
314-Tech Depd Case Mgmt – Other (QSP) 171M00000X
20 10/19/2020
ND Medicaid - Individual Provider Type, Specialty and Taxonomy Valid Values
PROVIDER TYPE CODE PROVIDER SPECIALTY CODE TAXONOMY CODE
048-Qualified Service
Providers
315-Tech Depd Case Mgmt – Asmt (QSP) 171M00000X
049-1915i State Plan
Amendment Services
641-Care Coordination 171M00000X
049-1915i State Plan
Amendment Services
642-Supported Employment 171M00000X
049-1915i State Plan
Amendment Services
643-Pre-Vocational 171M00000X
049-1915i State Plan
Amendment Services
644-Education 171M00000X
049-1915i State Plan
Amendment Services
086-Respite 171M00000X
049-1915i State Plan
Amendment Services
645-Training & Support for Unpaid Caregivers 171M00000X
049-1915i State Plan
Amendment Services
646-Peer Support 175T00000X
049-1915i State Plan
Amendment Services
387-Private Vehicle 347C00000X
049-1915i State Plan
Amendment Services
647-Family Peer Support 175T00000X
049-1915i State Plan
Amendment Services
648-Benefits Planning 171M00000X
049-1915i State Plan
Amendment Services
649-Community Transition Service 171M00000X
049-1915i State Plan
Amendment Services
650-Housing Supports 171M00000X
21 10/19/2020