Medicare Provider Supplier To Healthcare Provider Taxonomy

$179 / year

This crosswalk links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. This crosswalk includes the Medicare Specialty Codes for those provider/supplier types who have Medicare Specialty Codes.

Complexity

The Healthcare Provider Taxonomy Code Set is a hierarchical code set that consists of codes, descriptions, and definitions. Healthcare Provider Taxonomy Codes are designed to categorize the type, classification, and/or specialization of health care providers. The Code Set consists of two sections: Individuals and Groups of Individuals, and Non-Individuals. The Code Set is updated twice a year, effective April 1 and October 1. The “Crosswalk – Medicare Provider/Supplier to Healthcare Provider Taxonomy” was updated because of changes made to the Healthcare Provider Taxonomy Code Set that will be implemented October 1, 2008. That Code Set is available from the Washington Publishing Company. The Code Set is maintained by the National Uniform Claim Committee. The Code Set is a Health Insurance Portability and Accountability (HIPAA) standard code set. As such, it is the only code set that may be used in HIPAA standard transactions to report the type/classification/specialization of a health care provider when such reporting is required.

When applying for a National Provider Identifier (NPI) from the National Plan and Provider Enumeration System (NPPES), a health care provider must select the Healthcare Provider Taxonomy Code or code description that the health care provider determines most closely describes the health care provider’s type/classification/specialization, and report that code or code description in the NPI application. In some situations, a health care provider might need to report more than one Healthcare Provider Taxonomy Code or code description in order to adequately describe the type/classification/specialization. Therefore, a health care provider may select more than one Healthcare Provider Taxonomy Code or code description when applying for an NPI, but must indicate one of them as the primary. The NPPES does not verify with the health care providers or with trusted sources that the Healthcare Provider Taxonomy Code or code description selections made by health care providers when applying for NPIs are accurate (e.g., the NPPES does not verify that an individual who reports a Physician Code is, in fact, a physician, or a physician with the reported specialization). The NPPES does, however, validate that the Code and code description selections exist within the current version of the Healthcare Provider Taxonomy Code Set.

The Healthcare Provider Taxonomy Codes and code descriptions that health care providers select when applying for NPIs may or may not be the same as the categorizations used by Medicare and other health plans in their enrollment and credentialing activities. The Healthcare Provider Taxonomy Code or code description information collected by NPPES is used to help uniquely identify health care providers in order to assign them NPIs, not to ensure that they are credentialed or qualified to render health care.

Date Created

2017-11-30

Last Modified

2019-10-201

Version

2019-10-201

Update Frequency

Semiannual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Provider Taxonomy Code, Healthcare Provider Taxonomy Code, Medicare Crosswalk Provider Taxonomy, Medicare Specialty Codes, Taxonomy, Taxonomy Code List

Other Titles

Taxonomy Code List 2019, Healthcare Provider Taxonomy Code Set 2019

NameDescriptionTypeConstraints
Medicare_Speciality_CodeMedicare Specialty Codes for those provider/supplier types who have Medicare Specialty Codesstring-
Medicare_Provider_Supplier_Type_DescriptionDescription for Type of Supplier for Medicare Healthcare Providerstring-
Provider_Taxonomy_CodeAlpha Numeric Unique Taxonomy Codestring-
Provider_Taxonomy_DescriptionProvider Taxonomy (DESCRIPTION: TYPE, CLASSIFICATION, SPECIALIZATION)string-
Medicare Speciality CodeMedicare Provider Supplier Type DescriptionProvider Taxonomy CodeProvider Taxonomy Description
1Physician/General Practice208D00000XAllopathic & Osteopathic Physicians/General Practice
2Physician/General Surgery208600000XAllopathic & Osteopathic Physicians/Surgery
2Physician/General Surgery2086H0002XAllopathic & Osteopathic Physicians/Surgery/Hospice and Palliative Medicine
2Physician/General Surgery2086S0120XAllopathic & Osteopathic Physicians/Surgery/Pediatric Surgery
2Physician/General Surgery2086S0122XAllopathic & Osteopathic Physicians/Surgery/Plastic and Reconstructive Surgery
2Physician/General Surgery2086S0105XAllopathic & Osteopathic Physicians/Surgery/Surgery of the Hand
2Physician/General Surgery2086S0102XAllopathic & Osteopathic Physicians/Surgery/Surgical Critical Care
2Physician/General Surgery2086X0206XAllopathic & Osteopathic Physicians/Surgery/Surgical Oncology
2Physician/General Surgery2086S0127XAllopathic & Osteopathic Physicians/Surgery/Trauma Surgery
2Physician/General Surgery2086S0129XAllopathic & Osteopathic Physicians/Surgery/Vascular Surgery