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

The Provider Taxonomy Code List allows a single provider (individual, group, or institution) to identify their specialty category. Providers may have one or more than one taxonomy associated to them. When determining what code or codes to associate with a provider, the user needs to review the requirements of the trading partner with which the code(s) are being used.
If using Internet Explorer, click on the Titles in the left frame to expand that node, or click the Expand link to display the entire list. After you have expanded the list, you can search for specific text within the list by clicking the Edit menu on the toolbar, and then selecting Find (on this Page)... option.

Within the list are links labeled [more] -- clicking one of those will display additional information about that node in the bottom frame to the left.
004010X096A1, 004010X097A1, 004010X098A1, Health Care Claim: Dental, Insitutional, & Professional
In the PRV segment in the header and detail areas, specifically, PRV03.
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 Provider Taxonomy is a unique alphanumeric code, ten characters in length. The provider taxonomy code list includes specialty categories for individuals, Groups of individuals, and non-individuals.

The “Individual Category” includes:
  • Physicians
  • Behavioral Health and Social Service Providers
  • Chiropractic Providers
  • Dental Providers
  • Dietary and Nutritional Service Providers
  • Emergency Medical Service Providers
  • Eye and Vision Service Providers
  • Nursing Service Providers
  • Nursing Service Related Providers
  • Other Service Providers
  • Pharmacy Service Providers
  • Physician Assistants and Advanced Practice Nursing Providers
  • Podiatric Medicine and Surgery Providers
  • Respiratory, Rehabilitative and Restorative Providers
  • Speech, Language and Hearing Providers
  • Student, Health Care
  • Technologist, Technician, and Other Technical Service Providers
The Group (of Individuals) category includes:
  • Multi-Specialty
  • Single Specialty
The Non-individual category includes:
  • Agencies
  • Ambulatory Health Care Facilities
  • Hospital Units
  • Hospitals
  • Laboratories
  • Managed Care Organizations
  • Nursing and Custodial Care Facilities
  • Residential Treatment Facilities
  • Respite Care Facilities
  • Suppliers
  • Transportation Services
NUCC Provider Taxonomy Process
Effective 2001, the National Uniform Claim Committee (NUCC) took over the administration of the National Health Care Provider Taxonomy Code List. Ongoing duties, including processing taxonomy code requests and maintenance of the external Provider Taxonomy code list, will fall under the NUCC Data Subcommittee. Primary distribution of the Provider Taxonomy code list remains the responsibility of Washington Publishing Company (WPC), through this web site.

MEDICAID
All requests related to Medicaid should first be coordinated by the National Medicaid EDI HIPAA (NMEH) Work Group.

The NUCC Data Subcommittee
Request a change in writing via email to: Taxonomy@wpc-edi.com

Criteria for reviewing change requests to the Health Care Provider Taxonomy Code List is based on the following factors:
  • Proven business need for acceptance / change (e.g., Cost savings, increased efficiencies, with the benefits of the acceptance / change outweighing the costs of implementation. As this is a national list, requests should help solve needs on a national level vs. state specific level.)
  • No existing code that will suffice in place of the perceived need for a new code
  • Does the new request (for a medical specialty code) presently exist within the American Board of Medical Specialties?
  • Does the Organization code presently exist with the code list? Is there consistency between the list and the POS code list?
While existing Level I Health Care Provider Type Codes and Level II Health Care Provider Classification Codes have been defined, the same cannot be said for all Level III Health Care Provider Area of Specialization codes. Therefore, every new Taxonomy code request must be accompanied by a definition. Taxonomy code requests lacking definitions will not be considered for inclusion in future revisions of the Health Care Provider Taxonomy Code List.
The Provider Taxonomy Code List is published (released) twice a year in July and January. The July publication is effective for use on October 1st and the January publication is effective for use on April 1st. The time between the publication release and the effective date is considered an implementation period to allow providers, payers and vendors an opportunity to incorporate any changes into their systems.
The current online listing is version 5.1 and contains codes effective October 1, 2005.
Revisions since the last release are color coded. New items are green, modified items are orange, and inactive items are red. The following screen shots represent a change summary.
The complete list for the current release version 5.1 is available as a PDF or in an electronic file suitable for updating a database.

The complete list for the previous version 5.0 is available as a 5.0 PDF as are the prvious versions 4.1 PDF and 4.0 PDF.

In the absence of an all-encompassing Provider Classification System, both X12N and the National Provider System Workgroup from the Centers for Medicare and Medicaid Services (CMS) commenced work on identifying and coding an external provider table that would be able to codify provider type and provider area of specialization for all medical related providers. CMS' intent was to provide a single coding structure to support work on the National Provider System, while X12N needed a single common table for trading partner use. The two projects worked independently to some extent until April 1996 when the lists were coordinated and a single taxonomy was proposed. A sub-group of the X12N TG2 WG 15 was charged with resolving differences in the two proposed taxonomies. Their work resulted in a single taxonomy that both CMS and members of X12N found meaningful, easy to use, and functional for electronic transactions.

The sub-group initially started with the CMS draft taxonomy. This list incorporated all types of providers associated with medical care in various ways. Many of the providers listed, such as technologists or technicians, support or repair equipment/machinery. A number of the providers offer medical services, in concert with others, and do not or cannot bill independently for their portion. The amount of research to validate and classify all providers using the proposed hierarchical structure was enormous. The X12N sub-group focused on medical providers who are licensed practitioners, those who bill for health-related services rendered, and those who appeared on the Medicare CMS Provider Specialty listing. This included providers who were licensed to practice medicine via state licensure agencies. In addition, a very broad definition of "areas of specialization" was used, which included nationally recognized specialties, provider self-designated specialties, areas of practice focus, and any request by any agency or trading partner submitted before the first taxonomy release. This level of detail captured specialty information in categories detailed enough to support those trading credentialing information, yet broad enough to support those wishing to trade directory level specialization information.

In 2001, ANSI ASC X12N asked the NUCC to become the official maintainer of the Health Care Provider Taxonomy List. The NUCC has a formal operating protocol and its membership includes representation from key provider and payer organizations, as well as state and federal agencies, standard development organizations and the National Uniform Billing Committee (NUBC). Criteria for membership includes a national scope and representation of a unique constituency affected by health care electronic commerce, with an emphasis on maintaining a provider/payer balance.