United States Health Information Knowledgebase


Provider Type

Definition:Provider type classifies providers according to the type of license or accreditation they hold (e.g. physician, dentist, pharmacist, etc.) or the service they provide
Constraints:C154-[DE-4.04-1] Provider type SHALL be coded as specified in HITSP/C80 Section Provider Type

Value Set

http://www.nucc.org/index.php?option=com_content&task=view&id=14&Itemid=40" Exit Disclaimer href="/ViewItemDetails?&system=hitsp&itemKey=168454000" class="requiresAuthVerification">Provider Type Value Set

Definition:The Health Care Provider Taxonomy Vocabulary has been limited by HITSP to the value set reproduced below in Table 2-127 Provider Type Value Set Definition

Note on Missing Codes: Provider Type is expected to be a short list of 20-30 codes that identify types of healthcare providers, and would work with terminologies used to classify providers in other transactions. The Health Care Provider Taxonomy provides the appropriate high-level concepts but does not provide codes for them. A request for these codes has been made to NUCC

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Code System Name:Health Care Provider Taxonomy
Code System Source:National Uniform Claim Committee (NUCC)
Concept Code Concept Name Definition
Behavioral Health & Social Service Providers Broad classification aggregating providers who are trained and educated to perform services related to behavioral health, mental health, and counseling and may be licensed or practice within the scope or licensure or training
Chiropractic Providers 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
Dental Providers Broad category to identify practitioners who render services related the practice of dentistry. Dentistry is defined as the evaluation, diagnosis, prevention and/or treatment (nonsurgical, surgical or related procedures) of diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associated structures and their impact on the human body; provided by a dentist, within the scope of his/her education, training and experience, in accordance with the ethics of the profession and applicable law
Dietary and 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
Emergency Medical Service Providers Broad category for individuals who complete additional training and education in the area of pre-hospital emergency services and are licensed and/or practice within the scope of that training
Eye and Vision Service Providers Broad category grouping individuals who renders services related to the human eye and visual systems, but are not an allopathic or osteopathic physicians
Nursing Service Providers Providers who are trained and educated to perform and administer services related to health promotion, disease prevention, acute and chronic care, spiritual guidance and comfort for healing and health, restoration of health and health maintenance across the life span
Pharmacy Service Providers (Individuals) A broad category grouping providers who render services relating to the preparation and dispensing of drugs
Allopathic & Osteopathic Physicians A broad category grouping state licensed providers in allopathic or osteopathic medicine whose scope of practice is determined by education
Podiatric Medicine and Surgery Providers Broad category grouping licensed providers who renders services related to the human foot
Respiratory, Developmental, Rehabilitative and Restorative Service Providers A provider who is trained and educated to perform services related to respiratory care, physical therapy, occupational therapy, developmental therapy, rehabilitation and restorative services and may be licensed, certified or practice within the scope of training
Speech, Language and Hearing Providers A provider who renders services to improve communicative skills of people with language, speech and hearing impairments
Agencies A non-facility provider that renders outpatient outreach services that are not provided at a specific location. The licensure or registration is assigned to the agency rather than to the individual practitioners as would be the case in a group practice
Ambulatory Health Care Facilities A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health)
Hospitals A health care organization that has a governing body, an organized medical staff and professional staff and inpatient facilities and provides medical nursing and related services for ill and injured patients 24 hrs per day, seven days per week. For licensing purposes, each state has its own definition of hospital
Laboratories A room or building equipped for scientific experimentation, research, testing, or clinical studies of materials, fluids, or tissues obtained from patients
Managed Care Organizations Not Available
Nursing & Custodial Care Facilities Broad category identifying licensed facilities with inpatient beds specializing in nursing and custodial care
Residential Treatment Facilities Live in facilities where patients or clients, who because of their physical, mental, or emotional condition, are not able to live independently, and who receive treatment appropriate to their particular needs in a less restrictive environment than an inpatient facility. For example, an RTC may provide educational training and therapy for children with emotional disturbances or continuing care and therapy for people with severe mental handicaps
Suppliers Suppliers, pharmacies, and other health care providers who supply health care related products or medications and associated professional and administrative services
Physician Assistants & Advanced Practice Nursing Providers A broad grouping of providers who are: 1) trained, educated, and certified to perform basic medical and minor surgical services (or to assist the physician in performance of more complex services) under general physician supervision; and 2) trained, educated at a post-graduate level, and certified to perform autonomous and specialized roles as nurse practitioners, midwives, nurse anesthetists, or clinical nurse specialists
Nursing Service Related Providers Providers not otherwise classified, who perform or administer services in or related to the delivery or research of health care services, disease, and restoration of health. An individual provider who is not represented in one of the identified categories but whose data may be needed for clinical, operational or administrative processes
Respite Care Facility A facility with dorm rooms where individuals who are unable to care for themselves may stay on a short term basis overnight to allow relief to persons normally providing care to them

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There are no Conceptual Domains linked to Provider Type.

Relationship Organization Item
utilizes HITSP Provider Type Value Set   
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