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Health Care Provider Taxonomy

Code Set Resources

The following on the Health Care Provider Taxonomy code set are available from the "Provider Taxonomy" drop-down menu:

On-line Lookup is the complete list of Health Care Provider Taxonomy codes.  Click on names with a plus sign to expand the list and few the additional codes.  Click on the word "definition" to view the definition of the code.

Questions is where you can submit a question about the code set.

More Information is a list of FAQs about the code set and how to use it.

New Codes is a complete list of new codes that have been added to the code set since the last update.

Modifications is a complete list of modifications that have been made to the code set since the last update.

PDF is where you can download a PDF version of the current or previous versions of the code set. 

CSV is where you can download a Comma Separated Values (CSV) version of the code set. 

Vendors interested in incorporating the Health Care Provider Taxonomy code set into their commercial products must complete the license request form found on the CSV page.

Background Information

The Health Care Provider Taxonomy code set is an external, nonmedical data code set designed for use in an electronic environment, specifically within the ASC X12N Health Care transactions. This includes the transactions mandated under HIPAA.

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

The National Uniform Claim Committee (NUCC) is presently maintaining the code set. It is used in transactions specified in HIPAA and the National Provider Identifier (NPI) application for enumeration. Effective 2001, the NUCC took over the administration of the code set. Ongoing duties, including processing taxonomy code requests and maintenance of the code set, fall under the NUCC Code Subcommittee.

Code Request/Change Criteria

To request new codes or modifications to existing codes please fill out the form below and send it to: This email address is being protected from spambots. You need JavaScript enabled to view it.

Health Care Provider Taxonomy Code Set Request Form [Word File]

The following are the criteria that are used to evaluate change requests to the Health Care Provider Taxonomy code set:

Overall

  • Request meets a national need and not a state or local need
    • Exception – Provider is recognized in one or few states, but needs to obtain an NPI
  • Request meets a need not currently uniquely identified in the code set

Requirement
Only one (1) of the following needs to be met. Provider Specialty is used to do the following:

  • Categorize providers in a provider directory
  • Apply for an NPI for a health care provider (as defined by HIPAA)
  • Identify a provider in electronic transaction(s)
  • Identify a provider for reimbursement purposes
  • Identify provider practice focus and/or education/training for provider enrollment in health plans
  • Identify course area of specialization of education/training at accredited post-secondary educational institutions
  • Identify course area of specialization of continuing education offered by established CEU program sponsors
  • Identify providers in local, regional or national health information exchange
  • Identify providers in public health-related data transactions
  • If you are unable to select any criteria from the previous list, but still believe that you qualify for a taxonomy code, it is acceptable to fill out the request form.

Meeting one or more of the following provides additional business justification of the need for a unique code:

  • American Board of Medical Specialties (ABMS) and/or American Osteopathic Association certification exists.
  • Accreditation Council for Graduate Medical Education (ACGME) – accredited residency or subspecialty training program
  • Existence of a nationally recognized specialty board, or a specialty defined by a subspecialty certification or a certificate of special competence issued by such a board or a nationally recognized accrediting body, or recognized by a regulatory agency
  • Demand for services is such that a significant number of providers choose to limit their practice to that specialty
  • The specialty is based on major new concepts in health science having broad professional support
  • The specialty is a distinct and well-defined new field of health care that entails special concern with the problems of a specific patient group, organ system, disease entity, or health care procedure

Additional criteria considered for request to change existing codes and/or definitions:

  • The recommended change will not affect those individuals/organizations that have already utilized or are currently utilizing the existing code/definition.
  • The recommended change will not exclude or eliminate the ability for any subset of individuals/organizations to be identified by the changed code/definition or by another appropriate taxonomy code

Additional criteria considered for requests to delete existing codes:

  • The code under review is a 100% duplicate of another existing code, i.e., the definitions for both codes would be identical.
  • An analysis of the impact of deleting the code has been completed.
  • This may include identifying the number of providers that have chosen the code on their NPI application.
  • The relevant professional organization(s) has been notified and is in agreement with the request.
  • An entity/professional organization has committed to providing the necessary outreach to the providers, not just its members, to inform them of the deletion of the code and their need to update their taxonomy code with any relevant entities.

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 set.

Copyright 2014 American Medical Association
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