Provider Type Summaries

01 - Hospital

02 - Psychiatric Hospital

04 - Psychiatric Residential Treatment Facility (PRTF)

11 - Intermediate Care Facility/Mental Retardation/Developmentally Disabled Services (ICF/MR/DD)

12 - Nursing Facility

13 - Specialized Children's Services Clinic

15 - Health Access Nurturing Development Services (HANDS)

17 - Acquired Brain Injury

20 - Preventive and Remedial Public Health Services

21 - School Based Services

22 - Commission For Children with Special Health Care Needs

23 - Targeted Case Management and Rehabilitative Services

24 - First Steps

27 - Adult Targeted Case Management

28 - Children's Targeted Case Management

29 - Impact Plus

30 - Community Mental Health Center

31- Primary Care Center/Federally Qualified Health Centers

32 - Family Planning

33 - Supports for Community Living

34 - Home Health Agency

35 - Rural Health Clinic

36 - Ambulatory Surgical Center

37 - Independent Lab

39 - Renal Dialysis Clinic

40 - Early and Periodic Screening, Diagnosis, and Treatment Special Services (EPSDT) - Screening Clinics

41 - Model Waiver II

42 - Home and Community Based Waiver

43 - Adult Day Health Care

44 - Hospice

45 - Early and Periodic Screening, Diagnosis, and Treatment Special Services (EPSDT)

50 - Hearing Aid Dealer

509 - Hearing Aid Dealer Group

52 - Optician

528 - Optician Group

54 - Pharmacy

55 - Emergency Transportation

56 - Non-Emergency Transportation

57 - Transportation Broker

60 - Dentist

61 - Dentist Group

64 -Physician

659 - Physician Group

70 -Audiologist

709 - Audiologist Group

74 - Certified Registered Nurse Anesthetist

749 - Certified Registered Nurse Anesthetist Group

77 - Optometrist

779 - Optometrist Group

78 - Advanced Registered Nurse Practitioner

789 - Advanced Registered Nurse Practitioner Group

80 - Podiatrist

809 - Podiatrist Group

82 - Licensed Clinical Social Worker

829 - Licensed Clinical Social Worker Group

85 - Chiropractor

859 - Chiropractor Group

86 - Other Lab and X Ray

87 - Physical Therapist

879 - Physical Therapist Group

88 - Occupational Therapist

889 - Occupational Therapist Group

89 - Licensed Psychologist

899 - Psychologist Group

90 - Durable Medical Equipment (DME)

91 - Comprehensive Outpatient Rehab Facility (CORF)

92 - Psychiatric Distinct Part Unit (DPU)

93 - Rehabilitation Distinct Part Unit (DPU)

95 - Physician Assistant

959 - Physician's Assistant Group