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Provider Type Summaries

Welcome

Please select the provider type from the list below for application information.

If you have any questions on the information provided for the provider types below, contact Provider Enrollment from 8 a.m. - 4:30 p.m. ET Monday through Friday at (877) 838-5085.

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Current Provider Number and Type

01 - Hospital

02 - Psychiatric Hospital

03 - Behavioral Health Service Organization (BHSO)

04 - Psychiatric Residential Treatment Facility (PRTF)

10 - Intermediate Care Facility - Individuals with Intellectual Disability (ICF/IID) Clinic

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

18 - Private Duty Nursing

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

66 - Behavioral Health Multi-Specialty 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

79 - Speech Language Pathologist

799 - Speech Language Pathologist Group

80 - Podiatrist

809 - Podiatrist Group

81 - Licensed Professional Clinical Counselor

819 - Licensed Professional Clinical Counselor Group

82 - Licensed Clinical Social Worker

829 - Licensed Clinical Social Worker Group

83 - Licensed Marriage and Family Therapist

839 - Licensed Marriage and Family Therapist Group

84 - Licensed Psychological Practitioner

849 - Licensed Psychological Practitioner 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

 

Policy Information
   

Contact Information
 

Kentucky Department for Medicaid Services
Provider Enrollment
P.O. Box 2110
Frankfort, KY 40602
Toll free: (877) 838-5085
Monday to Friday
8 a.m. - 4:30 p.m. ET

Email

For other questions or assistance, e-mail the CHFS DMS Webmaster

 

Last Updated 8/1/2014
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