Suppliers/Durable Medical 40 DME 87 All Other 332B00000X Equipment & Medical Supplies REGISTERED DIETICIAN Registered Dietary & Nutritional Service 41 (IN-ST) 4R Dietician 133V00000X Providers/Dietician, Registered NON-EMER MED Transportation Services TRANSPORT NEMT - Medical Transport 42 (IN-ST) 45 Non-profit 343900000X (VAN) NON-EMER MED Transportation Services TRANSPORT NEMT - Medical Transport 42 (IN-ST) 46 Profit 343900000X (VAN) NON-EMER MED Transportation Services TRANSPORT NEMT - Medical Transport 42 (IN-ST) 47 F+F 343900000X (VAN) NON-EMER MED Transportation Services TRANSPORT Waiver Medical Transport 42 (IN-ST) 4W Services 343900000X (VAN) NON-EMER MED Transportation Services TRANSPORT Medical Transport 42 (IN-ST) 4X 343900000X (VAN) LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc CASE MGT - Case Nursing Service Providers NHV/FTM Registered Nurse Case 43 (IN-ST) 81 163WC0400X Management HOME HEALTH AGENCY 44 87 All Other 251E00000X Agencies/Home Health CASE MGMT - Case Other Service Providers Case 45 (IN-ST) 81 171M00000X Manager/Care Coordinator Case CASE MGMT Other Service Providers Case 46 - HIV 81 171M00000X Manager/Care Coordinator Case CASE MGMT Other Service Providers Case 47 - CMI 81 171M00000X Manager/Care Coordinator CASE MGMT Case - PREGNANT Other Service Providers Case 48 WOMEN 81 171M00000X Manager/Care Coordinator CASE MGMT Case - DEVELOP Other Service Providers Case 49 DISABLED 81 171M00000X Manager/Care Coordinator
40 DME 87 All Other 332B00000X Suppliers/Durable Medical Equipment & Medical Supplies 41 REGISTERED DIETICIAN (IN-ST) 4R Registered Dietician 133V00000X Dietary & Nutritional Service Providers/Dietician, Registered 42 NON-EMER MED TRANSPORT (IN-ST) 45 NEMT - Non-profit 343900000X Transportation Services Medical Transport (VAN) 42 NON-EMER MED TRANSPORT (IN-ST) 46 NEMT - Profit 343900000X Transportation Services Medical Transport (VAN) 42 NON-EMER MED TRANSPORT (IN-ST) 47 NEMT - F+F 343900000X Transportation Services Medical Transport (VAN) 42 NON-EMER MED TRANSPORT (IN-ST) 4W Waiver Services 343900000X Transportation Services Medical Transport (VAN) 42 NON-EMER MED TRANSPORT (IN-ST) 4X 343900000X Transportation Services Medical Transport (VAN) LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc 43 CASE MGT - NHV/FTM (IN-ST) 81 Case 163WC0400X Nursing Service Providers Registered Nurse Case Management 44 HOME HEALTH AGENCY 87 All Other 251E00000X Agencies/Home Health 45 CASE MGMT - (IN-ST) 81 Case 171M00000X Other Service Providers Case Manager/Care Coordinator 46 CASE MGMT - HIV 81 Case 171M00000X Other Service Providers Case Manager/Care Coordinator 47 CASE MGMT - CMI 81 Case 171M00000X Other Service Providers Case Manager/Care Coordinator 48 CASE MGMT - PREGNANT WOMEN 81 Case 171M00000X Other Service Providers Case Manager/Care Coordinator 49 CASE MGMT - DEVELOP DISABLED 81 Case 171M00000X Other Service Providers Case Manager/Care Coordinator
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx