Allopathic & Osteopathic PHYSICIAN Physicians/Internal Medicine, 20 (IND & GP) 39 Nephrology 207RN0300X Nephrology LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc Allopathic & Osteopathic PHYSICIAN Hand Physicians/Orthopaedic 20 (IND & GP) 40 Surgery 207XS0106X Surgery/Hand Surgery PHYSICIAN Internal Allopathic & Osteopathic 20 (IND & GP) 41 Medicine 207R00000X Physicians/Internal Medicine Podiatry - PHYSICIAN Surgical Podiatric Medicine and Surgery 20 (IND & GP) 48 Chiropody 213E00000X Providers - Podiatrists PHYSICIAN (Admin. Allopathic & Osteopathic 20 (IND & GP) 49 Medicine) 207R00000X Physicians/Internal Medicine Clinic or PHYSICIAN Other Group 20 (IND & GP) 70 Practice 193200000X Multi-Specialty Group THIRD PARTY BILL Medicare Advantage 21 9U Plans NA NULL THIRD PARTY BILL OCDD - Point of 21 9V Entry NA NULL THIRD PARTY BILL OAAS - Point of 21 9W Entry NA NULL THIRD PARTY BILL OAD - Point 21 9X of Entry NA NULL THIRD Juvenile PARTY BILL Court/Drug Treatment 21 9Y Center NA NULL THIRD Other PARTY BILL Contract with a State 21 9Z Agency NA NULL PERSONAL CARE Personal Nursing Service Related ATTENDANT Care Providers Technician Personal 22 (WVR) 82 Attendant 3747P1801X Care Attendant Independent Laboratory Laboratories/Clinical Medical 23 LAB 69 (Billing 291U00000X Laboratory
20 PHYSICIAN (IND & GP) 39 Nephrology 207RN0300X Allopathic & Osteopathic Physicians/Internal Medicine, Nephrology LTX_Prov_ Specialty_ Desc LTX_Taxonomy_Desc 20 PHYSICIAN (IND & GP) 40 Hand Surgery 207XS0106X Allopathic & Osteopathic Physicians/Orthopaedic Surgery/Hand Surgery 20 PHYSICIAN (IND & GP) 41 Internal Medicine 207R00000X Allopathic & Osteopathic Physicians/Internal Medicine 20 PHYSICIAN (IND & GP) 48 Podiatry - Surgical Chiropody 213E00000X Podiatric Medicine and Surgery Providers - Podiatrists 20 PHYSICIAN (IND & GP) 49 (Admin. Medicine) 207R00000X Allopathic & Osteopathic Physicians/Internal Medicine 20 PHYSICIAN (IND & GP) 70 Clinic or Other Group Practice 193200000X Multi-Specialty Group 21 THIRD PARTY BILL 9U Medicare Advantage Plans NA NULL 21 THIRD PARTY BILL 9V OCDD - Point of Entry NA NULL 21 THIRD PARTY BILL 9W OAAS - Point of Entry NA NULL 21 THIRD PARTY BILL 9X OAD - Point of Entry NA NULL 21 THIRD PARTY BILL 9Y Juvenile Court/Drug Treatment Center NA NULL 21 THIRD PARTY BILL 9Z Other Contract with a State Agency NA NULL 22 PERSONAL CARE ATTENDANT (WVR) 82 Personal Care Attendant 3747P1801X Nursing Service Related Providers Technician Personal Care Attendant 23 LAB 69 Independent Laboratory (Billing 291U00000X Laboratories/Clinical Medical Laboratory
PIHP_CSoC_SystemsCompanionGuide-Sept2018_V12.docx