ND Medicaid Provider Taxonomy Listing-Individual

How to Search: Hold Control Key and Press F; Enter your search criteria (NPI #) in the upper right, Click NEXT in the search box

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1003006651 207V00000X 020 Physicians 016 OB/GYN

1003008525 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1003010570 207R00000X 020 Physicians 011 Internal Medicine

1003011396 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1003013020 2085R0202X 020 Physicians 167 Diagnostic Radiology

1003014499 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003015314 207Q00000X 020 Physicians 173 Family Medicine

1003017427 2084N0400X 020 Physicians 013 Neurology

1003017732 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1003018250 208G00000X 020 Physicians 033 Thoracic Surgery

1003027517 1223G0001X 012 Dental Providers 001 General Practice

1003027517 122300000X 012 Dental Providers 019 Dentists

1003027582 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1003038811 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1003044975 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1003045097 208600000X 020 Physicians 275 Surgery

1003045097 2086S0102X 020 Physicians 539 Surgical Critical Care

1003052556 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1003055864 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1003061367 2085R0202X 020 Physicians 167 Diagnostic Radiology

1003063751 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1003068941 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1003076894 207R00000X 020 Physicians 011 Internal Medicine

1003076894 207Q00000X 020 Physicians 173 Family Medicine

1003079112 2085R0202X 020 Physicians 167 Diagnostic Radiology

1003085523 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1003087081 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1003097973 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003098401 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1003100595 207R00000X 020 Physicians 011 Internal Medicine

1 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1003101049 207L00000X 020 Physicians 005 Anesthesiology

1003105958 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1003119785 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1003122151 207Q00000X 020 Physicians 173 Family Medicine

1003122987 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1003127903 207P00000X 020 Physicians 270 Emergency Medicine

1003128992 207P00000X 020 Physicians 270 Emergency Medicine

1003135013 207T00000X 020 Physicians 014 Neurological Surgery

1003146861 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1003149790 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1003151564 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003157371 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003168444 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003170952 207R00000X 020 Physicians 011 Internal Medicine

1003179425 207T00000X 020 Physicians 014 Neurological Surgery

1003179920 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003206731 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1003208232 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003211855 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1003211855 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1003222738 207T00000X 020 Physicians 014 Neurological Surgery

1003222878 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003225244 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1003237736 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1003242256 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1003252909 207V00000X 020 Physicians 016 OB/GYN

1003253634 207W00000X 020 Physicians 018 Ophthalmology

1003259854 2085R0202X 020 Physicians 167 Diagnostic Radiology

1003265752 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1003265752 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1003267394 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

2 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1003268764 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003271008 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1003271784 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003278243 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1003291840 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1003298316 207L00000X 020 Physicians 005 Anesthesiology

1003307182 1223G0001X 012 Dental Providers 001 General Practice

1003314196 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1003314196 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1003314261 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003334830 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1003345323 207P00000X 020 Physicians 270 Emergency Medicine

1003353889 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1003353889 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1003358755 1223P0221X 012 Dental Providers 063 Pedodontics

1003359779 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1003362427 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1003363151 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1003367327 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1003369851 2084P0800X 020 Physicians 121 Psychiatry

1003370149 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1003371782 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1003381054 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003383878 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003392887 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1003398389 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1003450305 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1003452822 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003462201 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1003468893 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1003468984 207Q00000X 020 Physicians 173 Family Medicine

3 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1003472317 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1003473752 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1003477894 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1003802430 208200000X 020 Physicians 024 Plastic Surgery

1003805730 1223G0001X 012 Dental Providers 001 General Practice

1003805730 122300000X 012 Dental Providers 019 Dentists

1003814484 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003829417 208G00000X 020 Physicians 033 Thoracic Surgery

1003833773 208000000X 020 Physicians 049 Pediatrics

1003834995 207V00000X 020 Physicians 016 OB/GYN

1003835984 207Q00000X 020 Physicians 173 Family Medicine

1003837220 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1003837964 207Q00000X 020 Physicians 173 Family Medicine

1003838590 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1003840687 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1003842162 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1003843574 208100000X 020 Physicians 025 Physical Medicine and Rehab

1003843640 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1003844648 207Q00000X 020 Physicians 173 Family Medicine

1003847971 207Q00000X 020 Physicians 173 Family Medicine

1003859117 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1003859117 1223G0001X 012 Dental Providers 001 General Practice

1003862756 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1003879545 207Q00000X 020 Physicians 173 Family Medicine

1003880402 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003880733 208M00000X 020 Physicians 344 Hospitalist

1003880865 207RC0200X 020 Physicians 206 Critical Care Medicine

1003881251 207L00000X 020 Physicians 005 Anesthesiology

1003881715 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003883703 207L00000X 020 Physicians 005 Anesthesiology

1003887076 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

4 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1003893355 207Y00000X 020 Physicians 217 Otolaryngology

1003893686 207ZH0000X 020 Physicians 560 Hematology; Pathology

1003893686 207ZP0101X 020 Physicians 436 Anatomic Pathology

1003893686 207ZP0101X 020 Physicians 022 Pathology

1003893686 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1003893769 207L00000X 020 Physicians 005 Anesthesiology

1003894171 207L00000X 020 Physicians 005 Anesthesiology

1003894312 208100000X 020 Physicians 025 Physical Medicine and Rehab

1003894312 2081S0010X 020 Physicians 548 Physical Medicine & Rehabilitation; Spor

1003894338 207L00000X 020 Physicians 005 Anesthesiology

1003894833 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003896515 207R00000X 020 Physicians 011 Internal Medicine

1003896515 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1003901356 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003902354 207X00000X 020 Physicians 020 Orthopedic Surgery

1003907809 207V00000X 020 Physicians 016 OB/GYN

1003907841 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1003908492 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1003913898 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1003914730 2084P0800X 020 Physicians 121 Psychiatry

1003923780 207RC0000X 020 Physicians 006 Cardiovascular Disease

1003928797 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003932344 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1003932518 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1003934878 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1003963042 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1003972571 111N00000X 011 Chiropractic Providers 047 Chiropractor

1003985243 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1003997230 207RC0200X 020 Physicians 206 Critical Care Medicine

1003999582 207Q00000X 020 Physicians 173 Family Medicine

1013001114 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

5 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013001114 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1013001114 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1013003540 207Q00000X 020 Physicians 173 Family Medicine

1013003755 207Q00000X 020 Physicians 173 Family Medicine

1013004969 208000000X 020 Physicians 049 Pediatrics

1013006253 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1013006253 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1013006253 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1013008655 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1013013424 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1013015783 208M00000X 020 Physicians 344 Hospitalist

1013015783 208000000X 020 Physicians 049 Pediatrics

1013016989 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1013016989 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1013028422 207Q00000X 020 Physicians 173 Family Medicine

1013030097 207P00000X 020 Physicians 270 Emergency Medicine

1013038942 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1013049683 207L00000X 020 Physicians 005 Anesthesiology

1013053982 2080P0210X 020 Physicians 232 Pediatric Nephrology

1013054063 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1013057959 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1013064807 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1013089937 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1013089937 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1013096049 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1013100973 208M00000X 020 Physicians 344 Hospitalist

1013124981 207Q00000X 020 Physicians 173 Family Medicine

1013125913 207T00000X 020 Physicians 014 Neurological Surgery

1013126325 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1013127687 122300000X 012 Dental Providers 019 Dentists

1013128222 207R00000X 020 Physicians 011 Internal Medicine

6 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013128222 207RI0011X 020 Physicians 188 Interventional Cardiology

1013128917 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1013131325 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1013141738 208000000X 020 Physicians 049 Pediatrics

1013141738 207R00000X 020 Physicians 011 Internal Medicine

1013144401 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1013144773 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013146836 207N00000X 020 Physicians 007 Dermatology

1013147263 2085R0202X 020 Physicians 167 Diagnostic Radiology

1013159664 208000000X 020 Physicians 049 Pediatrics

1013159664 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1013163922 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013163963 207V00000X 020 Physicians 016 OB/GYN

1013166925 207P00000X 020 Physicians 270 Emergency Medicine

1013171800 208600000X 020 Physicians 275 Surgery

1013171800 207RC0200X 020 Physicians 206 Critical Care Medicine

1013176759 207R00000X 020 Physicians 011 Internal Medicine

1013178326 207Q00000X 020 Physicians 173 Family Medicine

1013179241 208000000X 020 Physicians 049 Pediatrics

1013179407 2080P0202X 020 Physicians 221 Pediatric Cardiology

1013181130 207RI0200X 020 Physicians 185 Infectious Diseases

1013205947 2085R0202X 020 Physicians 167 Diagnostic Radiology

1013220490 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013220508 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013225614 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1013233436 207L00000X 020 Physicians 005 Anesthesiology

1013242270 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1013242999 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1013254994 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1013260850 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1013270503 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

7 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013270503 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013277664 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1013277987 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1013278977 208000000X 020 Physicians 049 Pediatrics

1013282425 207X00000X 020 Physicians 020 Orthopedic Surgery

1013282524 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013287473 207L00000X 020 Physicians 005 Anesthesiology

1013295260 208600000X 020 Physicians 275 Surgery

1013301217 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1013301217 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1013304435 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1013313535 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1013319193 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1013319334 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1013319607 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1013322387 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1013322387 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013326149 207L00000X 020 Physicians 005 Anesthesiology

1013326149 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1013332683 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1013342211 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1013343284 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013354018 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1013354018 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013356781 2085R0202X 020 Physicians 167 Diagnostic Radiology

1013357573 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1013360197 207Q00000X 020 Physicians 173 Family Medicine

1013375500 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1013395748 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013395839 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1013398445 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

8 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013402429 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1013413756 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013438936 2084P0800X 020 Physicians 121 Psychiatry

1013448778 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1013454818 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013461235 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1013472018 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1013482090 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1013483692 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013486166 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1013495324 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1013557669 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013559491 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013564624 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1013576883 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1013579424 207Q00000X 020 Physicians 173 Family Medicine

1013900505 208M00000X 020 Physicians 344 Hospitalist

1013900505 207PE0004X 020 Physicians 093 Emergency Medical Services

1013901768 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1013919638 111N00000X 011 Chiropractic Providers 047 Chiropractor

1013929371 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1013930833 364SP0807X 036 Phys Assts and Advanced Nursing Provs 629 Clinical Nurse Specialist Child&Adol

1013934017 207R00000X 020 Physicians 011 Internal Medicine

1013934652 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1013934652 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1013934785 207Q00000X 020 Physicians 173 Family Medicine

1013934793 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1013934793 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1013934975 207Q00000X 020 Physicians 173 Family Medicine

1013934975 207P00000X 020 Physicians 270 Emergency Medicine

1013935600 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

9 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013935667 207R00000X 020 Physicians 011 Internal Medicine

1013935667 207RH0003X 020 Physicians 179 Hematology/Oncology

1013935717 207RI0200X 020 Physicians 185 Infectious Diseases

1013935758 207Q00000X 020 Physicians 173 Family Medicine

1013935782 207Q00000X 020 Physicians 173 Family Medicine

1013938232 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1013938752 207RH0000X 020 Physicians 178 Hematology

1013938752 207RH0003X 020 Physicians 179 Hematology/Oncology

1013939693 207X00000X 020 Physicians 020 Orthopedic Surgery

1013948116 207RC0200X 020 Physicians 206 Critical Care Medicine

1013948116 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1013948116 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1013948116 207L00000X 020 Physicians 005 Anesthesiology

1013954080 208G00000X 020 Physicians 033 Thoracic Surgery

1013955848 207RG0100X 020 Physicians 010 Gastroenterology

1013957646 207L00000X 020 Physicians 005 Anesthesiology

1013958669 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013958883 2085R0202X 020 Physicians 167 Diagnostic Radiology

1013966837 207Q00000X 020 Physicians 173 Family Medicine

1013968981 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1013970482 207RG0100X 020 Physicians 010 Gastroenterology

1013970532 207R00000X 020 Physicians 011 Internal Medicine

1013978568 208600000X 020 Physicians 275 Surgery

1013981927 208000000X 020 Physicians 049 Pediatrics

1013982172 207P00000X 020 Physicians 270 Emergency Medicine

1013984012 207RC0000X 020 Physicians 006 Cardiovascular Disease

1013985001 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013989359 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1013990555 207P00000X 020 Physicians 270 Emergency Medicine

1013990555 207PE0004X 020 Physicians 093 Emergency Medical Services

1013994326 207RN0300X 020 Physicians 105 Nephrology

10 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1013994730 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1013994730 208000000X 020 Physicians 049 Pediatrics

1013995356 207RI0200X 020 Physicians 185 Infectious Diseases

1013996008 208M00000X 020 Physicians 344 Hospitalist

1013996008 207Q00000X 020 Physicians 173 Family Medicine

1013996008 207P00000X 020 Physicians 270 Emergency Medicine

1013996065 2085R0202X 020 Physicians 167 Diagnostic Radiology

1013997014 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1013997865 207RG0100X 020 Physicians 010 Gastroenterology

1013999572 208100000X 020 Physicians 025 Physical Medicine and Rehab

1023024213 207V00000X 020 Physicians 016 OB/GYN

1023030517 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023030517 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023030665 207Q00000X 020 Physicians 173 Family Medicine

1023030681 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1023034329 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1023035029 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1023035029 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1023036753 207P00000X 020 Physicians 270 Emergency Medicine

1023036753 207R00000X 020 Physicians 011 Internal Medicine

1023038007 2084N0400X 020 Physicians 013 Neurology

1023039245 2084N0400X 020 Physicians 013 Neurology

1023039369 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023051810 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1023051810 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1023054210 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1023057429 207Q00000X 020 Physicians 173 Family Medicine

1023057429 207P00000X 020 Physicians 270 Emergency Medicine

1023057767 207P00000X 020 Physicians 270 Emergency Medicine

1023058252 207ZP0101X 020 Physicians 022 Pathology

1023063328 111N00000X 011 Chiropractic Providers 047 Chiropractor

11 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023065182 207L00000X 020 Physicians 005 Anesthesiology

1023067204 207V00000X 020 Physicians 016 OB/GYN

1023068137 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1023073160 207L00000X 020 Physicians 005 Anesthesiology

1023075975 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1023075975 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023076064 208600000X 020 Physicians 275 Surgery

1023078862 207R00000X 020 Physicians 011 Internal Medicine

1023080389 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023080751 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1023083169 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1023083169 207ZP0101X 020 Physicians 022 Pathology

1023084605 208G00000X 020 Physicians 033 Thoracic Surgery

1023084605 208600000X 020 Physicians 275 Surgery

1023089414 207RC0000X 020 Physicians 006 Cardiovascular Disease

1023093580 207Q00000X 020 Physicians 173 Family Medicine

1023093770 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023094539 208000000X 020 Physicians 049 Pediatrics

1023094539 2080P0006X 020 Physicians 223 Pediatric Developmental & Beha

1023094737 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023094810 207L00000X 020 Physicians 005 Anesthesiology

1023095486 207T00000X 020 Physicians 014 Neurological Surgery

1023097078 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023097565 208600000X 020 Physicians 275 Surgery

1023097755 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023098316 207L00000X 020 Physicians 005 Anesthesiology

1023098316 207RC0200X 020 Physicians 206 Critical Care Medicine

1023098332 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023098837 207V00000X 020 Physicians 016 OB/GYN

1023099488 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023102118 207Y00000X 020 Physicians 217 Otolaryngology

12 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023104536 207RI0200X 020 Physicians 185 Infectious Diseases

1023109139 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023109253 207V00000X 020 Physicians 016 OB/GYN

1023115805 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023120482 207P00000X 020 Physicians 270 Emergency Medicine

1023124567 111N00000X 011 Chiropractic Providers 047 Chiropractor

1023141579 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023141579 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1023149655 111N00000X 011 Chiropractic Providers 047 Chiropractor

1023154879 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023161585 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023164845 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023171568 208100000X 020 Physicians 025 Physical Medicine and Rehab

1023182110 207Q00000X 020 Physicians 173 Family Medicine

1023191590 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1023192143 111N00000X 011 Chiropractic Providers 047 Chiropractor

1023211695 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1023224177 207V00000X 020 Physicians 016 OB/GYN

1023227162 2084N0400X 020 Physicians 013 Neurology

1023228772 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1023234135 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023236726 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023238508 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1023242567 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1023242641 207R00000X 020 Physicians 011 Internal Medicine

1023244977 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1023246022 207P00000X 020 Physicians 270 Emergency Medicine

1023246824 208M00000X 020 Physicians 344 Hospitalist

1023246915 208600000X 020 Physicians 275 Surgery

1023254398 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1023258472 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

13 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023268711 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023271020 1223P0221X 012 Dental Providers 063 Pedodontics

1023273273 208M00000X 020 Physicians 344 Hospitalist

1023274230 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1023274230 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1023284288 207R00000X 020 Physicians 011 Internal Medicine

1023295300 207RG0100X 020 Physicians 010 Gastroenterology

1023297348 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1023300688 207Q00000X 020 Physicians 173 Family Medicine

1023303112 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1023303112 208000000X 020 Physicians 049 Pediatrics

1023303112 207P00000X 020 Physicians 270 Emergency Medicine

1023303112 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1023308632 2080P0202X 020 Physicians 221 Pediatric Cardiology

1023308665 207P00000X 020 Physicians 270 Emergency Medicine

1023316874 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1023316874 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1023316874 101Y00000X 010 Behav Health & Social Svc Prov 152 Counselor

1023320009 207P00000X 020 Physicians 270 Emergency Medicine

1023320314 208600000X 020 Physicians 275 Surgery

1023329513 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023338282 2085R0202X 020 Physicians 167 Diagnostic Radiology

1023347796 111N00000X 011 Chiropractic Providers 047 Chiropractor

1023350949 207Q00000X 020 Physicians 173 Family Medicine

1023351061 207RG0100X 020 Physicians 010 Gastroenterology

1023363108 1223G0001X 012 Dental Providers 001 General Practice

1023363108 122300000X 012 Dental Providers 019 Dentists

1023363587 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1023370061 2084P0800X 020 Physicians 121 Psychiatry

1023370780 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1023371374 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

14 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023372265 122300000X 012 Dental Providers 019 Dentists

1023374352 207R00000X 020 Physicians 011 Internal Medicine

1023374964 207W00000X 020 Physicians 018 Ophthalmology

1023375292 207L00000X 020 Physicians 005 Anesthesiology

1023377397 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023378726 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1023390663 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023396900 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023397221 208M00000X 020 Physicians 344 Hospitalist

1023398898 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023400140 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1023406121 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1023411386 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1023412228 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1023412228 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1023422763 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1023422805 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023422805 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1023422805 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1023426459 207X00000X 020 Physicians 020 Orthopedic Surgery

1023431574 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1023432499 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1023439346 183500000X 018 Pharmacy 253 Pharmacist

1023440617 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1023440617 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1023451689 207P00000X 020 Physicians 270 Emergency Medicine

1023453255 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1023455029 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023455029 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023456985 207T00000X 020 Physicians 014 Neurological Surgery

1023459211 208000000X 020 Physicians 049 Pediatrics

15 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023461100 208000000X 020 Physicians 049 Pediatrics

1023461126 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1023469723 122300000X 012 Dental Providers 019 Dentists

1023473725 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1023487675 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1023487675 171M00000X 010 Behav Health & Social Svc Prov 489 Case Aide

1023491909 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023491909 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023494382 208M00000X 020 Physicians 344 Hospitalist

1023497112 207RP1001X 020 Physicians 029 Pulmonary Diseases

1023502069 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1023504073 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023511664 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023522489 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1023522489 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1023522489 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1023524451 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023524964 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023538451 122300000X 012 Dental Providers 019 Dentists

1023540804 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1023550951 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1023553492 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1023555174 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023560448 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1023564887 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1023568516 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023572625 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1023580453 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1023584919 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1023585833 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1023648557 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

16 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1023649860 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1023654787 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1023654845 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1023663598 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1023672540 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1033100045 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1033104120 207L00000X 020 Physicians 005 Anesthesiology

1033106091 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1033111315 207RI0011X 020 Physicians 188 Interventional Cardiology

1033115118 207X00000X 020 Physicians 020 Orthopedic Surgery

1033117247 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033123351 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033129598 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033130216 207T00000X 020 Physicians 014 Neurological Surgery

1033130372 208000000X 020 Physicians 049 Pediatrics

1033131628 207R00000X 020 Physicians 011 Internal Medicine

1033134374 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1033136031 207PE0004X 020 Physicians 093 Emergency Medical Services

1033136031 207P00000X 020 Physicians 270 Emergency Medicine

1033136676 204F00000X 020 Physicians 279 Transplant Surgery

1033136999 207Q00000X 020 Physicians 173 Family Medicine

1033137070 122300000X 012 Dental Providers 019 Dentists

1033137682 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033138789 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1033139324 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033140223 207SG0203X 020 Physicians 118 Clinical Molecular Genetics

1033141353 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033144597 208800000X 020 Physicians 034 Urology

1033146188 2080P0210X 020 Physicians 232 Pediatric Nephrology

1033146543 208G00000X 020 Physicians 033 Thoracic Surgery

1033147210 2084P0800X 020 Physicians 121 Psychiatry

17 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033148853 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1033148853 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1033149364 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1033149364 207ZP0101X 020 Physicians 022 Pathology

1033150024 207Q00000X 020 Physicians 173 Family Medicine

1033154760 207X00000X 020 Physicians 020 Orthopedic Surgery

1033155593 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1033167416 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033168364 207P00000X 020 Physicians 270 Emergency Medicine

1033174370 207ZH0000X 020 Physicians 560 Hematology; Pathology

1033178231 2084N0400X 020 Physicians 013 Neurology

1033178280 207V00000X 020 Physicians 016 OB/GYN

1033183520 207RC0000X 020 Physicians 006 Cardiovascular Disease

1033183702 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033188594 207T00000X 020 Physicians 014 Neurological Surgery

1033189949 207R00000X 020 Physicians 011 Internal Medicine

1033189949 207RN0300X 020 Physicians 105 Nephrology

1033191200 208600000X 020 Physicians 275 Surgery

1033195029 207X00000X 020 Physicians 020 Orthopedic Surgery

1033196944 207L00000X 020 Physicians 005 Anesthesiology

1033196944 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1033197744 208600000X 020 Physicians 275 Surgery

1033197744 204F00000X 020 Physicians 279 Transplant Surgery

1033198163 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033198684 207L00000X 020 Physicians 005 Anesthesiology

1033200837 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033206495 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1033210570 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1033216817 207Q00000X 020 Physicians 173 Family Medicine

1033217955 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1033220439 2085R0202X 020 Physicians 167 Diagnostic Radiology

18 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033221486 208G00000X 020 Physicians 033 Thoracic Surgery

1033222534 207V00000X 020 Physicians 016 OB/GYN

1033223094 122300000X 012 Dental Providers 019 Dentists

1033229521 122300000X 012 Dental Providers 019 Dentists

1033232608 207RG0100X 020 Physicians 010 Gastroenterology

1033238126 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1033243605 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033258520 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1033260146 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1033262506 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033274816 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1033280870 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033283379 2084N0400X 020 Physicians 013 Neurology

1033288154 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033293444 207RH0003X 020 Physicians 179 Hematology/Oncology

1033294392 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033302062 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1033302286 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1033305024 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033309638 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1033310255 208200000X 020 Physicians 024 Plastic Surgery

1033311089 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1033311139 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1033315718 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1033317854 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1033348545 207P00000X 020 Physicians 270 Emergency Medicine

1033352307 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1033352851 207RG0100X 020 Physicians 010 Gastroenterology

1033363627 208000000X 020 Physicians 049 Pediatrics

1033364013 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1033364013 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

19 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033369608 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033372321 207V00000X 020 Physicians 016 OB/GYN

1033374954 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1033379151 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033381231 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033384565 207P00000X 020 Physicians 270 Emergency Medicine

1033385174 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033395017 207P00000X 020 Physicians 270 Emergency Medicine

1033396437 207R00000X 020 Physicians 011 Internal Medicine

1033396437 208M00000X 020 Physicians 344 Hospitalist

1033397294 207L00000X 020 Physicians 005 Anesthesiology

1033398458 1223G0001X 012 Dental Providers 001 General Practice

1033400031 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033404108 207Q00000X 020 Physicians 173 Family Medicine

1033404546 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1033406228 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1033416771 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033417571 2085R0202X 020 Physicians 167 Diagnostic Radiology

1033419585 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1033420377 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1033421698 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1033424742 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033427760 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1033430780 207R00000X 020 Physicians 011 Internal Medicine

1033442678 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033442744 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033454319 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033456033 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033476569 207T00000X 020 Physicians 014 Neurological Surgery

1033477021 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1033477021 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

20 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033477021 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1033485842 207L00000X 020 Physicians 005 Anesthesiology

1033491576 208000000X 020 Physicians 049 Pediatrics

1033497169 208600000X 020 Physicians 275 Surgery

1033506308 207R00000X 020 Physicians 011 Internal Medicine

1033508411 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1033523907 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033525365 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1033525860 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033534631 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033535299 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033537105 207R00000X 020 Physicians 011 Internal Medicine

1033537105 208000000X 020 Physicians 049 Pediatrics

1033537295 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1033538194 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1033538822 207V00000X 020 Physicians 016 OB/GYN

1033539598 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033541610 207RN0300X 020 Physicians 105 Nephrology

1033544382 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033551114 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033551569 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033553409 208800000X 020 Physicians 034 Urology

1033554316 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1033555370 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1033556295 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033558523 207V00000X 020 Physicians 016 OB/GYN

1033559620 207RP1001X 020 Physicians 029 Pulmonary Diseases

1033559620 207R00000X 020 Physicians 011 Internal Medicine

1033565023 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033565601 207R00000X 020 Physicians 011 Internal Medicine

1033572698 207W00000X 020 Physicians 018 Ophthalmology

21 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033585401 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033591250 207L00000X 020 Physicians 005 Anesthesiology

1033591565 208600000X 020 Physicians 275 Surgery

1033591961 207P00000X 020 Physicians 270 Emergency Medicine

1033593025 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033598214 207RG0300X 020 Physicians 587 Internal Medicine; Geriatric Medicine

1033598214 207R00000X 020 Physicians 011 Internal Medicine

1033598560 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033600903 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1033602644 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1033603683 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033609698 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033624127 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033627039 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1033630231 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033631296 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1033631296 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1033631296 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033637897 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033639687 208600000X 020 Physicians 275 Surgery

1033639851 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1033645874 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033652433 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033655162 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1033657556 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033661509 111N00000X 011 Chiropractic Providers 047 Chiropractor

1033663414 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033664487 208M00000X 020 Physicians 344 Hospitalist

1033665310 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1033675574 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1033676010 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

22 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1033680517 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1033680517 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033680517 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1033687652 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033690458 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1033743133 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1033749924 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1033752530 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1033765995 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033770201 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1033771639 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1033772157 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1033779509 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1043216799 207V00000X 020 Physicians 016 OB/GYN

1043221880 111N00000X 011 Chiropractic Providers 047 Chiropractor

1043224348 207Q00000X 020 Physicians 173 Family Medicine

1043226939 207L00000X 020 Physicians 005 Anesthesiology

1043227630 207T00000X 020 Physicians 014 Neurological Surgery

1043228745 204F00000X 020 Physicians 279 Transplant Surgery

1043231269 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043231384 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1043237035 207RI0200X 020 Physicians 185 Infectious Diseases

1043237522 207Q00000X 020 Physicians 173 Family Medicine

1043240658 207V00000X 020 Physicians 016 OB/GYN

1043240914 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1043242290 207Q00000X 020 Physicians 173 Family Medicine

1043243041 208000000X 020 Physicians 049 Pediatrics

1043243314 207L00000X 020 Physicians 005 Anesthesiology

1043245277 207Q00000X 020 Physicians 173 Family Medicine

1043250087 207L00000X 020 Physicians 005 Anesthesiology

1043255755 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

23 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1043262629 207RC0000X 020 Physicians 006 Cardiovascular Disease

1043262694 2084P0800X 020 Physicians 121 Psychiatry

1043264567 207L00000X 020 Physicians 005 Anesthesiology

1043266224 207L00000X 020 Physicians 005 Anesthesiology

1043280027 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043280332 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1043280530 207X00000X 020 Physicians 020 Orthopedic Surgery

1043281397 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043282064 2085R0202X 020 Physicians 167 Diagnostic Radiology

1043282296 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1043282957 207X00000X 020 Physicians 020 Orthopedic Surgery

1043287311 2085P0229X 020 Physicians 241 Pediatric Radiology

1043290364 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043290869 208100000X 020 Physicians 025 Physical Medicine and Rehab

1043296056 208000000X 020 Physicians 049 Pediatrics

1043297633 207N00000X 020 Physicians 007 Dermatology

1043298169 207L00000X 020 Physicians 005 Anesthesiology

1043298227 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043298540 207T00000X 020 Physicians 014 Neurological Surgery

1043302474 207Q00000X 020 Physicians 173 Family Medicine

1043307697 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1043308372 207W00000X 020 Physicians 018 Ophthalmology

1043309065 207Q00000X 020 Physicians 173 Family Medicine

1043310188 2085R0202X 020 Physicians 167 Diagnostic Radiology

1043316524 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1043317829 207Q00000X 020 Physicians 173 Family Medicine

1043318264 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043321987 207RG0100X 020 Physicians 010 Gastroenterology

1043345705 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1043350366 2084N0400X 020 Physicians 013 Neurology

1043351810 207ZP0101X 020 Physicians 022 Pathology

24 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1043351810 207ZP0101X 020 Physicians 436 Anatomic Pathology

1043351810 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1043356405 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1043365984 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1043366917 207Q00000X 020 Physicians 173 Family Medicine

1043378912 207V00000X 020 Physicians 016 OB/GYN

1043382773 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1043404585 208M00000X 020 Physicians 344 Hospitalist

1043405756 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1043420722 207RG0100X 020 Physicians 010 Gastroenterology

1043424153 208000000X 020 Physicians 049 Pediatrics

1043426034 207RH0003X 020 Physicians 179 Hematology/Oncology

1043429087 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1043430010 207RC0200X 020 Physicians 206 Critical Care Medicine

1043430572 207RC0000X 020 Physicians 006 Cardiovascular Disease

1043430796 1223G0001X 012 Dental Providers 001 General Practice

1043439334 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1043441363 1223X0400X 012 Dental Providers 064 Orthodontics

1043442700 2084P0800X 020 Physicians 121 Psychiatry

1043447360 207N00000X 020 Physicians 007 Dermatology

1043453772 207V00000X 020 Physicians 016 OB/GYN

1043460686 2085R0202X 020 Physicians 167 Diagnostic Radiology

1043461536 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043462831 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1043465644 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1043467152 122300000X 012 Dental Providers 019 Dentists

1043470776 2085R0202X 020 Physicians 167 Diagnostic Radiology

1043474729 122300000X 012 Dental Providers 019 Dentists

1043476732 207RC0000X 020 Physicians 006 Cardiovascular Disease

1043479660 207V00000X 020 Physicians 016 OB/GYN

1043484710 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

25 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1043485634 2084P0800X 020 Physicians 121 Psychiatry

1043487846 207P00000X 020 Physicians 270 Emergency Medicine

1043489925 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1043501349 207L00000X 020 Physicians 005 Anesthesiology

1043508526 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043519796 207Q00000X 020 Physicians 173 Family Medicine

1043521685 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1043521685 208600000X 020 Physicians 275 Surgery

1043524465 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043529332 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043531023 207P00000X 020 Physicians 270 Emergency Medicine

1043539422 207XP3100X 020 Physicians 237 Pediatric Orthopedics

1043548548 207RC0000X 020 Physicians 006 Cardiovascular Disease

1043551773 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1043552672 207L00000X 020 Physicians 005 Anesthesiology

1043561673 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043565757 2084N0400X 020 Physicians 013 Neurology

1043565765 2085R0202X 020 Physicians 167 Diagnostic Radiology

1043566169 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043566607 208M00000X 020 Physicians 344 Hospitalist

1043566730 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043568611 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1043574460 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1043574460 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1043576853 208000000X 020 Physicians 049 Pediatrics

1043577729 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1043577729 208600000X 020 Physicians 275 Surgery

1043579329 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043599277 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1043599277 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043599327 208100000X 020 Physicians 025 Physical Medicine and Rehab

26 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1043601883 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043604218 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1043612609 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1043613680 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1043614050 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043615347 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043616519 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1043620271 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043634496 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1043635154 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043635360 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043643182 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043650302 207R00000X 020 Physicians 011 Internal Medicine

1043650302 208M00000X 020 Physicians 344 Hospitalist

1043654643 207Q00000X 020 Physicians 173 Family Medicine

1043658560 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1043658560 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1043660954 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1043661044 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043666530 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1043668817 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1043669310 122300000X 012 Dental Providers 019 Dentists

1043675705 111N00000X 011 Chiropractic Providers 047 Chiropractor

1043693849 207Q00000X 020 Physicians 173 Family Medicine

1043696420 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043696438 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1043696727 2084P0800X 020 Physicians 121 Psychiatry

1043698020 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1043699192 207R00000X 020 Physicians 011 Internal Medicine

1043702145 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1043706567 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

27 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1043707250 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1043709124 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1043716327 208800000X 020 Physicians 034 Urology

1043719735 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1043724206 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1043743784 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1043745573 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043745763 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1043745763 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1043745763 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1043746183 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1043746183 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1043759913 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043763220 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1043783574 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1043783996 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1043787815 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1043792476 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1043874316 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1053302026 207L00000X 020 Physicians 005 Anesthesiology

1053303123 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053307025 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1053307025 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053310243 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1053324418 207Q00000X 020 Physicians 173 Family Medicine

1053338913 207Q00000X 020 Physicians 173 Family Medicine

1053340117 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1053348755 207X00000X 020 Physicians 020 Orthopedic Surgery

1053349860 207RC0000X 020 Physicians 006 Cardiovascular Disease

1053349860 207RI0011X 020 Physicians 188 Interventional Cardiology

1053350504 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

28 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1053354514 207P00000X 020 Physicians 270 Emergency Medicine

1053354662 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053354738 208D00000X 020 Physicians 001 General Practice

1053358325 207L00000X 020 Physicians 005 Anesthesiology

1053359190 207P00000X 020 Physicians 270 Emergency Medicine

1053365122 207Q00000X 020 Physicians 173 Family Medicine

1053366153 111N00000X 011 Chiropractic Providers 047 Chiropractor

1053373373 207RC0000X 020 Physicians 006 Cardiovascular Disease

1053376780 2085R0202X 020 Physicians 167 Diagnostic Radiology

1053379230 207Q00000X 020 Physicians 173 Family Medicine

1053381798 207Q00000X 020 Physicians 173 Family Medicine

1053382143 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053385278 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053385468 1223X0400X 012 Dental Providers 064 Orthodontics

1053388777 207RG0100X 020 Physicians 010 Gastroenterology

1053388934 207RC0000X 020 Physicians 006 Cardiovascular Disease

1053389130 207RP1001X 020 Physicians 029 Pulmonary Diseases

1053389130 207RC0200X 020 Physicians 206 Critical Care Medicine

1053390849 2085R0202X 020 Physicians 167 Diagnostic Radiology

1053398347 208600000X 020 Physicians 275 Surgery

1053398909 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053399246 207RH0000X 020 Physicians 178 Hematology

1053399717 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053403485 207Q00000X 020 Physicians 173 Family Medicine

1053404756 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1053404806 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1053409086 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1053413708 2085R0202X 020 Physicians 167 Diagnostic Radiology

1053414631 208800000X 020 Physicians 034 Urology

1053417493 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1053417840 208600000X 020 Physicians 275 Surgery

29 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1053418400 122300000X 012 Dental Providers 019 Dentists

1053419903 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053422154 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1053423525 2085R0202X 020 Physicians 167 Diagnostic Radiology

1053425603 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1053453159 207R00000X 020 Physicians 011 Internal Medicine

1053456723 208000000X 020 Physicians 049 Pediatrics

1053465641 207NP0225X 020 Physicians 222 Pediatric Dermatology

1053468223 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1053474411 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1053474411 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053474882 122300000X 012 Dental Providers 019 Dentists

1053493494 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053496216 2084P0800X 020 Physicians 121 Psychiatry

1053497198 207RH0003X 020 Physicians 179 Hematology/Oncology

1053498824 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053505214 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1053507327 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1053509273 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053509273 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1053510982 1223G0001X 012 Dental Providers 001 General Practice

1053510982 122300000X 012 Dental Providers 019 Dentists

1053514844 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1053520643 1223G0001X 012 Dental Providers 001 General Practice

1053523613 207R00000X 020 Physicians 011 Internal Medicine

1053530345 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1053541292 2084N0400X 020 Physicians 013 Neurology

1053542357 208000000X 020 Physicians 049 Pediatrics

1053542357 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1053546937 207QG0300X 020 Physicians 586 Family Medicine; Geriatric Medicine

1053546937 207QH0002X 020 Physicians 590 Family Medicine; Hospice & Palliative Me

30 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1053546937 207RH0002X 020 Physicians 591 Internal Medicine; Hospice & Palliative

1053546937 207R00000X 020 Physicians 011 Internal Medicine

1053548107 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053548107 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1053548933 207P00000X 020 Physicians 270 Emergency Medicine

1053550228 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1053550434 2086S0102X 020 Physicians 539 Surgical Critical Care

1053550434 208600000X 020 Physicians 275 Surgery

1053559906 207RN0300X 020 Physicians 105 Nephrology

1053563957 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1053564278 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1053573287 2084N0400X 020 Physicians 013 Neurology

1053575142 208000000X 020 Physicians 049 Pediatrics

1053575803 1223P0221X 012 Dental Providers 063 Pedodontics

1053576454 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053577197 208800000X 020 Physicians 034 Urology

1053578005 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1053580092 207RN0300X 020 Physicians 105 Nephrology

1053581876 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1053585133 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053599407 207RC0000X 020 Physicians 006 Cardiovascular Disease

1053612697 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053615575 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1053620849 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1053625459 2084N0400X 020 Physicians 013 Neurology

1053631150 207L00000X 020 Physicians 005 Anesthesiology

1053639799 207L00000X 020 Physicians 005 Anesthesiology

1053644492 122300000X 012 Dental Providers 019 Dentists

1053644492 1223G0001X 012 Dental Providers 001 General Practice

1053648915 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1053674762 207P00000X 020 Physicians 270 Emergency Medicine

31 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1053678755 207RP1001X 020 Physicians 029 Pulmonary Diseases

1053685024 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053685719 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053689901 207R00000X 020 Physicians 011 Internal Medicine

1053692020 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1053692566 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1053693515 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1053702290 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1053714220 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1053718825 208M00000X 020 Physicians 344 Hospitalist

1053739458 207R00000X 020 Physicians 011 Internal Medicine

1053751743 207L00000X 020 Physicians 005 Anesthesiology

1053758300 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053761064 207R00000X 020 Physicians 011 Internal Medicine

1053763409 207Q00000X 020 Physicians 173 Family Medicine

1053774356 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1053775668 208600000X 020 Physicians 275 Surgery

1053780486 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053792838 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1053796490 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1053797647 183500000X 018 Pharmacy 253 Pharmacist

1053797936 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053799320 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1053802785 122300000X 012 Dental Providers 019 Dentists

1053803866 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1053806836 122300000X 012 Dental Providers 019 Dentists

1053806836 1223G0001X 012 Dental Providers 001 General Practice

1053807917 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1053814780 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1053814780 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1053814780 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

32 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1053821090 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1053823294 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1053823294 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1053825224 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053828202 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1053832006 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053849034 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1053849125 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1053849125 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1053854968 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1053868026 122300000X 012 Dental Providers 019 Dentists

1053896357 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1053897074 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1053955864 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1053957043 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1053976035 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1063040657 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1063052504 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063057222 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1063062693 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063064707 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1063400679 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063403665 208800000X 020 Physicians 034 Urology

1063404168 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1063414084 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063423895 2086S0102X 020 Physicians 539 Surgical Critical Care

1063423895 208600000X 020 Physicians 275 Surgery

1063430122 207Q00000X 020 Physicians 173 Family Medicine

1063430791 207RC0000X 020 Physicians 006 Cardiovascular Disease

1063430791 207R00000X 020 Physicians 011 Internal Medicine

1063434504 208G00000X 020 Physicians 033 Thoracic Surgery

33 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063434611 207R00000X 020 Physicians 011 Internal Medicine

1063434637 207W00000X 020 Physicians 018 Ophthalmology

1063439743 2080P0202X 020 Physicians 221 Pediatric Cardiology

1063439743 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1063442358 207P00000X 020 Physicians 270 Emergency Medicine

1063442804 208100000X 020 Physicians 025 Physical Medicine and Rehab

1063443729 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1063443976 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1063446557 207RP1001X 020 Physicians 029 Pulmonary Diseases

1063447910 2084P0800X 020 Physicians 121 Psychiatry

1063456218 207R00000X 020 Physicians 011 Internal Medicine

1063456218 208000000X 020 Physicians 049 Pediatrics

1063457000 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063460830 207Q00000X 020 Physicians 173 Family Medicine

1063461507 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063463032 207L00000X 020 Physicians 005 Anesthesiology

1063463966 207Q00000X 020 Physicians 173 Family Medicine

1063465995 207Q00000X 020 Physicians 173 Family Medicine

1063468130 208600000X 020 Physicians 275 Surgery

1063469336 2086S0129X 020 Physicians 289 Vascular Surgery

1063471506 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1063473122 2084N0400X 020 Physicians 013 Neurology

1063475283 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063476992 207P00000X 020 Physicians 270 Emergency Medicine

1063478170 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063478170 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1063481190 207RX0202X 020 Physicians 529 Medical Oncology

1063482297 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1063482388 208000000X 020 Physicians 049 Pediatrics

1063482438 111N00000X 011 Chiropractic Providers 047 Chiropractor

1063483436 207RC0000X 020 Physicians 006 Cardiovascular Disease

34 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063483436 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1063484061 2086S0129X 020 Physicians 289 Vascular Surgery

1063484095 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063485084 111N00000X 011 Chiropractic Providers 047 Chiropractor

1063485704 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063487684 207P00000X 020 Physicians 270 Emergency Medicine

1063489391 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1063490068 207L00000X 020 Physicians 005 Anesthesiology

1063491611 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1063491819 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063492759 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063499804 208D00000X 020 Physicians 001 General Practice

1063499879 207Q00000X 020 Physicians 173 Family Medicine

1063500791 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1063504496 207R00000X 020 Physicians 011 Internal Medicine

1063512895 207Q00000X 020 Physicians 173 Family Medicine

1063529881 208600000X 020 Physicians 275 Surgery

1063529881 207PE0004X 020 Physicians 093 Emergency Medical Services

1063534956 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063542371 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1063556520 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1063556652 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063556652 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1063565802 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063566685 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063568301 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1063573764 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1063581338 111N00000X 011 Chiropractic Providers 047 Chiropractor

1063588184 2084N0400X 020 Physicians 013 Neurology

1063596245 207V00000X 020 Physicians 016 OB/GYN

1063597698 2085R0202X 020 Physicians 167 Diagnostic Radiology

35 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063599108 207P00000X 020 Physicians 270 Emergency Medicine

1063599108 208000000X 020 Physicians 049 Pediatrics

1063599108 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1063599181 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1063606416 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1063613370 1223G0001X 012 Dental Providers 001 General Practice

1063614063 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1063615474 208000000X 020 Physicians 049 Pediatrics

1063615714 207Q00000X 020 Physicians 173 Family Medicine

1063619237 208800000X 020 Physicians 034 Urology

1063625275 207ZP0101X 020 Physicians 022 Pathology

1063632792 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1063638989 207RN0300X 020 Physicians 105 Nephrology

1063640100 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063644771 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1063649671 122300000X 012 Dental Providers 019 Dentists

1063649671 1223G0001X 012 Dental Providers 001 General Practice

1063652410 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063664829 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063671584 207Q00000X 020 Physicians 173 Family Medicine

1063672749 207Q00000X 020 Physicians 173 Family Medicine

1063673275 207RP1001X 020 Physicians 029 Pulmonary Diseases

1063682144 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063686186 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1063686186 208100000X 020 Physicians 025 Physical Medicine and Rehab

1063686186 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1063696425 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063697928 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1063705580 207RC0200X 020 Physicians 206 Critical Care Medicine

1063706562 207X00000X 020 Physicians 020 Orthopedic Surgery

1063708915 207X00000X 020 Physicians 020 Orthopedic Surgery

36 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063710457 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063711356 207P00000X 020 Physicians 270 Emergency Medicine

1063715449 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1063715449 207ZP0101X 020 Physicians 436 Anatomic Pathology

1063722767 207RN0300X 020 Physicians 105 Nephrology

1063724425 207RP1001X 020 Physicians 029 Pulmonary Diseases

1063724425 207RC0200X 020 Physicians 206 Critical Care Medicine

1063724458 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1063731180 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1063733947 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1063738649 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063738847 122300000X 012 Dental Providers 019 Dentists

1063752129 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063752806 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063765402 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1063766681 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1063768166 208M00000X 020 Physicians 344 Hospitalist

1063770063 207R00000X 020 Physicians 011 Internal Medicine

1063770063 208M00000X 020 Physicians 344 Hospitalist

1063779148 207L00000X 020 Physicians 005 Anesthesiology

1063785327 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063791853 207L00000X 020 Physicians 005 Anesthesiology

1063792844 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063797116 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1063798338 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1063799450 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063804326 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1063807790 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063814812 122300000X 012 Dental Providers 019 Dentists

1063817914 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1063820918 208M00000X 020 Physicians 344 Hospitalist

37 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063822062 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1063822062 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1063824266 207Q00000X 020 Physicians 173 Family Medicine

1063825685 2084P0800X 020 Physicians 121 Psychiatry

1063827202 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1063829869 208000000X 020 Physicians 049 Pediatrics

1063843290 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063846830 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1063851251 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1063853711 207Q00000X 020 Physicians 173 Family Medicine

1063856375 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063857233 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063859288 2085R0202X 020 Physicians 167 Diagnostic Radiology

1063867067 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1063870194 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063875656 207P00000X 020 Physicians 270 Emergency Medicine

1063881621 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1063881621 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1063881621 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1063881621 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1063883783 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1063891604 207P00000X 020 Physicians 270 Emergency Medicine

1063894293 208M00000X 020 Physicians 344 Hospitalist

1063895027 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1063896439 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063898948 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1063901122 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063913259 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1063926533 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1063936813 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1063936821 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

38 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1063937472 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1063937472 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1063937472 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1063942050 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1063946960 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1063948263 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1063948263 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1063948388 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1063963171 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1063963171 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1063963171 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1063966711 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1063968121 208600000X 020 Physicians 275 Surgery

1063974541 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1063979540 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1063998169 207Q00000X 020 Physicians 173 Family Medicine

1073003687 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1073003778 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1073004412 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073005161 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1073009981 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073024873 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1073025805 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1073025805 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1073027470 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1073033973 2084P0800X 020 Physicians 121 Psychiatry

1073038436 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1073038576 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1073038576 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1073061560 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1073064168 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

39 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073065538 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073066676 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1073087318 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073088597 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1073089355 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1073089439 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073091757 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073150520 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1073153565 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1073158408 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1073171864 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073174538 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073502357 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073502357 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1073506499 111N00000X 011 Chiropractic Providers 047 Chiropractor

1073506648 208G00000X 020 Physicians 033 Thoracic Surgery

1073507372 208000000X 020 Physicians 049 Pediatrics

1073512422 208G00000X 020 Physicians 033 Thoracic Surgery

1073512885 208600000X 020 Physicians 275 Surgery

1073513982 207Q00000X 020 Physicians 173 Family Medicine

1073515466 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1073516266 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073521738 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073523783 1223G0001X 012 Dental Providers 001 General Practice

1073524344 111N00000X 011 Chiropractic Providers 047 Chiropractor

1073530515 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073530549 207R00000X 020 Physicians 011 Internal Medicine

1073531646 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1073531711 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073533139 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073535563 207Q00000X 020 Physicians 173 Family Medicine

40 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073535662 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073537197 208D00000X 020 Physicians 001 General Practice

1073544995 207V00000X 020 Physicians 016 OB/GYN

1073545117 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073547014 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073553541 2084N0400X 020 Physicians 013 Neurology

1073557278 207RH0003X 020 Physicians 179 Hematology/Oncology

1073557278 207R00000X 020 Physicians 011 Internal Medicine

1073558110 207ZP0101X 020 Physicians 022 Pathology

1073559134 207RC0000X 020 Physicians 006 Cardiovascular Disease

1073564696 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073568648 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073570743 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073573044 207RG0100X 020 Physicians 010 Gastroenterology

1073573630 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073573721 208600000X 020 Physicians 275 Surgery

1073579306 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1073582375 207V00000X 020 Physicians 016 OB/GYN

1073586269 208600000X 020 Physicians 275 Surgery

1073586707 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1073587085 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073587473 207RG0100X 020 Physicians 010 Gastroenterology

1073587689 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073592556 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1073592614 207N00000X 020 Physicians 007 Dermatology

1073592986 207Y00000X 020 Physicians 217 Otolaryngology

1073593844 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1073593877 2080P0202X 020 Physicians 221 Pediatric Cardiology

1073596813 207RX0202X 020 Physicians 529 Medical Oncology

1073599320 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1073602793 208M00000X 020 Physicians 344 Hospitalist

41 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073603700 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1073603940 207Q00000X 020 Physicians 173 Family Medicine

1073604146 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1073605408 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073606505 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073609681 2085P0229X 020 Physicians 241 Pediatric Radiology

1073611711 208000000X 020 Physicians 049 Pediatrics

1073612552 208100000X 020 Physicians 025 Physical Medicine and Rehab

1073620837 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1073624177 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1073631503 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1073636213 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073648044 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073663357 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1073667135 208M00000X 020 Physicians 344 Hospitalist

1073672481 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073672614 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073682902 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1073684122 207RN0300X 020 Physicians 105 Nephrology

1073685913 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1073685913 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073690012 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1073690012 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1073697157 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1073698700 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1073700225 208G00000X 020 Physicians 033 Thoracic Surgery

1073702361 208M00000X 020 Physicians 344 Hospitalist

1073703690 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1073704623 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1073705596 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073706677 207P00000X 020 Physicians 270 Emergency Medicine

42 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073718169 207P00000X 020 Physicians 270 Emergency Medicine

1073720983 207Q00000X 020 Physicians 173 Family Medicine

1073728903 208100000X 020 Physicians 025 Physical Medicine and Rehab

1073730685 207X00000X 020 Physicians 020 Orthopedic Surgery

1073750501 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1073757456 207P00000X 020 Physicians 270 Emergency Medicine

1073760237 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073760674 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1073777389 122300000X 012 Dental Providers 019 Dentists

1073778874 208000000X 020 Physicians 049 Pediatrics

1073779138 208M00000X 020 Physicians 344 Hospitalist

1073779138 208000000X 020 Physicians 049 Pediatrics

1073779831 207RN0300X 020 Physicians 105 Nephrology

1073780375 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1073780375 207R00000X 020 Physicians 011 Internal Medicine

1073784476 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1073795928 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073811287 207R00000X 020 Physicians 011 Internal Medicine

1073811287 208M00000X 020 Physicians 344 Hospitalist

1073812715 2085R0202X 020 Physicians 167 Diagnostic Radiology

1073816641 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073817201 208000000X 020 Physicians 049 Pediatrics

1073825089 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073837506 2082S0105X 020 Physicians 256 Plastic Surgery Hand Surgery

1073837506 208200000X 020 Physicians 024 Plastic Surgery

1073841227 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073843074 207RN0300X 020 Physicians 105 Nephrology

1073843074 207R00000X 020 Physicians 011 Internal Medicine

1073843587 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1073855276 207V00000X 020 Physicians 016 OB/GYN

1073856100 207P00000X 020 Physicians 270 Emergency Medicine

43 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073871141 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073871166 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1073876371 207L00000X 020 Physicians 005 Anesthesiology

1073877577 207L00000X 020 Physicians 005 Anesthesiology

1073877999 207RC0200X 020 Physicians 206 Critical Care Medicine

1073881918 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073882734 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073883773 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1073886511 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073901666 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1073907531 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1073910253 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073917480 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073919205 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073919544 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073919726 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1073928586 207Q00000X 020 Physicians 173 Family Medicine

1073930574 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073935219 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1073935623 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1073952024 208000000X 020 Physicians 049 Pediatrics

1073952024 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1073956041 207R00000X 020 Physicians 011 Internal Medicine

1073960050 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073966115 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1073966776 208M00000X 020 Physicians 344 Hospitalist

1073966776 207R00000X 020 Physicians 011 Internal Medicine

1073966867 122300000X 012 Dental Providers 019 Dentists

1073968194 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1073971321 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1073972949 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

44 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1073974168 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1073975199 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1073975199 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1073980660 183500000X 018 Pharmacy 253 Pharmacist

1073981908 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1073985966 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083001929 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1083017370 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083018550 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1083018790 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083020499 2084P0800X 020 Physicians 121 Psychiatry

1083020499 2084N0400X 020 Physicians 013 Neurology

1083021059 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083022198 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083023733 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1083046916 207R00000X 020 Physicians 011 Internal Medicine

1083049431 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083051072 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083051866 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1083052948 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1083053482 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1083053482 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1083053995 2080P0202X 020 Physicians 221 Pediatric Cardiology

1083054449 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1083056592 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1083064323 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083064380 207P00000X 020 Physicians 270 Emergency Medicine

1083069983 208M00000X 020 Physicians 344 Hospitalist

1083069983 207R00000X 020 Physicians 011 Internal Medicine

1083070932 208800000X 020 Physicians 034 Urology

1083072466 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

45 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1083074173 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1083076681 207P00000X 020 Physicians 270 Emergency Medicine

1083078281 207P00000X 020 Physicians 270 Emergency Medicine

1083090112 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083090112 364SF0001X 036 Phys Assts and Advanced Nursing Provs 619 Clinical Nurse Specialist Family Health

1083097976 208M00000X 020 Physicians 344 Hospitalist

1083100036 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083100036 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1083101604 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1083104830 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1083111892 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1083122154 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1083133433 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083134159 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1083137756 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083142665 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083143580 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083143580 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083144851 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083168959 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1083172142 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1083172969 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1083182174 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083188783 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1083244909 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1083257737 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1083257737 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1083258289 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1083278543 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1083604748 207RP1001X 020 Physicians 029 Pulmonary Diseases

1083605026 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

46 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1083610810 208100000X 020 Physicians 025 Physical Medicine and Rehab

1083611511 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1083619522 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083620306 208000000X 020 Physicians 049 Pediatrics

1083623193 207T00000X 020 Physicians 014 Neurological Surgery

1083624241 208D00000X 020 Physicians 001 General Practice

1083630974 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1083632673 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1083632939 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083634521 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083637086 207P00000X 020 Physicians 270 Emergency Medicine

1083638738 208600000X 020 Physicians 275 Surgery

1083639397 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083640833 207Q00000X 020 Physicians 173 Family Medicine

1083643308 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1083643498 207Q00000X 020 Physicians 173 Family Medicine

1083646988 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1083646988 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1083648075 207RX0202X 020 Physicians 529 Medical Oncology

1083654792 207Q00000X 020 Physicians 173 Family Medicine

1083657035 207R00000X 020 Physicians 011 Internal Medicine

1083661649 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083662985 207P00000X 020 Physicians 270 Emergency Medicine

1083663967 207Q00000X 020 Physicians 173 Family Medicine

1083665913 208000000X 020 Physicians 049 Pediatrics

1083671572 208600000X 020 Physicians 275 Surgery

1083673719 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083675441 2084P0800X 020 Physicians 121 Psychiatry

1083675730 207L00000X 020 Physicians 005 Anesthesiology

1083675987 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083686489 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

47 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1083686810 207V00000X 020 Physicians 016 OB/GYN

1083689236 207L00000X 020 Physicians 005 Anesthesiology

1083689475 207RG0100X 020 Physicians 010 Gastroenterology

1083689483 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083690689 2084P0800X 020 Physicians 121 Psychiatry

1083691083 207RR0500X 020 Physicians 267 Rheumatology

1083692081 207R00000X 020 Physicians 011 Internal Medicine

1083692388 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083693642 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083694269 207ND0900X 020 Physicians 260 Dermatopathology

1083694574 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1083694608 2086S0120X 020 Physicians 245 Pediatric Surgery

1083695365 207L00000X 020 Physicians 005 Anesthesiology

1083696512 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1083700348 207V00000X 020 Physicians 016 OB/GYN

1083705206 207R00000X 020 Physicians 011 Internal Medicine

1083710610 207Q00000X 020 Physicians 173 Family Medicine

1083710800 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1083720114 1223G0001X 012 Dental Providers 001 General Practice

1083725014 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083734172 2084P0800X 020 Physicians 121 Psychiatry

1083739700 2080P0202X 020 Physicians 221 Pediatric Cardiology

1083748750 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1083750541 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1083760706 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083769855 207RG0100X 020 Physicians 010 Gastroenterology

1083788012 111N00000X 011 Chiropractic Providers 047 Chiropractor

1083793061 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083806061 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1083811236 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1083813182 2085R0202X 020 Physicians 167 Diagnostic Radiology

48 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1083815914 2080P0202X 020 Physicians 221 Pediatric Cardiology

1083819585 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1083820971 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083835003 207YP0228X 020 Physicians 140 Pediatric Otolaryngology

1083838403 207P00000X 020 Physicians 270 Emergency Medicine

1083838403 207Q00000X 020 Physicians 173 Family Medicine

1083838411 207Q00000X 020 Physicians 173 Family Medicine

1083844146 204F00000X 020 Physicians 279 Transplant Surgery

1083847685 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1083856884 208000000X 020 Physicians 049 Pediatrics

1083865620 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1083866339 208M00000X 020 Physicians 344 Hospitalist

1083870935 208000000X 020 Physicians 049 Pediatrics

1083872733 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083876361 207V00000X 020 Physicians 016 OB/GYN

1083877187 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083881510 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1083881510 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1083887236 111N00000X 011 Chiropractic Providers 047 Chiropractor

1083891899 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1083892095 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1083900971 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083901490 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1083904056 207V00000X 020 Physicians 016 OB/GYN

1083904569 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1083904866 207L00000X 020 Physicians 005 Anesthesiology

1083909733 208000000X 020 Physicians 049 Pediatrics

1083910863 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083921639 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1083931455 2085R0202X 020 Physicians 167 Diagnostic Radiology

1083937270 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

49 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1083937270 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1083948749 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1083958003 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1083971808 208000000X 020 Physicians 049 Pediatrics

1083973630 208100000X 020 Physicians 025 Physical Medicine and Rehab

1083973762 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1083981567 207X00000X 020 Physicians 020 Orthopedic Surgery

1083992002 208000000X 020 Physicians 049 Pediatrics

1083998371 208M00000X 020 Physicians 344 Hospitalist

1083999544 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1093001042 207P00000X 020 Physicians 270 Emergency Medicine

1093003212 208000000X 020 Physicians 049 Pediatrics

1093003212 208M00000X 020 Physicians 344 Hospitalist

1093003279 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1093005639 2084P0800X 020 Physicians 121 Psychiatry

1093005902 207X00000X 020 Physicians 020 Orthopedic Surgery

1093005902 207XP3100X 020 Physicians 237 Pediatric Orthopedics

1093019366 111N00000X 011 Chiropractic Providers 047 Chiropractor

1093020950 207X00000X 020 Physicians 020 Orthopedic Surgery

1093026270 208000000X 020 Physicians 049 Pediatrics

1093028334 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093028920 207RG0100X 020 Physicians 010 Gastroenterology

1093029076 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093035867 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1093040404 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1093040404 208000000X 020 Physicians 049 Pediatrics

1093052029 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1093060949 207P00000X 020 Physicians 270 Emergency Medicine

1093061988 207RR0500X 020 Physicians 267 Rheumatology

1093061988 207R00000X 020 Physicians 011 Internal Medicine

1093065823 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

50 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093078479 207Q00000X 020 Physicians 173 Family Medicine

1093088122 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1093093619 207RH0003X 020 Physicians 179 Hematology/Oncology

1093096406 207RN0300X 020 Physicians 105 Nephrology

1093113144 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093118424 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1093129512 122300000X 012 Dental Providers 019 Dentists

1093133043 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093134462 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093134462 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1093144818 208600000X 020 Physicians 275 Surgery

1093144818 208000000X 020 Physicians 049 Pediatrics

1093150716 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1093150716 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1093156457 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1093159055 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093159899 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1093172074 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093184657 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1093192494 208000000X 020 Physicians 049 Pediatrics

1093201402 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093201840 183500000X 018 Pharmacy 253 Pharmacist

1093203721 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1093213183 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1093213183 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1093219685 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093220089 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093226904 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1093226904 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1093233165 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093236267 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

51 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093236572 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093240533 207R00000X 020 Physicians 011 Internal Medicine

1093242471 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1093242646 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1093245094 207Q00000X 020 Physicians 173 Family Medicine

1093256588 111N00000X 011 Chiropractic Providers 047 Chiropractor

1093261968 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1093264996 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1093267346 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1093270597 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1093289241 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093291239 207Q00000X 020 Physicians 173 Family Medicine

1093292815 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093355026 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1093358152 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1093367799 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093369316 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093377301 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093700437 111N00000X 011 Chiropractic Providers 047 Chiropractor

1093700783 2080P0202X 020 Physicians 221 Pediatric Cardiology

1093703167 207W00000X 020 Physicians 018 Ophthalmology

1093703829 207L00000X 020 Physicians 005 Anesthesiology

1093703944 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093711566 207Q00000X 020 Physicians 173 Family Medicine

1093712630 207V00000X 020 Physicians 016 OB/GYN

1093714172 208100000X 020 Physicians 025 Physical Medicine and Rehab

1093714172 2084N0400X 020 Physicians 013 Neurology

1093714172 2084S0012X 020 Physicians 521 Sleep Medicine

1093714172 2084P2900X 020 Physicians 570 Psychiatry & Neurology; Pain Medicine

1093714800 207RG0100X 020 Physicians 010 Gastroenterology

1093714800 207R00000X 020 Physicians 011 Internal Medicine

52 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093714800 208M00000X 020 Physicians 344 Hospitalist

1093717001 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093725483 207RG0100X 020 Physicians 010 Gastroenterology

1093729519 207P00000X 020 Physicians 270 Emergency Medicine

1093732547 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1093733693 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1093734683 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093736217 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1093744120 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093744377 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093745382 207L00000X 020 Physicians 005 Anesthesiology

1093745572 208D00000X 020 Physicians 001 General Practice

1093745572 207Q00000X 020 Physicians 173 Family Medicine

1093746877 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093753956 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093753956 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093756736 2084P0800X 020 Physicians 121 Psychiatry

1093757791 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1093758617 207P00000X 020 Physicians 270 Emergency Medicine

1093761363 207PE0004X 020 Physicians 093 Emergency Medical Services

1093762056 207L00000X 020 Physicians 005 Anesthesiology

1093763062 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093763542 208600000X 020 Physicians 275 Surgery

1093767097 207R00000X 020 Physicians 011 Internal Medicine

1093767378 207L00000X 020 Physicians 005 Anesthesiology

1093769291 207V00000X 020 Physicians 016 OB/GYN

1093769580 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093770810 207R00000X 020 Physicians 011 Internal Medicine

1093770810 207RC0000X 020 Physicians 006 Cardiovascular Disease

1093771834 207L00000X 020 Physicians 005 Anesthesiology

1093773954 208800000X 020 Physicians 034 Urology

53 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093773954 2088P0231X 020 Physicians 246 Pediatric Urology

1093774499 207Q00000X 020 Physicians 173 Family Medicine

1093775900 207P00000X 020 Physicians 270 Emergency Medicine

1093775900 207Q00000X 020 Physicians 173 Family Medicine

1093776585 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1093777443 2085N0700X 020 Physicians 204 Neuroradiology

1093777443 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093778524 207R00000X 020 Physicians 011 Internal Medicine

1093778524 208000000X 020 Physicians 049 Pediatrics

1093782575 2084N0400X 020 Physicians 013 Neurology

1093788168 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1093788291 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093788689 208100000X 020 Physicians 025 Physical Medicine and Rehab

1093791048 208600000X 020 Physicians 275 Surgery

1093791048 204F00000X 020 Physicians 279 Transplant Surgery

1093792269 207RN0300X 020 Physicians 105 Nephrology

1093793234 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093799603 207Q00000X 020 Physicians 173 Family Medicine

1093799603 207P00000X 020 Physicians 270 Emergency Medicine

1093800344 207L00000X 020 Physicians 005 Anesthesiology

1093801359 207RH0003X 020 Physicians 179 Hematology/Oncology

1093807182 2084P0800X 020 Physicians 121 Psychiatry

1093807786 207X00000X 020 Physicians 020 Orthopedic Surgery

1093809329 2086S0120X 020 Physicians 245 Pediatric Surgery

1093810467 207P00000X 020 Physicians 270 Emergency Medicine

1093811473 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1093813677 111N00000X 011 Chiropractic Providers 047 Chiropractor

1093813743 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1093815011 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093815011 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093815300 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

54 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093819153 208800000X 020 Physicians 034 Urology

1093820730 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093824773 207Q00000X 020 Physicians 173 Family Medicine

1093825408 207VE0102X 020 Physicians 530 Reproductive Endocrinology

1093837197 207L00000X 020 Physicians 005 Anesthesiology

1093838617 208200000X 020 Physicians 024 Plastic Surgery

1093844383 207Q00000X 020 Physicians 173 Family Medicine

1093847360 2080P0202X 020 Physicians 221 Pediatric Cardiology

1093851842 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1093851859 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1093857146 207R00000X 020 Physicians 011 Internal Medicine

1093857633 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1093858607 208600000X 020 Physicians 275 Surgery

1093859613 207Y00000X 020 Physicians 217 Otolaryngology

1093867541 111N00000X 011 Chiropractic Providers 047 Chiropractor

1093869711 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1093870537 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1093886137 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093889479 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093898751 207W00000X 020 Physicians 018 Ophthalmology

1093902413 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1093909756 207RI0200X 020 Physicians 185 Infectious Diseases

1093912743 207V00000X 020 Physicians 016 OB/GYN

1093919342 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1093931990 122300000X 012 Dental Providers 019 Dentists

1093932212 2084N0400X 020 Physicians 013 Neurology

1093932709 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1093932709 208000000X 020 Physicians 049 Pediatrics

1093940736 207R00000X 020 Physicians 011 Internal Medicine

1093940843 207R00000X 020 Physicians 011 Internal Medicine

1093941858 207P00000X 020 Physicians 270 Emergency Medicine

55 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1093943656 207V00000X 020 Physicians 016 OB/GYN

1093945925 208G00000X 020 Physicians 033 Thoracic Surgery

1093945925 208600000X 020 Physicians 275 Surgery

1093953366 207R00000X 020 Physicians 011 Internal Medicine

1093955593 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093958803 207RC0000X 020 Physicians 006 Cardiovascular Disease

1093961906 208000000X 020 Physicians 049 Pediatrics

1093968695 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1093968695 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1093977209 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1093979882 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1093979882 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1093984221 2085R0202X 020 Physicians 167 Diagnostic Radiology

1093984221 2085P0229X 020 Physicians 241 Pediatric Radiology

1093988230 207L00000X 020 Physicians 005 Anesthesiology

1093988537 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1093991499 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1093992638 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1104000124 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1104008424 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1104016567 207P00000X 020 Physicians 270 Emergency Medicine

1104024488 2084N0400X 020 Physicians 013 Neurology

1104025113 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1104026731 207RP1001X 020 Physicians 029 Pulmonary Diseases

1104026731 207RC0200X 020 Physicians 206 Critical Care Medicine

1104033968 2084N0400X 020 Physicians 013 Neurology

1104035781 207T00000X 020 Physicians 014 Neurological Surgery

1104035955 207R00000X 020 Physicians 011 Internal Medicine

1104035955 207RN0300X 020 Physicians 105 Nephrology

1104037621 208G00000X 020 Physicians 033 Thoracic Surgery

1104042092 2084P0800X 020 Physicians 121 Psychiatry

56 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104043710 2080P0202X 020 Physicians 221 Pediatric Cardiology

1104051101 208600000X 020 Physicians 275 Surgery

1104051721 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1104054477 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104058254 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1104059492 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1104060904 207RI0200X 020 Physicians 185 Infectious Diseases

1104065499 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104067867 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104068303 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1104072172 208000000X 020 Physicians 049 Pediatrics

1104072685 207RC0000X 020 Physicians 006 Cardiovascular Disease

1104074483 208600000X 020 Physicians 275 Surgery

1104082288 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1104096569 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1104104736 207V00000X 020 Physicians 016 OB/GYN

1104108166 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1104110253 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1104110832 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1104114800 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1104116169 207L00000X 020 Physicians 005 Anesthesiology

1104116722 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1104116722 208000000X 020 Physicians 049 Pediatrics

1104117456 122300000X 012 Dental Providers 019 Dentists

1104119551 207R00000X 020 Physicians 011 Internal Medicine

1104123298 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1104123298 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104131853 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104132554 207RR0500X 020 Physicians 267 Rheumatology

1104137181 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104137405 207RC0000X 020 Physicians 006 Cardiovascular Disease

57 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104139484 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1104140714 207P00000X 020 Physicians 270 Emergency Medicine

1104142066 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1104142389 208800000X 020 Physicians 034 Urology

1104142678 207V00000X 020 Physicians 016 OB/GYN

1104152412 207RC0000X 020 Physicians 006 Cardiovascular Disease

1104155175 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1104159003 183500000X 018 Pharmacy 253 Pharmacist

1104166560 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104167402 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104168368 207RG0100X 020 Physicians 010 Gastroenterology

1104182526 207P00000X 020 Physicians 270 Emergency Medicine

1104182757 207R00000X 020 Physicians 011 Internal Medicine

1104182757 208M00000X 020 Physicians 344 Hospitalist

1104183326 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1104188689 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104189497 207P00000X 020 Physicians 270 Emergency Medicine

1104195031 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104205160 2084N0400X 020 Physicians 013 Neurology

1104225580 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1104231455 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1104231505 2084P0800X 020 Physicians 121 Psychiatry

1104231901 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104231992 2084P0800X 020 Physicians 121 Psychiatry

1104232362 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1104241868 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104245281 207P00000X 020 Physicians 270 Emergency Medicine

1104246693 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104249507 207Q00000X 020 Physicians 173 Family Medicine

1104249507 208M00000X 020 Physicians 344 Hospitalist

1104250109 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

58 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104250141 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104250141 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1104250141 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1104259720 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104262872 207P00000X 020 Physicians 270 Emergency Medicine

1104266618 207R00000X 020 Physicians 011 Internal Medicine

1104266618 207RN0300X 020 Physicians 105 Nephrology

1104271345 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104275320 122300000X 012 Dental Providers 019 Dentists

1104290634 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1104291921 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1104302348 207Q00000X 020 Physicians 173 Family Medicine

1104304195 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1104307149 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104307362 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1104307362 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1104317189 122300000X 012 Dental Providers 019 Dentists

1104328038 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104334564 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104335728 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1104344159 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1104356229 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1104360486 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104362219 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104364116 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1104378884 207X00000X 020 Physicians 020 Orthopedic Surgery

1104382365 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104388644 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1104388644 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1104389550 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1104399849 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

59 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104460476 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1104467174 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1104479534 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104488162 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1104802032 2080P0202X 020 Physicians 221 Pediatric Cardiology

1104804343 2085P0229X 020 Physicians 241 Pediatric Radiology

1104804848 207RC0000X 020 Physicians 006 Cardiovascular Disease

1104805522 207RR0500X 020 Physicians 267 Rheumatology

1104806231 207V00000X 020 Physicians 016 OB/GYN

1104806728 207R00000X 020 Physicians 011 Internal Medicine

1104807858 207Q00000X 020 Physicians 173 Family Medicine

1104809367 207R00000X 020 Physicians 011 Internal Medicine

1104809367 207RG0100X 020 Physicians 010 Gastroenterology

1104809367 2085U0001X 020 Physicians 583 Radiology; Diagnostic Ultrasound

1104811504 207X00000X 020 Physicians 020 Orthopedic Surgery

1104811678 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1104813583 207V00000X 020 Physicians 016 OB/GYN

1104814425 207W00000X 020 Physicians 018 Ophthalmology

1104814789 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1104828284 207P00000X 020 Physicians 270 Emergency Medicine

1104830298 207P00000X 020 Physicians 270 Emergency Medicine

1104833920 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104837251 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1104841501 207P00000X 020 Physicians 270 Emergency Medicine

1104844752 208600000X 020 Physicians 275 Surgery

1104844802 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104852185 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104853928 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1104858612 2084P0800X 020 Physicians 121 Psychiatry

1104860782 2084P0800X 020 Physicians 121 Psychiatry

1104861350 207RC0000X 020 Physicians 006 Cardiovascular Disease

60 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104864362 207P00000X 020 Physicians 270 Emergency Medicine

1104865716 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1104865716 207L00000X 020 Physicians 005 Anesthesiology

1104866847 207Q00000X 020 Physicians 173 Family Medicine

1104867316 207Y00000X 020 Physicians 217 Otolaryngology

1104875004 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104877059 207RC0000X 020 Physicians 006 Cardiovascular Disease

1104878990 2080P0202X 020 Physicians 221 Pediatric Cardiology

1104882935 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1104885763 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1104886654 207W00000X 020 Physicians 018 Ophthalmology

1104887504 207VH0002X 020 Physicians 545 Hospice and Palliative Medicine

1104890250 207P00000X 020 Physicians 270 Emergency Medicine

1104890250 207PE0004X 020 Physicians 093 Emergency Medical Services

1104890524 2085P0229X 020 Physicians 241 Pediatric Radiology

1104890607 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1104892108 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1104898303 2085R0202X 020 Physicians 167 Diagnostic Radiology

1104898360 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1104902121 207Q00000X 020 Physicians 173 Family Medicine

1104912849 207R00000X 020 Physicians 011 Internal Medicine

1104913045 208000000X 020 Physicians 049 Pediatrics

1104917111 207Q00000X 020 Physicians 173 Family Medicine

1104917905 207Q00000X 020 Physicians 173 Family Medicine

1104927268 111N00000X 011 Chiropractic Providers 047 Chiropractor

1104933068 207P00000X 020 Physicians 270 Emergency Medicine

1104933878 208600000X 020 Physicians 275 Surgery

1104945336 207RC0000X 020 Physicians 006 Cardiovascular Disease

1104945336 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1104947001 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1104947001 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

61 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1104947001 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1104962299 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1104963099 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1104972173 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1104990191 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1104994631 207R00000X 020 Physicians 011 Internal Medicine

1104996941 1223G0001X 012 Dental Providers 001 General Practice

1114014578 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114015542 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1114018678 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1114025855 2084P0800X 020 Physicians 121 Psychiatry

1114034287 208600000X 020 Physicians 275 Surgery

1114048378 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114049475 208M00000X 020 Physicians 344 Hospitalist

1114049475 207R00000X 020 Physicians 011 Internal Medicine

1114055860 207RH0003X 020 Physicians 179 Hematology/Oncology

1114058468 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1114091410 207R00000X 020 Physicians 011 Internal Medicine

1114095064 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1114100260 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114105004 207R00000X 020 Physicians 011 Internal Medicine

1114106820 207T00000X 020 Physicians 014 Neurological Surgery

1114110103 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1114110566 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1114112539 208600000X 020 Physicians 275 Surgery

1114112810 207R00000X 020 Physicians 011 Internal Medicine

1114112810 207RC0200X 020 Physicians 206 Critical Care Medicine

1114116753 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1114124708 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114129103 207L00000X 020 Physicians 005 Anesthesiology

1114129129 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

62 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1114132818 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1114138237 207RI0200X 020 Physicians 185 Infectious Diseases

1114155603 207RH0000X 020 Physicians 178 Hematology

1114155603 207RH0003X 020 Physicians 179 Hematology/Oncology

1114156072 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1114157609 208800000X 020 Physicians 034 Urology

1114168754 207RC0000X 020 Physicians 006 Cardiovascular Disease

1114173093 208000000X 020 Physicians 049 Pediatrics

1114173093 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1114173259 207P00000X 020 Physicians 270 Emergency Medicine

1114185154 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1114188406 207RP1001X 020 Physicians 029 Pulmonary Diseases

1114190493 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114197472 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1114198983 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114199106 208000000X 020 Physicians 049 Pediatrics

1114199106 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1114203114 207P00000X 020 Physicians 270 Emergency Medicine

1114205978 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114214822 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114220175 111N00000X 011 Chiropractic Providers 047 Chiropractor

1114226958 207R00000X 020 Physicians 011 Internal Medicine

1114234986 207R00000X 020 Physicians 011 Internal Medicine

1114239084 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1114242443 2084P0800X 020 Physicians 121 Psychiatry

1114246113 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114247228 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1114251063 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1114252129 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1114259348 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1114269297 208M00000X 020 Physicians 344 Hospitalist

63 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1114277068 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1114281540 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1114282936 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114283173 207ZP0213X 020 Physicians 238 Pediatric Pathology

1114287521 207RC0000X 020 Physicians 006 Cardiovascular Disease

1114288768 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114288933 207Q00000X 020 Physicians 173 Family Medicine

1114291267 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1114293891 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1114293941 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1114308657 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114309028 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114314093 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114314358 207Q00000X 020 Physicians 173 Family Medicine

1114318631 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1114321528 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114331055 208M00000X 020 Physicians 344 Hospitalist

1114336088 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1114339413 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1114346384 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1114347499 208000000X 020 Physicians 049 Pediatrics

1114349610 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114370210 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1114370707 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1114370707 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1114370814 207R00000X 020 Physicians 011 Internal Medicine

1114371937 208M00000X 020 Physicians 344 Hospitalist

1114381779 208000000X 020 Physicians 049 Pediatrics

1114381845 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1114395399 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114395654 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

64 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1114396785 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1114405230 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114410990 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1114430519 122300000X 012 Dental Providers 019 Dentists

1114434834 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1114454923 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1114461258 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1114461340 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114461340 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114467081 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1114470051 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1114474871 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114493780 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1114494226 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1114495207 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1114548096 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1114580701 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1114586559 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114589348 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114902186 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1114904224 207P00000X 020 Physicians 270 Emergency Medicine

1114904976 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1114906583 2084N0400X 020 Physicians 013 Neurology

1114906872 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114908159 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114910239 207Y00000X 020 Physicians 217 Otolaryngology

1114910791 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114915535 207RP1001X 020 Physicians 029 Pulmonary Diseases

1114917788 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1114921640 207P00000X 020 Physicians 270 Emergency Medicine

1114938131 207P00000X 020 Physicians 270 Emergency Medicine

65 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1114939113 207RG0100X 020 Physicians 010 Gastroenterology

1114944071 207R00000X 020 Physicians 011 Internal Medicine

1114944113 207Q00000X 020 Physicians 173 Family Medicine

1114944881 207L00000X 020 Physicians 005 Anesthesiology

1114945797 207Q00000X 020 Physicians 173 Family Medicine

1114945847 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1114948452 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1114949773 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1114951431 207Q00000X 020 Physicians 173 Family Medicine

1114951951 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1114952454 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1114953031 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1114953031 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1114956471 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1114956471 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1114963485 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1114964780 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1114966751 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1114968534 207X00000X 020 Physicians 020 Orthopedic Surgery

1114968674 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114972221 207Q00000X 020 Physicians 173 Family Medicine

1114974987 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1114976552 207L00000X 020 Physicians 005 Anesthesiology

1114978335 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1114984093 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1114985454 207RC0000X 020 Physicians 006 Cardiovascular Disease

1114987146 207R00000X 020 Physicians 011 Internal Medicine

1114987245 207R00000X 020 Physicians 011 Internal Medicine

1114987997 207RC0000X 020 Physicians 006 Cardiovascular Disease

1114989555 208600000X 020 Physicians 275 Surgery

1114991908 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

66 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1114993292 2085R0202X 020 Physicians 167 Diagnostic Radiology

1114993847 208M00000X 020 Physicians 344 Hospitalist

1114997442 207L00000X 020 Physicians 005 Anesthesiology

1114999265 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1114999265 207RC0000X 020 Physicians 006 Cardiovascular Disease

1124003660 2085R0202X 020 Physicians 167 Diagnostic Radiology

1124004130 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1124005491 2084P0800X 020 Physicians 121 Psychiatry

1124005905 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1124006242 207RG0100X 020 Physicians 010 Gastroenterology

1124008016 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124008057 208600000X 020 Physicians 275 Surgery

1124008453 207L00000X 020 Physicians 005 Anesthesiology

1124023882 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1124024724 2084P0800X 020 Physicians 121 Psychiatry

1124028394 207R00000X 020 Physicians 011 Internal Medicine

1124038344 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124040712 207Q00000X 020 Physicians 173 Family Medicine

1124042213 207P00000X 020 Physicians 270 Emergency Medicine

1124043229 207RR0500X 020 Physicians 267 Rheumatology

1124043468 207R00000X 020 Physicians 011 Internal Medicine

1124043583 122300000X 012 Dental Providers 019 Dentists

1124043583 1223G0001X 012 Dental Providers 001 General Practice

1124044334 2084N0400X 020 Physicians 013 Neurology

1124045117 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124045125 207Q00000X 020 Physicians 173 Family Medicine

1124045760 207V00000X 020 Physicians 016 OB/GYN

1124045810 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1124046016 207X00000X 020 Physicians 020 Orthopedic Surgery

1124049341 207V00000X 020 Physicians 016 OB/GYN

1124049465 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

67 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1124053285 207RH0003X 020 Physicians 179 Hematology/Oncology

1124054424 207R00000X 020 Physicians 011 Internal Medicine

1124054424 207RC0200X 020 Physicians 206 Critical Care Medicine

1124062096 2085R0202X 020 Physicians 167 Diagnostic Radiology

1124064431 2084P0800X 020 Physicians 121 Psychiatry

1124064431 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1124065529 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1124066766 207Q00000X 020 Physicians 173 Family Medicine

1124068978 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1124068978 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1124075619 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124077912 2085R0202X 020 Physicians 167 Diagnostic Radiology

1124078027 207T00000X 020 Physicians 014 Neurological Surgery

1124080015 208600000X 020 Physicians 275 Surgery

1124081658 207Q00000X 020 Physicians 173 Family Medicine

1124084652 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124084942 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1124085600 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124089677 208600000X 020 Physicians 275 Surgery

1124090642 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1124090642 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1124097027 207Q00000X 020 Physicians 173 Family Medicine

1124105978 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124116843 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1124120571 2085R0202X 020 Physicians 167 Diagnostic Radiology

1124120571 2085N0700X 020 Physicians 204 Neuroradiology

1124124623 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1124125901 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1124127733 207V00000X 020 Physicians 016 OB/GYN

1124128756 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1124135264 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

68 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1124135629 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124137955 111N00000X 011 Chiropractic Providers 047 Chiropractor

1124162169 2084N0400X 020 Physicians 013 Neurology

1124163282 207L00000X 020 Physicians 005 Anesthesiology

1124197728 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1124199278 207R00000X 020 Physicians 011 Internal Medicine

1124204177 2086S0102X 020 Physicians 539 Surgical Critical Care

1124204946 207VX0201X 020 Physicians 307 Gynecologic Oncology

1124214366 207P00000X 020 Physicians 270 Emergency Medicine

1124218664 208800000X 020 Physicians 034 Urology

1124219043 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1124220462 2080P0202X 020 Physicians 221 Pediatric Cardiology

1124221502 207X00000X 020 Physicians 020 Orthopedic Surgery

1124222351 207Q00000X 020 Physicians 173 Family Medicine

1124222351 207P00000X 020 Physicians 270 Emergency Medicine

1124222351 208M00000X 020 Physicians 344 Hospitalist

1124224753 208D00000X 020 Physicians 001 General Practice

1124228630 207V00000X 020 Physicians 016 OB/GYN

1124230024 207P00000X 020 Physicians 270 Emergency Medicine

1124247424 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1124249743 207Q00000X 020 Physicians 173 Family Medicine

1124251541 207R00000X 020 Physicians 011 Internal Medicine

1124266325 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1124275391 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1124280649 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1124280649 208200000X 020 Physicians 024 Plastic Surgery

1124281043 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1124282215 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1124283148 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1124283296 2080P0202X 020 Physicians 221 Pediatric Cardiology

1124299417 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

69 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1124307285 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1124310735 207W00000X 020 Physicians 018 Ophthalmology

1124330345 207P00000X 020 Physicians 270 Emergency Medicine

1124338496 207RR0500X 020 Physicians 267 Rheumatology

1124342662 208000000X 020 Physicians 049 Pediatrics

1124342662 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1124344858 2085R0202X 020 Physicians 167 Diagnostic Radiology

1124353206 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1124358395 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1124359922 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1124364914 111N00000X 011 Chiropractic Providers 047 Chiropractor

1124365911 111N00000X 011 Chiropractic Providers 047 Chiropractor

1124366216 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124376389 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1124376389 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1124376611 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1124379128 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124381405 1223G0001X 012 Dental Providers 001 General Practice

1124381405 122300000X 012 Dental Providers 019 Dentists

1124381470 207Q00000X 020 Physicians 173 Family Medicine

1124383021 208M00000X 020 Physicians 344 Hospitalist

1124383021 207R00000X 020 Physicians 011 Internal Medicine

1124387071 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124406988 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1124409495 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1124409917 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124411038 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124411780 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1124414172 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1124418793 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1124421201 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

70 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1124421391 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1124432885 207SG0202X 020 Physicians 083 Clinical Biochemical Genetics

1124439369 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124449467 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1124450556 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1124464771 208000000X 020 Physicians 049 Pediatrics

1124467741 2084P0800X 020 Physicians 121 Psychiatry

1124470711 207P00000X 020 Physicians 270 Emergency Medicine

1124476049 207Q00000X 020 Physicians 173 Family Medicine

1124478565 207Q00000X 020 Physicians 173 Family Medicine

1124486691 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1124487038 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124499603 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124513668 122300000X 012 Dental Providers 019 Dentists

1124517511 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1124524657 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1124526470 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1124530860 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1124539291 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1124557103 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1124557566 207Q00000X 020 Physicians 173 Family Medicine

1124557640 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1124577861 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1124588314 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1124659677 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1124660899 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124661442 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1124665013 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1124669189 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1124669221 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1124677406 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

71 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1124687694 207Q00000X 020 Physicians 173 Family Medicine

1124689104 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1124689104 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134105117 207X00000X 020 Physicians 020 Orthopedic Surgery

1134105596 208600000X 020 Physicians 275 Surgery

1134106339 207W00000X 020 Physicians 018 Ophthalmology

1134107030 207N00000X 020 Physicians 007 Dermatology

1134109630 207V00000X 020 Physicians 016 OB/GYN

1134111750 207X00000X 020 Physicians 020 Orthopedic Surgery

1134114259 207W00000X 020 Physicians 018 Ophthalmology

1134115165 207RG0100X 020 Physicians 010 Gastroenterology

1134116775 207R00000X 020 Physicians 011 Internal Medicine

1134116999 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1134117401 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1134118748 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134123003 208600000X 020 Physicians 275 Surgery

1134123565 207W00000X 020 Physicians 018 Ophthalmology

1134124019 207R00000X 020 Physicians 011 Internal Medicine

1134124019 207VH0002X 020 Physicians 545 Hospice and Palliative Medicine

1134125917 207V00000X 020 Physicians 016 OB/GYN

1134127327 207L00000X 020 Physicians 005 Anesthesiology

1134129042 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134136799 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1134141708 207RX0202X 020 Physicians 529 Medical Oncology

1134141708 207RH0003X 020 Physicians 179 Hematology/Oncology

1134146129 2086S0129X 020 Physicians 289 Vascular Surgery

1134147713 207RH0003X 020 Physicians 179 Hematology/Oncology

1134147713 2086X0206X 020 Physicians 276 Surgical Oncology

1134147713 207RX0202X 020 Physicians 529 Medical Oncology

1134147861 207V00000X 020 Physicians 016 OB/GYN

1134149552 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

72 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134149602 208000000X 020 Physicians 049 Pediatrics

1134152218 207N00000X 020 Physicians 007 Dermatology

1134152879 207Q00000X 020 Physicians 173 Family Medicine

1134154438 207X00000X 020 Physicians 020 Orthopedic Surgery

1134157233 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1134157233 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1134159791 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1134161706 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1134161797 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1134162118 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1134162118 207RG0100X 020 Physicians 010 Gastroenterology

1134164502 208M00000X 020 Physicians 344 Hospitalist

1134168685 207R00000X 020 Physicians 011 Internal Medicine

1134170228 207P00000X 020 Physicians 270 Emergency Medicine

1134171853 111N00000X 011 Chiropractic Providers 047 Chiropractor

1134173974 2085R0202X 020 Physicians 167 Diagnostic Radiology

1134176779 207Q00000X 020 Physicians 173 Family Medicine

1134176779 208D00000X 020 Physicians 001 General Practice

1134178072 208000000X 020 Physicians 049 Pediatrics

1134182355 207Q00000X 020 Physicians 173 Family Medicine

1134184252 207V00000X 020 Physicians 016 OB/GYN

1134186216 207L00000X 020 Physicians 005 Anesthesiology

1134188121 207Q00000X 020 Physicians 173 Family Medicine

1134188592 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1134189160 2086S0129X 020 Physicians 289 Vascular Surgery

1134189970 208000000X 020 Physicians 049 Pediatrics

1134193048 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1134196298 207P00000X 020 Physicians 270 Emergency Medicine

1134197569 207Q00000X 020 Physicians 173 Family Medicine

1134198161 207V00000X 020 Physicians 016 OB/GYN

1134202559 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

73 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134202559 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1134203805 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134208572 208100000X 020 Physicians 025 Physical Medicine and Rehab

1134210214 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134210214 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134211568 207Q00000X 020 Physicians 173 Family Medicine

1134211931 2085R0202X 020 Physicians 167 Diagnostic Radiology

1134212533 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1134213671 207R00000X 020 Physicians 011 Internal Medicine

1134214307 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1134214307 2085R0202X 020 Physicians 167 Diagnostic Radiology

1134215387 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1134217748 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1134217748 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1134218258 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1134221427 207Y00000X 020 Physicians 217 Otolaryngology

1134225436 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134225436 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134227895 207Q00000X 020 Physicians 173 Family Medicine

1134230972 2084P0800X 020 Physicians 121 Psychiatry

1134244882 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1134253248 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1134256241 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1134262843 208G00000X 020 Physicians 033 Thoracic Surgery

1134270689 111N00000X 011 Chiropractic Providers 047 Chiropractor

1134278344 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134291669 122300000X 012 Dental Providers 019 Dentists

1134304868 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1134307390 208600000X 020 Physicians 275 Surgery

1134307390 2086S0127X 020 Physicians 633 Trauma Surgery

1134309289 207P00000X 020 Physicians 270 Emergency Medicine

74 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134310899 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134312416 207W00000X 020 Physicians 018 Ophthalmology

1134316060 207R00000X 020 Physicians 011 Internal Medicine

1134318488 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1134321136 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134321789 207X00000X 020 Physicians 020 Orthopedic Surgery

1134322332 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1134327901 208600000X 020 Physicians 275 Surgery

1134327901 2086S0120X 020 Physicians 245 Pediatric Surgery

1134329592 207R00000X 020 Physicians 011 Internal Medicine

1134336340 207R00000X 020 Physicians 011 Internal Medicine

1134336340 207RN0300X 020 Physicians 105 Nephrology

1134336696 1223G0001X 012 Dental Providers 001 General Practice

1134345366 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134348436 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134354418 207RP1001X 020 Physicians 029 Pulmonary Diseases

1134356025 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1134358476 122300000X 012 Dental Providers 019 Dentists

1134360704 207RG0100X 020 Physicians 010 Gastroenterology

1134369259 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1134382104 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1134383078 122300000X 012 Dental Providers 019 Dentists

1134383227 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134389299 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1134390412 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1134390941 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134391899 207RH0003X 020 Physicians 179 Hematology/Oncology

1134392533 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1134393135 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1134400534 207RI0200X 020 Physicians 185 Infectious Diseases

1134404908 2085R0202X 020 Physicians 167 Diagnostic Radiology

75 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134411093 208000000X 020 Physicians 049 Pediatrics

1134411093 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1134411176 207R00000X 020 Physicians 011 Internal Medicine

1134411192 208000000X 020 Physicians 049 Pediatrics

1134411192 208M00000X 020 Physicians 344 Hospitalist

1134417140 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134417272 207Q00000X 020 Physicians 173 Family Medicine

1134418163 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1134418288 208000000X 020 Physicians 049 Pediatrics

1134428899 208000000X 020 Physicians 049 Pediatrics

1134428899 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1134431059 207R00000X 020 Physicians 011 Internal Medicine

1134433634 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1134433857 207Q00000X 020 Physicians 173 Family Medicine

1134437353 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1134442312 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1134448020 207R00000X 020 Physicians 011 Internal Medicine

1134449630 207R00000X 020 Physicians 011 Internal Medicine

1134454879 208M00000X 020 Physicians 344 Hospitalist

1134455835 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1134456783 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1134462716 2085N0700X 020 Physicians 204 Neuroradiology

1134468192 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134468192 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1134474810 2086S0102X 020 Physicians 539 Surgical Critical Care

1134475734 207ZD0900X 020 Physicians 581 Pathology; Dermatopathology

1134499783 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1134504426 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134504913 208M00000X 020 Physicians 344 Hospitalist

1134505050 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1134505761 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

76 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134508054 2085N0700X 020 Physicians 204 Neuroradiology

1134508484 208M00000X 020 Physicians 344 Hospitalist

1134508484 207R00000X 020 Physicians 011 Internal Medicine

1134508484 207Q00000X 020 Physicians 173 Family Medicine

1134510852 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1134522428 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134528144 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134530637 111N00000X 011 Chiropractic Providers 047 Chiropractor

1134538085 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134538770 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134538911 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1134539315 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134540024 207RI0200X 020 Physicians 185 Infectious Diseases

1134543556 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134547318 207P00000X 020 Physicians 270 Emergency Medicine

1134551112 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134552763 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134555857 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1134561798 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1134566821 2084N0400X 020 Physicians 013 Neurology

1134572092 207Q00000X 020 Physicians 173 Family Medicine

1134572092 207R00000X 020 Physicians 011 Internal Medicine

1134576655 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1134578016 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134578537 207Q00000X 020 Physicians 173 Family Medicine

1134579139 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1134582042 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1134582042 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1134583446 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1134599905 1223G0001X 012 Dental Providers 001 General Practice

1134611544 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

77 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1134615180 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1134619687 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1134646938 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1134647530 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1134647530 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134664048 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1134665003 208600000X 020 Physicians 275 Surgery

1134665219 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1134673353 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1134678675 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1134685373 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1134687874 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1134749831 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1134766561 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1134774110 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1134781321 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1134786213 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1134787146 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144200437 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1144206806 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144207309 208800000X 020 Physicians 034 Urology

1144207325 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144208364 207R00000X 020 Physicians 011 Internal Medicine

1144209008 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144209057 207L00000X 020 Physicians 005 Anesthesiology

1144209057 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1144209198 207R00000X 020 Physicians 011 Internal Medicine

1144215088 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1144224403 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144237280 207V00000X 020 Physicians 016 OB/GYN

1144240029 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

78 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1144240029 207P00000X 020 Physicians 270 Emergency Medicine

1144240532 207X00000X 020 Physicians 020 Orthopedic Surgery

1144241357 207P00000X 020 Physicians 270 Emergency Medicine

1144241480 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144242587 208000000X 020 Physicians 049 Pediatrics

1144242587 207R00000X 020 Physicians 011 Internal Medicine

1144242637 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144243247 207P00000X 020 Physicians 270 Emergency Medicine

1144247008 208M00000X 020 Physicians 344 Hospitalist

1144247008 207Q00000X 020 Physicians 173 Family Medicine

1144247750 207RN0300X 020 Physicians 105 Nephrology

1144248295 207L00000X 020 Physicians 005 Anesthesiology

1144250226 208G00000X 020 Physicians 033 Thoracic Surgery

1144251190 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144255423 111N00000X 011 Chiropractic Providers 047 Chiropractor

1144255985 111N00000X 011 Chiropractic Providers 047 Chiropractor

1144262320 207X00000X 020 Physicians 020 Orthopedic Surgery

1144264714 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144265513 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1144268566 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1144269374 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1144274176 208000000X 020 Physicians 049 Pediatrics

1144274176 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1144276973 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1144279555 207X00000X 020 Physicians 020 Orthopedic Surgery

1144280280 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144281825 207R00000X 020 Physicians 011 Internal Medicine

1144291014 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1144291352 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1144291451 207ZP0101X 020 Physicians 022 Pathology

1144292780 208G00000X 020 Physicians 033 Thoracic Surgery

79 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1144292780 207ZB0001X 020 Physicians 563 Blood Banking & Transfusion Medicine

1144294208 207N00000X 020 Physicians 007 Dermatology

1144294216 207P00000X 020 Physicians 270 Emergency Medicine

1144294620 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144296542 207P00000X 020 Physicians 270 Emergency Medicine

1144311093 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1144312570 207Q00000X 020 Physicians 173 Family Medicine

1144315441 207Q00000X 020 Physicians 173 Family Medicine

1144317744 207Q00000X 020 Physicians 173 Family Medicine

1144321134 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1144323700 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1144326349 111N00000X 011 Chiropractic Providers 047 Chiropractor

1144333022 208000000X 020 Physicians 049 Pediatrics

1144337593 2080P0210X 020 Physicians 232 Pediatric Nephrology

1144376385 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1144377631 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1144377946 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144380866 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1144390089 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1144391608 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144391608 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144401845 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144413105 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1144413428 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1144418492 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144425323 207R00000X 020 Physicians 011 Internal Medicine

1144427055 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144427931 2084P0800X 020 Physicians 121 Psychiatry

1144428285 207RN0300X 020 Physicians 105 Nephrology

1144430679 122300000X 012 Dental Providers 019 Dentists

1144431909 1223X0400X 012 Dental Providers 064 Orthodontics

80 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1144453762 208000000X 020 Physicians 049 Pediatrics

1144453762 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1144455932 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144457730 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144462037 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1144464223 208600000X 020 Physicians 275 Surgery

1144465311 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144466111 207R00000X 020 Physicians 011 Internal Medicine

1144466111 207RC0000X 020 Physicians 006 Cardiovascular Disease

1144480971 2085R0202X 020 Physicians 167 Diagnostic Radiology

1144484494 207L00000X 020 Physicians 005 Anesthesiology

1144487505 1223G0001X 012 Dental Providers 001 General Practice

1144487505 122300000X 012 Dental Providers 019 Dentists

1144488198 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1144488198 207ZP0101X 020 Physicians 022 Pathology

1144491523 207W00000X 020 Physicians 018 Ophthalmology

1144499187 207RC0000X 020 Physicians 006 Cardiovascular Disease

1144505231 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1144510389 207Q00000X 020 Physicians 173 Family Medicine

1144515537 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1144516360 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1144519372 208100000X 020 Physicians 025 Physical Medicine and Rehab

1144526740 208000000X 020 Physicians 049 Pediatrics

1144528258 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1144531203 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1144541533 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1144541723 208G00000X 020 Physicians 033 Thoracic Surgery

1144548553 207L00000X 020 Physicians 005 Anesthesiology

1144560517 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144568767 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144568767 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

81 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1144571308 207P00000X 020 Physicians 270 Emergency Medicine

1144572041 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1144580424 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1144587031 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1144587031 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1144588302 208800000X 020 Physicians 034 Urology

1144592486 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1144592486 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144595828 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144604158 207Q00000X 020 Physicians 173 Family Medicine

1144605486 208M00000X 020 Physicians 344 Hospitalist

1144610700 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144613803 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144619859 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1144619859 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1144620287 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1144621228 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1144637182 208000000X 020 Physicians 049 Pediatrics

1144641036 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1144642893 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144648643 208600000X 020 Physicians 275 Surgery

1144653114 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1144659715 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1144662339 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1144662719 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144662719 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144665027 208000000X 020 Physicians 049 Pediatrics

1144671645 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1144671736 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1144672783 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1144673674 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

82 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1144673674 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144704792 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1144711532 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1144728577 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1144739798 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1144740184 208M00000X 020 Physicians 344 Hospitalist

1144747114 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144763483 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1144767385 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1144773649 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1144784000 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1144871922 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1144874108 122300000X 012 Dental Providers 019 Dentists

1144876103 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154300226 207RX0202X 020 Physicians 529 Medical Oncology

1154300226 207RH0003X 020 Physicians 179 Hematology/Oncology

1154300861 207K00000X 020 Physicians 003 Allergy & Immunology

1154300929 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154305324 207ZP0213X 020 Physicians 238 Pediatric Pathology

1154309953 207P00000X 020 Physicians 270 Emergency Medicine

1154313419 207W00000X 020 Physicians 018 Ophthalmology

1154319911 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1154329589 111N00000X 011 Chiropractic Providers 047 Chiropractor

1154331320 207RC0000X 020 Physicians 006 Cardiovascular Disease

1154337400 207Q00000X 020 Physicians 173 Family Medicine

1154341147 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1154341147 208000000X 020 Physicians 049 Pediatrics

1154343705 207R00000X 020 Physicians 011 Internal Medicine

1154349702 207R00000X 020 Physicians 011 Internal Medicine

1154349884 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1154354454 111N00000X 011 Chiropractic Providers 047 Chiropractor

83 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1154355311 2086S0129X 020 Physicians 289 Vascular Surgery

1154356715 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154359677 111N00000X 011 Chiropractic Providers 047 Chiropractor

1154361202 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154366144 2084P0800X 020 Physicians 121 Psychiatry

1154366797 207P00000X 020 Physicians 270 Emergency Medicine

1154369718 111N00000X 011 Chiropractic Providers 047 Chiropractor

1154375061 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1154376176 208600000X 020 Physicians 275 Surgery

1154384493 207L00000X 020 Physicians 005 Anesthesiology

1154384527 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154390227 207Q00000X 020 Physicians 173 Family Medicine

1154391142 2086S0120X 020 Physicians 245 Pediatric Surgery

1154391951 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1154392587 208G00000X 020 Physicians 033 Thoracic Surgery

1154393510 207RX0202X 020 Physicians 529 Medical Oncology

1154393999 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1154395358 2084N0400X 020 Physicians 013 Neurology

1154396547 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154396547 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1154397958 207V00000X 020 Physicians 016 OB/GYN

1154403749 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1154403749 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154404549 207RI0200X 020 Physicians 185 Infectious Diseases

1154404598 208G00000X 020 Physicians 033 Thoracic Surgery

1154405231 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1154408219 207RR0500X 020 Physicians 267 Rheumatology

1154410074 207Q00000X 020 Physicians 173 Family Medicine

1154412518 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1154413581 207X00000X 020 Physicians 020 Orthopedic Surgery

1154417418 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

84 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1154419596 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154421642 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1154422012 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1154426997 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154427565 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1154429702 207P00000X 020 Physicians 270 Emergency Medicine

1154445526 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154454858 207R00000X 020 Physicians 011 Internal Medicine

1154458446 122300000X 012 Dental Providers 019 Dentists

1154468890 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1154471357 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154475101 207ZP0101X 020 Physicians 436 Anatomic Pathology

1154478444 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1154484186 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1154488245 1223G0001X 012 Dental Providers 001 General Practice

1154491595 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1154503274 207X00000X 020 Physicians 020 Orthopedic Surgery

1154509479 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154513018 207K00000X 020 Physicians 003 Allergy & Immunology

1154521342 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154522423 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154522746 207X00000X 020 Physicians 020 Orthopedic Surgery

1154524288 207R00000X 020 Physicians 011 Internal Medicine

1154524288 207RN0300X 020 Physicians 105 Nephrology

1154525541 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1154530020 2085N0700X 020 Physicians 204 Neuroradiology

1154531366 207L00000X 020 Physicians 005 Anesthesiology

1154532547 207X00000X 020 Physicians 020 Orthopedic Surgery

1154536696 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154542785 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1154550200 207R00000X 020 Physicians 011 Internal Medicine

85 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1154550531 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1154552586 207L00000X 020 Physicians 005 Anesthesiology

1154563401 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1154563443 207RC0000X 020 Physicians 006 Cardiovascular Disease

1154564615 207RC0200X 020 Physicians 206 Critical Care Medicine

1154565661 207N00000X 020 Physicians 007 Dermatology

1154565752 207R00000X 020 Physicians 011 Internal Medicine

1154566412 207RI0200X 020 Physicians 185 Infectious Diseases

1154576684 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1154576684 207ZH0000X 020 Physicians 560 Hematology; Pathology

1154586071 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1154587863 2084N0400X 020 Physicians 013 Neurology

1154592327 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1154592558 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1154594919 2086S0102X 020 Physicians 539 Surgical Critical Care

1154597011 2086S0120X 020 Physicians 245 Pediatric Surgery

1154597532 207P00000X 020 Physicians 270 Emergency Medicine

1154609824 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1154617256 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1154618130 207Q00000X 020 Physicians 173 Family Medicine

1154619211 207L00000X 020 Physicians 005 Anesthesiology

1154628972 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154629491 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1154632503 207R00000X 020 Physicians 011 Internal Medicine

1154641595 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154642239 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154647758 207RH0003X 020 Physicians 179 Hematology/Oncology

1154647816 208600000X 020 Physicians 275 Surgery

1154652634 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1154652634 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1154675577 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

86 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1154676385 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1154677375 2085R0202X 020 Physicians 167 Diagnostic Radiology

1154680429 207R00000X 020 Physicians 011 Internal Medicine

1154680429 208M00000X 020 Physicians 344 Hospitalist

1154705606 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1154711943 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154718955 208M00000X 020 Physicians 344 Hospitalist

1154726057 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1154727873 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154736403 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154737419 207Q00000X 020 Physicians 173 Family Medicine

1154739639 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154741197 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1154746212 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1154746212 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1154746493 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1154748895 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1154759223 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1154759223 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1154759223 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1154760502 208100000X 020 Physicians 025 Physical Medicine and Rehab

1154768927 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1154768927 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154769016 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1154777977 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1154788297 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1154788503 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1154792539 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1154795136 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1154798577 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1154807741 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

87 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1154809267 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154815330 207Q00000X 020 Physicians 173 Family Medicine

1154823318 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1154849693 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1154851244 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154852705 208200000X 020 Physicians 024 Plastic Surgery

1154857191 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1154857605 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1154863850 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1154863850 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1154868321 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1154875128 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1154876704 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1154887750 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1154894434 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1154896314 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1154899094 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154952083 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154956027 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1154967016 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1154972180 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1154978526 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1154981280 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1154982353 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1154988202 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1154988202 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1164401105 207RG0100X 020 Physicians 010 Gastroenterology

1164401378 207L00000X 020 Physicians 005 Anesthesiology

1164406419 207L00000X 020 Physicians 005 Anesthesiology

1164406500 207RG0100X 020 Physicians 010 Gastroenterology

1164406914 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

88 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164408191 207RC0000X 020 Physicians 006 Cardiovascular Disease

1164408530 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164409827 207RH0000X 020 Physicians 178 Hematology

1164412151 207P00000X 020 Physicians 270 Emergency Medicine

1164419644 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1164425740 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1164427274 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164431789 111N00000X 011 Chiropractic Providers 047 Chiropractor

1164438743 207T00000X 020 Physicians 014 Neurological Surgery

1164440731 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1164440731 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1164440863 207V00000X 020 Physicians 016 OB/GYN

1164442257 207P00000X 020 Physicians 270 Emergency Medicine

1164442638 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1164445052 207P00000X 020 Physicians 270 Emergency Medicine

1164449013 207L00000X 020 Physicians 005 Anesthesiology

1164449013 207PE0004X 020 Physicians 093 Emergency Medical Services

1164449013 207P00000X 020 Physicians 270 Emergency Medicine

1164449633 207P00000X 020 Physicians 270 Emergency Medicine

1164449633 207PE0004X 020 Physicians 093 Emergency Medical Services

1164454278 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1164454278 207X00000X 020 Physicians 020 Orthopedic Surgery

1164457040 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1164460887 207RR0500X 020 Physicians 267 Rheumatology

1164468450 207RP1001X 020 Physicians 029 Pulmonary Diseases

1164468450 207RC0200X 020 Physicians 206 Critical Care Medicine

1164468450 207R00000X 020 Physicians 011 Internal Medicine

1164468583 208000000X 020 Physicians 049 Pediatrics

1164468583 2080P0202X 020 Physicians 221 Pediatric Cardiology

1164469805 207P00000X 020 Physicians 270 Emergency Medicine

1164472072 207T00000X 020 Physicians 014 Neurological Surgery

89 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164472684 208600000X 020 Physicians 275 Surgery

1164478327 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164479242 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1164492252 207T00000X 020 Physicians 014 Neurological Surgery

1164492765 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164493540 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164495222 2084P2900X 020 Physicians 570 Psychiatry & Neurology; Pain Medicine

1164495222 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1164495222 2084P0800X 020 Physicians 121 Psychiatry

1164495222 207L00000X 020 Physicians 005 Anesthesiology

1164495727 207V00000X 020 Physicians 016 OB/GYN

1164496345 207P00000X 020 Physicians 270 Emergency Medicine

1164496683 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164496808 207Y00000X 020 Physicians 217 Otolaryngology

1164498739 207R00000X 020 Physicians 011 Internal Medicine

1164501920 207L00000X 020 Physicians 005 Anesthesiology

1164504767 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164505608 2080P0210X 020 Physicians 232 Pediatric Nephrology

1164505624 207RC0000X 020 Physicians 006 Cardiovascular Disease

1164511242 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1164512091 208000000X 020 Physicians 049 Pediatrics

1164512265 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1164512273 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1164514469 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164514519 207RN0300X 020 Physicians 105 Nephrology

1164514519 207R00000X 020 Physicians 011 Internal Medicine

1164518429 208000000X 020 Physicians 049 Pediatrics

1164519260 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1164519278 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164527503 208G00000X 020 Physicians 033 Thoracic Surgery

1164528519 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

90 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164528519 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164532537 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1164557047 208800000X 020 Physicians 034 Urology

1164567764 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164568929 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164569448 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1164570578 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1164575973 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1164576773 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1164597480 207RI0200X 020 Physicians 185 Infectious Diseases

1164600458 2080P0210X 020 Physicians 232 Pediatric Nephrology

1164600458 208000000X 020 Physicians 049 Pediatrics

1164603460 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164603551 111N00000X 011 Chiropractic Providers 047 Chiropractor

1164603783 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164604492 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164617569 207V00000X 020 Physicians 016 OB/GYN

1164621876 207L00000X 020 Physicians 005 Anesthesiology

1164622577 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1164626859 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1164638052 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164638185 2084N0400X 020 Physicians 013 Neurology

1164641288 208100000X 020 Physicians 025 Physical Medicine and Rehab

1164641320 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164642252 207L00000X 020 Physicians 005 Anesthesiology

1164642377 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1164646782 2085P0229X 020 Physicians 241 Pediatric Radiology

1164650297 207R00000X 020 Physicians 011 Internal Medicine

1164651600 207RC0200X 020 Physicians 206 Critical Care Medicine

1164659199 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1164662946 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

91 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164677191 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164678660 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1164678660 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164683363 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1164684163 207RI0011X 020 Physicians 188 Interventional Cardiology

1164684411 208000000X 020 Physicians 049 Pediatrics

1164689931 207R00000X 020 Physicians 011 Internal Medicine

1164692463 207L00000X 020 Physicians 005 Anesthesiology

1164694964 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1164703674 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1164707402 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164709804 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164710539 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164714911 207R00000X 020 Physicians 011 Internal Medicine

1164714911 208000000X 020 Physicians 049 Pediatrics

1164726055 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1164736724 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1164738449 207RI0011X 020 Physicians 188 Interventional Cardiology

1164738449 207RC0000X 020 Physicians 006 Cardiovascular Disease

1164740072 207R00000X 020 Physicians 011 Internal Medicine

1164743142 2084P0800X 020 Physicians 121 Psychiatry

1164744942 2086S0105X 020 Physicians 546 Surgery of the Hand

1164748489 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164749511 207RP1001X 020 Physicians 029 Pulmonary Diseases

1164764585 207L00000X 020 Physicians 005 Anesthesiology

1164765822 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164779211 2085R0202X 020 Physicians 167 Diagnostic Radiology

1164780292 207P00000X 020 Physicians 270 Emergency Medicine

1164781860 2081P0004X 020 Physicians 636 Physical Med & Rehab; Spinal Cord Injury

1164781860 208100000X 020 Physicians 025 Physical Medicine and Rehab

1164785317 207R00000X 020 Physicians 011 Internal Medicine

92 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164788600 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1164788667 207Y00000X 020 Physicians 217 Otolaryngology

1164796884 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1164797874 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1164797874 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1164801742 208000000X 020 Physicians 049 Pediatrics

1164802591 207L00000X 020 Physicians 005 Anesthesiology

1164804548 122300000X 012 Dental Providers 019 Dentists

1164804993 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164805230 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164806030 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1164808853 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164816203 207W00000X 020 Physicians 018 Ophthalmology

1164816203 207WX0110X 020 Physicians 634 Pediatric Ophthalomology and Strabismus

1164821153 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164823316 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1164823316 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1164823316 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1164833919 111N00000X 011 Chiropractic Providers 047 Chiropractor

1164834289 207R00000X 020 Physicians 011 Internal Medicine

1164834289 208M00000X 020 Physicians 344 Hospitalist

1164834347 207Q00000X 020 Physicians 173 Family Medicine

1164841292 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1164842548 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164849790 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164850087 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164851457 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164855532 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164859831 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1164863411 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164866489 2085R0202X 020 Physicians 167 Diagnostic Radiology

93 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1164869277 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1164875035 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1164884904 207Q00000X 020 Physicians 173 Family Medicine

1164892709 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1164901799 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1164906962 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1164908158 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1164908810 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164918082 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1164945994 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1164950846 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1164958005 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1164980645 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1164991881 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1164997623 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174008288 207X00000X 020 Physicians 020 Orthopedic Surgery

1174010870 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1174014526 122300000X 012 Dental Providers 019 Dentists

1174022412 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174035224 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174040133 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1174044689 1223P0221X 012 Dental Providers 063 Pedodontics

1174049092 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1174053185 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1174076756 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1174076756 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1174077184 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1174082291 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174097745 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1174155501 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1174155774 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

94 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1174156145 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1174164537 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1174174254 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1174174932 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1174175186 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1174180129 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1174184832 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1174187256 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1174500201 2085R0202X 020 Physicians 167 Diagnostic Radiology

1174501043 207Q00000X 020 Physicians 173 Family Medicine

1174501423 207RP1001X 020 Physicians 029 Pulmonary Diseases

1174501969 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1174502355 207L00000X 020 Physicians 005 Anesthesiology

1174503577 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1174503759 207L00000X 020 Physicians 005 Anesthesiology

1174515274 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1174523351 207RR0500X 020 Physicians 267 Rheumatology

1174524318 111N00000X 011 Chiropractic Providers 047 Chiropractor

1174525059 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1174529929 207VX0201X 020 Physicians 307 Gynecologic Oncology

1174541874 207R00000X 020 Physicians 011 Internal Medicine

1174542120 207P00000X 020 Physicians 270 Emergency Medicine

1174544308 208100000X 020 Physicians 025 Physical Medicine and Rehab

1174550180 207R00000X 020 Physicians 011 Internal Medicine

1174550925 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174556609 207P00000X 020 Physicians 270 Emergency Medicine

1174559611 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174560080 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1174561617 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1174564595 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174565188 207Q00000X 020 Physicians 173 Family Medicine

95 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1174569826 207X00000X 020 Physicians 020 Orthopedic Surgery

1174569958 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1174570659 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1174570659 208000000X 020 Physicians 049 Pediatrics

1174573778 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1174577332 207N00000X 020 Physicians 007 Dermatology

1174581698 207L00000X 020 Physicians 005 Anesthesiology

1174582126 208000000X 020 Physicians 049 Pediatrics

1174584619 208800000X 020 Physicians 034 Urology

1174586697 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1174593321 207Y00000X 020 Physicians 217 Otolaryngology

1174593644 207VF0040X 020 Physicians 565 Female Pelvic Medicine & Reconstructive

1174593644 207V00000X 020 Physicians 016 OB/GYN

1174593941 207V00000X 020 Physicians 016 OB/GYN

1174596993 208200000X 020 Physicians 024 Plastic Surgery

1174597272 111N00000X 011 Chiropractic Providers 047 Chiropractor

1174597876 207RC0000X 020 Physicians 006 Cardiovascular Disease

1174597876 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1174599641 207V00000X 020 Physicians 016 OB/GYN

1174603088 208000000X 020 Physicians 049 Pediatrics

1174603856 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1174609432 207P00000X 020 Physicians 270 Emergency Medicine

1174611370 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1174611438 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1174613012 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174613038 207Q00000X 020 Physicians 173 Family Medicine

1174616668 207R00000X 020 Physicians 011 Internal Medicine

1174618755 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174619431 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1174621106 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1174621858 207V00000X 020 Physicians 016 OB/GYN

96 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1174622245 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1174628705 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174630180 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174633036 1223G0001X 012 Dental Providers 001 General Practice

1174633184 207Y00000X 020 Physicians 217 Otolaryngology

1174635437 207L00000X 020 Physicians 005 Anesthesiology

1174640411 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1174640411 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1174640411 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174650386 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1174668107 207V00000X 020 Physicians 016 OB/GYN

1174676845 207P00000X 020 Physicians 270 Emergency Medicine

1174677785 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1174695704 207R00000X 020 Physicians 011 Internal Medicine

1174695704 208000000X 020 Physicians 049 Pediatrics

1174708135 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1174708135 208000000X 020 Physicians 049 Pediatrics

1174716294 207R00000X 020 Physicians 011 Internal Medicine

1174716294 204F00000X 020 Physicians 279 Transplant Surgery

1174716294 207RG0100X 020 Physicians 010 Gastroenterology

1174716294 207RI0008X 020 Physicians 340 Hepatology

1174716567 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1174724116 207Q00000X 020 Physicians 173 Family Medicine

1174727184 208000000X 020 Physicians 049 Pediatrics

1174727184 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1174732549 1223G0001X 012 Dental Providers 001 General Practice

1174735690 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1174740559 2086S0129X 020 Physicians 289 Vascular Surgery

1174741086 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1174746200 207R00000X 020 Physicians 011 Internal Medicine

1174752067 207R00000X 020 Physicians 011 Internal Medicine

97 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1174754279 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1174755615 2080S0012X 020 Physicians 558 Pediatric Sleep Medicine

1174755615 208000000X 020 Physicians 049 Pediatrics

1174758361 1223G0001X 012 Dental Providers 001 General Practice

1174758361 122300000X 012 Dental Providers 019 Dentists

1174761084 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174763312 207P00000X 020 Physicians 270 Emergency Medicine

1174767347 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1174773469 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1174773469 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1174785984 2086X0206X 020 Physicians 276 Surgical Oncology

1174789796 207RN0300X 020 Physicians 105 Nephrology

1174799878 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174801955 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1174802896 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1174812077 2086S0129X 020 Physicians 289 Vascular Surgery

1174813729 2086S0129X 020 Physicians 289 Vascular Surgery

1174818819 207VX0201X 020 Physicians 307 Gynecologic Oncology

1174839542 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1174839724 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1174854947 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1174857700 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174858468 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1174881015 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1174881361 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1174882666 208000000X 020 Physicians 049 Pediatrics

1174889273 1223G0001X 012 Dental Providers 001 General Practice

1174889273 122300000X 012 Dental Providers 019 Dentists

1174893879 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1174897847 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1174903579 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

98 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1174919419 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174930309 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174939300 2085N0700X 020 Physicians 204 Neuroradiology

1174941264 207V00000X 020 Physicians 016 OB/GYN

1174950786 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1174953608 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1174958532 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174962559 208600000X 020 Physicians 275 Surgery

1174963318 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1174963706 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1174967194 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1174970248 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1174971246 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1174979249 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174979249 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1174979694 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1174980320 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1174981831 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1174983654 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1174985469 208000000X 020 Physicians 049 Pediatrics

1184005944 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184009573 207Q00000X 020 Physicians 173 Family Medicine

1184010738 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1184010969 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1184013047 111N00000X 011 Chiropractic Providers 047 Chiropractor

1184016198 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1184018889 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184021776 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1184021776 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1184026718 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1184027492 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

99 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184027534 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184033250 207R00000X 020 Physicians 011 Internal Medicine

1184035321 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184038044 207P00000X 020 Physicians 270 Emergency Medicine

1184038168 122300000X 012 Dental Providers 019 Dentists

1184038937 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184042988 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1184049454 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184060980 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184062663 208000000X 020 Physicians 049 Pediatrics

1184062663 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1184063000 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184069460 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184076473 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1184076606 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184079469 207R00000X 020 Physicians 011 Internal Medicine

1184080228 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1184085219 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184090433 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1184102329 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184103863 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1184108060 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1184115685 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1184129652 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1184129652 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184132813 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184142473 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1184142747 208M00000X 020 Physicians 344 Hospitalist

1184142945 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1184142945 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1184143232 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

100 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184144149 208800000X 020 Physicians 034 Urology

1184145914 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1184145914 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1184154643 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1184157349 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1184161754 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184163149 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1184174971 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1184175127 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184193070 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184198707 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1184254369 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1184271892 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1184282774 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1184600926 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1184600926 207L00000X 020 Physicians 005 Anesthesiology

1184600926 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1184600926 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1184602385 2085P0229X 020 Physicians 241 Pediatric Radiology

1184602666 207Q00000X 020 Physicians 173 Family Medicine

1184603144 2084N0400X 020 Physicians 013 Neurology

1184603607 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184603664 208100000X 020 Physicians 025 Physical Medicine and Rehab

1184604142 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184604613 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184612426 2084P0800X 020 Physicians 121 Psychiatry

1184625931 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1184629651 122300000X 012 Dental Providers 019 Dentists

1184631244 208G00000X 020 Physicians 033 Thoracic Surgery

1184632101 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1184633059 2080P0205X 020 Physicians 226 Pediatric Endocrinology

101 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184636052 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184637704 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1184641656 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1184641854 207R00000X 020 Physicians 011 Internal Medicine

1184642738 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1184645533 208D00000X 020 Physicians 001 General Practice

1184652414 207RR0500X 020 Physicians 267 Rheumatology

1184654287 207P00000X 020 Physicians 270 Emergency Medicine

1184659294 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184661118 207X00000X 020 Physicians 020 Orthopedic Surgery

1184665747 208G00000X 020 Physicians 033 Thoracic Surgery

1184667503 207L00000X 020 Physicians 005 Anesthesiology

1184670812 208M00000X 020 Physicians 344 Hospitalist

1184672891 207L00000X 020 Physicians 005 Anesthesiology

1184674947 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184675100 207W00000X 020 Physicians 018 Ophthalmology

1184681108 208800000X 020 Physicians 034 Urology

1184682916 207RR0500X 020 Physicians 267 Rheumatology

1184683237 207P00000X 020 Physicians 270 Emergency Medicine

1184684458 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184685810 207RC0000X 020 Physicians 006 Cardiovascular Disease

1184691867 207L00000X 020 Physicians 005 Anesthesiology

1184692071 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184694127 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1184694770 207RP1001X 020 Physicians 029 Pulmonary Diseases

1184694770 207R00000X 020 Physicians 011 Internal Medicine

1184694770 207RC0200X 020 Physicians 206 Critical Care Medicine

1184696312 2084P0800X 020 Physicians 121 Psychiatry

1184697757 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184701856 207Q00000X 020 Physicians 173 Family Medicine

1184707572 207VX0201X 020 Physicians 307 Gynecologic Oncology

102 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184709826 208000000X 020 Physicians 049 Pediatrics

1184710444 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1184712515 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184713844 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1184715559 208100000X 020 Physicians 025 Physical Medicine and Rehab

1184716193 2080P0008X 020 Physicians 233 Pediatric Neurodevelopment

1184716193 208000000X 020 Physicians 049 Pediatrics

1184716771 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1184720666 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184721854 207ZP0101X 020 Physicians 022 Pathology

1184724148 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1184725921 208600000X 020 Physicians 275 Surgery

1184727026 207V00000X 020 Physicians 016 OB/GYN

1184729337 207ZB0001X 020 Physicians 563 Blood Banking & Transfusion Medicine

1184731689 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1184731952 207P00000X 020 Physicians 270 Emergency Medicine

1184735474 207ZP0101X 020 Physicians 436 Anatomic Pathology

1184737009 207R00000X 020 Physicians 011 Internal Medicine

1184748774 207RC0000X 020 Physicians 006 Cardiovascular Disease

1184749582 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1184753527 1223G0001X 012 Dental Providers 001 General Practice

1184760068 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1184760068 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1184760274 207Q00000X 020 Physicians 173 Family Medicine

1184760902 2084P0800X 020 Physicians 121 Psychiatry

1184760936 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1184778284 2084P0800X 020 Physicians 121 Psychiatry

1184798746 208100000X 020 Physicians 025 Physical Medicine and Rehab

1184801045 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184808354 207RI0011X 020 Physicians 188 Interventional Cardiology

1184808354 207RC0000X 020 Physicians 006 Cardiovascular Disease

103 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184813016 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184814592 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1184816506 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1184818718 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1184821985 207V00000X 020 Physicians 016 OB/GYN

1184827560 207P00000X 020 Physicians 270 Emergency Medicine

1184834954 207P00000X 020 Physicians 270 Emergency Medicine

1184841397 2084N0400X 020 Physicians 013 Neurology

1184845026 207L00000X 020 Physicians 005 Anesthesiology

1184855025 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1184855587 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1184857021 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1184865438 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1184870156 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184871618 207RC0200X 020 Physicians 206 Critical Care Medicine

1184871758 207P00000X 020 Physicians 270 Emergency Medicine

1184873762 2084N0400X 020 Physicians 013 Neurology

1184873796 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1184873911 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1184881252 208000000X 020 Physicians 049 Pediatrics

1184881252 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1184884645 207VX0201X 020 Physicians 307 Gynecologic Oncology

1184885543 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184885758 207P00000X 020 Physicians 270 Emergency Medicine

1184887242 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184890956 207R00000X 020 Physicians 011 Internal Medicine

1184893349 207R00000X 020 Physicians 011 Internal Medicine

1184898090 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1184898090 207ZD0900X 020 Physicians 581 Pathology; Dermatopathology

1184900466 208600000X 020 Physicians 275 Surgery

1184902330 208600000X 020 Physicians 275 Surgery

104 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1184903544 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1184903544 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1184908113 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184912362 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1184913261 2085R0202X 020 Physicians 167 Diagnostic Radiology

1184914160 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184916850 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1184935462 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1184936072 207Q00000X 020 Physicians 173 Family Medicine

1184936072 208D00000X 020 Physicians 001 General Practice

1184936205 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1184958555 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1184958555 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1184960452 208M00000X 020 Physicians 344 Hospitalist

1184960452 207R00000X 020 Physicians 011 Internal Medicine

1184966186 207L00000X 020 Physicians 005 Anesthesiology

1184966780 207L00000X 020 Physicians 005 Anesthesiology

1184967952 208M00000X 020 Physicians 344 Hospitalist

1184972275 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1184980997 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1184988560 2080P0202X 020 Physicians 221 Pediatric Cardiology

1194000869 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1194005553 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194005553 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194005553 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194022541 207RG0100X 020 Physicians 010 Gastroenterology

1194022541 207R00000X 020 Physicians 011 Internal Medicine

1194039636 207RI0011X 020 Physicians 188 Interventional Cardiology

1194045963 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194050328 208000000X 020 Physicians 049 Pediatrics

1194050328 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

105 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1194053637 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194056002 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194056630 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1194062927 111N00000X 011 Chiropractic Providers 047 Chiropractor

1194063503 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1194071696 111N00000X 011 Chiropractic Providers 047 Chiropractor

1194073007 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1194073569 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1194074682 207RI0200X 020 Physicians 185 Infectious Diseases

1194082123 208G00000X 020 Physicians 033 Thoracic Surgery

1194084343 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1194084343 207ZP0101X 020 Physicians 022 Pathology

1194085225 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194085969 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194088963 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1194102822 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1194103754 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194108720 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194108720 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194110627 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194110692 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194128272 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194135392 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1194135616 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1194136713 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1194136895 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194144790 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1194158006 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194162081 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1194165886 208600000X 020 Physicians 275 Surgery

1194167262 208M00000X 020 Physicians 344 Hospitalist

106 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1194167262 207R00000X 020 Physicians 011 Internal Medicine

1194171322 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1194175422 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1194175422 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194175968 207Q00000X 020 Physicians 173 Family Medicine

1194182816 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194189423 207RH0003X 020 Physicians 179 Hematology/Oncology

1194189423 207R00000X 020 Physicians 011 Internal Medicine

1194189670 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194194027 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1194201624 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194202150 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1194206698 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194209627 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1194215608 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1194215830 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194216671 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1194218966 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1194229666 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1194255026 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1194260349 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194266981 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1194362111 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194365759 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1194365973 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1194369009 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194382143 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1194386581 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194386581 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1194700336 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194703967 207RP1001X 020 Physicians 029 Pulmonary Diseases

107 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1194705392 207RG0100X 020 Physicians 010 Gastroenterology

1194705806 2086S0120X 020 Physicians 245 Pediatric Surgery

1194706028 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1194706754 207T00000X 020 Physicians 014 Neurological Surgery

1194710939 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194712091 111N00000X 011 Chiropractic Providers 047 Chiropractor

1194716084 2084P0800X 020 Physicians 121 Psychiatry

1194719757 207W00000X 020 Physicians 018 Ophthalmology

1194725960 207Q00000X 020 Physicians 173 Family Medicine

1194728329 207R00000X 020 Physicians 011 Internal Medicine

1194732370 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1194735944 207ZP0101X 020 Physicians 022 Pathology

1194737775 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194742635 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1194742668 207R00000X 020 Physicians 011 Internal Medicine

1194742866 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194743542 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194743765 207Q00000X 020 Physicians 173 Family Medicine

1194745133 207Q00000X 020 Physicians 173 Family Medicine

1194745588 207P00000X 020 Physicians 270 Emergency Medicine

1194746313 207Q00000X 020 Physicians 173 Family Medicine

1194747758 207Q00000X 020 Physicians 173 Family Medicine

1194748616 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1194748616 207RC0200X 020 Physicians 206 Critical Care Medicine

1194753335 2085P0229X 020 Physicians 241 Pediatric Radiology

1194753335 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194754002 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1194754002 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1194755249 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1194755728 207RG0100X 020 Physicians 010 Gastroenterology

1194755900 207RG0100X 020 Physicians 010 Gastroenterology

108 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1194755900 207R00000X 020 Physicians 011 Internal Medicine

1194757419 207Q00000X 020 Physicians 173 Family Medicine

1194767129 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1194770214 208000000X 020 Physicians 049 Pediatrics

1194771097 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194777987 207L00000X 020 Physicians 005 Anesthesiology

1194778068 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1194778191 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1194778191 208000000X 020 Physicians 049 Pediatrics

1194779850 208000000X 020 Physicians 049 Pediatrics

1194779850 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1194781161 207P00000X 020 Physicians 270 Emergency Medicine

1194781674 207RC0000X 020 Physicians 006 Cardiovascular Disease

1194782011 208G00000X 020 Physicians 033 Thoracic Surgery

1194784595 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194784835 207RC0000X 020 Physicians 006 Cardiovascular Disease

1194789891 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194790790 207RC0000X 020 Physicians 006 Cardiovascular Disease

1194793919 207P00000X 020 Physicians 270 Emergency Medicine

1194797878 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1194798835 207T00000X 020 Physicians 014 Neurological Surgery

1194798900 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1194799254 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194799585 207RI0200X 020 Physicians 185 Infectious Diseases

1194818443 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1194821355 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1194833376 207X00000X 020 Physicians 020 Orthopedic Surgery

1194846063 207L00000X 020 Physicians 005 Anesthesiology

1194846964 207RC0000X 020 Physicians 006 Cardiovascular Disease

1194849166 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194880328 2084N0400X 020 Physicians 013 Neurology

109 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1194884338 207RH0003X 020 Physicians 179 Hematology/Oncology

1194884353 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194891648 1223G0001X 012 Dental Providers 001 General Practice

1194891648 122300000X 012 Dental Providers 019 Dentists

1194895086 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1194898585 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1194909432 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1194910257 208000000X 020 Physicians 049 Pediatrics

1194910505 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1194918300 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1194919357 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194928416 2085R0202X 020 Physicians 167 Diagnostic Radiology

1194929182 207RI0011X 020 Physicians 188 Interventional Cardiology

1194929182 207RC0000X 020 Physicians 006 Cardiovascular Disease

1194930537 207Q00000X 020 Physicians 173 Family Medicine

1194936492 207W00000X 020 Physicians 018 Ophthalmology

1194939371 207L00000X 020 Physicians 005 Anesthesiology

1194949008 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1194950527 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1194954065 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1194978734 207R00000X 020 Physicians 011 Internal Medicine

1194985291 207RG0100X 020 Physicians 010 Gastroenterology

1194986075 207L00000X 020 Physicians 005 Anesthesiology

1194986109 207P00000X 020 Physicians 270 Emergency Medicine

1194993774 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1205001120 2084P0800X 020 Physicians 121 Psychiatry

1205006897 207N00000X 020 Physicians 007 Dermatology

1205012051 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205013919 207R00000X 020 Physicians 011 Internal Medicine

1205023926 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205031713 207N00000X 020 Physicians 007 Dermatology

110 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1205046265 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1205046265 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1205051117 122300000X 012 Dental Providers 019 Dentists

1205053832 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205055506 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205061223 207RN0300X 020 Physicians 105 Nephrology

1205061975 207P00000X 020 Physicians 270 Emergency Medicine

1205062114 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1205064284 207X00000X 020 Physicians 020 Orthopedic Surgery

1205080744 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205083995 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1205088515 207Q00000X 020 Physicians 173 Family Medicine

1205095361 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1205098399 207VX0201X 020 Physicians 307 Gynecologic Oncology

1205098464 207RN0300X 020 Physicians 105 Nephrology

1205100203 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1205101714 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1205101714 208000000X 020 Physicians 049 Pediatrics

1205101912 207P00000X 020 Physicians 270 Emergency Medicine

1205103637 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1205107448 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1205110848 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1205120920 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205122132 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205123957 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205133873 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205136710 208000000X 020 Physicians 049 Pediatrics

1205143906 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1205145794 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205148673 207V00000X 020 Physicians 016 OB/GYN

1205172921 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

111 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1205179777 207RH0003X 020 Physicians 179 Hematology/Oncology

1205184181 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1205187606 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1205187606 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1205190139 207RI0200X 020 Physicians 185 Infectious Diseases

1205198082 207P00000X 020 Physicians 270 Emergency Medicine

1205198157 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1205200359 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1205200359 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1205206117 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205220993 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1205230950 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1205232998 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205240900 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1205247541 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1205247913 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1205256203 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1205258779 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1205265865 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1205268455 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205273950 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1205280047 208000000X 020 Physicians 049 Pediatrics

1205283090 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205296993 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205297512 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1205297512 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205302734 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1205313160 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1205328549 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1205337888 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205351798 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

112 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1205351798 106E00000X 010 Behav Health & Social Svc Prov 566 Assistant Behavior Analyst

1205351798 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1205352390 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1205352390 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1205354685 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1205362142 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1205364403 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1205364403 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1205366788 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205367885 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1205367885 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1205377793 207T00000X 020 Physicians 014 Neurological Surgery

1205475126 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1205481405 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205498615 207Q00000X 020 Physicians 173 Family Medicine

1205498656 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1205800240 207RC0000X 020 Physicians 006 Cardiovascular Disease

1205800646 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205801891 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205804937 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205806379 2084N0400X 020 Physicians 013 Neurology

1205807310 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1205807534 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205807724 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1205807963 207W00000X 020 Physicians 018 Ophthalmology

1205808490 208600000X 020 Physicians 275 Surgery

1205808490 2086S0102X 020 Physicians 539 Surgical Critical Care

1205808490 2086S0120X 020 Physicians 245 Pediatric Surgery

1205808607 207RC0000X 020 Physicians 006 Cardiovascular Disease

1205809308 207RC0000X 020 Physicians 006 Cardiovascular Disease

1205811569 2085R0202X 020 Physicians 167 Diagnostic Radiology

113 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1205814787 207Q00000X 020 Physicians 173 Family Medicine

1205815636 207VG0400X 020 Physicians 553 Gynecology

1205815636 207VX0201X 020 Physicians 307 Gynecologic Oncology

1205815636 207V00000X 020 Physicians 016 OB/GYN

1205815644 2085N0700X 020 Physicians 204 Neuroradiology

1205816329 2085N0904X 020 Physicians 495 Nuclear Radiology

1205822954 207Y00000X 020 Physicians 217 Otolaryngology

1205823978 207L00000X 020 Physicians 005 Anesthesiology

1205825593 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205828308 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1205829900 122300000X 012 Dental Providers 019 Dentists

1205829900 1223G0001X 012 Dental Providers 001 General Practice

1205837283 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1205840386 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205853165 208M00000X 020 Physicians 344 Hospitalist

1205853207 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1205853975 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1205854080 207ZP0101X 020 Physicians 436 Anatomic Pathology

1205854932 207L00000X 020 Physicians 005 Anesthesiology

1205857380 2084N0400X 020 Physicians 013 Neurology

1205857547 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1205857547 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1205857943 156FX1800X 015 Eye and Vision Service Providers 411 Optician

1205857943 152WC0802X 015 Eye and Vision Service Providers 617 Corneal and Contact Management

1205857943 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1205862273 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1205862521 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205863669 208100000X 020 Physicians 025 Physical Medicine and Rehab

1205864865 207RC0000X 020 Physicians 006 Cardiovascular Disease

1205864865 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1205875598 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

114 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1205881331 2084P0800X 020 Physicians 121 Psychiatry

1205882081 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205882560 207W00000X 020 Physicians 018 Ophthalmology

1205886819 2085R0202X 020 Physicians 167 Diagnostic Radiology

1205887312 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1205889748 207RC0200X 020 Physicians 206 Critical Care Medicine

1205890316 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1205897634 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1205898319 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1205913324 208000000X 020 Physicians 049 Pediatrics

1205922879 207QA0401X 020 Physicians 562 Family Medicine; Addiction Medicine

1205923653 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1205923653 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1205924636 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1205924891 111N00000X 011 Chiropractic Providers 047 Chiropractor

1205927316 207R00000X 020 Physicians 011 Internal Medicine

1205928785 208M00000X 020 Physicians 344 Hospitalist

1205933595 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1205942158 207Q00000X 020 Physicians 173 Family Medicine

1205949070 207RI0200X 020 Physicians 185 Infectious Diseases

1205967015 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1205968971 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1205974714 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1205976982 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1205982592 208600000X 020 Physicians 275 Surgery

1205982972 207L00000X 020 Physicians 005 Anesthesiology

1205983756 207R00000X 020 Physicians 011 Internal Medicine

1205986742 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1205991924 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1215011945 208000000X 020 Physicians 049 Pediatrics

1215019831 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

115 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215019831 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1215024310 207Q00000X 020 Physicians 173 Family Medicine

1215028014 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215028170 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215034095 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215036199 207K00000X 020 Physicians 003 Allergy & Immunology

1215038971 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215040803 207Q00000X 020 Physicians 173 Family Medicine

1215048079 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215048277 207Q00000X 020 Physicians 173 Family Medicine

1215048574 207RC0000X 020 Physicians 006 Cardiovascular Disease

1215079934 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1215104609 207P00000X 020 Physicians 270 Emergency Medicine

1215105051 2084N0400X 020 Physicians 013 Neurology

1215108246 1223P0221X 012 Dental Providers 063 Pedodontics

1215120126 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1215124573 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215126032 2084N0400X 020 Physicians 013 Neurology

1215126503 2085R0202X 020 Physicians 167 Diagnostic Radiology

1215133129 207X00000X 020 Physicians 020 Orthopedic Surgery

1215136437 207L00000X 020 Physicians 005 Anesthesiology

1215137179 207V00000X 020 Physicians 016 OB/GYN

1215138086 207P00000X 020 Physicians 270 Emergency Medicine

1215149406 207ZP0101X 020 Physicians 022 Pathology

1215149406 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1215151097 207W00000X 020 Physicians 018 Ophthalmology

1215156518 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1215158019 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215159884 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1215159884 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1215160213 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

116 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215162417 207N00000X 020 Physicians 007 Dermatology

1215178454 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1215181029 207VX0201X 020 Physicians 307 Gynecologic Oncology

1215186523 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215193503 208000000X 020 Physicians 049 Pediatrics

1215199013 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1215199500 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1215199781 207V00000X 020 Physicians 016 OB/GYN

1215201314 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215206834 111N00000X 011 Chiropractic Providers 047 Chiropractor

1215211750 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1215217849 207P00000X 020 Physicians 270 Emergency Medicine

1215221841 207P00000X 020 Physicians 270 Emergency Medicine

1215230354 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1215232350 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215246533 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215248547 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215248547 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215253232 207Y00000X 020 Physicians 217 Otolaryngology

1215254784 207L00000X 020 Physicians 005 Anesthesiology

1215256698 1223G0001X 012 Dental Providers 001 General Practice

1215256698 122300000X 012 Dental Providers 019 Dentists

1215271515 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1215273792 2085R0202X 020 Physicians 167 Diagnostic Radiology

1215287495 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1215290416 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215291083 207Q00000X 020 Physicians 173 Family Medicine

1215292750 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215295134 207L00000X 020 Physicians 005 Anesthesiology

1215297387 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1215298179 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

117 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215298914 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215302856 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1215306154 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215307962 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215310149 183500000X 018 Pharmacy 253 Pharmacist

1215312236 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1215312756 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1215317631 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1215323332 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1215330758 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1215330881 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215333984 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215335328 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1215339510 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1215341243 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1215341243 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215341417 207Q00000X 020 Physicians 173 Family Medicine

1215342068 213ES0131X 021 Podiatric Medicine & Surgery Service 540 Surgery Foot

1215346259 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1215346291 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215362546 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1215365648 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215372081 2085N0904X 020 Physicians 495 Nuclear Radiology

1215372081 2085R0202X 020 Physicians 167 Diagnostic Radiology

1215373915 208600000X 020 Physicians 275 Surgery

1215374996 207Q00000X 020 Physicians 173 Family Medicine

1215376421 207P00000X 020 Physicians 270 Emergency Medicine

1215378120 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215379888 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215385349 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215399324 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

118 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215403407 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215409891 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215414099 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215414867 208600000X 020 Physicians 275 Surgery

1215431853 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215432877 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1215435896 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215447404 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1215449905 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215454426 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1215459011 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1215459011 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1215463088 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1215468384 111N00000X 011 Chiropractic Providers 047 Chiropractor

1215471362 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1215471529 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215474762 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215476254 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215480009 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215481486 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215481577 1223G0001X 012 Dental Providers 001 General Practice

1215489414 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1215489414 101Y00000X 010 Behav Health & Social Svc Prov 152 Counselor

1215489414 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1215560669 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1215567896 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1215569652 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1215582283 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1215585880 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215587712 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1215596366 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

119 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215597356 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1215597612 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215900634 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1215901228 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1215901301 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1215901699 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1215901707 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1215905518 207Q00000X 020 Physicians 173 Family Medicine

1215908876 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1215909890 207RI0200X 020 Physicians 185 Infectious Diseases

1215914379 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1215916267 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1215916267 207X00000X 020 Physicians 020 Orthopedic Surgery

1215916770 207V00000X 020 Physicians 016 OB/GYN

1215916929 207X00000X 020 Physicians 020 Orthopedic Surgery

1215925904 208D00000X 020 Physicians 001 General Practice

1215930599 208200000X 020 Physicians 024 Plastic Surgery

1215942057 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1215953732 207P00000X 020 Physicians 270 Emergency Medicine

1215953732 207Q00000X 020 Physicians 173 Family Medicine

1215953732 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1215953732 208M00000X 020 Physicians 344 Hospitalist

1215954177 2085R0202X 020 Physicians 167 Diagnostic Radiology

1215954854 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1215954854 2085R0202X 020 Physicians 167 Diagnostic Radiology

1215955810 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1215958434 207N00000X 020 Physicians 007 Dermatology

1215963426 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215963426 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1215964499 2084N0400X 020 Physicians 013 Neurology

1215967393 207R00000X 020 Physicians 011 Internal Medicine

120 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1215967898 207Q00000X 020 Physicians 173 Family Medicine

1215968177 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215969415 208000000X 020 Physicians 049 Pediatrics

1215971056 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1215971056 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1215971429 207RH0003X 020 Physicians 179 Hematology/Oncology

1215971429 207RH0000X 020 Physicians 178 Hematology

1215972930 207P00000X 020 Physicians 270 Emergency Medicine

1215981758 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1215984950 207L00000X 020 Physicians 005 Anesthesiology

1215986807 207RC0000X 020 Physicians 006 Cardiovascular Disease

1215990544 207P00000X 020 Physicians 270 Emergency Medicine

1215991799 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1215993365 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1225000987 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225002884 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225003817 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225007222 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225008329 207RC0000X 020 Physicians 006 Cardiovascular Disease

1225008527 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1225009566 207L00000X 020 Physicians 005 Anesthesiology

1225009566 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1225012057 2080A0000X 020 Physicians 564 Pediatric Adolescent Medicine

1225013022 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1225013634 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1225015225 207L00000X 020 Physicians 005 Anesthesiology

1225015316 207L00000X 020 Physicians 005 Anesthesiology

1225016025 204F00000X 020 Physicians 279 Transplant Surgery

1225016025 208600000X 020 Physicians 275 Surgery

1225017312 208100000X 020 Physicians 025 Physical Medicine and Rehab

1225017312 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

121 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1225021520 207RN0300X 020 Physicians 105 Nephrology

1225030968 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225046717 207RG0100X 020 Physicians 010 Gastroenterology

1225052046 2085R0202X 020 Physicians 167 Diagnostic Radiology

1225052046 208D00000X 020 Physicians 001 General Practice

1225052665 111N00000X 011 Chiropractic Providers 047 Chiropractor

1225053440 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225055189 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225055213 208M00000X 020 Physicians 344 Hospitalist

1225055734 207X00000X 020 Physicians 020 Orthopedic Surgery

1225056955 207Q00000X 020 Physicians 173 Family Medicine

1225058357 207RC0000X 020 Physicians 006 Cardiovascular Disease

1225059447 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1225063647 207V00000X 020 Physicians 016 OB/GYN

1225064306 208600000X 020 Physicians 275 Surgery

1225064868 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1225069693 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1225070865 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1225073661 207RH0003X 020 Physicians 179 Hematology/Oncology

1225073661 207R00000X 020 Physicians 011 Internal Medicine

1225073893 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225080476 207X00000X 020 Physicians 020 Orthopedic Surgery

1225082647 207V00000X 020 Physicians 016 OB/GYN

1225082829 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1225082829 2085R0202X 020 Physicians 167 Diagnostic Radiology

1225084460 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1225084460 207ZP0101X 020 Physicians 436 Anatomic Pathology

1225084460 207RH0000X 020 Physicians 178 Hematology

1225084460 207ZC0006X 020 Physicians 021 Clinical Pathology

1225085491 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1225086200 1223D0001X 012 Dental Providers 498 Dental Public Health

122 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1225086762 207P00000X 020 Physicians 270 Emergency Medicine

1225087562 208G00000X 020 Physicians 033 Thoracic Surgery

1225089949 208600000X 020 Physicians 275 Surgery

1225091812 207RI0011X 020 Physicians 188 Interventional Cardiology

1225091812 207RC0000X 020 Physicians 006 Cardiovascular Disease

1225097702 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1225097702 2084P0800X 020 Physicians 121 Psychiatry

1225098783 208800000X 020 Physicians 034 Urology

1225100175 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1225100175 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225102304 207Q00000X 020 Physicians 173 Family Medicine

1225106099 111N00000X 011 Chiropractic Providers 047 Chiropractor

1225107055 207L00000X 020 Physicians 005 Anesthesiology

1225108772 207R00000X 020 Physicians 011 Internal Medicine

1225108772 207RI0200X 020 Physicians 185 Infectious Diseases

1225111974 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1225120652 207R00000X 020 Physicians 011 Internal Medicine

1225120652 207RH0002X 020 Physicians 591 Internal Medicine; Hospice & Palliative

1225123599 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225126030 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1225136138 207V00000X 020 Physicians 016 OB/GYN

1225149883 208100000X 020 Physicians 025 Physical Medicine and Rehab

1225149933 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1225153968 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1225158132 207VX0201X 020 Physicians 307 Gynecologic Oncology

1225160153 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225164346 207X00000X 020 Physicians 020 Orthopedic Surgery

1225166523 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1225166523 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1225176613 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1225176936 111N00000X 011 Chiropractic Providers 047 Chiropractor

123 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1225205180 207RN0300X 020 Physicians 105 Nephrology

1225216658 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225220759 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225220783 207RN0300X 020 Physicians 105 Nephrology

1225222862 207NP0225X 020 Physicians 222 Pediatric Dermatology

1225228836 207R00000X 020 Physicians 011 Internal Medicine

1225230220 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1225230881 122300000X 012 Dental Providers 019 Dentists

1225239569 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225246358 207RI0011X 020 Physicians 188 Interventional Cardiology

1225247406 2080P0202X 020 Physicians 221 Pediatric Cardiology

1225250418 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225250715 207L00000X 020 Physicians 005 Anesthesiology

1225259997 207T00000X 020 Physicians 014 Neurological Surgery

1225260003 207T00000X 020 Physicians 014 Neurological Surgery

1225261480 207RG0100X 020 Physicians 010 Gastroenterology

1225262306 207T00000X 020 Physicians 014 Neurological Surgery

1225264104 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1225264153 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1225265952 2080P0202X 020 Physicians 221 Pediatric Cardiology

1225266562 2085R0202X 020 Physicians 167 Diagnostic Radiology

1225268469 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225272990 2085N0700X 020 Physicians 204 Neuroradiology

1225287741 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1225289689 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1225290497 2084N0400X 020 Physicians 013 Neurology

1225290653 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225294101 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225294747 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1225294762 207V00000X 020 Physicians 016 OB/GYN

1225298508 207L00000X 020 Physicians 005 Anesthesiology

124 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1225299290 208M00000X 020 Physicians 344 Hospitalist

1225299290 207R00000X 020 Physicians 011 Internal Medicine

1225299647 207W00000X 020 Physicians 018 Ophthalmology

1225304215 207RP1001X 020 Physicians 029 Pulmonary Diseases

1225316433 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225324494 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1225332836 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1225332893 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1225340565 208000000X 020 Physicians 049 Pediatrics

1225340565 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1225356934 2085R0202X 020 Physicians 167 Diagnostic Radiology

1225365927 208M00000X 020 Physicians 344 Hospitalist

1225367022 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1225369168 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1225369168 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1225382658 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225384019 207R00000X 020 Physicians 011 Internal Medicine

1225390073 207VH0002X 020 Physicians 545 Hospice and Palliative Medicine

1225390073 207RH0002X 020 Physicians 591 Internal Medicine; Hospice & Palliative

1225390875 207Q00000X 020 Physicians 173 Family Medicine

1225392053 207Q00000X 020 Physicians 173 Family Medicine

1225397664 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225408784 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1225416191 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225419872 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225432198 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1225440324 207N00000X 020 Physicians 007 Dermatology

1225443278 208M00000X 020 Physicians 344 Hospitalist

1225444045 207X00000X 020 Physicians 020 Orthopedic Surgery

1225445380 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225445380 163W00000X 016 Nursing Service Providers 129 Registered Nurse

125 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1225446156 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1225448111 111N00000X 011 Chiropractic Providers 047 Chiropractor

1225449846 207R00000X 020 Physicians 011 Internal Medicine

1225461452 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1225461494 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1225463813 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225471493 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1225479918 208D00000X 020 Physicians 001 General Practice

1225489743 122300000X 012 Dental Providers 019 Dentists

1225493828 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1225504731 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225507411 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1225508344 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1225517089 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225523004 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225541212 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1225549132 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1225550395 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1225562531 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1225564438 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225570930 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225574163 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1225576739 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1225579840 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1225581747 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1225582489 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225597750 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225660756 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1225662695 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1225681083 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1225696651 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

126 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1235102351 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235104811 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1235104829 208100000X 020 Physicians 025 Physical Medicine and Rehab

1235109703 2085R0202X 020 Physicians 167 Diagnostic Radiology

1235115023 207RH0000X 020 Physicians 178 Hematology

1235119892 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235120403 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1235130428 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1235131434 207V00000X 020 Physicians 016 OB/GYN

1235135823 207X00000X 020 Physicians 020 Orthopedic Surgery

1235141698 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1235147331 207RR0500X 020 Physicians 267 Rheumatology

1235150491 207Y00000X 020 Physicians 217 Otolaryngology

1235150574 207V00000X 020 Physicians 016 OB/GYN

1235151705 207Q00000X 020 Physicians 173 Family Medicine

1235151721 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235153099 1223G0001X 012 Dental Providers 001 General Practice

1235153099 122300000X 012 Dental Providers 019 Dentists

1235156753 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1235160888 207L00000X 020 Physicians 005 Anesthesiology

1235161670 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235166323 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1235166737 207R00000X 020 Physicians 011 Internal Medicine

1235168543 207P00000X 020 Physicians 270 Emergency Medicine

1235171208 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1235173170 207PE0004X 020 Physicians 093 Emergency Medical Services

1235174376 207Q00000X 020 Physicians 173 Family Medicine

1235175449 207RI0200X 020 Physicians 185 Infectious Diseases

1235175894 207P00000X 020 Physicians 270 Emergency Medicine

1235177577 207R00000X 020 Physicians 011 Internal Medicine

1235177841 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

127 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1235182395 207L00000X 020 Physicians 005 Anesthesiology

1235184557 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1235190786 208800000X 020 Physicians 034 Urology

1235193418 2084P0800X 020 Physicians 121 Psychiatry

1235200320 207R00000X 020 Physicians 011 Internal Medicine

1235200320 207RH0000X 020 Physicians 178 Hematology

1235200320 207RX0202X 020 Physicians 529 Medical Oncology

1235200452 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235211848 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1235211848 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1235213075 207P00000X 020 Physicians 270 Emergency Medicine

1235213695 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235214966 2080A0000X 020 Physicians 564 Pediatric Adolescent Medicine

1235216862 207V00000X 020 Physicians 016 OB/GYN

1235218793 2086S0102X 020 Physicians 539 Surgical Critical Care

1235219205 207R00000X 020 Physicians 011 Internal Medicine

1235221664 207Q00000X 020 Physicians 173 Family Medicine

1235237439 207ZD0900X 020 Physicians 581 Pathology; Dermatopathology

1235237439 207ND0900X 020 Physicians 260 Dermatopathology

1235237439 207ZP0101X 020 Physicians 022 Pathology

1235237918 207V00000X 020 Physicians 016 OB/GYN

1235244286 122300000X 012 Dental Providers 019 Dentists

1235248410 207L00000X 020 Physicians 005 Anesthesiology

1235253857 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1235253857 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1235258591 2085R0202X 020 Physicians 167 Diagnostic Radiology

1235263344 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1235263815 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235271388 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1235284290 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235288267 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

128 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1235295171 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1235300245 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1235306804 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1235306812 207RC0000X 020 Physicians 006 Cardiovascular Disease

1235314741 207RP1001X 020 Physicians 029 Pulmonary Diseases

1235316373 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1235318296 207T00000X 020 Physicians 014 Neurological Surgery

1235325549 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235330382 207RI0011X 020 Physicians 188 Interventional Cardiology

1235331232 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235332206 207L00000X 020 Physicians 005 Anesthesiology

1235334988 111N00000X 011 Chiropractic Providers 047 Chiropractor

1235337007 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1235337072 2085R0202X 020 Physicians 167 Diagnostic Radiology

1235343922 207RI0011X 020 Physicians 188 Interventional Cardiology

1235358524 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235358615 2085R0202X 020 Physicians 167 Diagnostic Radiology

1235366097 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235367848 207R00000X 020 Physicians 011 Internal Medicine

1235369604 207V00000X 020 Physicians 016 OB/GYN

1235369950 207R00000X 020 Physicians 011 Internal Medicine

1235369950 207RC0000X 020 Physicians 006 Cardiovascular Disease

1235372616 207V00000X 020 Physicians 016 OB/GYN

1235376682 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1235384892 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1235391483 207Q00000X 020 Physicians 173 Family Medicine

1235393489 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1235394180 207P00000X 020 Physicians 270 Emergency Medicine

1235397639 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1235398900 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235409426 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

129 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1235409764 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235410705 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235418997 2085R0202X 020 Physicians 167 Diagnostic Radiology

1235421553 207X00000X 020 Physicians 020 Orthopedic Surgery

1235422056 207Q00000X 020 Physicians 173 Family Medicine

1235441577 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1235442468 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1235442575 208600000X 020 Physicians 275 Surgery

1235444233 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235444233 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1235446865 2080P0202X 020 Physicians 221 Pediatric Cardiology

1235450982 207Q00000X 020 Physicians 173 Family Medicine

1235456773 207Q00000X 020 Physicians 173 Family Medicine

1235457680 2084P0800X 020 Physicians 121 Psychiatry

1235467374 122300000X 012 Dental Providers 019 Dentists

1235485426 207Q00000X 020 Physicians 173 Family Medicine

1235488966 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1235490269 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235490970 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1235496191 2084P0800X 020 Physicians 121 Psychiatry

1235516352 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1235516352 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235522574 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1235525502 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1235532557 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235533068 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235533555 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235541756 207Q00000X 020 Physicians 173 Family Medicine

1235541863 207L00000X 020 Physicians 005 Anesthesiology

1235542473 208600000X 020 Physicians 275 Surgery

1235559667 2084P0800X 020 Physicians 121 Psychiatry

130 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1235562562 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1235563313 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1235563917 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1235573049 207Q00000X 020 Physicians 173 Family Medicine

1235575606 207V00000X 020 Physicians 016 OB/GYN

1235576232 207RR0500X 020 Physicians 267 Rheumatology

1235576661 207Q00000X 020 Physicians 173 Family Medicine

1235577206 207R00000X 020 Physicians 011 Internal Medicine

1235577362 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1235577685 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1235579871 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1235586249 207Q00000X 020 Physicians 173 Family Medicine

1235644840 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235654617 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1235657073 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1235657073 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1235659475 207Q00000X 020 Physicians 173 Family Medicine

1235662982 2084P0800X 020 Physicians 121 Psychiatry

1235688672 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1235688672 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1235693227 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1235693227 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1235780883 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1235790775 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1235794140 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1235795485 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1245200344 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245200807 207V00000X 020 Physicians 016 OB/GYN

1245200914 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245203264 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245203546 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

131 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245203777 2085R0202X 020 Physicians 167 Diagnostic Radiology

1245204114 207VX0201X 020 Physicians 307 Gynecologic Oncology

1245205830 2085R0202X 020 Physicians 167 Diagnostic Radiology

1245210814 207RG0100X 020 Physicians 010 Gastroenterology

1245210848 207Q00000X 020 Physicians 173 Family Medicine

1245210871 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245215201 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1245216118 208600000X 020 Physicians 275 Surgery

1245218155 207L00000X 020 Physicians 005 Anesthesiology

1245219708 207X00000X 020 Physicians 020 Orthopedic Surgery

1245223023 207N00000X 020 Physicians 007 Dermatology

1245226083 208G00000X 020 Physicians 033 Thoracic Surgery

1245233584 207W00000X 020 Physicians 018 Ophthalmology

1245236785 207X00000X 020 Physicians 020 Orthopedic Surgery

1245247626 111N00000X 011 Chiropractic Providers 047 Chiropractor

1245248418 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1245249135 1223G0001X 012 Dental Providers 001 General Practice

1245252816 208M00000X 020 Physicians 344 Hospitalist

1245253954 207Q00000X 020 Physicians 173 Family Medicine

1245255900 207P00000X 020 Physicians 270 Emergency Medicine

1245258896 207V00000X 020 Physicians 016 OB/GYN

1245262849 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245264795 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1245274109 2085R0202X 020 Physicians 167 Diagnostic Radiology

1245275957 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1245279702 207R00000X 020 Physicians 011 Internal Medicine

1245279702 207P00000X 020 Physicians 270 Emergency Medicine

1245279835 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1245280254 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245283787 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245284314 207Q00000X 020 Physicians 173 Family Medicine

132 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245286764 207Q00000X 020 Physicians 173 Family Medicine

1245286988 207R00000X 020 Physicians 011 Internal Medicine

1245287069 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245287259 208600000X 020 Physicians 275 Surgery

1245289669 183500000X 018 Pharmacy 253 Pharmacist

1245290329 207R00000X 020 Physicians 011 Internal Medicine

1245290329 208000000X 020 Physicians 049 Pediatrics

1245291525 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1245298991 207RC0000X 020 Physicians 006 Cardiovascular Disease

1245299809 207L00000X 020 Physicians 005 Anesthesiology

1245318625 122300000X 012 Dental Providers 019 Dentists

1245323930 208000000X 020 Physicians 049 Pediatrics

1245324359 2086S0102X 020 Physicians 539 Surgical Critical Care

1245325257 208M00000X 020 Physicians 344 Hospitalist

1245326503 207L00000X 020 Physicians 005 Anesthesiology

1245327899 207R00000X 020 Physicians 011 Internal Medicine

1245328681 207RR0500X 020 Physicians 267 Rheumatology

1245361450 111N00000X 011 Chiropractic Providers 047 Chiropractor

1245383108 2084N0400X 020 Physicians 013 Neurology

1245390137 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245390731 207L00000X 020 Physicians 005 Anesthesiology

1245395094 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1245399252 122300000X 012 Dental Providers 019 Dentists

1245405018 111N00000X 011 Chiropractic Providers 047 Chiropractor

1245405638 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245406339 208000000X 020 Physicians 049 Pediatrics

1245413913 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245413913 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1245413913 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1245413913 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1245414457 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

133 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245419951 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245430370 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1245436732 207RG0100X 020 Physicians 010 Gastroenterology

1245437128 207X00000X 020 Physicians 020 Orthopedic Surgery

1245437730 207P00000X 020 Physicians 270 Emergency Medicine

1245438100 207W00000X 020 Physicians 018 Ophthalmology

1245439744 2085R0202X 020 Physicians 167 Diagnostic Radiology

1245441492 183500000X 018 Pharmacy 253 Pharmacist

1245441542 207L00000X 020 Physicians 005 Anesthesiology

1245444561 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245452713 207X00000X 020 Physicians 020 Orthopedic Surgery

1245465301 2085R0202X 020 Physicians 167 Diagnostic Radiology

1245465350 207P00000X 020 Physicians 270 Emergency Medicine

1245465970 122300000X 012 Dental Providers 019 Dentists

1245468859 207R00000X 020 Physicians 011 Internal Medicine

1245477314 207Q00000X 020 Physicians 173 Family Medicine

1245480896 183500000X 018 Pharmacy 253 Pharmacist

1245482991 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245491588 207P00000X 020 Physicians 270 Emergency Medicine

1245492347 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1245493766 207P00000X 020 Physicians 270 Emergency Medicine

1245493840 208600000X 020 Physicians 275 Surgery

1245494152 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1245526722 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1245526722 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1245526722 122300000X 012 Dental Providers 019 Dentists

1245529676 2084N0400X 020 Physicians 013 Neurology

1245538941 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1245541051 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245541895 2084P0800X 020 Physicians 121 Psychiatry

1245541895 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

134 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245551134 207RX0202X 020 Physicians 529 Medical Oncology

1245551134 207R00000X 020 Physicians 011 Internal Medicine

1245558428 207RG0100X 020 Physicians 010 Gastroenterology

1245558428 207R00000X 020 Physicians 011 Internal Medicine

1245564772 208000000X 020 Physicians 049 Pediatrics

1245564772 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1245565324 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1245573179 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1245575539 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245580703 111N00000X 011 Chiropractic Providers 047 Chiropractor

1245585033 207L00000X 020 Physicians 005 Anesthesiology

1245585165 207P00000X 020 Physicians 270 Emergency Medicine

1245585587 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245591502 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1245593169 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1245597384 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1245602119 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245608272 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1245612449 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245617331 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1245620269 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245625615 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245627629 207V00000X 020 Physicians 016 OB/GYN

1245631571 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1245633445 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1245633460 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245633486 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245633577 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1245633577 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245636406 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1245641489 207Q00000X 020 Physicians 173 Family Medicine

135 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245641760 207R00000X 020 Physicians 011 Internal Medicine

1245657048 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245663657 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245671536 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1245671536 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1245671536 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245673201 208600000X 020 Physicians 275 Surgery

1245677277 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245677277 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1245677277 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1245684265 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245692680 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1245700368 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245706001 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1245708155 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1245713015 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245724269 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245731728 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245733799 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245740083 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245742337 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1245742337 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1245747922 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245748649 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245753177 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1245755511 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245760461 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245765072 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1245772359 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1245772359 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1245772953 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

136 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1245781343 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1245783596 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245784123 111N00000X 011 Chiropractic Providers 047 Chiropractor

1245798842 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1245862549 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1245862549 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1245865377 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1245871466 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1245873207 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245877299 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1245893361 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1255305884 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255307203 207RI0200X 020 Physicians 185 Infectious Diseases

1255307203 207R00000X 020 Physicians 011 Internal Medicine

1255310595 2084N0400X 020 Physicians 013 Neurology

1255310918 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255310934 2084N0400X 020 Physicians 013 Neurology

1255311940 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255315792 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1255316873 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255317038 208600000X 020 Physicians 275 Surgery

1255319000 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255319513 208600000X 020 Physicians 275 Surgery

1255319513 204F00000X 020 Physicians 279 Transplant Surgery

1255323796 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1255331278 2086S0129X 020 Physicians 289 Vascular Surgery

1255333704 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255337846 208100000X 020 Physicians 025 Physical Medicine and Rehab

1255341285 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255344537 207RC0200X 020 Physicians 206 Critical Care Medicine

1255344537 207RP1001X 020 Physicians 029 Pulmonary Diseases

137 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1255359584 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255359832 207X00000X 020 Physicians 020 Orthopedic Surgery

1255360244 207RG0100X 020 Physicians 010 Gastroenterology

1255361093 208100000X 020 Physicians 025 Physical Medicine and Rehab

1255363503 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1255363693 208600000X 020 Physicians 275 Surgery

1255365540 207T00000X 020 Physicians 014 Neurological Surgery

1255368007 207P00000X 020 Physicians 270 Emergency Medicine

1255369104 207Q00000X 020 Physicians 173 Family Medicine

1255369393 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1255369393 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1255372900 207R00000X 020 Physicians 011 Internal Medicine

1255374450 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255383022 207L00000X 020 Physicians 005 Anesthesiology

1255387031 207Q00000X 020 Physicians 173 Family Medicine

1255388294 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1255389268 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1255390779 207RC0000X 020 Physicians 006 Cardiovascular Disease

1255394573 207Q00000X 020 Physicians 173 Family Medicine

1255397196 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255402301 207Q00000X 020 Physicians 173 Family Medicine

1255404711 111N00000X 011 Chiropractic Providers 047 Chiropractor

1255420030 2085N0700X 020 Physicians 204 Neuroradiology

1255421277 207L00000X 020 Physicians 005 Anesthesiology

1255422895 207L00000X 020 Physicians 005 Anesthesiology

1255444022 2084P0800X 020 Physicians 121 Psychiatry

1255445607 207RC0000X 020 Physicians 006 Cardiovascular Disease

1255445607 207R00000X 020 Physicians 011 Internal Medicine

1255448668 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1255449989 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1255452926 207T00000X 020 Physicians 014 Neurological Surgery

138 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1255463394 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255463394 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1255464046 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1255469284 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255487013 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1255487435 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1255502498 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1255502498 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255503223 207RG0100X 020 Physicians 010 Gastroenterology

1255506929 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255507877 207R00000X 020 Physicians 011 Internal Medicine

1255508859 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1255508859 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1255521092 207QG0300X 020 Physicians 586 Family Medicine; Geriatric Medicine

1255521092 207Q00000X 020 Physicians 173 Family Medicine

1255523221 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255523320 2080P0202X 020 Physicians 221 Pediatric Cardiology

1255523924 207V00000X 020 Physicians 016 OB/GYN

1255524849 208200000X 020 Physicians 024 Plastic Surgery

1255526430 208000000X 020 Physicians 049 Pediatrics

1255526430 2084N0400X 020 Physicians 013 Neurology

1255530713 207R00000X 020 Physicians 011 Internal Medicine

1255530853 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255533576 207R00000X 020 Physicians 011 Internal Medicine

1255533576 208M00000X 020 Physicians 344 Hospitalist

1255533576 208000000X 020 Physicians 049 Pediatrics

1255534871 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1255541983 207RC0000X 020 Physicians 006 Cardiovascular Disease

1255542932 207L00000X 020 Physicians 005 Anesthesiology

1255565354 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255575767 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

139 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1255576609 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1255578068 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255580767 111N00000X 011 Chiropractic Providers 047 Chiropractor

1255582011 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255587572 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1255589321 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1255590220 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255590220 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255591608 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255592903 208800000X 020 Physicians 034 Urology

1255595195 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1255595823 207R00000X 020 Physicians 011 Internal Medicine

1255599098 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1255599403 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255605762 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1255608535 208000000X 020 Physicians 049 Pediatrics

1255608535 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1255608733 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255621348 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1255630182 2084N0400X 020 Physicians 013 Neurology

1255630182 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1255630570 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255633244 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1255637260 207L00000X 020 Physicians 005 Anesthesiology

1255650123 207P00000X 020 Physicians 270 Emergency Medicine

1255650610 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255650826 2084N0400X 020 Physicians 013 Neurology

1255651808 207Q00000X 020 Physicians 173 Family Medicine

1255652780 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1255652780 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255657409 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

140 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1255658001 208000000X 020 Physicians 049 Pediatrics

1255658399 207PE0004X 020 Physicians 093 Emergency Medical Services

1255664421 207RN0300X 020 Physicians 105 Nephrology

1255671624 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255676714 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1255679114 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255683280 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255695615 208000000X 020 Physicians 049 Pediatrics

1255698767 207V00000X 020 Physicians 016 OB/GYN

1255703344 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255704318 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255707519 207R00000X 020 Physicians 011 Internal Medicine

1255709481 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1255713012 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255725115 122300000X 012 Dental Providers 019 Dentists

1255728242 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1255734414 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255734588 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255737326 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1255737326 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255743233 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255745378 122300000X 012 Dental Providers 019 Dentists

1255749024 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255750105 207R00000X 020 Physicians 011 Internal Medicine

1255754925 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255754941 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255763389 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255763496 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255764528 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255767273 207R00000X 020 Physicians 011 Internal Medicine

1255772216 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

141 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1255773867 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255773867 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255775797 207RN0300X 020 Physicians 105 Nephrology

1255776126 2085R0202X 020 Physicians 167 Diagnostic Radiology

1255780250 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255786281 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1255786281 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1255799565 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1255822557 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1255825253 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255826848 1223G0001X 012 Dental Providers 001 General Practice

1255827697 208800000X 020 Physicians 034 Urology

1255839122 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1255839122 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1255841821 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255866521 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1255872289 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1255875928 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1255879565 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1255880621 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255895835 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1255899027 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1255899027 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1255961090 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255961959 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1255965604 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255970307 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1255981056 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1255983888 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1255990974 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1255996674 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

142 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265086771 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1265092027 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1265093124 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265096234 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1265401103 208000000X 020 Physicians 049 Pediatrics

1265401103 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1265402267 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1265402366 207RH0003X 020 Physicians 179 Hematology/Oncology

1265402366 207RH0000X 020 Physicians 178 Hematology

1265402929 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265403596 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265404057 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1265404073 208600000X 020 Physicians 275 Surgery

1265405120 207RC0200X 020 Physicians 206 Critical Care Medicine

1265405252 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265405922 2084N0400X 020 Physicians 013 Neurology

1265405922 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1265405922 2084S0012X 020 Physicians 521 Sleep Medicine

1265405922 2084P0800X 020 Physicians 121 Psychiatry

1265406698 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265406979 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265410096 207RP1001X 020 Physicians 029 Pulmonary Diseases

1265411177 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265411243 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1265411243 207RC0000X 020 Physicians 006 Cardiovascular Disease

1265411748 2085R0202X 020 Physicians 167 Diagnostic Radiology

1265418248 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1265418420 207RC0000X 020 Physicians 006 Cardiovascular Disease

1265418578 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265424972 208800000X 020 Physicians 034 Urology

1265427918 207W00000X 020 Physicians 018 Ophthalmology

143 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265430466 111N00000X 011 Chiropractic Providers 047 Chiropractor

1265432769 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1265447734 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1265447734 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1265447734 207ZP0101X 020 Physicians 022 Pathology

1265447734 207ZH0000X 020 Physicians 560 Hematology; Pathology

1265450233 207RP1001X 020 Physicians 029 Pulmonary Diseases

1265450969 207V00000X 020 Physicians 016 OB/GYN

1265453492 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1265455018 2085R0202X 020 Physicians 167 Diagnostic Radiology

1265456370 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265456370 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1265463525 207P00000X 020 Physicians 270 Emergency Medicine

1265466809 207VX0201X 020 Physicians 307 Gynecologic Oncology

1265468334 2080P0202X 020 Physicians 221 Pediatric Cardiology

1265470371 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265470447 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265471296 207Q00000X 020 Physicians 173 Family Medicine

1265474068 207RC0200X 020 Physicians 206 Critical Care Medicine

1265475263 207L00000X 020 Physicians 005 Anesthesiology

1265475305 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1265480750 207R00000X 020 Physicians 011 Internal Medicine

1265485312 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1265485312 208000000X 020 Physicians 049 Pediatrics

1265492862 207RC0000X 020 Physicians 006 Cardiovascular Disease

1265494157 207V00000X 020 Physicians 016 OB/GYN

1265497556 207W00000X 020 Physicians 018 Ophthalmology

1265499479 207RC0000X 020 Physicians 006 Cardiovascular Disease

1265510622 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265515753 208000000X 020 Physicians 049 Pediatrics

1265516439 208600000X 020 Physicians 275 Surgery

144 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265525299 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265531768 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1265545784 207VE0102X 020 Physicians 530 Reproductive Endocrinology

1265546345 207RP1001X 020 Physicians 029 Pulmonary Diseases

1265560049 207Q00000X 020 Physicians 173 Family Medicine

1265568851 207R00000X 020 Physicians 011 Internal Medicine

1265570956 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265571137 2085R0202X 020 Physicians 167 Diagnostic Radiology

1265576680 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1265605778 207Y00000X 020 Physicians 217 Otolaryngology

1265612204 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1265612204 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1265612774 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1265623177 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1265626055 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265636427 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1265637532 2084P0800X 020 Physicians 121 Psychiatry

1265638746 207W00000X 020 Physicians 018 Ophthalmology

1265641187 207RG0100X 020 Physicians 010 Gastroenterology

1265645766 1223G0001X 012 Dental Providers 001 General Practice

1265648158 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1265655062 183500000X 018 Pharmacy 253 Pharmacist

1265660740 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265660757 207L00000X 020 Physicians 005 Anesthesiology

1265663322 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1265663439 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265664726 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265664726 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1265667893 208000000X 020 Physicians 049 Pediatrics

1265674337 207V00000X 020 Physicians 016 OB/GYN

1265674873 2084V0102X 020 Physicians 552 Vascular Neurology

145 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265674873 2084N0400X 020 Physicians 013 Neurology

1265681258 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1265685432 207Q00000X 020 Physicians 173 Family Medicine

1265686133 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265687438 207P00000X 020 Physicians 270 Emergency Medicine

1265690911 207RI0200X 020 Physicians 185 Infectious Diseases

1265694434 207L00000X 020 Physicians 005 Anesthesiology

1265700850 111N00000X 011 Chiropractic Providers 047 Chiropractor

1265707848 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1265712558 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265723134 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1265723134 2084P0800X 020 Physicians 121 Psychiatry

1265727572 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1265727663 207RP1001X 020 Physicians 029 Pulmonary Diseases

1265729362 207P00000X 020 Physicians 270 Emergency Medicine

1265743496 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1265743876 122300000X 012 Dental Providers 019 Dentists

1265745152 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1265758593 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265773204 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1265773519 111N00000X 011 Chiropractic Providers 047 Chiropractor

1265775043 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1265775068 208000000X 020 Physicians 049 Pediatrics

1265789457 2085R0202X 020 Physicians 167 Diagnostic Radiology

1265794523 207P00000X 020 Physicians 270 Emergency Medicine

1265802524 1223G0001X 012 Dental Providers 001 General Practice

1265802581 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1265806152 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1265821177 111N00000X 011 Chiropractic Providers 047 Chiropractor

1265822647 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1265826598 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

146 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265829675 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1265829675 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1265834535 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1265835714 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265837991 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1265842199 208000000X 020 Physicians 049 Pediatrics

1265842447 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1265861157 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1265864284 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1265871826 207V00000X 020 Physicians 016 OB/GYN

1265872030 207Q00000X 020 Physicians 173 Family Medicine

1265872212 207V00000X 020 Physicians 016 OB/GYN

1265875405 207X00000X 020 Physicians 020 Orthopedic Surgery

1265877492 111N00000X 011 Chiropractic Providers 047 Chiropractor

1265879480 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1265879837 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1265885636 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1265885867 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265885867 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1265894950 207RH0003X 020 Physicians 179 Hematology/Oncology

1265894950 207R00000X 020 Physicians 011 Internal Medicine

1265909659 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1265915094 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1265919468 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1265922009 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1265950075 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1265957617 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1265960918 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1265968192 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1265976732 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1265985626 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

147 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1265989487 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1275001992 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1275007874 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1275010688 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1275010688 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1275010720 208600000X 020 Physicians 275 Surgery

1275017899 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275026551 111N00000X 011 Chiropractic Providers 047 Chiropractor

1275027641 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275029225 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275040610 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1275058216 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275058216 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275059370 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1275060147 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275080947 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1275185159 207Q00000X 020 Physicians 173 Family Medicine

1275502726 207T00000X 020 Physicians 014 Neurological Surgery

1275504383 207R00000X 020 Physicians 011 Internal Medicine

1275505679 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1275507600 207RG0100X 020 Physicians 010 Gastroenterology

1275511933 207RP1001X 020 Physicians 029 Pulmonary Diseases

1275512378 208000000X 020 Physicians 049 Pediatrics

1275512691 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1275512691 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1275512691 207ZH0000X 020 Physicians 560 Hematology; Pathology

1275513152 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275513772 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275521577 207V00000X 020 Physicians 016 OB/GYN

1275524357 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275528218 207V00000X 020 Physicians 016 OB/GYN

148 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1275532467 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275534042 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1275544678 208600000X 020 Physicians 275 Surgery

1275550949 207R00000X 020 Physicians 011 Internal Medicine

1275551780 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275551848 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275561102 207Q00000X 020 Physicians 173 Family Medicine

1275561482 152WC0802X 015 Eye and Vision Service Providers 617 Corneal and Contact Management

1275561482 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275561482 156FX1800X 015 Eye and Vision Service Providers 411 Optician

1275561649 208600000X 020 Physicians 275 Surgery

1275563348 207P00000X 020 Physicians 270 Emergency Medicine

1275566143 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1275568933 207RC0000X 020 Physicians 006 Cardiovascular Disease

1275570236 207L00000X 020 Physicians 005 Anesthesiology

1275572554 207P00000X 020 Physicians 270 Emergency Medicine

1275573891 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1275574832 208G00000X 020 Physicians 033 Thoracic Surgery

1275575581 207Q00000X 020 Physicians 173 Family Medicine

1275577454 207W00000X 020 Physicians 018 Ophthalmology

1275578452 207R00000X 020 Physicians 011 Internal Medicine

1275578593 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275579583 207RP1001X 020 Physicians 029 Pulmonary Diseases

1275580284 208600000X 020 Physicians 275 Surgery

1275585861 2084S0012X 020 Physicians 521 Sleep Medicine

1275585861 2084N0400X 020 Physicians 013 Neurology

1275596538 208800000X 020 Physicians 034 Urology

1275600231 207RI0200X 020 Physicians 185 Infectious Diseases

1275601122 207V00000X 020 Physicians 016 OB/GYN

1275602740 207L00000X 020 Physicians 005 Anesthesiology

1275605198 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

149 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1275607509 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275610214 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1275612616 207ZP0101X 020 Physicians 022 Pathology

1275616104 207Y00000X 020 Physicians 217 Otolaryngology

1275621104 207P00000X 020 Physicians 270 Emergency Medicine

1275621161 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275621609 208000000X 020 Physicians 049 Pediatrics

1275621609 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1275621864 122300000X 012 Dental Providers 019 Dentists

1275624280 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275625030 111N00000X 011 Chiropractic Providers 047 Chiropractor

1275625162 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1275629719 2084P0800X 020 Physicians 121 Psychiatry

1275631640 208000000X 020 Physicians 049 Pediatrics

1275636888 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1275640757 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1275647125 207R00000X 020 Physicians 011 Internal Medicine

1275647125 207RG0100X 020 Physicians 010 Gastroenterology

1275669038 207RH0003X 020 Physicians 179 Hematology/Oncology

1275679029 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1275680720 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1275681611 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1275693749 207X00000X 020 Physicians 020 Orthopedic Surgery

1275695025 156FX1800X 015 Eye and Vision Service Providers 411 Optician

1275695025 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275695025 152WC0802X 015 Eye and Vision Service Providers 617 Corneal and Contact Management

1275700197 207P00000X 020 Physicians 270 Emergency Medicine

1275707937 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1275715682 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1275718975 111N00000X 011 Chiropractic Providers 047 Chiropractor

1275720005 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

150 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1275720898 207RG0100X 020 Physicians 010 Gastroenterology

1275725822 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1275726887 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1275728677 207RI0200X 020 Physicians 185 Infectious Diseases

1275732455 207P00000X 020 Physicians 270 Emergency Medicine

1275735219 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1275736761 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1275742090 207RN0300X 020 Physicians 105 Nephrology

1275744195 207L00000X 020 Physicians 005 Anesthesiology

1275746984 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1275750689 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1275757783 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1275762395 207R00000X 020 Physicians 011 Internal Medicine

1275762924 207Q00000X 020 Physicians 173 Family Medicine

1275763955 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275775512 208G00000X 020 Physicians 033 Thoracic Surgery

1275788960 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275793978 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275794596 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275796013 207L00000X 020 Physicians 005 Anesthesiology

1275797565 208000000X 020 Physicians 049 Pediatrics

1275803314 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275813305 207V00000X 020 Physicians 016 OB/GYN

1275815680 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275815680 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275821449 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275823932 207L00000X 020 Physicians 005 Anesthesiology

1275826810 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1275826810 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1275851420 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275852907 207Q00000X 020 Physicians 173 Family Medicine

151 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1275854226 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275858714 207Y00000X 020 Physicians 217 Otolaryngology

1275859670 208600000X 020 Physicians 275 Surgery

1275866709 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1275866709 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1275866824 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275866824 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1275876054 2084N0400X 020 Physicians 013 Neurology

1275890899 207L00000X 020 Physicians 005 Anesthesiology

1275897415 2084P0800X 020 Physicians 121 Psychiatry

1275908196 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275909244 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1275916330 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275916462 207Q00000X 020 Physicians 173 Family Medicine

1275916462 207P00000X 020 Physicians 270 Emergency Medicine

1275927923 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1275928368 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1275931412 111N00000X 011 Chiropractic Providers 047 Chiropractor

1275936809 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1275943342 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1275949745 207R00000X 020 Physicians 011 Internal Medicine

1275950925 2085R0202X 020 Physicians 167 Diagnostic Radiology

1275951063 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1275955767 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1275966285 207R00000X 020 Physicians 011 Internal Medicine

1275970238 122300000X 012 Dental Providers 019 Dentists

1275970733 207R00000X 020 Physicians 011 Internal Medicine

1275973091 207Q00000X 020 Physicians 173 Family Medicine

1275979528 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1275984635 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1275984635 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

152 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1275984635 363LX0106X 036 Phys Assts and Advanced Nursing Provs 536 Nurse Practitioner; Occupational Health

1275991952 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1275994717 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285002741 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1285003608 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285005991 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1285009159 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1285012005 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1285012294 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1285018192 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285032052 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1285041277 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1285045534 2085N0700X 020 Physicians 204 Neuroradiology

1285045534 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285045971 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1285047738 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1285074757 207RP1001X 020 Physicians 029 Pulmonary Diseases

1285075325 207L00000X 020 Physicians 005 Anesthesiology

1285075853 2084P0800X 020 Physicians 121 Psychiatry

1285079921 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1285081323 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1285083436 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285096404 2084N0400X 020 Physicians 013 Neurology

1285098343 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285116509 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285117028 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285149633 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1285153007 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285161554 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1285170530 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1285171223 207Q00000X 020 Physicians 173 Family Medicine

153 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285171579 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285184879 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1285196162 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285253302 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1285271601 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1285272799 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1285272955 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1285274175 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1285293472 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285294348 207Q00000X 020 Physicians 173 Family Medicine

1285298240 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1285600726 207V00000X 020 Physicians 016 OB/GYN

1285600726 207VX0000X 020 Physicians 211 Obstetrics

1285602425 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285602805 2086S0129X 020 Physicians 289 Vascular Surgery

1285605006 207V00000X 020 Physicians 016 OB/GYN

1285606285 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285606665 207Q00000X 020 Physicians 173 Family Medicine

1285606665 207V00000X 020 Physicians 016 OB/GYN

1285606715 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285608273 207R00000X 020 Physicians 011 Internal Medicine

1285608273 207RI0200X 020 Physicians 185 Infectious Diseases

1285608547 207RC0000X 020 Physicians 006 Cardiovascular Disease

1285608547 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1285608547 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1285610204 207ZH0000X 020 Physicians 560 Hematology; Pathology

1285611459 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285611616 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285612945 207ZP0101X 020 Physicians 436 Anatomic Pathology

1285612945 207ZC0006X 020 Physicians 021 Clinical Pathology

1285612945 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

154 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285612945 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1285613091 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285613851 207RI0011X 020 Physicians 188 Interventional Cardiology

1285614362 207RC0000X 020 Physicians 006 Cardiovascular Disease

1285615724 207RI0011X 020 Physicians 188 Interventional Cardiology

1285626184 207ZP0101X 020 Physicians 022 Pathology

1285626648 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1285629014 207R00000X 020 Physicians 011 Internal Medicine

1285632398 207Q00000X 020 Physicians 173 Family Medicine

1285636423 207R00000X 020 Physicians 011 Internal Medicine

1285639575 207W00000X 020 Physicians 018 Ophthalmology

1285641324 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285642280 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285644328 207X00000X 020 Physicians 020 Orthopedic Surgery

1285648899 208000000X 020 Physicians 049 Pediatrics

1285648899 2080P0202X 020 Physicians 221 Pediatric Cardiology

1285650952 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285651950 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285651950 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1285655407 207Q00000X 020 Physicians 173 Family Medicine

1285656389 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1285656868 208000000X 020 Physicians 049 Pediatrics

1285660035 207RH0003X 020 Physicians 179 Hematology/Oncology

1285660928 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1285662056 207L00000X 020 Physicians 005 Anesthesiology

1285664169 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1285664169 2084P0800X 020 Physicians 121 Psychiatry

1285664409 207RC0000X 020 Physicians 006 Cardiovascular Disease

1285665067 208000000X 020 Physicians 049 Pediatrics

1285666735 207P00000X 020 Physicians 270 Emergency Medicine

1285668624 207R00000X 020 Physicians 011 Internal Medicine

155 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285668814 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285670067 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1285670067 1223G0001X 012 Dental Providers 001 General Practice

1285672246 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1285673525 207RC0000X 020 Physicians 006 Cardiovascular Disease

1285673947 207R00000X 020 Physicians 011 Internal Medicine

1285675728 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285678441 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1285683029 208G00000X 020 Physicians 033 Thoracic Surgery

1285688226 207Q00000X 020 Physicians 173 Family Medicine

1285701631 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1285701631 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1285713396 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1285716571 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1285717082 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1285717116 207Q00000X 020 Physicians 173 Family Medicine

1285720904 207RC0000X 020 Physicians 006 Cardiovascular Disease

1285721894 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1285721894 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1285722926 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1285724708 207RI0200X 020 Physicians 185 Infectious Diseases

1285725820 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1285729533 208100000X 020 Physicians 025 Physical Medicine and Rehab

1285730689 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285731802 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1285732313 1223G0001X 012 Dental Providers 001 General Practice

1285732958 207T00000X 020 Physicians 014 Neurological Surgery

1285733279 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285738427 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285742965 207P00000X 020 Physicians 270 Emergency Medicine

1285750810 2084P0800X 020 Physicians 121 Psychiatry

156 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285751776 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285755587 207V00000X 020 Physicians 016 OB/GYN

1285768911 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1285770081 2084P0800X 020 Physicians 121 Psychiatry

1285788570 207R00000X 020 Physicians 011 Internal Medicine

1285788927 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285788950 207W00000X 020 Physicians 018 Ophthalmology

1285798470 207W00000X 020 Physicians 018 Ophthalmology

1285798934 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1285798934 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1285800631 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1285810010 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1285820290 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1285821645 207L00000X 020 Physicians 005 Anesthesiology

1285824011 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1285834614 207Q00000X 020 Physicians 173 Family Medicine

1285845917 207Q00000X 020 Physicians 173 Family Medicine

1285847269 1223G0001X 012 Dental Providers 001 General Practice

1285856237 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285859157 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1285861997 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1285861997 207ZP0101X 020 Physicians 436 Anatomic Pathology

1285861997 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1285863050 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285863126 207Q00000X 020 Physicians 173 Family Medicine

1285868968 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1285875666 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285884767 207Q00000X 020 Physicians 173 Family Medicine

1285884767 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285885715 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285886838 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

157 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285888958 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1285893867 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1285894964 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1285898031 207P00000X 020 Physicians 270 Emergency Medicine

1285898221 207W00000X 020 Physicians 018 Ophthalmology

1285898361 2085R0202X 020 Physicians 167 Diagnostic Radiology

1285899138 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1285908855 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1285908855 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1285908855 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1285916031 111N00000X 011 Chiropractic Providers 047 Chiropractor

1285920587 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285924043 208M00000X 020 Physicians 344 Hospitalist

1285926212 207X00000X 020 Physicians 020 Orthopedic Surgery

1285926360 207Q00000X 020 Physicians 173 Family Medicine

1285929653 207L00000X 020 Physicians 005 Anesthesiology

1285937938 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1285941872 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1285941872 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1285945162 207T00000X 020 Physicians 014 Neurological Surgery

1285950089 207RH0003X 020 Physicians 179 Hematology/Oncology

1285952077 208M00000X 020 Physicians 344 Hospitalist

1285962548 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1285963793 2084N0400X 020 Physicians 013 Neurology

1285963793 2084V0102X 020 Physicians 552 Vascular Neurology

1285968404 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1285969642 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1285972737 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1285976670 207Q00000X 020 Physicians 173 Family Medicine

1285980565 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1285987081 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

158 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1285987495 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1285991299 207P00000X 020 Physicians 270 Emergency Medicine

1285992354 2080P0202X 020 Physicians 221 Pediatric Cardiology

1285994376 208000000X 020 Physicians 049 Pediatrics

1285994517 207P00000X 020 Physicians 270 Emergency Medicine

1295013506 208000000X 020 Physicians 049 Pediatrics

1295013506 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1295015642 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1295020527 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1295021988 1223P0221X 012 Dental Providers 063 Pedodontics

1295026532 207Q00000X 020 Physicians 173 Family Medicine

1295026540 207Y00000X 020 Physicians 217 Otolaryngology

1295026540 207YP0228X 020 Physicians 140 Pediatric Otolaryngology

1295027472 207T00000X 020 Physicians 014 Neurological Surgery

1295027530 207L00000X 020 Physicians 005 Anesthesiology

1295033694 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295040517 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1295041697 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1295041697 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1295043362 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1295044212 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1295051670 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1295060382 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1295063980 1223X0400X 012 Dental Providers 515 Orthodontics & Dentofacial Orthopedics

1295076750 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1295081461 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295099836 207Q00000X 020 Physicians 173 Family Medicine

1295105831 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295106763 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1295109502 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1295111300 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

159 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1295114817 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1295117240 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1295120202 208000000X 020 Physicians 049 Pediatrics

1295121317 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1295124501 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295126639 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1295131670 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295131670 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1295136521 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295138162 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295149169 122300000X 012 Dental Providers 019 Dentists

1295154474 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295156495 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1295158020 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295174563 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1295178077 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295179687 208800000X 020 Physicians 034 Urology

1295185007 122300000X 012 Dental Providers 019 Dentists

1295187862 2084P0800X 020 Physicians 121 Psychiatry

1295211431 207Q00000X 020 Physicians 173 Family Medicine

1295212298 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1295219996 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295254522 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1295255446 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1295255446 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295256188 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295257400 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1295258507 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1295260495 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295261030 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295262996 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

160 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1295265338 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1295265866 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1295265866 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295266831 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1295268472 111N00000X 011 Chiropractic Providers 047 Chiropractor

1295268803 207R00000X 020 Physicians 011 Internal Medicine

1295271690 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1295273456 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295277929 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1295287183 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1295299857 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1295365484 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1295369882 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1295384477 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295384477 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1295384915 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1295390730 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1295392041 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1295395176 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1295704245 207RC0000X 020 Physicians 006 Cardiovascular Disease

1295706273 208M00000X 020 Physicians 344 Hospitalist

1295706273 207R00000X 020 Physicians 011 Internal Medicine

1295712040 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1295712388 207L00000X 020 Physicians 005 Anesthesiology

1295713170 207W00000X 020 Physicians 018 Ophthalmology

1295713253 207RC0000X 020 Physicians 006 Cardiovascular Disease

1295714954 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295719730 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1295728848 2080P0202X 020 Physicians 221 Pediatric Cardiology

1295731040 207W00000X 020 Physicians 018 Ophthalmology

1295738789 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

161 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1295744837 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1295746121 207RC0000X 020 Physicians 006 Cardiovascular Disease

1295747996 111N00000X 011 Chiropractic Providers 047 Chiropractor

1295748440 207Q00000X 020 Physicians 173 Family Medicine

1295752293 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295752962 2085N0700X 020 Physicians 204 Neuroradiology

1295752962 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295753994 208000000X 020 Physicians 049 Pediatrics

1295755718 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1295757698 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1295761385 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1295765733 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1295766392 207Q00000X 020 Physicians 173 Family Medicine

1295767994 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1295767994 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1295768554 207R00000X 020 Physicians 011 Internal Medicine

1295770857 207Q00000X 020 Physicians 173 Family Medicine

1295776714 207Q00000X 020 Physicians 173 Family Medicine

1295779726 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1295779809 208600000X 020 Physicians 275 Surgery

1295782308 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295789345 207RG0100X 020 Physicians 010 Gastroenterology

1295794378 207R00000X 020 Physicians 011 Internal Medicine

1295804250 207RH0003X 020 Physicians 179 Hematology/Oncology

1295804250 207R00000X 020 Physicians 011 Internal Medicine

1295804334 1223G0001X 012 Dental Providers 001 General Practice

1295804334 122300000X 012 Dental Providers 019 Dentists

1295812808 207RP1001X 020 Physicians 029 Pulmonary Diseases

1295818789 2086S0120X 020 Physicians 245 Pediatric Surgery

1295822104 208800000X 020 Physicians 034 Urology

1295822146 207N00000X 020 Physicians 007 Dermatology

162 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1295823425 208G00000X 020 Physicians 033 Thoracic Surgery

1295827376 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1295827376 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1295835015 207W00000X 020 Physicians 018 Ophthalmology

1295836575 208600000X 020 Physicians 275 Surgery

1295840023 1223G0001X 012 Dental Providers 001 General Practice

1295840023 122300000X 012 Dental Providers 019 Dentists

1295840395 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1295845790 122300000X 012 Dental Providers 019 Dentists

1295847861 207Q00000X 020 Physicians 173 Family Medicine

1295854990 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1295857720 207RH0003X 020 Physicians 179 Hematology/Oncology

1295861078 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295861185 2084P0800X 020 Physicians 121 Psychiatry

1295862837 2085N0700X 020 Physicians 204 Neuroradiology

1295862837 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295877702 2085P0229X 020 Physicians 241 Pediatric Radiology

1295881266 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295882264 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295882264 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1295888774 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295890184 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1295894277 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295913457 2088P0231X 020 Physicians 246 Pediatric Urology

1295915007 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1295916369 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1295926145 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1295926145 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1295930279 122300000X 012 Dental Providers 019 Dentists

1295933471 208600000X 020 Physicians 275 Surgery

1295938009 2085R0202X 020 Physicians 167 Diagnostic Radiology

163 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1295938413 208600000X 020 Physicians 275 Surgery

1295938504 1223G0001X 012 Dental Providers 001 General Practice

1295938504 122300000X 012 Dental Providers 019 Dentists

1295945657 1223G0001X 012 Dental Providers 001 General Practice

1295945673 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295948578 2085P0229X 020 Physicians 241 Pediatric Radiology

1295950277 207PE0004X 020 Physicians 093 Emergency Medical Services

1295956852 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1295959823 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1295959823 207L00000X 020 Physicians 005 Anesthesiology

1295967388 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1295968022 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1295976439 207L00000X 020 Physicians 005 Anesthesiology

1295981371 207Y00000X 020 Physicians 217 Otolaryngology

1295982056 2085P0229X 020 Physicians 241 Pediatric Radiology

1295990141 208600000X 020 Physicians 275 Surgery

1295992154 207Q00000X 020 Physicians 173 Family Medicine

1295995868 207RC0000X 020 Physicians 006 Cardiovascular Disease

1295995900 2085R0202X 020 Physicians 167 Diagnostic Radiology

1295996296 207RC0000X 020 Physicians 006 Cardiovascular Disease

1295997377 2084N0400X 020 Physicians 013 Neurology

1306006861 207L00000X 020 Physicians 005 Anesthesiology

1306016860 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1306028675 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1306036017 2084P0800X 020 Physicians 121 Psychiatry

1306036017 2080P0006X 020 Physicians 223 Pediatric Developmental & Beha

1306036017 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1306040134 207K00000X 020 Physicians 003 Allergy & Immunology

1306040985 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1306045984 208600000X 020 Physicians 275 Surgery

1306048574 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

164 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1306056130 2085N0700X 020 Physicians 204 Neuroradiology

1306056130 2085R0202X 020 Physicians 167 Diagnostic Radiology

1306057450 207W00000X 020 Physicians 018 Ophthalmology

1306061726 207V00000X 020 Physicians 016 OB/GYN

1306065297 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1306065602 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1306068176 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1306086293 208800000X 020 Physicians 034 Urology

1306086376 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1306086376 2084N0400X 020 Physicians 013 Neurology

1306087051 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1306089750 207W00000X 020 Physicians 018 Ophthalmology

1306092069 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306092655 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1306096268 207R00000X 020 Physicians 011 Internal Medicine

1306098546 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1306106638 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1306118906 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1306123435 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306124599 207W00000X 020 Physicians 018 Ophthalmology

1306124821 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1306126255 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306130844 2084N0400X 020 Physicians 013 Neurology

1306132709 207L00000X 020 Physicians 005 Anesthesiology

1306134309 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306137195 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1306137195 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1306144159 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1306145628 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1306149323 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1306155726 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

165 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1306161575 207R00000X 020 Physicians 011 Internal Medicine

1306161575 207RP1001X 020 Physicians 029 Pulmonary Diseases

1306165972 207Y00000X 020 Physicians 217 Otolaryngology

1306167689 207R00000X 020 Physicians 011 Internal Medicine

1306169065 207R00000X 020 Physicians 011 Internal Medicine

1306170808 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306171483 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1306173703 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1306178439 207VX0000X 020 Physicians 211 Obstetrics

1306178439 207V00000X 020 Physicians 016 OB/GYN

1306188776 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1306204391 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1306212469 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1306215363 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1306216734 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1306221460 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306227459 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1306227459 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1306239066 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1306251871 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1306263868 208000000X 020 Physicians 049 Pediatrics

1306263868 208M00000X 020 Physicians 344 Hospitalist

1306268586 111N00000X 011 Chiropractic Providers 047 Chiropractor

1306274600 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1306277348 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306281308 208600000X 020 Physicians 275 Surgery

1306282025 207RH0003X 020 Physicians 179 Hematology/Oncology

1306286448 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306286786 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1306288147 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1306289889 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

166 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1306292842 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306295043 2084P0800X 020 Physicians 121 Psychiatry

1306297585 207P00000X 020 Physicians 270 Emergency Medicine

1306298534 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306299011 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1306299375 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1306303649 183500000X 018 Pharmacy 253 Pharmacist

1306310917 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1306318829 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1306329438 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306329438 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1306338496 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306368220 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1306368808 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1306374277 122300000X 012 Dental Providers 019 Dentists

1306395710 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306395710 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1306396726 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306488309 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1306495072 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306805163 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1306807458 207RC0000X 020 Physicians 006 Cardiovascular Disease

1306808738 2085R0202X 020 Physicians 167 Diagnostic Radiology

1306809520 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1306810163 2083P0500X 020 Physicians 257 Preventive Med/Occupational-Environ Med

1306810346 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1306810577 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1306811369 208M00000X 020 Physicians 344 Hospitalist

1306813092 207T00000X 020 Physicians 014 Neurological Surgery

1306821038 207R00000X 020 Physicians 011 Internal Medicine

1306821707 2080P0202X 020 Physicians 221 Pediatric Cardiology

167 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1306822028 207RG0100X 020 Physicians 010 Gastroenterology

1306822549 207RC0000X 020 Physicians 006 Cardiovascular Disease

1306822549 2080P0202X 020 Physicians 221 Pediatric Cardiology

1306822861 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1306824297 207ZP0101X 020 Physicians 022 Pathology

1306824644 208800000X 020 Physicians 034 Urology

1306828389 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1306829445 208600000X 020 Physicians 275 Surgery

1306838644 2085R0202X 020 Physicians 167 Diagnostic Radiology

1306846993 207Q00000X 020 Physicians 173 Family Medicine

1306851761 208600000X 020 Physicians 275 Surgery

1306851761 208D00000X 020 Physicians 001 General Practice

1306852694 207P00000X 020 Physicians 270 Emergency Medicine

1306863261 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1306863303 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1306864665 207Q00000X 020 Physicians 173 Family Medicine

1306864905 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1306864905 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1306869433 207ZC0006X 020 Physicians 021 Clinical Pathology

1306869433 2080P0202X 020 Physicians 221 Pediatric Cardiology

1306869433 208000000X 020 Physicians 049 Pediatrics

1306870498 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1306873369 207R00000X 020 Physicians 011 Internal Medicine

1306880885 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1306881636 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306887286 207Q00000X 020 Physicians 173 Family Medicine

1306887393 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1306887773 207Q00000X 020 Physicians 173 Family Medicine

1306888623 208000000X 020 Physicians 049 Pediatrics

1306890710 208600000X 020 Physicians 275 Surgery

1306903273 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

168 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1306903729 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1306904073 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1306910666 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1306927520 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1306930417 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1306932660 207Q00000X 020 Physicians 173 Family Medicine

1306932876 1223G0001X 012 Dental Providers 001 General Practice

1306933452 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1306935259 207P00000X 020 Physicians 270 Emergency Medicine

1306937941 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1306955521 207Q00000X 020 Physicians 173 Family Medicine

1306955661 208100000X 020 Physicians 025 Physical Medicine and Rehab

1306958715 207V00000X 020 Physicians 016 OB/GYN

1306966858 2085R0202X 020 Physicians 167 Diagnostic Radiology

1306970926 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1306980875 2085R0202X 020 Physicians 167 Diagnostic Radiology

1306988589 207P00000X 020 Physicians 270 Emergency Medicine

1306988688 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1306990924 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1306994652 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1306998273 2084P0800X 020 Physicians 121 Psychiatry

1306998273 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1306998844 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1316001092 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1316001092 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316014970 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1316018468 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1316018906 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316021488 207R00000X 020 Physicians 011 Internal Medicine

1316021488 207RG0100X 020 Physicians 010 Gastroenterology

1316021603 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

169 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1316021603 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1316023922 207R00000X 020 Physicians 011 Internal Medicine

1316033749 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1316039746 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1316064835 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316073448 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1316080120 207RX0202X 020 Physicians 529 Medical Oncology

1316080120 207RH0003X 020 Physicians 179 Hematology/Oncology

1316081946 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316085384 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1316101074 2084P0800X 020 Physicians 121 Psychiatry

1316116254 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316121189 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1316125461 2085R0202X 020 Physicians 167 Diagnostic Radiology

1316125461 2085N0700X 020 Physicians 204 Neuroradiology

1316140270 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1316140346 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1316141914 207W00000X 020 Physicians 018 Ophthalmology

1316146541 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1316147127 183500000X 018 Pharmacy 253 Pharmacist

1316155534 2084P0800X 020 Physicians 121 Psychiatry

1316155534 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1316158819 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316160914 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1316166614 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316168057 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316171903 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316175565 207P00000X 020 Physicians 270 Emergency Medicine

1316175862 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1316179567 183500000X 018 Pharmacy 253 Pharmacist

1316181787 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

170 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1316184195 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1316184195 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1316184724 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316201890 207P00000X 020 Physicians 270 Emergency Medicine

1316202476 207P00000X 020 Physicians 270 Emergency Medicine

1316224165 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316238421 207P00000X 020 Physicians 270 Emergency Medicine

1316243538 207X00000X 020 Physicians 020 Orthopedic Surgery

1316247323 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1316256282 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1316258676 207R00000X 020 Physicians 011 Internal Medicine

1316259294 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316265176 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1316272503 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1316280738 2084B0040X 020 Physicians 640 Psychiatry & Neurology;Behavioral Neurol

1316280886 207Y00000X 020 Physicians 217 Otolaryngology

1316285471 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1316287386 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316292527 207P00000X 020 Physicians 270 Emergency Medicine

1316309982 208M00000X 020 Physicians 344 Hospitalist

1316311582 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316315385 364SX0200X 036 Phys Assts and Advanced Nursing Provs 559 Clinical Nurse Specialist Oncology

1316315773 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1316316821 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1316318108 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316318132 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316326150 208M00000X 020 Physicians 344 Hospitalist

1316330350 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316331929 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1316332141 207R00000X 020 Physicians 011 Internal Medicine

1316336985 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

171 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1316340144 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1316341712 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1316353188 207Q00000X 020 Physicians 173 Family Medicine

1316355969 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316367238 207R00000X 020 Physicians 011 Internal Medicine

1316367238 208000000X 020 Physicians 049 Pediatrics

1316368236 207RI0011X 020 Physicians 188 Interventional Cardiology

1316369739 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1316369739 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1316374390 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1316379613 207R00000X 020 Physicians 011 Internal Medicine

1316387467 207Q00000X 020 Physicians 173 Family Medicine

1316395197 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1316396310 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1316397490 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316398316 1223G0001X 012 Dental Providers 001 General Practice

1316403058 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316418437 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316421795 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1316422447 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1316436926 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1316440472 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1316449655 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1316453236 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316464803 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316473341 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316484173 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1316485592 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316488083 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1316492812 208000000X 020 Physicians 049 Pediatrics

1316492812 208M00000X 020 Physicians 344 Hospitalist

172 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1316495575 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1316496680 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1316496680 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1316496680 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1316498637 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1316498637 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316509227 208600000X 020 Physicians 275 Surgery

1316583560 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316586183 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1316592447 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1316908809 208000000X 020 Physicians 049 Pediatrics

1316908809 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1316910573 2084N0400X 020 Physicians 013 Neurology

1316910938 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316911266 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1316917461 207L00000X 020 Physicians 005 Anesthesiology

1316917685 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1316919848 207X00000X 020 Physicians 020 Orthopedic Surgery

1316920515 208000000X 020 Physicians 049 Pediatrics

1316922057 2085R0202X 020 Physicians 167 Diagnostic Radiology

1316923378 2085R0202X 020 Physicians 167 Diagnostic Radiology

1316925621 2085R0202X 020 Physicians 167 Diagnostic Radiology

1316926546 207RC0000X 020 Physicians 006 Cardiovascular Disease

1316926587 207Y00000X 020 Physicians 217 Otolaryngology

1316926892 207W00000X 020 Physicians 018 Ophthalmology

1316927254 207RC0000X 020 Physicians 006 Cardiovascular Disease

1316927254 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1316927304 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1316932940 207Q00000X 020 Physicians 173 Family Medicine

1316946700 207RC0000X 020 Physicians 006 Cardiovascular Disease

1316948920 208600000X 020 Physicians 275 Surgery

173 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1316949571 207Y00000X 020 Physicians 217 Otolaryngology

1316965981 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1316967615 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1316971567 207Q00000X 020 Physicians 173 Family Medicine

1316972631 208G00000X 020 Physicians 033 Thoracic Surgery

1316973928 207Q00000X 020 Physicians 173 Family Medicine

1316974876 207W00000X 020 Physicians 018 Ophthalmology

1316981517 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1316981541 207VX0201X 020 Physicians 307 Gynecologic Oncology

1316985021 207Q00000X 020 Physicians 173 Family Medicine

1316986474 207RC0000X 020 Physicians 006 Cardiovascular Disease

1316986649 207Q00000X 020 Physicians 173 Family Medicine

1316987936 2085R0202X 020 Physicians 167 Diagnostic Radiology

1316989338 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1316989882 207Q00000X 020 Physicians 173 Family Medicine

1316994130 207W00000X 020 Physicians 018 Ophthalmology

1326001835 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326005604 2084P0800X 020 Physicians 121 Psychiatry

1326009564 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1326009630 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326009960 207RC0000X 020 Physicians 006 Cardiovascular Disease

1326010679 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326011487 207RG0100X 020 Physicians 010 Gastroenterology

1326012196 207R00000X 020 Physicians 011 Internal Medicine

1326012295 207P00000X 020 Physicians 270 Emergency Medicine

1326016163 207Q00000X 020 Physicians 173 Family Medicine

1326016650 207Q00000X 020 Physicians 173 Family Medicine

1326019621 207Y00000X 020 Physicians 217 Otolaryngology

1326019738 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1326021841 207Y00000X 020 Physicians 217 Otolaryngology

1326025925 207L00000X 020 Physicians 005 Anesthesiology

174 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1326027186 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326027871 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1326028812 207K00000X 020 Physicians 003 Allergy & Immunology

1326033770 207P00000X 020 Physicians 270 Emergency Medicine

1326034554 208G00000X 020 Physicians 033 Thoracic Surgery

1326040015 207RR0500X 020 Physicians 267 Rheumatology

1326040676 111N00000X 011 Chiropractic Providers 047 Chiropractor

1326044041 207X00000X 020 Physicians 020 Orthopedic Surgery

1326048232 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326054107 111N00000X 011 Chiropractic Providers 047 Chiropractor

1326054560 2080P0202X 020 Physicians 221 Pediatric Cardiology

1326057126 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326057605 208000000X 020 Physicians 049 Pediatrics

1326059338 207P00000X 020 Physicians 270 Emergency Medicine

1326060427 207X00000X 020 Physicians 020 Orthopedic Surgery

1326064015 208600000X 020 Physicians 275 Surgery

1326064817 207R00000X 020 Physicians 011 Internal Medicine

1326069667 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1326072232 207V00000X 020 Physicians 016 OB/GYN

1326080292 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1326080656 208000000X 020 Physicians 049 Pediatrics

1326081514 207X00000X 020 Physicians 020 Orthopedic Surgery

1326083460 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326083668 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326087107 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326087404 207V00000X 020 Physicians 016 OB/GYN

1326094640 207L00000X 020 Physicians 005 Anesthesiology

1326100363 2084N0400X 020 Physicians 013 Neurology

1326103847 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326109471 364SP0809X 036 Phys Assts and Advanced Nursing Provs 547 Clinical Nurse Specialist Psychiatric/M

1326110883 207PE0004X 020 Physicians 093 Emergency Medical Services

175 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1326123555 207Q00000X 020 Physicians 173 Family Medicine

1326133877 207Q00000X 020 Physicians 173 Family Medicine

1326134214 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1326134685 207R00000X 020 Physicians 011 Internal Medicine

1326135476 207X00000X 020 Physicians 020 Orthopedic Surgery

1326136763 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1326137175 207R00000X 020 Physicians 011 Internal Medicine

1326144791 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326145228 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326145665 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1326145947 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1326148446 2086X0206X 020 Physicians 276 Surgical Oncology

1326148859 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326149519 207RI0200X 020 Physicians 185 Infectious Diseases

1326153693 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1326153693 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1326154956 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326167404 207RR0500X 020 Physicians 267 Rheumatology

1326168634 207RC0000X 020 Physicians 006 Cardiovascular Disease

1326168634 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1326168857 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1326169061 2080P0202X 020 Physicians 221 Pediatric Cardiology

1326169061 208000000X 020 Physicians 049 Pediatrics

1326169921 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1326171950 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1326176223 207Q00000X 020 Physicians 173 Family Medicine

1326184888 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1326191594 207Q00000X 020 Physicians 173 Family Medicine

1326195454 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1326216037 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1326218405 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

176 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1326219601 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1326222514 207X00000X 020 Physicians 020 Orthopedic Surgery

1326227372 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1326230798 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326249467 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1326260191 208600000X 020 Physicians 275 Surgery

1326263963 207W00000X 020 Physicians 018 Ophthalmology

1326272329 207R00000X 020 Physicians 011 Internal Medicine

1326275942 207L00000X 020 Physicians 005 Anesthesiology

1326278136 207P00000X 020 Physicians 270 Emergency Medicine

1326278573 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326278912 207Q00000X 020 Physicians 173 Family Medicine

1326282112 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326287244 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326294513 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326297565 207T00000X 020 Physicians 014 Neurological Surgery

1326300260 208600000X 020 Physicians 275 Surgery

1326301250 208800000X 020 Physicians 034 Urology

1326302209 207L00000X 020 Physicians 005 Anesthesiology

1326306309 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1326306630 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1326306630 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1326307760 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326308917 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326311564 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326320904 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1326330143 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326332032 111N00000X 011 Chiropractic Providers 047 Chiropractor

1326335944 207R00000X 020 Physicians 011 Internal Medicine

1326338120 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1326339631 2085R0202X 020 Physicians 167 Diagnostic Radiology

177 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1326343187 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1326344615 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326351131 207K00000X 020 Physicians 003 Allergy & Immunology

1326352840 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326358185 207P00000X 020 Physicians 270 Emergency Medicine

1326359258 207ZP0101X 020 Physicians 022 Pathology

1326359761 208000000X 020 Physicians 049 Pediatrics

1326360447 183500000X 018 Pharmacy 253 Pharmacist

1326363102 2085R0202X 020 Physicians 167 Diagnostic Radiology

1326364902 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1326372319 122300000X 012 Dental Providers 019 Dentists

1326373127 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1326373317 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326374778 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1326375270 207V00000X 020 Physicians 016 OB/GYN

1326383787 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1326386061 111N00000X 011 Chiropractic Providers 047 Chiropractor

1326387465 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326396243 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326413071 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1326416678 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1326416678 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1326416678 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1326420936 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326421090 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326423955 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1326438649 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326440900 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1326441585 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1326441726 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1326441742 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

178 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1326450222 2080P0202X 020 Physicians 221 Pediatric Cardiology

1326452517 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326453556 207R00000X 020 Physicians 011 Internal Medicine

1326462490 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1326465659 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1326468588 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1326471202 208D00000X 020 Physicians 001 General Practice

1326474065 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1326484999 207N00000X 020 Physicians 007 Dermatology

1326485368 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1326485368 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1326490129 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1326496480 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1326497728 207Q00000X 020 Physicians 173 Family Medicine

1326501875 111N00000X 011 Chiropractic Providers 047 Chiropractor

1326503616 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1326521691 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1326532060 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1326544636 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1326553413 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1326557703 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1326564139 183500000X 018 Pharmacy 253 Pharmacist

1326568270 208600000X 020 Physicians 275 Surgery

1326575903 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1326576828 122300000X 012 Dental Providers 019 Dentists

1326591439 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1326603218 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1326603218 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1326603218 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1326693151 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1336101849 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

179 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336102680 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1336105196 207P00000X 020 Physicians 270 Emergency Medicine

1336107804 122300000X 012 Dental Providers 019 Dentists

1336109404 207R00000X 020 Physicians 011 Internal Medicine

1336109404 208000000X 020 Physicians 049 Pediatrics

1336111855 2084N0400X 020 Physicians 013 Neurology

1336113349 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336115435 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1336117480 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336125426 207PE0004X 020 Physicians 093 Emergency Medical Services

1336126267 2084N0400X 020 Physicians 013 Neurology

1336128461 2085P0229X 020 Physicians 241 Pediatric Radiology

1336128461 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336129196 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336130426 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336137165 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336138601 207Q00000X 020 Physicians 173 Family Medicine

1336138882 122300000X 012 Dental Providers 019 Dentists

1336146703 208100000X 020 Physicians 025 Physical Medicine and Rehab

1336148345 207X00000X 020 Physicians 020 Orthopedic Surgery

1336150333 111N00000X 011 Chiropractic Providers 047 Chiropractor

1336151257 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336167063 207VE0102X 020 Physicians 530 Reproductive Endocrinology

1336168988 208M00000X 020 Physicians 344 Hospitalist

1336170265 208100000X 020 Physicians 025 Physical Medicine and Rehab

1336173871 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1336176379 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1336179456 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1336179910 207V00000X 020 Physicians 016 OB/GYN

1336183482 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1336183482 2085N0700X 020 Physicians 204 Neuroradiology

180 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336183482 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336184464 207R00000X 020 Physicians 011 Internal Medicine

1336186048 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1336186063 207L00000X 020 Physicians 005 Anesthesiology

1336188218 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336188671 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336189539 207L00000X 020 Physicians 005 Anesthesiology

1336189729 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1336191030 207P00000X 020 Physicians 270 Emergency Medicine

1336191030 207Q00000X 020 Physicians 173 Family Medicine

1336195924 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336195924 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336198464 111N00000X 011 Chiropractic Providers 047 Chiropractor

1336199975 207R00000X 020 Physicians 011 Internal Medicine

1336208669 207V00000X 020 Physicians 016 OB/GYN

1336212810 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336215912 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1336223494 208G00000X 020 Physicians 033 Thoracic Surgery

1336223577 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1336223866 207RH0003X 020 Physicians 179 Hematology/Oncology

1336228246 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336229129 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336229129 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1336235696 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336237684 207W00000X 020 Physicians 018 Ophthalmology

1336239490 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336239490 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336242916 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336244896 207Q00000X 020 Physicians 173 Family Medicine

1336247253 207L00000X 020 Physicians 005 Anesthesiology

1336247980 122300000X 012 Dental Providers 019 Dentists

181 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336248244 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336255132 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336268572 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336283860 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1336285931 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336285931 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336291822 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1336300771 2084N0400X 020 Physicians 013 Neurology

1336302736 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336302777 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1336303403 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1336304906 207V00000X 020 Physicians 016 OB/GYN

1336307198 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1336321348 207R00000X 020 Physicians 011 Internal Medicine

1336327873 207R00000X 020 Physicians 011 Internal Medicine

1336332436 207L00000X 020 Physicians 005 Anesthesiology

1336334606 208000000X 020 Physicians 049 Pediatrics

1336341437 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1336341866 207P00000X 020 Physicians 270 Emergency Medicine

1336349778 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1336351972 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1336363324 207RN0300X 020 Physicians 105 Nephrology

1336368240 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1336370667 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1336376029 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1336376045 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1336376045 207L00000X 020 Physicians 005 Anesthesiology

1336377357 207V00000X 020 Physicians 016 OB/GYN

1336380815 2085R0202X 020 Physicians 167 Diagnostic Radiology

1336381185 207T00000X 020 Physicians 014 Neurological Surgery

1336382852 207R00000X 020 Physicians 011 Internal Medicine

182 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336386093 207V00000X 020 Physicians 016 OB/GYN

1336388669 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336392455 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1336397587 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1336397835 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1336401389 122300000X 012 Dental Providers 019 Dentists

1336407113 207RP1001X 020 Physicians 029 Pulmonary Diseases

1336412352 207Q00000X 020 Physicians 173 Family Medicine

1336414309 2080P0202X 020 Physicians 221 Pediatric Cardiology

1336417484 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1336419969 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336424233 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1336427525 207Q00000X 020 Physicians 173 Family Medicine

1336427913 207L00000X 020 Physicians 005 Anesthesiology

1336429125 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1336435189 208M00000X 020 Physicians 344 Hospitalist

1336435270 208000000X 020 Physicians 049 Pediatrics

1336435270 2080P0202X 020 Physicians 221 Pediatric Cardiology

1336437946 207RC0200X 020 Physicians 206 Critical Care Medicine

1336440924 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336442912 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1336443233 208M00000X 020 Physicians 344 Hospitalist

1336446988 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336446988 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336450543 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336451665 207RH0003X 020 Physicians 179 Hematology/Oncology

1336452572 207R00000X 020 Physicians 011 Internal Medicine

1336452572 208M00000X 020 Physicians 344 Hospitalist

1336454131 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336456656 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336462886 2084A2900X 020 Physicians 612 Psychiatry&Neurology; Neurocritical Care

183 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336462886 207RC0200X 020 Physicians 206 Critical Care Medicine

1336462886 207R00000X 020 Physicians 011 Internal Medicine

1336465053 207L00000X 020 Physicians 005 Anesthesiology

1336469725 122300000X 012 Dental Providers 019 Dentists

1336475979 207L00000X 020 Physicians 005 Anesthesiology

1336478924 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1336481415 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1336481803 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1336482553 208M00000X 020 Physicians 344 Hospitalist

1336482553 207R00000X 020 Physicians 011 Internal Medicine

1336482850 207R00000X 020 Physicians 011 Internal Medicine

1336483429 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336484542 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336490929 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336496579 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336508274 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1336508274 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1336522606 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336527258 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336530682 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1336535533 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1336536291 208M00000X 020 Physicians 344 Hospitalist

1336542562 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336556091 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1336568575 207PE0004X 020 Physicians 093 Emergency Medical Services

1336569185 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1336571918 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1336571918 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1336571918 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1336571918 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1336572486 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

184 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1336579507 111N00000X 011 Chiropractic Providers 047 Chiropractor

1336581552 208M00000X 020 Physicians 344 Hospitalist

1336591965 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1336594563 2084P0800X 020 Physicians 121 Psychiatry

1336599083 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336607548 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1336615392 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336629526 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1336633825 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1336633825 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1336635242 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1336653260 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1336678515 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1336683267 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1336683614 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1336686906 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1336695105 183500000X 018 Pharmacy 253 Pharmacist

1336696798 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1336696921 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1336698018 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336700970 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1336706217 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1336708387 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1336771591 2084P0800X 020 Physicians 121 Psychiatry

1336772839 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1336786334 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1336792431 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1336792803 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1336798610 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1346202777 207R00000X 020 Physicians 011 Internal Medicine

1346202777 208000000X 020 Physicians 049 Pediatrics

185 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346206158 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346210218 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346210499 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1346210572 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1346210572 207RG0100X 020 Physicians 010 Gastroenterology

1346212131 207RG0100X 020 Physicians 010 Gastroenterology

1346212313 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1346214509 207RC0000X 020 Physicians 006 Cardiovascular Disease

1346214509 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1346214525 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346226370 207RH0000X 020 Physicians 178 Hematology

1346228657 207P00000X 020 Physicians 270 Emergency Medicine

1346228715 207RC0000X 020 Physicians 006 Cardiovascular Disease

1346241478 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346241999 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1346244332 208600000X 020 Physicians 275 Surgery

1346251527 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1346252178 111N00000X 011 Chiropractic Providers 047 Chiropractor

1346254406 208600000X 020 Physicians 275 Surgery

1346254984 207P00000X 020 Physicians 270 Emergency Medicine

1346258340 111N00000X 011 Chiropractic Providers 047 Chiropractor

1346259074 122300000X 012 Dental Providers 019 Dentists

1346260080 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346262912 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1346262938 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1346263407 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346267887 207Q00000X 020 Physicians 173 Family Medicine

1346268992 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1346270931 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346275062 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346280351 2080P0202X 020 Physicians 221 Pediatric Cardiology

186 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346280435 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1346281870 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346281870 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346281987 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1346285541 207Q00000X 020 Physicians 173 Family Medicine

1346286648 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346287554 207X00000X 020 Physicians 020 Orthopedic Surgery

1346289634 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346291762 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346293354 207L00000X 020 Physicians 005 Anesthesiology

1346297462 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346297827 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346298395 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346307758 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346313616 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1346321429 207RR0500X 020 Physicians 267 Rheumatology

1346322559 207L00000X 020 Physicians 005 Anesthesiology

1346328218 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1346328820 2086S0129X 020 Physicians 289 Vascular Surgery

1346330214 207T00000X 020 Physicians 014 Neurological Surgery

1346332947 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1346338100 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346346780 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1346348000 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1346351467 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1346352861 208000000X 020 Physicians 049 Pediatrics

1346352861 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1346362423 207L00000X 020 Physicians 005 Anesthesiology

1346388915 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1346396314 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1346401122 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

187 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346402518 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1346402518 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1346403995 207R00000X 020 Physicians 011 Internal Medicine

1346404530 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1346405602 207Q00000X 020 Physicians 173 Family Medicine

1346413291 207Q00000X 020 Physicians 173 Family Medicine

1346430592 2080P0202X 020 Physicians 221 Pediatric Cardiology

1346432283 208000000X 020 Physicians 049 Pediatrics

1346432283 207R00000X 020 Physicians 011 Internal Medicine

1346432341 208000000X 020 Physicians 049 Pediatrics

1346434693 208M00000X 020 Physicians 344 Hospitalist

1346436417 208100000X 020 Physicians 025 Physical Medicine and Rehab

1346443488 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346448925 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346453644 208600000X 020 Physicians 275 Surgery

1346456233 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1346468022 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346472776 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1346478500 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346478716 208000000X 020 Physicians 049 Pediatrics

1346479185 2084P0800X 020 Physicians 121 Psychiatry

1346479185 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1346482569 207P00000X 020 Physicians 270 Emergency Medicine

1346485463 111N00000X 011 Chiropractic Providers 047 Chiropractor

1346493459 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346501046 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346504016 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346514049 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1346519568 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1346534864 2084N0400X 020 Physicians 013 Neurology

1346535218 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

188 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346536885 208M00000X 020 Physicians 344 Hospitalist

1346539632 207R00000X 020 Physicians 011 Internal Medicine

1346541067 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346542024 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346542024 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346542727 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1346542727 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1346547445 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346549508 207RR0500X 020 Physicians 267 Rheumatology

1346553294 207RG0100X 020 Physicians 010 Gastroenterology

1346557584 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346559523 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346561222 208000000X 020 Physicians 049 Pediatrics

1346568219 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1346569423 207V00000X 020 Physicians 016 OB/GYN

1346571320 207RC0000X 020 Physicians 006 Cardiovascular Disease

1346572062 207Q00000X 020 Physicians 173 Family Medicine

1346573201 183500000X 018 Pharmacy 253 Pharmacist

1346583101 2085R0202X 020 Physicians 167 Diagnostic Radiology

1346591542 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346592680 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1346593365 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1346593365 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1346600251 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346600251 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346601507 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346607058 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1346609229 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346613916 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1346613916 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1346616661 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

189 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346622198 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346622644 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346626579 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1346628765 207R00000X 020 Physicians 011 Internal Medicine

1346628765 207RN0300X 020 Physicians 105 Nephrology

1346631371 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1346632874 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346637048 207N00000X 020 Physicians 007 Dermatology

1346649829 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346651361 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1346652096 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1346667177 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1346667177 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1346667177 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1346669082 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1346676897 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1346676897 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1346699741 207Q00000X 020 Physicians 173 Family Medicine

1346725900 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1346746815 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346749355 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1346755964 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1346755964 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1346755964 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1346755964 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1346766458 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1346772548 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1346781648 208600000X 020 Physicians 275 Surgery

1346785326 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1346787900 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1346787900 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

190 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1346787900 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1346791159 111N00000X 011 Chiropractic Providers 047 Chiropractor

1346792256 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1346792561 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1346799400 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1346871258 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1346878576 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1346882230 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346884947 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346888161 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1346893856 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1346896016 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356301998 207Q00000X 020 Physicians 173 Family Medicine

1356304075 2086S0129X 020 Physicians 289 Vascular Surgery

1356305429 207RC0000X 020 Physicians 006 Cardiovascular Disease

1356311898 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1356313043 208G00000X 020 Physicians 033 Thoracic Surgery

1356313480 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1356313910 207RN0300X 020 Physicians 105 Nephrology

1356314223 207Q00000X 020 Physicians 173 Family Medicine

1356314256 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356314785 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356314876 2084N0008X 020 Physicians 630 Psychiatry&Neurology; Neuromuscular Med

1356314876 2084N0400X 020 Physicians 013 Neurology

1356315121 207RP1001X 020 Physicians 029 Pulmonary Diseases

1356315170 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356315188 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356315642 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356317093 207P00000X 020 Physicians 270 Emergency Medicine

1356317895 207P00000X 020 Physicians 270 Emergency Medicine

1356320105 2085R0202X 020 Physicians 167 Diagnostic Radiology

191 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1356321541 207L00000X 020 Physicians 005 Anesthesiology

1356322432 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1356328165 208100000X 020 Physicians 025 Physical Medicine and Rehab

1356328637 207L00000X 020 Physicians 005 Anesthesiology

1356329593 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356335863 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1356336358 208600000X 020 Physicians 275 Surgery

1356350185 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356350623 207RX0202X 020 Physicians 529 Medical Oncology

1356350623 207RH0000X 020 Physicians 178 Hematology

1356355457 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356357149 208D00000X 020 Physicians 001 General Practice

1356359111 207R00000X 020 Physicians 011 Internal Medicine

1356360531 207RH0003X 020 Physicians 179 Hematology/Oncology

1356368021 207Q00000X 020 Physicians 173 Family Medicine

1356368021 2083X0100X 020 Physicians 533 Occupational Medicine

1356368021 207P00000X 020 Physicians 270 Emergency Medicine

1356374433 208M00000X 020 Physicians 344 Hospitalist

1356374433 207R00000X 020 Physicians 011 Internal Medicine

1356375646 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1356375646 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356375679 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356378558 208800000X 020 Physicians 034 Urology

1356383574 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356387534 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356388326 207L00000X 020 Physicians 005 Anesthesiology

1356389118 208600000X 020 Physicians 275 Surgery

1356391643 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356394324 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1356406243 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1356406243 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

192 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1356413363 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1356413363 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1356414528 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1356419378 207V00000X 020 Physicians 016 OB/GYN

1356423990 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1356426993 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356427447 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1356430284 207RP1001X 020 Physicians 029 Pulmonary Diseases

1356433718 207P00000X 020 Physicians 270 Emergency Medicine

1356434708 208100000X 020 Physicians 025 Physical Medicine and Rehab

1356434914 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356436471 207Q00000X 020 Physicians 173 Family Medicine

1356439053 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1356439798 207RC0000X 020 Physicians 006 Cardiovascular Disease

1356439947 111N00000X 011 Chiropractic Providers 047 Chiropractor

1356449227 207Q00000X 020 Physicians 173 Family Medicine

1356455901 207RI0200X 020 Physicians 185 Infectious Diseases

1356459861 122300000X 012 Dental Providers 019 Dentists

1356473409 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356475982 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356489389 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356502124 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1356502769 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356504120 208000000X 020 Physicians 049 Pediatrics

1356504120 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1356508139 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356509004 207R00000X 020 Physicians 011 Internal Medicine

1356513212 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1356518237 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1356522825 208000000X 020 Physicians 049 Pediatrics

1356524029 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

193 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1356537831 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356545446 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356551089 207X00000X 020 Physicians 020 Orthopedic Surgery

1356565964 207V00000X 020 Physicians 016 OB/GYN

1356576979 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1356576979 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356584759 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1356584759 2084P0800X 020 Physicians 121 Psychiatry

1356585251 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1356588586 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356599856 2084P0800X 020 Physicians 121 Psychiatry

1356603997 207Q00000X 020 Physicians 173 Family Medicine

1356605968 208M00000X 020 Physicians 344 Hospitalist

1356605968 207R00000X 020 Physicians 011 Internal Medicine

1356609937 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356630206 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356633440 207T00000X 020 Physicians 014 Neurological Surgery

1356639033 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356646723 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1356651228 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356654388 207Q00000X 020 Physicians 173 Family Medicine

1356654388 207P00000X 020 Physicians 270 Emergency Medicine

1356661474 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1356668123 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356668222 207Q00000X 020 Physicians 173 Family Medicine

1356669394 207R00000X 020 Physicians 011 Internal Medicine

1356678296 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356679344 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1356680086 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1356692339 208000000X 020 Physicians 049 Pediatrics

1356692339 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

194 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1356704944 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356720510 207T00000X 020 Physicians 014 Neurological Surgery

1356720510 2084N0400X 020 Physicians 013 Neurology

1356720858 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356721377 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356723100 207L00000X 020 Physicians 005 Anesthesiology

1356732846 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356735724 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1356736482 2085R0202X 020 Physicians 167 Diagnostic Radiology

1356736896 2084P0800X 020 Physicians 121 Psychiatry

1356738546 208000000X 020 Physicians 049 Pediatrics

1356739551 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1356739551 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1356744882 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356745608 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356749345 111N00000X 011 Chiropractic Providers 047 Chiropractor

1356750046 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356750061 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356752505 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1356753750 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356759534 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1356760441 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1356763502 111N00000X 011 Chiropractic Providers 047 Chiropractor

1356770036 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1356774483 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1356777239 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356777239 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1356781967 207RI0200X 020 Physicians 185 Infectious Diseases

1356782643 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1356782643 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356783252 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

195 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1356790224 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356799209 2084P0800X 020 Physicians 121 Psychiatry

1356808315 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1356809743 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1356820922 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356824981 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1356835151 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356837579 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356843361 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356846042 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356846117 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1356846422 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1356847446 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356857973 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1356857973 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1356858286 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1356858963 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356864094 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356865497 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356866784 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1356866784 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1356881130 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1356895338 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356972665 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1356979579 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1356980395 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1356993026 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366000424 207Q00000X 020 Physicians 173 Family Medicine

1366004764 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1366007288 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1366072944 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

196 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366074379 183500000X 018 Pharmacy 253 Pharmacist

1366078636 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1366095804 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366404519 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366408106 207RC0000X 020 Physicians 006 Cardiovascular Disease

1366408106 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1366408395 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1366412843 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366415549 207L00000X 020 Physicians 005 Anesthesiology

1366415887 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1366418048 207P00000X 020 Physicians 270 Emergency Medicine

1366420499 207Q00000X 020 Physicians 173 Family Medicine

1366420564 2086S0120X 020 Physicians 245 Pediatric Surgery

1366420564 208600000X 020 Physicians 275 Surgery

1366420564 2086S0102X 020 Physicians 539 Surgical Critical Care

1366421752 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366422263 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366423048 2084N0400X 020 Physicians 013 Neurology

1366429573 207K00000X 020 Physicians 003 Allergy & Immunology

1366433187 207Q00000X 020 Physicians 173 Family Medicine

1366447468 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1366448920 208000000X 020 Physicians 049 Pediatrics

1366449639 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1366450587 1223G0001X 012 Dental Providers 001 General Practice

1366450587 122300000X 012 Dental Providers 019 Dentists

1366453011 207R00000X 020 Physicians 011 Internal Medicine

1366454399 207V00000X 020 Physicians 016 OB/GYN

1366454399 207VG0400X 020 Physicians 553 Gynecology

1366455719 208800000X 020 Physicians 034 Urology

1366458614 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1366464927 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

197 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366467136 207N00000X 020 Physicians 007 Dermatology

1366469033 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1366470593 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1366470601 207R00000X 020 Physicians 011 Internal Medicine

1366471013 207W00000X 020 Physicians 018 Ophthalmology

1366472441 207RC0000X 020 Physicians 006 Cardiovascular Disease

1366472441 207R00000X 020 Physicians 011 Internal Medicine

1366472441 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1366476848 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366477580 208G00000X 020 Physicians 033 Thoracic Surgery

1366481418 207Q00000X 020 Physicians 173 Family Medicine

1366484727 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1366485724 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366490062 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366492696 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1366493181 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1366494254 122300000X 012 Dental Providers 019 Dentists

1366494809 207X00000X 020 Physicians 020 Orthopedic Surgery

1366496523 208000000X 020 Physicians 049 Pediatrics

1366496697 208600000X 020 Physicians 275 Surgery

1366498156 207L00000X 020 Physicians 005 Anesthesiology

1366498206 2084N0400X 020 Physicians 013 Neurology

1366499600 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1366509226 207YP0228X 020 Physicians 140 Pediatric Otolaryngology

1366513970 208200000X 020 Physicians 024 Plastic Surgery

1366514218 207ZP0101X 020 Physicians 022 Pathology

1366524969 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1366529315 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1366533374 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366538068 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366539314 207ZP0101X 020 Physicians 436 Anatomic Pathology

198 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366539314 207RH0000X 020 Physicians 178 Hematology

1366539314 207ZP0101X 020 Physicians 022 Pathology

1366540098 207Q00000X 020 Physicians 173 Family Medicine

1366542227 207RN0300X 020 Physicians 105 Nephrology

1366546863 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1366547069 111N00000X 011 Chiropractic Providers 047 Chiropractor

1366548752 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1366552317 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366555708 207P00000X 020 Physicians 270 Emergency Medicine

1366575250 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1366589632 207RC0000X 020 Physicians 006 Cardiovascular Disease

1366599185 2086S0120X 020 Physicians 245 Pediatric Surgery

1366604878 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1366608465 207Q00000X 020 Physicians 173 Family Medicine

1366611345 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366614190 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366624777 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1366634255 2084N0400X 020 Physicians 013 Neurology

1366635302 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1366642191 207RN0300X 020 Physicians 105 Nephrology

1366647919 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366650277 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366659278 207Q00000X 020 Physicians 173 Family Medicine

1366659690 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366670366 208M00000X 020 Physicians 344 Hospitalist

1366670366 207R00000X 020 Physicians 011 Internal Medicine

1366673279 207R00000X 020 Physicians 011 Internal Medicine

1366674301 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1366674657 207RG0100X 020 Physicians 010 Gastroenterology

1366680720 208600000X 020 Physicians 275 Surgery

1366688798 208000000X 020 Physicians 049 Pediatrics

199 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366694614 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366698011 207RC0000X 020 Physicians 006 Cardiovascular Disease

1366698482 2084N0400X 020 Physicians 013 Neurology

1366699779 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1366700742 122300000X 012 Dental Providers 019 Dentists

1366703613 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1366704694 208000000X 020 Physicians 049 Pediatrics

1366704694 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1366705501 2080P0202X 020 Physicians 221 Pediatric Cardiology

1366716102 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366719460 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1366725020 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1366727547 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1366728412 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366730467 207R00000X 020 Physicians 011 Internal Medicine

1366742603 111N00000X 011 Chiropractic Providers 047 Chiropractor

1366744187 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1366755878 207R00000X 020 Physicians 011 Internal Medicine

1366761215 207R00000X 020 Physicians 011 Internal Medicine

1366761314 207Y00000X 020 Physicians 217 Otolaryngology

1366763195 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1366766040 207P00000X 020 Physicians 270 Emergency Medicine

1366766107 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1366766925 207P00000X 020 Physicians 270 Emergency Medicine

1366773087 2085N0700X 020 Physicians 204 Neuroradiology

1366773087 2085R0202X 020 Physicians 167 Diagnostic Radiology

1366776437 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366776437 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1366776437 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1366776437 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1366777534 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

200 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366783631 207W00000X 020 Physicians 018 Ophthalmology

1366788663 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1366788663 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1366790990 207R00000X 020 Physicians 011 Internal Medicine

1366790990 207RI0200X 020 Physicians 185 Infectious Diseases

1366792319 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1366793606 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1366795379 208D00000X 020 Physicians 001 General Practice

1366797045 207R00000X 020 Physicians 011 Internal Medicine

1366802290 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366806085 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1366810962 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1366813560 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366814964 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1366824385 207Q00000X 020 Physicians 173 Family Medicine

1366839177 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1366841421 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1366841421 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1366841421 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1366843641 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1366860520 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1366860520 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1366865107 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1366869661 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1366871865 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366875486 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366887176 207R00000X 020 Physicians 011 Internal Medicine

1366892614 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366892689 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366893174 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1366899304 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

201 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1366900474 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1366911026 111N00000X 011 Chiropractic Providers 047 Chiropractor

1366926180 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366926594 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1366932089 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366933020 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1366934291 207Q00000X 020 Physicians 173 Family Medicine

1366956823 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366965295 208M00000X 020 Physicians 344 Hospitalist

1366965527 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1366967465 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366967465 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1366989865 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1366992661 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1366992661 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1366992661 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376008300 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376026682 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1376032631 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376037721 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1376049593 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376050963 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376056671 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376059287 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376060996 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1376063370 2084P0800X 020 Physicians 121 Psychiatry

1376069468 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1376069468 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1376071050 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1376077024 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376081745 207Y00000X 020 Physicians 217 Otolaryngology

202 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376091793 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376094094 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376097014 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376097675 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1376099424 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1376099424 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1376105254 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376177063 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1376184416 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376185967 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376188623 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1376190793 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1376192237 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376199810 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376501304 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1376512178 207R00000X 020 Physicians 011 Internal Medicine

1376513416 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376513770 207Q00000X 020 Physicians 173 Family Medicine

1376516286 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376517169 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1376517268 207R00000X 020 Physicians 011 Internal Medicine

1376517763 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376518969 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376520247 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1376521013 207L00000X 020 Physicians 005 Anesthesiology

1376521609 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376522557 2084N0400X 020 Physicians 013 Neurology

1376522557 207L00000X 020 Physicians 005 Anesthesiology

1376522557 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1376522557 2084P0800X 020 Physicians 121 Psychiatry

1376523860 208000000X 020 Physicians 049 Pediatrics

203 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376530675 207V00000X 020 Physicians 016 OB/GYN

1376551499 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376558205 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376560045 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1376561977 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376562140 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376562546 207RC0000X 020 Physicians 006 Cardiovascular Disease

1376565903 208D00000X 020 Physicians 001 General Practice

1376565960 207RC0000X 020 Physicians 006 Cardiovascular Disease

1376570341 207Q00000X 020 Physicians 173 Family Medicine

1376571257 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376576504 207P00000X 020 Physicians 270 Emergency Medicine

1376576652 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1376576652 207L00000X 020 Physicians 005 Anesthesiology

1376576975 207L00000X 020 Physicians 005 Anesthesiology

1376579698 204F00000X 020 Physicians 279 Transplant Surgery

1376581710 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1376581710 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1376584060 207L00000X 020 Physicians 005 Anesthesiology

1376584946 208600000X 020 Physicians 275 Surgery

1376585059 207X00000X 020 Physicians 020 Orthopedic Surgery

1376585281 207RX0202X 020 Physicians 529 Medical Oncology

1376591826 207RN0300X 020 Physicians 105 Nephrology

1376596023 208600000X 020 Physicians 275 Surgery

1376597237 207RC0000X 020 Physicians 006 Cardiovascular Disease

1376603142 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1376618389 208600000X 020 Physicians 275 Surgery

1376620831 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376621185 207P00000X 020 Physicians 270 Emergency Medicine

1376622613 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1376624445 2084N0400X 020 Physicians 013 Neurology

204 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376629972 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1376632091 207P00000X 020 Physicians 270 Emergency Medicine

1376634386 207Q00000X 020 Physicians 173 Family Medicine

1376635755 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376636514 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1376639286 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1376639476 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1376639476 152WC0802X 015 Eye and Vision Service Providers 617 Corneal and Contact Management

1376639476 156FX1800X 015 Eye and Vision Service Providers 411 Optician

1376641035 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1376648113 2086S0129X 020 Physicians 289 Vascular Surgery

1376649848 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1376656751 208000000X 020 Physicians 049 Pediatrics

1376660217 207L00000X 020 Physicians 005 Anesthesiology

1376660811 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376665265 122300000X 012 Dental Providers 019 Dentists

1376668251 2086S0120X 020 Physicians 245 Pediatric Surgery

1376670448 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376670679 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1376681064 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376699744 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376702175 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1376702175 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1376703942 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1376703942 207RC0000X 020 Physicians 006 Cardiovascular Disease

1376710459 207P00000X 020 Physicians 270 Emergency Medicine

1376713107 2080P0202X 020 Physicians 221 Pediatric Cardiology

1376713107 208000000X 020 Physicians 049 Pediatrics

1376721704 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376722686 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1376727115 207RH0000X 020 Physicians 178 Hematology

205 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376727115 207RH0003X 020 Physicians 179 Hematology/Oncology

1376730093 208600000X 020 Physicians 275 Surgery

1376732321 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376735035 208000000X 020 Physicians 049 Pediatrics

1376735035 2080P0202X 020 Physicians 221 Pediatric Cardiology

1376737536 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376741157 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376745935 2084N0400X 020 Physicians 013 Neurology

1376747030 207Q00000X 020 Physicians 173 Family Medicine

1376748491 207X00000X 020 Physicians 020 Orthopedic Surgery

1376749176 122300000X 012 Dental Providers 019 Dentists

1376753277 207X00000X 020 Physicians 020 Orthopedic Surgery

1376753459 208600000X 020 Physicians 275 Surgery

1376753459 2086S0102X 020 Physicians 539 Surgical Critical Care

1376757567 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376762823 207RR0500X 020 Physicians 267 Rheumatology

1376765305 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376769109 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1376771881 207V00000X 020 Physicians 016 OB/GYN

1376774752 207RG0100X 020 Physicians 010 Gastroenterology

1376779827 207L00000X 020 Physicians 005 Anesthesiology

1376786798 2085R0202X 020 Physicians 167 Diagnostic Radiology

1376786830 207R00000X 020 Physicians 011 Internal Medicine

1376795757 111N00000X 011 Chiropractic Providers 047 Chiropractor

1376797720 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376803957 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1376807909 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1376812792 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1376816587 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1376832576 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376838730 207P00000X 020 Physicians 270 Emergency Medicine

206 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376838821 207L00000X 020 Physicians 005 Anesthesiology

1376853945 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376863647 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1376869909 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376869917 207L00000X 020 Physicians 005 Anesthesiology

1376871475 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376881482 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376896803 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1376899203 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1376905570 207P00000X 020 Physicians 270 Emergency Medicine

1376914358 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376914358 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376919498 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1376919548 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376925958 2084P0800X 020 Physicians 121 Psychiatry

1376929000 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1376929513 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376929547 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1376930032 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1376939132 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376945964 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376947887 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1376947887 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1376948356 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1376950782 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1376951046 207Q00000X 020 Physicians 173 Family Medicine

1376953620 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1376958009 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1376958397 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1376968990 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1376975466 122300000X 012 Dental Providers 019 Dentists

207 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1376987826 2084N0400X 020 Physicians 013 Neurology

1376995407 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1376995407 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1376996538 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386001642 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1386009892 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386012458 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1386016368 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1386016368 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1386016368 106E00000X 010 Behav Health & Social Svc Prov 566 Assistant Behavior Analyst

1386018067 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1386028314 207WX0107X 020 Physicians 616 Retina Specialist

1386028314 207W00000X 020 Physicians 018 Ophthalmology

1386028777 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1386028942 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386034940 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386042513 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1386044550 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1386046902 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1386057123 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1386057800 207Q00000X 020 Physicians 173 Family Medicine

1386059509 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386066173 207R00000X 020 Physicians 011 Internal Medicine

1386076461 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1386082709 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1386085926 207P00000X 020 Physicians 270 Emergency Medicine

1386087765 2084P0800X 020 Physicians 121 Psychiatry

1386088433 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1386092955 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1386099885 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386108579 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

208 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1386111276 170300000X 017 Other Service Providers 585 Genetic Counselor MS

1386111391 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1386134369 207Q00000X 020 Physicians 173 Family Medicine

1386142818 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1386161149 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1386164358 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1386171304 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1386173482 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1386173482 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1386186211 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1386204345 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386205581 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1386274918 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1386276863 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386286276 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1386288181 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1386296275 207Q00000X 020 Physicians 173 Family Medicine

1386602043 208600000X 020 Physicians 275 Surgery

1386606689 207R00000X 020 Physicians 011 Internal Medicine

1386611622 207L00000X 020 Physicians 005 Anesthesiology

1386617975 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386618312 207RP1001X 020 Physicians 029 Pulmonary Diseases

1386618924 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386619971 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386621142 207RC0000X 020 Physicians 006 Cardiovascular Disease

1386622991 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386623551 207N00000X 020 Physicians 007 Dermatology

1386625960 207Q00000X 020 Physicians 173 Family Medicine

1386629335 2084N0400X 020 Physicians 013 Neurology

1386634491 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1386653293 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

209 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1386661056 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386662948 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386664696 208000000X 020 Physicians 049 Pediatrics

1386665503 2085R0202X 020 Physicians 167 Diagnostic Radiology

1386667061 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1386680080 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1386681682 2084P0800X 020 Physicians 121 Psychiatry

1386686467 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1386687408 2084P0800X 020 Physicians 121 Psychiatry

1386688356 2080A0000X 020 Physicians 564 Pediatric Adolescent Medicine

1386691533 207Q00000X 020 Physicians 173 Family Medicine

1386697571 207V00000X 020 Physicians 016 OB/GYN

1386715886 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1386716223 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1386720340 207RH0003X 020 Physicians 179 Hematology/Oncology

1386720340 207RH0000X 020 Physicians 178 Hematology

1386721066 207Q00000X 020 Physicians 173 Family Medicine

1386723245 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1386725364 207V00000X 020 Physicians 016 OB/GYN

1386725786 2084P0800X 020 Physicians 121 Psychiatry

1386725901 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1386727857 207V00000X 020 Physicians 016 OB/GYN

1386727873 207RC0000X 020 Physicians 006 Cardiovascular Disease

1386731065 207Q00000X 020 Physicians 173 Family Medicine

1386734424 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1386734754 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1386738730 207Q00000X 020 Physicians 173 Family Medicine

1386740272 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386752244 207RC0000X 020 Physicians 006 Cardiovascular Disease

1386752244 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1386753630 207P00000X 020 Physicians 270 Emergency Medicine

210 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1386755023 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1386758167 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386766111 207RC0000X 020 Physicians 006 Cardiovascular Disease

1386769404 207RG0100X 020 Physicians 010 Gastroenterology

1386773430 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1386776052 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1386783918 2084P0800X 020 Physicians 121 Psychiatry

1386789824 207Q00000X 020 Physicians 173 Family Medicine

1386808368 207N00000X 020 Physicians 007 Dermatology

1386811842 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1386814044 207R00000X 020 Physicians 011 Internal Medicine

1386814044 207RC0000X 020 Physicians 006 Cardiovascular Disease

1386814044 207RI0011X 020 Physicians 188 Interventional Cardiology

1386816049 207P00000X 020 Physicians 270 Emergency Medicine

1386822864 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1386825362 2085R0202X 020 Physicians 167 Diagnostic Radiology

1386837318 208M00000X 020 Physicians 344 Hospitalist

1386839041 207L00000X 020 Physicians 005 Anesthesiology

1386846095 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1386849446 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1386849446 122300000X 012 Dental Providers 019 Dentists

1386849446 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1386850006 207T00000X 020 Physicians 014 Neurological Surgery

1386853802 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1386859973 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1386860286 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1386865988 2085R0202X 020 Physicians 167 Diagnostic Radiology

1386867919 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1386870251 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1386871614 2084N0400X 020 Physicians 013 Neurology

1386872240 207X00000X 020 Physicians 020 Orthopedic Surgery

211 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1386875383 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1386880862 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386885317 207P00000X 020 Physicians 270 Emergency Medicine

1386888113 2084N0400X 020 Physicians 013 Neurology

1386888568 208000000X 020 Physicians 049 Pediatrics

1386895290 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1386897734 207RN0300X 020 Physicians 105 Nephrology

1386906733 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386906733 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1386908218 208M00000X 020 Physicians 344 Hospitalist

1386908218 207R00000X 020 Physicians 011 Internal Medicine

1386908747 207R00000X 020 Physicians 011 Internal Medicine

1386908747 207RN0300X 020 Physicians 105 Nephrology

1386908747 207RC0200X 020 Physicians 206 Critical Care Medicine

1386909539 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1386910875 207ZD0900X 020 Physicians 581 Pathology; Dermatopathology

1386917201 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386918381 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1386918704 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386919462 208000000X 020 Physicians 049 Pediatrics

1386925485 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1386930485 122300000X 012 Dental Providers 019 Dentists

1386936847 111N00000X 011 Chiropractic Providers 047 Chiropractor

1386937001 207X00000X 020 Physicians 020 Orthopedic Surgery

1386939791 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1386949337 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386951481 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1386953321 207RI0200X 020 Physicians 185 Infectious Diseases

1386961407 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1386964062 208000000X 020 Physicians 049 Pediatrics

1386964062 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

212 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1386964138 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386979623 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1386981777 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1386986644 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1386990869 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1396001079 207X00000X 020 Physicians 020 Orthopedic Surgery

1396001772 207L00000X 020 Physicians 005 Anesthesiology

1396011045 207P00000X 020 Physicians 270 Emergency Medicine

1396011078 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1396021952 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396023958 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396034781 207P00000X 020 Physicians 270 Emergency Medicine

1396038162 207RG0100X 020 Physicians 010 Gastroenterology

1396044806 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1396048518 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1396056123 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1396058004 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1396064465 2085R0202X 020 Physicians 167 Diagnostic Radiology

1396069076 207L00000X 020 Physicians 005 Anesthesiology

1396077822 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396092219 207R00000X 020 Physicians 011 Internal Medicine

1396104022 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1396104535 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1396104535 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1396104535 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396104535 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1396108437 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396112371 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1396112371 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1396118238 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1396122065 208000000X 020 Physicians 049 Pediatrics

213 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1396127965 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396132882 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1396132932 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396134458 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396156881 208M00000X 020 Physicians 344 Hospitalist

1396157830 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1396157830 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396159646 183500000X 018 Pharmacy 253 Pharmacist

1396160594 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396160867 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396164208 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1396164448 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396170445 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1396170445 171M00000X 010 Behav Health & Social Svc Prov 489 Case Aide

1396181509 208M00000X 020 Physicians 344 Hospitalist

1396184123 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1396185054 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1396185492 207Q00000X 020 Physicians 173 Family Medicine

1396188132 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396189866 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396194031 2084P0800X 020 Physicians 121 Psychiatry

1396197018 207Q00000X 020 Physicians 173 Family Medicine

1396213690 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1396213690 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1396221149 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396223087 1223G0001X 012 Dental Providers 001 General Practice

1396226072 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396228847 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1396228847 106E00000X 010 Behav Health & Social Svc Prov 566 Assistant Behavior Analyst

1396228847 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1396239216 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

214 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1396245874 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396258844 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1396259396 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1396260808 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1396263208 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396269569 183500000X 018 Pharmacy 253 Pharmacist

1396280954 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1396290748 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1396293841 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396294435 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1396294963 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1396295333 183500000X 018 Pharmacy 253 Pharmacist

1396299079 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1396303137 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396304853 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1396390654 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396393724 183500000X 018 Pharmacy 253 Pharmacist

1396394904 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1396707733 207R00000X 020 Physicians 011 Internal Medicine

1396707733 208M00000X 020 Physicians 344 Hospitalist

1396708418 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1396708418 208600000X 020 Physicians 275 Surgery

1396710588 208000000X 020 Physicians 049 Pediatrics

1396713301 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396715827 2084N0400X 020 Physicians 013 Neurology

1396717245 207RP1001X 020 Physicians 029 Pulmonary Diseases

1396717245 207RC0200X 020 Physicians 206 Critical Care Medicine

1396717823 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396718714 207L00000X 020 Physicians 005 Anesthesiology

1396720066 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1396721312 208G00000X 020 Physicians 033 Thoracic Surgery

215 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1396722013 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1396722138 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396722542 207R00000X 020 Physicians 011 Internal Medicine

1396722963 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396723888 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396724282 207L00000X 020 Physicians 005 Anesthesiology

1396725297 2084N0400X 020 Physicians 013 Neurology

1396731832 207Q00000X 020 Physicians 173 Family Medicine

1396736443 207Q00000X 020 Physicians 173 Family Medicine

1396737359 207L00000X 020 Physicians 005 Anesthesiology

1396740460 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396754669 207ZP0101X 020 Physicians 022 Pathology

1396755930 207V00000X 020 Physicians 016 OB/GYN

1396756516 2084P0800X 020 Physicians 121 Psychiatry

1396762399 207Q00000X 020 Physicians 173 Family Medicine

1396763025 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1396763975 207Q00000X 020 Physicians 173 Family Medicine

1396763983 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1396766515 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1396766630 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1396766630 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1396768180 207W00000X 020 Physicians 018 Ophthalmology

1396769683 2080P0202X 020 Physicians 221 Pediatric Cardiology

1396775722 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1396776951 207W00000X 020 Physicians 018 Ophthalmology

1396776951 207WX0107X 020 Physicians 616 Retina Specialist

1396779864 207RP1001X 020 Physicians 029 Pulmonary Diseases

1396779971 208600000X 020 Physicians 275 Surgery

1396781696 207X00000X 020 Physicians 020 Orthopedic Surgery

1396786679 207Q00000X 020 Physicians 173 Family Medicine

1396788782 207RP1001X 020 Physicians 029 Pulmonary Diseases

216 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1396789657 207P00000X 020 Physicians 270 Emergency Medicine

1396791232 208200000X 020 Physicians 024 Plastic Surgery

1396791232 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1396808283 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396809919 2084P0800X 020 Physicians 121 Psychiatry

1396820452 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396824496 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1396828059 207RH0003X 020 Physicians 179 Hematology/Oncology

1396828430 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1396830683 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1396831509 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1396833729 207W00000X 020 Physicians 018 Ophthalmology

1396834305 183500000X 018 Pharmacy 253 Pharmacist

1396842175 207Q00000X 020 Physicians 173 Family Medicine

1396857058 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1396857686 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1396861217 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1396867909 207RP1001X 020 Physicians 029 Pulmonary Diseases

1396880571 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1396881181 207RC0000X 020 Physicians 006 Cardiovascular Disease

1396891065 207V00000X 020 Physicians 016 OB/GYN

1396891065 207VG0400X 020 Physicians 553 Gynecology

1396891073 2085R0202X 020 Physicians 167 Diagnostic Radiology

1396893038 111N00000X 011 Chiropractic Providers 047 Chiropractor

1396893202 207P00000X 020 Physicians 270 Emergency Medicine

1396895942 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396898649 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396903654 207Q00000X 020 Physicians 173 Family Medicine

1396904942 2080P0202X 020 Physicians 221 Pediatric Cardiology

1396906533 208600000X 020 Physicians 275 Surgery

1396907416 1223G0001X 012 Dental Providers 001 General Practice

217 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1396910006 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396911004 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1396915310 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396916664 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1396931424 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1396935920 207YX0905X 020 Physicians 549 Otolaryngology/Facial Plastic Surgery

1396937124 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1396938197 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1396948493 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1396966263 207P00000X 020 Physicians 270 Emergency Medicine

1396968061 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1396969945 2085R0202X 020 Physicians 167 Diagnostic Radiology

1396972584 2085R0202X 020 Physicians 167 Diagnostic Radiology

1396972584 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1396973111 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1396975819 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1396982716 207R00000X 020 Physicians 011 Internal Medicine

1396989166 208000000X 020 Physicians 049 Pediatrics

1396989935 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1396993283 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1396993283 207ZP0101X 020 Physicians 436 Anatomic Pathology

1396996815 111N00000X 011 Chiropractic Providers 047 Chiropractor

1407006059 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1407008402 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1407009400 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1407011620 207L00000X 020 Physicians 005 Anesthesiology

1407014368 208000000X 020 Physicians 049 Pediatrics

1407017882 2084N0400X 020 Physicians 013 Neurology

1407019029 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1407024326 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407027998 2085R0202X 020 Physicians 167 Diagnostic Radiology

218 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407036627 111N00000X 011 Chiropractic Providers 047 Chiropractor

1407040462 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1407047913 207ZC0006X 020 Physicians 021 Clinical Pathology

1407047913 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1407047913 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1407048697 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407050594 1223G0001X 012 Dental Providers 001 General Practice

1407059728 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1407060239 208600000X 020 Physicians 275 Surgery

1407065014 207RC0000X 020 Physicians 006 Cardiovascular Disease

1407065014 2080P0202X 020 Physicians 221 Pediatric Cardiology

1407067994 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1407073224 2086S0102X 020 Physicians 539 Surgical Critical Care

1407075799 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1407081169 207RP1001X 020 Physicians 029 Pulmonary Diseases

1407081169 207RC0200X 020 Physicians 206 Critical Care Medicine

1407082241 122300000X 012 Dental Providers 019 Dentists

1407084205 208000000X 020 Physicians 049 Pediatrics

1407084205 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1407084981 207X00000X 020 Physicians 020 Orthopedic Surgery

1407085616 2084P0800X 020 Physicians 121 Psychiatry

1407090632 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407090772 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1407095292 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1407099054 208000000X 020 Physicians 049 Pediatrics

1407111321 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1407111461 2084N0400X 020 Physicians 013 Neurology

1407124332 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1407127848 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407128135 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407130156 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

219 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407131063 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407140460 207R00000X 020 Physicians 011 Internal Medicine

1407141799 207Y00000X 020 Physicians 217 Otolaryngology

1407146202 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1407148356 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1407148356 208000000X 020 Physicians 049 Pediatrics

1407151574 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407151574 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407151921 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407151921 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407155922 208000000X 020 Physicians 049 Pediatrics

1407156326 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407161003 207Q00000X 020 Physicians 173 Family Medicine

1407161003 208M00000X 020 Physicians 344 Hospitalist

1407161482 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1407162985 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1407162985 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407163074 208000000X 020 Physicians 049 Pediatrics

1407171226 207XP3100X 020 Physicians 237 Pediatric Orthopedics

1407174279 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407181589 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407181639 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1407187982 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1407187982 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1407187982 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1407192362 111N00000X 011 Chiropractic Providers 047 Chiropractor

1407205586 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407207558 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1407212210 111N00000X 011 Chiropractic Providers 047 Chiropractor

1407222367 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407223894 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

220 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407225055 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407227101 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407236946 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407238371 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407243074 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407257967 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407262124 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407267453 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1407267990 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1407267990 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1407267990 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1407271794 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407279839 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1407290786 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407295793 1223G0001X 012 Dental Providers 001 General Practice

1407295793 122300000X 012 Dental Providers 019 Dentists

1407297914 208000000X 020 Physicians 049 Pediatrics

1407299167 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407305584 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407309057 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407309057 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407337447 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1407340052 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1407340136 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407340755 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1407344286 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407344328 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1407344328 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1407361421 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1407361421 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1407361744 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

221 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407365398 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407369960 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407372089 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407375355 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1407375355 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1407381510 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407393358 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407393358 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1407396864 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1407399652 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1407408669 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1407412505 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407416019 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407416563 207Q00000X 020 Physicians 173 Family Medicine

1407419419 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407484678 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1407489958 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1407493216 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407806110 207P00000X 020 Physicians 270 Emergency Medicine

1407806722 2084P0800X 020 Physicians 121 Psychiatry

1407807464 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1407810575 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1407811896 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407816994 207V00000X 020 Physicians 016 OB/GYN

1407816994 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1407818693 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407820780 207U00000X 020 Physicians 103 Nuclear Medicine

1407820921 207RC0000X 020 Physicians 006 Cardiovascular Disease

1407821663 207P00000X 020 Physicians 270 Emergency Medicine

1407822463 208600000X 020 Physicians 275 Surgery

1407826449 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

222 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407828239 2080P0202X 020 Physicians 221 Pediatric Cardiology

1407829005 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407834344 208G00000X 020 Physicians 033 Thoracic Surgery

1407834344 208600000X 020 Physicians 275 Surgery

1407834518 208600000X 020 Physicians 275 Surgery

1407836026 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407836034 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1407836034 207L00000X 020 Physicians 005 Anesthesiology

1407836422 207RP1001X 020 Physicians 029 Pulmonary Diseases

1407844582 207W00000X 020 Physicians 018 Ophthalmology

1407846330 207W00000X 020 Physicians 018 Ophthalmology

1407849391 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407849391 2085N0700X 020 Physicians 204 Neuroradiology

1407850225 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1407852122 208000000X 020 Physicians 049 Pediatrics

1407860208 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1407865751 207X00000X 020 Physicians 020 Orthopedic Surgery

1407865751 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1407870710 207N00000X 020 Physicians 007 Dermatology

1407874076 207Q00000X 020 Physicians 173 Family Medicine

1407874266 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407876634 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407877749 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1407880057 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407881493 208800000X 020 Physicians 034 Urology

1407891112 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407896699 207L00000X 020 Physicians 005 Anesthesiology

1407897168 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1407897804 2084N0400X 020 Physicians 013 Neurology

1407902919 207RN0300X 020 Physicians 105 Nephrology

1407903156 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

223 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1407906183 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1407915226 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407921752 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1407929524 207R00000X 020 Physicians 011 Internal Medicine

1407931140 208000000X 020 Physicians 049 Pediatrics

1407935901 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1407936099 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1407941891 208M00000X 020 Physicians 344 Hospitalist

1407945918 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407945918 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1407947567 111N00000X 011 Chiropractic Providers 047 Chiropractor

1407948839 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407951056 122300000X 012 Dental Providers 019 Dentists

1407951056 1223G0001X 012 Dental Providers 001 General Practice

1407952542 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407953086 208800000X 020 Physicians 034 Urology

1407954613 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1407955479 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1407955479 2085N0700X 020 Physicians 204 Neuroradiology

1407955479 2085R0202X 020 Physicians 167 Diagnostic Radiology

1407957418 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1407968084 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1407968522 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1407979040 207L00000X 020 Physicians 005 Anesthesiology

1407999022 111N00000X 011 Chiropractic Providers 047 Chiropractor

1417000985 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417004912 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417006974 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1417007402 207Q00000X 020 Physicians 173 Family Medicine

1417020827 111N00000X 011 Chiropractic Providers 047 Chiropractor

1417022393 208600000X 020 Physicians 275 Surgery

224 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1417022716 207R00000X 020 Physicians 011 Internal Medicine

1417022716 208M00000X 020 Physicians 344 Hospitalist

1417026550 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1417026550 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417026725 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1417026725 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1417027988 207RH0003X 020 Physicians 179 Hematology/Oncology

1417028978 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417029596 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1417031519 207Y00000X 020 Physicians 217 Otolaryngology

1417036922 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1417040189 207Q00000X 020 Physicians 173 Family Medicine

1417043779 207P00000X 020 Physicians 270 Emergency Medicine

1417045295 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1417046459 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417049321 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417052077 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1417053869 208G00000X 020 Physicians 033 Thoracic Surgery

1417068420 2084N0400X 020 Physicians 013 Neurology

1417069089 207Q00000X 020 Physicians 173 Family Medicine

1417077694 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1417087487 207R00000X 020 Physicians 011 Internal Medicine

1417097007 1223G0001X 012 Dental Providers 001 General Practice

1417100611 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417103102 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1417107525 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1417109760 207R00000X 020 Physicians 011 Internal Medicine

1417116328 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417122078 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417123498 207K00000X 020 Physicians 003 Allergy & Immunology

1417124827 207P00000X 020 Physicians 270 Emergency Medicine

225 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1417137647 207P00000X 020 Physicians 270 Emergency Medicine

1417149279 207Q00000X 020 Physicians 173 Family Medicine

1417152885 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417153115 122300000X 012 Dental Providers 019 Dentists

1417154329 208200000X 020 Physicians 024 Plastic Surgery

1417181397 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1417181546 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1417182163 207Q00000X 020 Physicians 173 Family Medicine

1417184326 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417186586 207Q00000X 020 Physicians 173 Family Medicine

1417186933 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1417187907 2084P0800X 020 Physicians 121 Psychiatry

1417188855 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1417188939 207N00000X 020 Physicians 007 Dermatology

1417208232 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1417208299 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1417217209 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1417235466 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417243239 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1417243783 207P00000X 020 Physicians 270 Emergency Medicine

1417255191 208600000X 020 Physicians 275 Surgery

1417272667 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417284928 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417286097 207RC0200X 020 Physicians 206 Critical Care Medicine

1417286097 207RP1001X 020 Physicians 029 Pulmonary Diseases

1417286683 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417288754 122300000X 012 Dental Providers 019 Dentists

1417303173 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417304163 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1417310731 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1417310731 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

226 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1417311465 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1417316936 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417326349 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1417337866 208800000X 020 Physicians 034 Urology

1417344995 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1417350372 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417353657 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417363383 183500000X 018 Pharmacy 253 Pharmacist

1417363466 207R00000X 020 Physicians 011 Internal Medicine

1417364126 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417367996 207V00000X 020 Physicians 016 OB/GYN

1417376690 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417386186 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417395302 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1417396037 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1417397316 207RH0003X 020 Physicians 179 Hematology/Oncology

1417397324 207P00000X 020 Physicians 270 Emergency Medicine

1417403460 208000000X 020 Physicians 049 Pediatrics

1417409665 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1417410275 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1417430588 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1417438847 183500000X 018 Pharmacy 253 Pharmacist

1417447426 207Q00000X 020 Physicians 173 Family Medicine

1417465444 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1417465519 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1417473448 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1417476102 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1417476656 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1417477969 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1417490160 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1417490160 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

227 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1417501461 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417503442 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417579020 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1417591140 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417594425 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1417901950 207L00000X 020 Physicians 005 Anesthesiology

1417904558 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417904558 2085N0700X 020 Physicians 204 Neuroradiology

1417906991 208600000X 020 Physicians 275 Surgery

1417910373 207Q00000X 020 Physicians 173 Family Medicine

1417914169 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417914532 208G00000X 020 Physicians 033 Thoracic Surgery

1417915158 207RC0000X 020 Physicians 006 Cardiovascular Disease

1417916297 207RC0000X 020 Physicians 006 Cardiovascular Disease

1417920166 207RH0003X 020 Physicians 179 Hematology/Oncology

1417920166 207RH0000X 020 Physicians 178 Hematology

1417921206 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1417923194 207P00000X 020 Physicians 270 Emergency Medicine

1417923533 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1417924630 208000000X 020 Physicians 049 Pediatrics

1417926759 207Q00000X 020 Physicians 173 Family Medicine

1417928060 2085R0202X 020 Physicians 167 Diagnostic Radiology

1417929001 207X00000X 020 Physicians 020 Orthopedic Surgery

1417929449 207RP1001X 020 Physicians 029 Pulmonary Diseases

1417929605 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1417929894 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1417929894 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1417931908 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1417932823 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417934738 207RN0300X 020 Physicians 105 Nephrology

1417935131 2085R0202X 020 Physicians 167 Diagnostic Radiology

228 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1417936600 2086S0102X 020 Physicians 539 Surgical Critical Care

1417936600 208600000X 020 Physicians 275 Surgery

1417936600 2086S0120X 020 Physicians 245 Pediatric Surgery

1417936956 207W00000X 020 Physicians 018 Ophthalmology

1417937814 2084N0400X 020 Physicians 013 Neurology

1417940354 207RP1001X 020 Physicians 029 Pulmonary Diseases

1417942335 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417949108 207X00000X 020 Physicians 020 Orthopedic Surgery

1417956376 208000000X 020 Physicians 049 Pediatrics

1417959362 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1417960477 2083X0100X 020 Physicians 533 Occupational Medicine

1417961319 208000000X 020 Physicians 049 Pediatrics

1417974379 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1417977463 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1417981713 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417983164 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1417988510 208600000X 020 Physicians 275 Surgery

1417991696 207R00000X 020 Physicians 011 Internal Medicine

1427002930 207V00000X 020 Physicians 016 OB/GYN

1427004217 207P00000X 020 Physicians 270 Emergency Medicine

1427008465 207W00000X 020 Physicians 018 Ophthalmology

1427010214 207P00000X 020 Physicians 270 Emergency Medicine

1427010214 208M00000X 020 Physicians 344 Hospitalist

1427011352 208G00000X 020 Physicians 033 Thoracic Surgery

1427011790 207Q00000X 020 Physicians 173 Family Medicine

1427013150 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427020932 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1427022698 207RP1001X 020 Physicians 029 Pulmonary Diseases

1427023126 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1427024538 207RC0200X 020 Physicians 206 Critical Care Medicine

1427028646 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

229 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427028893 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1427029800 207L00000X 020 Physicians 005 Anesthesiology

1427030949 207Q00000X 020 Physicians 173 Family Medicine

1427034222 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1427035377 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427035682 207N00000X 020 Physicians 007 Dermatology

1427035989 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1427037977 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1427037977 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1427041029 111N00000X 011 Chiropractic Providers 047 Chiropractor

1427046275 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427057231 207R00000X 020 Physicians 011 Internal Medicine

1427058676 207X00000X 020 Physicians 020 Orthopedic Surgery

1427058841 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427058841 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1427059724 208800000X 020 Physicians 034 Urology

1427060334 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427070002 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1427070671 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1427071752 2084N0400X 020 Physicians 013 Neurology

1427073188 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1427075985 207R00000X 020 Physicians 011 Internal Medicine

1427077106 207X00000X 020 Physicians 020 Orthopedic Surgery

1427078831 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1427080266 111N00000X 011 Chiropractic Providers 047 Chiropractor

1427083278 208000000X 020 Physicians 049 Pediatrics

1427083278 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1427083401 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1427085042 207Q00000X 020 Physicians 173 Family Medicine

1427085836 208600000X 020 Physicians 275 Surgery

1427092238 208000000X 020 Physicians 049 Pediatrics

230 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427095702 207RC0200X 020 Physicians 206 Critical Care Medicine

1427096767 2085U0001X 020 Physicians 583 Radiology; Diagnostic Ultrasound

1427105105 207R00000X 020 Physicians 011 Internal Medicine

1427105105 207RP1001X 020 Physicians 029 Pulmonary Diseases

1427105105 207RC0200X 020 Physicians 206 Critical Care Medicine

1427113703 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1427113703 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427122266 207RX0202X 020 Physicians 529 Medical Oncology

1427122266 207R00000X 020 Physicians 011 Internal Medicine

1427122266 207RH0003X 020 Physicians 179 Hematology/Oncology

1427122811 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427136787 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427138429 207T00000X 020 Physicians 014 Neurological Surgery

1427140409 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1427144781 207P00000X 020 Physicians 270 Emergency Medicine

1427146109 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1427147594 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427147594 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1427147594 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1427157270 2084N0400X 020 Physicians 013 Neurology

1427165356 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1427169788 207T00000X 020 Physicians 014 Neurological Surgery

1427176254 207RP1001X 020 Physicians 029 Pulmonary Diseases

1427179423 207RG0100X 020 Physicians 010 Gastroenterology

1427179423 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1427182633 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427182823 207Q00000X 020 Physicians 173 Family Medicine

1427183722 208600000X 020 Physicians 275 Surgery

1427186766 183500000X 018 Pharmacy 253 Pharmacist

1427192111 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1427193051 111N00000X 011 Chiropractic Providers 047 Chiropractor

231 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427194885 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427197466 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1427202431 207L00000X 020 Physicians 005 Anesthesiology

1427204346 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1427211655 208000000X 020 Physicians 049 Pediatrics

1427213271 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427215151 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1427216175 208100000X 020 Physicians 025 Physical Medicine and Rehab

1427222033 208600000X 020 Physicians 275 Surgery

1427222561 207RC0200X 020 Physicians 206 Critical Care Medicine

1427229954 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427232354 207R00000X 020 Physicians 011 Internal Medicine

1427234319 237700000X 023 Speech Language and Hearing Svc Prov 512 Hearing Services Specialist

1427240357 208000000X 020 Physicians 049 Pediatrics

1427242478 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1427247204 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427249234 207R00000X 020 Physicians 011 Internal Medicine

1427249234 207RG0100X 020 Physicians 010 Gastroenterology

1427249689 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427252014 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1427252097 207R00000X 020 Physicians 011 Internal Medicine

1427252097 207RC0000X 020 Physicians 006 Cardiovascular Disease

1427252097 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1427262872 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427267186 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427274729 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1427275817 207RG0100X 020 Physicians 010 Gastroenterology

1427276260 207Q00000X 020 Physicians 173 Family Medicine

1427276732 207RG0100X 020 Physicians 010 Gastroenterology

1427279546 208800000X 020 Physicians 034 Urology

1427281583 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

232 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427285311 208600000X 020 Physicians 275 Surgery

1427287218 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427287697 207RC0000X 020 Physicians 006 Cardiovascular Disease

1427287911 207Q00000X 020 Physicians 173 Family Medicine

1427288018 207Q00000X 020 Physicians 173 Family Medicine

1427289842 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1427290055 207Y00000X 020 Physicians 217 Otolaryngology

1427292796 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427302918 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427304666 207R00000X 020 Physicians 011 Internal Medicine

1427310614 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427318005 207X00000X 020 Physicians 020 Orthopedic Surgery

1427319649 208100000X 020 Physicians 025 Physical Medicine and Rehab

1427321710 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427323922 183500000X 018 Pharmacy 253 Pharmacist

1427327980 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427338318 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427341627 208M00000X 020 Physicians 344 Hospitalist

1427341627 207R00000X 020 Physicians 011 Internal Medicine

1427344233 208600000X 020 Physicians 275 Surgery

1427344233 2086S0102X 020 Physicians 539 Surgical Critical Care

1427345586 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427346618 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427347004 2085R0202X 020 Physicians 167 Diagnostic Radiology

1427348291 2086S0102X 020 Physicians 539 Surgical Critical Care

1427349174 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1427354091 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427357839 207RG0100X 020 Physicians 010 Gastroenterology

1427359504 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427374123 207Q00000X 020 Physicians 173 Family Medicine

1427374131 207Q00000X 020 Physicians 173 Family Medicine

233 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427377712 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1427388040 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1427394139 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1427401132 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1427405513 183500000X 018 Pharmacy 253 Pharmacist

1427413269 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427420793 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1427422815 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1427434968 207T00000X 020 Physicians 014 Neurological Surgery

1427435254 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427436781 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427436799 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427437086 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427437862 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427450873 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1427450873 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1427450873 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1427454248 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427457217 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1427457217 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1427460088 111N00000X 011 Chiropractic Providers 047 Chiropractor

1427460385 207V00000X 020 Physicians 016 OB/GYN

1427462944 208D00000X 020 Physicians 001 General Practice

1427464072 208G00000X 020 Physicians 033 Thoracic Surgery

1427464379 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1427466044 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427475706 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1427478536 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1427478809 207L00000X 020 Physicians 005 Anesthesiology

1427481324 207ZP0101X 020 Physicians 022 Pathology

1427481324 207ZP0101X 020 Physicians 436 Anatomic Pathology

234 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427481324 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1427482736 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427485812 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427486349 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1427487164 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427492677 207Q00000X 020 Physicians 173 Family Medicine

1427493972 2084P0800X 020 Physicians 121 Psychiatry

1427494095 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1427494426 207P00000X 020 Physicians 270 Emergency Medicine

1427496579 122300000X 012 Dental Providers 019 Dentists

1427497064 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427498039 207Q00000X 020 Physicians 173 Family Medicine

1427506013 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1427506302 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1427514165 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1427517770 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1427519628 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1427524610 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1427533421 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1427534114 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427545102 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1427548999 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427551779 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1427566231 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1427574011 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1427576230 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1427585330 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1427591619 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427591619 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1427591619 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1427593524 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

235 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1427603588 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1427612415 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1427612415 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1427618800 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1427680156 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1437100815 2085P0229X 020 Physicians 241 Pediatric Radiology

1437101888 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1437103959 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1437110004 2086S0120X 020 Physicians 245 Pediatric Surgery

1437118114 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1437120839 2085N0700X 020 Physicians 204 Neuroradiology

1437120839 2085P0229X 020 Physicians 241 Pediatric Radiology

1437120839 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437121589 207RC0000X 020 Physicians 006 Cardiovascular Disease

1437123809 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437124872 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437125689 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437135027 207V00000X 020 Physicians 016 OB/GYN

1437135217 207P00000X 020 Physicians 270 Emergency Medicine

1437136330 207L00000X 020 Physicians 005 Anesthesiology

1437136595 207L00000X 020 Physicians 005 Anesthesiology

1437137213 207RC0000X 020 Physicians 006 Cardiovascular Disease

1437137775 207P00000X 020 Physicians 270 Emergency Medicine

1437138054 207ZP0101X 020 Physicians 436 Anatomic Pathology

1437138054 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1437139144 2086S0120X 020 Physicians 245 Pediatric Surgery

1437139151 207RR0500X 020 Physicians 267 Rheumatology

1437139276 207PE0004X 020 Physicians 093 Emergency Medical Services

1437140001 207L00000X 020 Physicians 005 Anesthesiology

1437142486 111N00000X 011 Chiropractic Providers 047 Chiropractor

1437145265 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

236 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437149408 207RC0200X 020 Physicians 206 Critical Care Medicine

1437149523 207T00000X 020 Physicians 014 Neurological Surgery

1437149937 207P00000X 020 Physicians 270 Emergency Medicine

1437150356 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1437150414 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1437153905 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437158268 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437164399 207R00000X 020 Physicians 011 Internal Medicine

1437164399 208M00000X 020 Physicians 344 Hospitalist

1437171006 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437172699 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1437177086 207R00000X 020 Physicians 011 Internal Medicine

1437185394 208000000X 020 Physicians 049 Pediatrics

1437185394 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1437190188 207R00000X 020 Physicians 011 Internal Medicine

1437197191 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1437198223 2080P0202X 020 Physicians 221 Pediatric Cardiology

1437199510 207P00000X 020 Physicians 270 Emergency Medicine

1437200839 111N00000X 011 Chiropractic Providers 047 Chiropractor

1437200938 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437204823 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1437205499 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1437222452 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1437223815 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1437224201 207R00000X 020 Physicians 011 Internal Medicine

1437228095 1223G0001X 012 Dental Providers 001 General Practice

1437228566 122300000X 012 Dental Providers 019 Dentists

1437228566 1223G0001X 012 Dental Providers 001 General Practice

1437231578 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437234531 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437235934 111N00000X 011 Chiropractic Providers 047 Chiropractor

237 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437244043 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1437245214 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1437246303 207X00000X 020 Physicians 020 Orthopedic Surgery

1437247665 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437249307 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1437250800 207Q00000X 020 Physicians 173 Family Medicine

1437252012 207RC0000X 020 Physicians 006 Cardiovascular Disease

1437252293 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1437253531 2085P0229X 020 Physicians 241 Pediatric Radiology

1437261724 207ZC0006X 020 Physicians 021 Clinical Pathology

1437286150 207P00000X 020 Physicians 270 Emergency Medicine

1437287869 208100000X 020 Physicians 025 Physical Medicine and Rehab

1437293909 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1437295003 207L00000X 020 Physicians 005 Anesthesiology

1437311735 2086S0120X 020 Physicians 245 Pediatric Surgery

1437311834 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437314473 207V00000X 020 Physicians 016 OB/GYN

1437318490 207L00000X 020 Physicians 005 Anesthesiology

1437320710 2086S0102X 020 Physicians 539 Surgical Critical Care

1437320710 208600000X 020 Physicians 275 Surgery

1437323128 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437323243 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437323557 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1437343548 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437345295 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437350725 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1437362571 207P00000X 020 Physicians 270 Emergency Medicine

1437363660 207X00000X 020 Physicians 020 Orthopedic Surgery

1437364155 207P00000X 020 Physicians 270 Emergency Medicine

1437366523 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1437366614 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

238 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437367927 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1437370608 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1437370608 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1437376340 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437380763 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1437384104 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1437388378 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437391083 207W00000X 020 Physicians 018 Ophthalmology

1437393113 208600000X 020 Physicians 275 Surgery

1437393113 208G00000X 020 Physicians 033 Thoracic Surgery

1437403615 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1437403615 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1437404795 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437404795 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1437406907 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437408382 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437410719 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437415288 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1437418993 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437419322 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1437425733 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437441102 2085R0202X 020 Physicians 167 Diagnostic Radiology

1437445087 208800000X 020 Physicians 034 Urology

1437445327 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437445442 207Q00000X 020 Physicians 173 Family Medicine

1437461225 207V00000X 020 Physicians 016 OB/GYN

1437464815 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437464815 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1437467073 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437470200 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437475001 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

239 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437478179 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1437480084 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1437483823 207R00000X 020 Physicians 011 Internal Medicine

1437485265 111N00000X 011 Chiropractic Providers 047 Chiropractor

1437495447 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437497625 111N00000X 011 Chiropractic Providers 047 Chiropractor

1437498466 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437500923 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1437500972 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437504578 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437505245 207R00000X 020 Physicians 011 Internal Medicine

1437516341 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437518016 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437521366 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1437525748 208M00000X 020 Physicians 344 Hospitalist

1437532132 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437534476 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437535937 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1437537750 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1437537750 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1437549185 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437552874 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437554177 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437554482 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1437559051 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1437559127 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1437559127 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1437563459 208600000X 020 Physicians 275 Surgery

1437565330 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437570371 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437573870 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

240 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437573870 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1437581600 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437581766 207Q00000X 020 Physicians 173 Family Medicine

1437590577 2084N0400X 020 Physicians 013 Neurology

1437591062 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1437591062 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437593753 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437597556 208600000X 020 Physicians 275 Surgery

1437600525 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1437602844 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1437614146 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1437623535 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437626215 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437631355 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437637501 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437643533 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437645306 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1437645306 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437655495 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1437657251 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1437660198 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1437662640 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1437662970 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1437671773 207Q00000X 020 Physicians 173 Family Medicine

1437685047 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437685062 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1437693009 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437714508 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1437715166 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1437715166 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1437715687 163W00000X 016 Nursing Service Providers 129 Registered Nurse

241 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1437718053 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1437718202 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1437771441 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1437778347 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1437795796 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1447203195 207L00000X 020 Physicians 005 Anesthesiology

1447203336 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1447204078 207V00000X 020 Physicians 016 OB/GYN

1447212899 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447220835 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447221882 2086S0129X 020 Physicians 289 Vascular Surgery

1447222807 207L00000X 020 Physicians 005 Anesthesiology

1447222955 207L00000X 020 Physicians 005 Anesthesiology

1447224084 208000000X 020 Physicians 049 Pediatrics

1447228143 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447230818 207ZP0101X 020 Physicians 022 Pathology

1447230818 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1447230958 2084N0400X 020 Physicians 013 Neurology

1447231626 207RC0000X 020 Physicians 006 Cardiovascular Disease

1447237532 207L00000X 020 Physicians 005 Anesthesiology

1447238167 207L00000X 020 Physicians 005 Anesthesiology

1447238803 207RC0000X 020 Physicians 006 Cardiovascular Disease

1447239942 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1447241799 207Q00000X 020 Physicians 173 Family Medicine

1447243431 208600000X 020 Physicians 275 Surgery

1447259494 208000000X 020 Physicians 049 Pediatrics

1447259973 208600000X 020 Physicians 275 Surgery

1447266234 207R00000X 020 Physicians 011 Internal Medicine

1447267596 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1447271671 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1447271671 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

242 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1447277348 2084N0400X 020 Physicians 013 Neurology

1447278171 208600000X 020 Physicians 275 Surgery

1447281878 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1447287610 207X00000X 020 Physicians 020 Orthopedic Surgery

1447287677 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1447288352 207Q00000X 020 Physicians 173 Family Medicine

1447296140 207P00000X 020 Physicians 270 Emergency Medicine

1447297189 207W00000X 020 Physicians 018 Ophthalmology

1447297239 207P00000X 020 Physicians 270 Emergency Medicine

1447297742 207RH0000X 020 Physicians 178 Hematology

1447297742 207RH0003X 020 Physicians 179 Hematology/Oncology

1447303334 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447303334 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1447303656 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1447308051 111N00000X 011 Chiropractic Providers 047 Chiropractor

1447310339 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1447347547 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1447348040 207Q00000X 020 Physicians 173 Family Medicine

1447350400 2084P0800X 020 Physicians 121 Psychiatry

1447350400 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1447356225 111N00000X 011 Chiropractic Providers 047 Chiropractor

1447356506 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1447362645 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1447367495 2084P0800X 020 Physicians 121 Psychiatry

1447367941 207Q00000X 020 Physicians 173 Family Medicine

1447378104 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447387923 207Q00000X 020 Physicians 173 Family Medicine

1447393772 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1447393962 207V00000X 020 Physicians 016 OB/GYN

1447395512 207Y00000X 020 Physicians 217 Otolaryngology

1447406129 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

243 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1447406129 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447411772 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447414024 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447414024 2085N0904X 020 Physicians 495 Nuclear Radiology

1447416946 207W00000X 020 Physicians 018 Ophthalmology

1447418181 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1447419338 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1447420377 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447423538 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447424247 207Q00000X 020 Physicians 173 Family Medicine

1447424247 208M00000X 020 Physicians 344 Hospitalist

1447424874 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1447425178 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1447432976 111N00000X 011 Chiropractic Providers 047 Chiropractor

1447437256 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447440276 207P00000X 020 Physicians 270 Emergency Medicine

1447443627 207Q00000X 020 Physicians 173 Family Medicine

1447447511 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1447450549 208000000X 020 Physicians 049 Pediatrics

1447450549 207R00000X 020 Physicians 011 Internal Medicine

1447452446 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447456686 207Q00000X 020 Physicians 173 Family Medicine

1447457247 2086S0129X 020 Physicians 289 Vascular Surgery

1447468780 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1447473913 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447474994 207VH0002X 020 Physicians 545 Hospice and Palliative Medicine

1447474994 207V00000X 020 Physicians 016 OB/GYN

1447475637 207RI0011X 020 Physicians 188 Interventional Cardiology

1447475637 207RC0000X 020 Physicians 006 Cardiovascular Disease

1447475637 207R00000X 020 Physicians 011 Internal Medicine

1447483474 207P00000X 020 Physicians 270 Emergency Medicine

244 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1447483474 207PE0004X 020 Physicians 093 Emergency Medical Services

1447485321 208100000X 020 Physicians 025 Physical Medicine and Rehab

1447489430 207X00000X 020 Physicians 020 Orthopedic Surgery

1447493135 207V00000X 020 Physicians 016 OB/GYN

1447494430 207ZP0101X 020 Physicians 436 Anatomic Pathology

1447494430 207ZP0101X 020 Physicians 022 Pathology

1447494430 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1447504006 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447514203 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1447517115 208000000X 020 Physicians 049 Pediatrics

1447525514 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1447525514 208000000X 020 Physicians 049 Pediatrics

1447536693 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447548623 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447548904 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1447556584 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447561360 2085R0202X 020 Physicians 167 Diagnostic Radiology

1447564570 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1447564729 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447567011 207R00000X 020 Physicians 011 Internal Medicine

1447576392 208000000X 020 Physicians 049 Pediatrics

1447579743 208D00000X 020 Physicians 001 General Practice

1447589270 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447593413 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1447598446 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1447600010 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447603790 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447603832 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1447603832 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1447606611 183500000X 018 Pharmacy 253 Pharmacist

1447607742 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

245 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1447607742 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1447610241 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1447611306 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1447613021 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447616552 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1447616552 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1447620695 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1447632682 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1447635321 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447644695 207R00000X 020 Physicians 011 Internal Medicine

1447647342 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447649819 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447652300 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447653910 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447656723 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1447660683 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1447661681 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1447661830 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1447664487 207P00000X 020 Physicians 270 Emergency Medicine

1447664883 208600000X 020 Physicians 275 Surgery

1447665583 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1447666177 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1447667399 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447668785 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447668892 207ZP0101X 020 Physicians 436 Anatomic Pathology

1447668892 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1447673991 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1447673991 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1447678891 207PE0004X 020 Physicians 093 Emergency Medical Services

1447679733 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447690458 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

246 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1447691175 207RC0000X 020 Physicians 006 Cardiovascular Disease

1447692595 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447694617 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1447694674 208000000X 020 Physicians 049 Pediatrics

1447694674 207R00000X 020 Physicians 011 Internal Medicine

1447694930 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1447694930 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1447696406 208M00000X 020 Physicians 344 Hospitalist

1447698816 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1447701016 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1447703293 207Q00000X 020 Physicians 173 Family Medicine

1447719281 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447724216 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1447735030 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447742655 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447746177 183500000X 018 Pharmacy 253 Pharmacist

1447747738 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1447766878 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1447772207 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1447772470 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447775440 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1447787056 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1447799382 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1447804448 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1447804679 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1447819586 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1447872528 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1447897038 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457300824 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1457302622 207Y00000X 020 Physicians 217 Otolaryngology

1457303000 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

247 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457303695 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1457308645 207RC0000X 020 Physicians 006 Cardiovascular Disease

1457308645 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1457309239 208600000X 020 Physicians 275 Surgery

1457309478 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457309924 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457312217 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457315970 207Q00000X 020 Physicians 173 Family Medicine

1457319121 207P00000X 020 Physicians 270 Emergency Medicine

1457321226 207Q00000X 020 Physicians 173 Family Medicine

1457324329 207V00000X 020 Physicians 016 OB/GYN

1457327199 207R00000X 020 Physicians 011 Internal Medicine

1457330409 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457338477 207L00000X 020 Physicians 005 Anesthesiology

1457338725 207RP1001X 020 Physicians 029 Pulmonary Diseases

1457338774 207V00000X 020 Physicians 016 OB/GYN

1457339368 207V00000X 020 Physicians 016 OB/GYN

1457339426 208000000X 020 Physicians 049 Pediatrics

1457339673 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1457339939 207Q00000X 020 Physicians 173 Family Medicine

1457340416 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457347007 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1457352064 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1457353690 208200000X 020 Physicians 024 Plastic Surgery

1457353716 208100000X 020 Physicians 025 Physical Medicine and Rehab

1457355281 207Q00000X 020 Physicians 173 Family Medicine

1457356800 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457357691 207X00000X 020 Physicians 020 Orthopedic Surgery

1457358160 207RN0300X 020 Physicians 105 Nephrology

1457359630 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457365082 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

248 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457369035 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457369241 207T00000X 020 Physicians 014 Neurological Surgery

1457372385 207RH0000X 020 Physicians 178 Hematology

1457377707 207P00000X 020 Physicians 270 Emergency Medicine

1457378127 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1457378127 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457381212 207X00000X 020 Physicians 020 Orthopedic Surgery

1457381980 207Q00000X 020 Physicians 173 Family Medicine

1457383374 2084P0800X 020 Physicians 121 Psychiatry

1457386906 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457387391 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457393704 111N00000X 011 Chiropractic Providers 047 Chiropractor

1457395246 207L00000X 020 Physicians 005 Anesthesiology

1457395691 2084P0800X 020 Physicians 121 Psychiatry

1457396921 207Q00000X 020 Physicians 173 Family Medicine

1457398836 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457399644 207Q00000X 020 Physicians 173 Family Medicine

1457401085 2085R0202X 020 Physicians 167 Diagnostic Radiology

1457407066 207ZP0213X 020 Physicians 238 Pediatric Pathology

1457408239 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1457409542 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457409542 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1457413858 207Q00000X 020 Physicians 173 Family Medicine

1457413858 208M00000X 020 Physicians 344 Hospitalist

1457419616 207K00000X 020 Physicians 003 Allergy & Immunology

1457422883 207Q00000X 020 Physicians 173 Family Medicine

1457423220 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1457424244 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457424681 208M00000X 020 Physicians 344 Hospitalist

1457424681 207R00000X 020 Physicians 011 Internal Medicine

1457425845 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

249 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457429680 207RH0003X 020 Physicians 179 Hematology/Oncology

1457433054 122300000X 012 Dental Providers 019 Dentists

1457433054 1223G0001X 012 Dental Providers 001 General Practice

1457434946 207Q00000X 020 Physicians 173 Family Medicine

1457435760 207P00000X 020 Physicians 270 Emergency Medicine

1457439879 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457440430 183500000X 018 Pharmacy 253 Pharmacist

1457441594 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1457447716 207R00000X 020 Physicians 011 Internal Medicine

1457447807 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1457451346 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457451981 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457451981 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1457452187 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457457194 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1457457335 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457461881 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457469199 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1457470155 207RC0000X 020 Physicians 006 Cardiovascular Disease

1457471120 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1457471880 207V00000X 020 Physicians 016 OB/GYN

1457472623 207Y00000X 020 Physicians 217 Otolaryngology

1457497208 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1457509523 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1457511941 207RH0003X 020 Physicians 179 Hematology/Oncology

1457514903 207R00000X 020 Physicians 011 Internal Medicine

1457517542 207Q00000X 020 Physicians 173 Family Medicine

1457520322 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457524902 208000000X 020 Physicians 049 Pediatrics

1457527467 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457538019 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

250 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457540106 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1457540783 207Q00000X 020 Physicians 173 Family Medicine

1457542888 207L00000X 020 Physicians 005 Anesthesiology

1457549594 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457550923 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1457551228 207T00000X 020 Physicians 014 Neurological Surgery

1457554628 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1457554628 207L00000X 020 Physicians 005 Anesthesiology

1457554628 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1457554909 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1457579203 207L00000X 020 Physicians 005 Anesthesiology

1457580110 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1457582074 207RI0200X 020 Physicians 185 Infectious Diseases

1457583460 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457587578 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1457594079 207R00000X 020 Physicians 011 Internal Medicine

1457594079 208M00000X 020 Physicians 344 Hospitalist

1457595704 207R00000X 020 Physicians 011 Internal Medicine

1457599326 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1457607632 207Q00000X 020 Physicians 173 Family Medicine

1457607772 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1457612517 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1457612962 183500000X 018 Pharmacy 253 Pharmacist

1457614729 207R00000X 020 Physicians 011 Internal Medicine

1457615155 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457615155 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457617060 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1457624710 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457627341 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457636003 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457636003 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

251 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457639601 208600000X 020 Physicians 275 Surgery

1457649048 207W00000X 020 Physicians 018 Ophthalmology

1457650566 207RC0000X 020 Physicians 006 Cardiovascular Disease

1457653263 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1457663171 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1457665911 208G00000X 020 Physicians 033 Thoracic Surgery

1457670853 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457672172 207L00000X 020 Physicians 005 Anesthesiology

1457672354 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1457683864 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457684300 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457691826 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1457700783 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1457702227 208000000X 020 Physicians 049 Pediatrics

1457703142 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1457703852 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1457717746 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1457722597 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1457735128 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457736704 208600000X 020 Physicians 275 Surgery

1457738197 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1457746489 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457748006 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1457749418 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1457749889 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1457752420 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457753089 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1457761546 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457762627 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457762627 363LC0200X 036 Phys Assts and Advanced Nursing Provs 596 Nurse Practitioer; Critical Care Medicin

1457762627 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

252 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1457784423 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457791352 207P00000X 020 Physicians 270 Emergency Medicine

1457791725 207Q00000X 020 Physicians 173 Family Medicine

1457795205 207R00000X 020 Physicians 011 Internal Medicine

1457795775 207RG0100X 020 Physicians 010 Gastroenterology

1457797011 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1457799652 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1457799652 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457805566 111N00000X 011 Chiropractic Providers 047 Chiropractor

1457807323 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1457818882 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457822686 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1457838914 208600000X 020 Physicians 275 Surgery

1457844581 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457852063 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1457866063 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457867491 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1457872640 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1457872863 207Q00000X 020 Physicians 173 Family Medicine

1457872889 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457883704 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457886491 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1457896680 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457908204 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1457911083 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1457912529 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1457915019 183500000X 018 Pharmacy 253 Pharmacist

1457988636 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1457995979 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1457996019 111N00000X 011 Chiropractic Providers 047 Chiropractor

1467002733 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

253 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467008243 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1467012351 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1467013102 122300000X 012 Dental Providers 019 Dentists

1467013896 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1467016477 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1467400689 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1467404707 207RC0000X 020 Physicians 006 Cardiovascular Disease

1467412528 207QS0010X 020 Physicians 273 Sports Medicine

1467414649 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1467414649 207ZC0500X 020 Physicians 631 Pathology;Cytopathology

1467417923 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1467418061 207P00000X 020 Physicians 270 Emergency Medicine

1467419267 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1467419390 1223G0001X 012 Dental Providers 001 General Practice

1467422154 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467427625 1223P0221X 012 Dental Providers 063 Pedodontics

1467427625 1223D0001X 012 Dental Providers 498 Dental Public Health

1467429613 207RG0100X 020 Physicians 010 Gastroenterology

1467430371 207RC0000X 020 Physicians 006 Cardiovascular Disease

1467430678 207RC0000X 020 Physicians 006 Cardiovascular Disease

1467430975 207Q00000X 020 Physicians 173 Family Medicine

1467431262 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467432096 207RG0100X 020 Physicians 010 Gastroenterology

1467432468 207RH0000X 020 Physicians 178 Hematology

1467437673 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1467438424 207Y00000X 020 Physicians 217 Otolaryngology

1467438812 208000000X 020 Physicians 049 Pediatrics

1467446401 207Y00000X 020 Physicians 217 Otolaryngology

1467447532 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1467453464 208000000X 020 Physicians 049 Pediatrics

1467460055 207Q00000X 020 Physicians 173 Family Medicine

254 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467462127 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1467470013 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467471714 111N00000X 011 Chiropractic Providers 047 Chiropractor

1467473686 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1467474056 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1467480335 207P00000X 020 Physicians 270 Emergency Medicine

1467486969 207R00000X 020 Physicians 011 Internal Medicine

1467489468 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1467494302 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1467497487 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467504449 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1467517920 207ZP0101X 020 Physicians 436 Anatomic Pathology

1467525824 111N00000X 011 Chiropractic Providers 047 Chiropractor

1467528455 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467530840 1223G0001X 012 Dental Providers 001 General Practice

1467533851 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467533851 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1467534669 2084P0800X 020 Physicians 121 Psychiatry

1467536342 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1467536615 207RP1001X 020 Physicians 029 Pulmonary Diseases

1467537217 207T00000X 020 Physicians 014 Neurological Surgery

1467539908 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467539908 2085N0700X 020 Physicians 204 Neuroradiology

1467542043 207R00000X 020 Physicians 011 Internal Medicine

1467542951 207W00000X 020 Physicians 018 Ophthalmology

1467543447 207L00000X 020 Physicians 005 Anesthesiology

1467543470 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467545814 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1467555078 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1467561464 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1467563817 207L00000X 020 Physicians 005 Anesthesiology

255 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467564534 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1467566331 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467568261 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467572214 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1467578716 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1467580589 208600000X 020 Physicians 275 Surgery

1467585349 207RI0011X 020 Physicians 188 Interventional Cardiology

1467591438 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1467595983 207R00000X 020 Physicians 011 Internal Medicine

1467599084 111N00000X 011 Chiropractic Providers 047 Chiropractor

1467603951 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1467605154 183500000X 018 Pharmacy 253 Pharmacist

1467616128 207RN0300X 020 Physicians 105 Nephrology

1467616128 208M00000X 020 Physicians 344 Hospitalist

1467618645 207RP1001X 020 Physicians 029 Pulmonary Diseases

1467624585 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1467624585 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1467625293 207SC0300X 020 Physicians 085 Clinical Cytogentics

1467625293 207ZC0006X 020 Physicians 021 Clinical Pathology

1467626051 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1467626259 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1467628313 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467636902 207RG0100X 020 Physicians 010 Gastroenterology

1467642165 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1467646919 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1467655811 122300000X 012 Dental Providers 019 Dentists

1467657460 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1467658989 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1467664235 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467667774 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467677328 207P00000X 020 Physicians 270 Emergency Medicine

256 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467678847 122300000X 012 Dental Providers 019 Dentists

1467681833 207RH0003X 020 Physicians 179 Hematology/Oncology

1467683987 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467684423 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1467684423 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1467692707 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1467692962 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467694844 207T00000X 020 Physicians 014 Neurological Surgery

1467697698 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1467700286 122300000X 012 Dental Providers 019 Dentists

1467701847 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1467702696 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1467706846 208000000X 020 Physicians 049 Pediatrics

1467706846 208M00000X 020 Physicians 344 Hospitalist

1467712638 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1467718825 207L00000X 020 Physicians 005 Anesthesiology

1467722702 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467728931 208000000X 020 Physicians 049 Pediatrics

1467740670 207L00000X 020 Physicians 005 Anesthesiology

1467744201 208600000X 020 Physicians 275 Surgery

1467744706 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467744730 207R00000X 020 Physicians 011 Internal Medicine

1467747147 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1467747832 207X00000X 020 Physicians 020 Orthopedic Surgery

1467755165 207RP1001X 020 Physicians 029 Pulmonary Diseases

1467765602 122300000X 012 Dental Providers 019 Dentists

1467771758 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1467775924 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1467788398 207ND0900X 020 Physicians 260 Dermatopathology

1467788398 207N00000X 020 Physicians 007 Dermatology

1467800581 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

257 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467800797 208M00000X 020 Physicians 344 Hospitalist

1467801704 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1467802553 1223G0001X 012 Dental Providers 001 General Practice

1467807230 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1467814954 207Q00000X 020 Physicians 173 Family Medicine

1467815266 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1467821009 207Y00000X 020 Physicians 217 Otolaryngology

1467831537 207L00000X 020 Physicians 005 Anesthesiology

1467842294 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1467855163 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1467866467 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1467870154 2085R0202X 020 Physicians 167 Diagnostic Radiology

1467873109 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1467877506 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467877977 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1467888107 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1467890244 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1467891267 207RP1001X 020 Physicians 029 Pulmonary Diseases

1467891267 207RC0200X 020 Physicians 206 Critical Care Medicine

1467894220 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1467898163 208000000X 020 Physicians 049 Pediatrics

1467909903 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1467928150 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1467938399 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467938886 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1467940502 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1467947291 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1467948455 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1467953265 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1467954073 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1467962092 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

258 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1467968487 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1467968487 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1467968487 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1467974410 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1467978551 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1467978551 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1467987925 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1467999474 208800000X 020 Physicians 034 Urology

1477007250 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1477007367 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477009017 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477009066 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477033744 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477036374 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1477045193 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1477045326 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1477047447 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477053411 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477053734 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477066751 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1477071447 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477077980 208M00000X 020 Physicians 344 Hospitalist

1477082097 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477085074 208000000X 020 Physicians 049 Pediatrics

1477092690 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1477106714 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477115095 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477184034 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1477185577 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1477188597 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1477194843 163W00000X 016 Nursing Service Providers 129 Registered Nurse

259 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477198786 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1477505725 207X00000X 020 Physicians 020 Orthopedic Surgery

1477506137 207Q00000X 020 Physicians 173 Family Medicine

1477512762 207T00000X 020 Physicians 014 Neurological Surgery

1477513893 207RC0000X 020 Physicians 006 Cardiovascular Disease

1477523231 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477525368 207RC0000X 020 Physicians 006 Cardiovascular Disease

1477525368 2080P0201X 020 Physicians 108 Pediatric Allergy

1477525871 207RC0000X 020 Physicians 006 Cardiovascular Disease

1477525871 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1477526051 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477526101 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1477526119 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477526135 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1477529121 2084P0800X 020 Physicians 121 Psychiatry

1477530095 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477532398 207RG0100X 020 Physicians 010 Gastroenterology

1477538775 207Q00000X 020 Physicians 173 Family Medicine

1477545242 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477551422 207X00000X 020 Physicians 020 Orthopedic Surgery

1477552867 207P00000X 020 Physicians 270 Emergency Medicine

1477570919 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477571172 207Q00000X 020 Physicians 173 Family Medicine

1477572865 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477574697 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477574887 207Y00000X 020 Physicians 217 Otolaryngology

1477575033 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477583086 207Q00000X 020 Physicians 173 Family Medicine

1477583466 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1477583664 207V00000X 020 Physicians 016 OB/GYN

1477587368 2085R0202X 020 Physicians 167 Diagnostic Radiology

260 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477590925 207X00000X 020 Physicians 020 Orthopedic Surgery

1477590925 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1477595551 207Q00000X 020 Physicians 173 Family Medicine

1477623866 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1477624278 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477633733 2086S0120X 020 Physicians 245 Pediatric Surgery

1477635779 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1477642536 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477642536 207U00000X 020 Physicians 103 Nuclear Medicine

1477642536 2085N0700X 020 Physicians 204 Neuroradiology

1477642551 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477642551 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1477644276 207L00000X 020 Physicians 005 Anesthesiology

1477644482 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477647576 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1477651628 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477651628 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1477655660 208200000X 020 Physicians 024 Plastic Surgery

1477657914 207R00000X 020 Physicians 011 Internal Medicine

1477658508 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1477660082 207Q00000X 020 Physicians 173 Family Medicine

1477661437 207RC0000X 020 Physicians 006 Cardiovascular Disease

1477661437 207RI0011X 020 Physicians 188 Interventional Cardiology

1477664886 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477665057 207L00000X 020 Physicians 005 Anesthesiology

1477667806 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1477672921 208000000X 020 Physicians 049 Pediatrics

1477674794 111N00000X 011 Chiropractic Providers 047 Chiropractor

1477679876 122300000X 012 Dental Providers 019 Dentists

1477679876 1223G0001X 012 Dental Providers 001 General Practice

1477679991 207P00000X 020 Physicians 270 Emergency Medicine

261 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477690758 207L00000X 020 Physicians 005 Anesthesiology

1477694016 207P00000X 020 Physicians 270 Emergency Medicine

1477696995 207Y00000X 020 Physicians 217 Otolaryngology

1477702645 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477709459 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1477710499 2088P0231X 020 Physicians 246 Pediatric Urology

1477712750 207PE0004X 020 Physicians 093 Emergency Medical Services

1477715589 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477718856 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1477719474 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477724664 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1477735926 208M00000X 020 Physicians 344 Hospitalist

1477738821 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477740918 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1477742922 207RC0000X 020 Physicians 006 Cardiovascular Disease

1477742922 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1477746477 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1477751584 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477751584 2085P0229X 020 Physicians 241 Pediatric Radiology

1477755718 207Q00000X 020 Physicians 173 Family Medicine

1477757532 207L00000X 020 Physicians 005 Anesthesiology

1477758845 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1477760700 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1477769396 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1477780526 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1477782316 207R00000X 020 Physicians 011 Internal Medicine

1477784213 208000000X 020 Physicians 049 Pediatrics

1477784528 122300000X 012 Dental Providers 019 Dentists

1477786416 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1477786416 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1477794766 207Q00000X 020 Physicians 173 Family Medicine

262 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477806487 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477808939 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1477810331 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1477816791 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1477818227 207Q00000X 020 Physicians 173 Family Medicine

1477819985 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477827608 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1477828812 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477829455 207R00000X 020 Physicians 011 Internal Medicine

1477833358 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1477833804 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1477836054 364SA2200X 036 Phys Assts and Advanced Nursing Provs 550 Clinical Nurse Specialist Adult Health

1477836831 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1477844348 208000000X 020 Physicians 049 Pediatrics

1477845840 207Q00000X 020 Physicians 173 Family Medicine

1477846749 207X00000X 020 Physicians 020 Orthopedic Surgery

1477849941 207V00000X 020 Physicians 016 OB/GYN

1477849958 207L00000X 020 Physicians 005 Anesthesiology

1477862563 2084P0800X 020 Physicians 121 Psychiatry

1477867554 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1477867943 207Q00000X 020 Physicians 173 Family Medicine

1477870681 207Q00000X 020 Physicians 173 Family Medicine

1477879138 207L00000X 020 Physicians 005 Anesthesiology

1477879385 207P00000X 020 Physicians 270 Emergency Medicine

1477880276 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1477893840 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477896447 2085R0202X 020 Physicians 167 Diagnostic Radiology

1477897569 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477907392 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1477919397 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1477921930 111N00000X 011 Chiropractic Providers 047 Chiropractor

263 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477924470 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1477924470 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477929172 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1477930790 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477931053 208M00000X 020 Physicians 344 Hospitalist

1477931079 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1477931806 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1477934081 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1477936029 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1477942936 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477942944 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1477942944 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477946101 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1477952752 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1477955144 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1477955144 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1477956357 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1477956357 363LP1700X 036 Phys Assts and Advanced Nursing Provs 535 Nurse Practitioner; Perinatal

1477959419 207V00000X 020 Physicians 016 OB/GYN

1477959922 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1477964377 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1477965614 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1477967008 207P00000X 020 Physicians 270 Emergency Medicine

1477969913 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477972784 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1477980464 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1477982544 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1477988459 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1477990166 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1477990216 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1477990216 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

264 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1477990216 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1477990216 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477997443 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1477997443 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1477997948 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487000709 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1487000709 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487001962 207P00000X 020 Physicians 270 Emergency Medicine

1487003075 208M00000X 020 Physicians 344 Hospitalist

1487003315 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1487003315 208000000X 020 Physicians 049 Pediatrics

1487023180 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487023990 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487028684 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487028932 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1487029765 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487030367 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487033692 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1487034468 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1487052056 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487056966 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487057907 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1487062006 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487066304 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1487071908 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487072807 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487074480 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1487075404 2084P0800X 020 Physicians 121 Psychiatry

1487079919 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1487083044 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487096434 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

265 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1487099289 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1487106555 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487129631 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487139580 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1487144119 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1487145231 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1487145231 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1487148755 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1487154803 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487173480 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1487173803 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1487173803 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1487173803 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1487177275 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487179610 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1487179610 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487182440 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487182663 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487184255 207Q00000X 020 Physicians 173 Family Medicine

1487207320 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487208526 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1487212205 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487296927 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1487298220 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1487606067 2084N0400X 020 Physicians 013 Neurology

1487607172 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487608618 207P00000X 020 Physicians 270 Emergency Medicine

1487608915 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487610465 208600000X 020 Physicians 275 Surgery

1487615969 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1487625877 207N00000X 020 Physicians 007 Dermatology

266 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1487626909 207RC0000X 020 Physicians 006 Cardiovascular Disease

1487627022 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487631032 207Q00000X 020 Physicians 173 Family Medicine

1487632725 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487633962 207RX0202X 020 Physicians 529 Medical Oncology

1487634309 207ZP0101X 020 Physicians 022 Pathology

1487636775 207RN0300X 020 Physicians 105 Nephrology

1487637732 208100000X 020 Physicians 025 Physical Medicine and Rehab

1487641817 207W00000X 020 Physicians 018 Ophthalmology

1487650040 207RP1001X 020 Physicians 029 Pulmonary Diseases

1487661203 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487661336 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1487661351 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1487663761 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487669859 207R00000X 020 Physicians 011 Internal Medicine

1487669859 207RC0000X 020 Physicians 006 Cardiovascular Disease

1487671483 207Q00000X 020 Physicians 173 Family Medicine

1487672184 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1487674040 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487675724 208000000X 020 Physicians 049 Pediatrics

1487677852 2084P0800X 020 Physicians 121 Psychiatry

1487681599 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487682753 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1487684676 207RC0000X 020 Physicians 006 Cardiovascular Disease

1487686689 208M00000X 020 Physicians 344 Hospitalist

1487686689 207Q00000X 020 Physicians 173 Family Medicine

1487688933 2084N0400X 020 Physicians 013 Neurology

1487689469 207R00000X 020 Physicians 011 Internal Medicine

1487692182 207V00000X 020 Physicians 016 OB/GYN

1487692489 207L00000X 020 Physicians 005 Anesthesiology

1487692661 208000000X 020 Physicians 049 Pediatrics

267 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1487699252 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487699476 207R00000X 020 Physicians 011 Internal Medicine

1487699476 208M00000X 020 Physicians 344 Hospitalist

1487706081 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487706081 363LX0106X 036 Phys Assts and Advanced Nursing Provs 536 Nurse Practitioner; Occupational Health

1487706230 207ZP0101X 020 Physicians 436 Anatomic Pathology

1487706230 207ZH0000X 020 Physicians 560 Hematology; Pathology

1487709580 111N00000X 011 Chiropractic Providers 047 Chiropractor

1487712360 207P00000X 020 Physicians 270 Emergency Medicine

1487715405 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487720595 208000000X 020 Physicians 049 Pediatrics

1487731014 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1487737136 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487738704 208000000X 020 Physicians 049 Pediatrics

1487741237 207RG0100X 020 Physicians 010 Gastroenterology

1487741237 207R00000X 020 Physicians 011 Internal Medicine

1487741484 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487742151 207V00000X 020 Physicians 016 OB/GYN

1487743332 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1487743332 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1487743712 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487745493 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1487745493 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1487747267 207W00000X 020 Physicians 018 Ophthalmology

1487748679 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1487754487 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487765855 122300000X 012 Dental Providers 019 Dentists

1487769717 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487774667 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1487774667 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1487800124 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

268 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1487810941 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1487810941 208000000X 020 Physicians 049 Pediatrics

1487811675 207RH0000X 020 Physicians 178 Hematology

1487811907 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1487814273 208600000X 020 Physicians 275 Surgery

1487817904 2084N0400X 020 Physicians 013 Neurology

1487819371 183500000X 018 Pharmacy 253 Pharmacist

1487824132 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487831848 207Q00000X 020 Physicians 173 Family Medicine

1487834305 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487841037 207Q00000X 020 Physicians 173 Family Medicine

1487846978 207P00000X 020 Physicians 270 Emergency Medicine

1487848784 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1487853404 207Q00000X 020 Physicians 173 Family Medicine

1487864195 207P00000X 020 Physicians 270 Emergency Medicine

1487878294 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1487880274 207W00000X 020 Physicians 018 Ophthalmology

1487882395 207L00000X 020 Physicians 005 Anesthesiology

1487886271 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1487895660 2085R0202X 020 Physicians 167 Diagnostic Radiology

1487902037 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1487903407 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1487917340 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1487917340 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1487923751 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1487932794 183500000X 018 Pharmacy 253 Pharmacist

1487941118 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1487944922 207L00000X 020 Physicians 005 Anesthesiology

1487945630 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1487948196 111N00000X 011 Chiropractic Providers 047 Chiropractor

1487948832 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

269 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1487972386 207L00000X 020 Physicians 005 Anesthesiology

1487972972 208600000X 020 Physicians 275 Surgery

1487979183 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487979282 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1487991097 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1487993044 111N00000X 011 Chiropractic Providers 047 Chiropractor

1487997557 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497015424 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1497021158 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1497027841 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1497027841 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1497035257 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497035786 2084P0800X 020 Physicians 121 Psychiatry

1497037642 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497040414 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1497045173 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497050686 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1497068415 2085N0700X 020 Physicians 204 Neuroradiology

1497071781 122300000X 012 Dental Providers 019 Dentists

1497071781 1223G0001X 012 Dental Providers 001 General Practice

1497080873 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1497108054 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497149470 111N00000X 011 Chiropractic Providers 047 Chiropractor

1497157028 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1497158026 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1497158828 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1497162309 208600000X 020 Physicians 275 Surgery

1497162358 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1497162507 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1497162507 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1497163653 208000000X 020 Physicians 049 Pediatrics

270 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1497163653 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1497165864 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1497167704 208M00000X 020 Physicians 344 Hospitalist

1497167852 208M00000X 020 Physicians 344 Hospitalist

1497167852 207PH0002X 020 Physicians 571 Emergency Medicine; Hospice and Palliati

1497173546 207R00000X 020 Physicians 011 Internal Medicine

1497174593 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497177232 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497193239 207Q00000X 020 Physicians 173 Family Medicine

1497199046 208000000X 020 Physicians 049 Pediatrics

1497199236 208000000X 020 Physicians 049 Pediatrics

1497203988 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1497205876 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1497222715 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497224224 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1497227987 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497235261 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497240709 207Q00000X 020 Physicians 173 Family Medicine

1497242689 122300000X 012 Dental Providers 019 Dentists

1497248264 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1497270417 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497275572 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1497275572 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1497278667 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1497283196 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1497310940 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1497311013 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1497387195 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1497390298 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1497396865 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1497397111 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

271 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1497706436 207L00000X 020 Physicians 005 Anesthesiology

1497708481 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1497708481 208000000X 020 Physicians 049 Pediatrics

1497708499 207P00000X 020 Physicians 270 Emergency Medicine

1497709695 207RG0100X 020 Physicians 010 Gastroenterology

1497711824 208000000X 020 Physicians 049 Pediatrics

1497711824 208M00000X 020 Physicians 344 Hospitalist

1497713366 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497720189 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497721328 207X00000X 020 Physicians 020 Orthopedic Surgery

1497723662 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1497726285 207P00000X 020 Physicians 270 Emergency Medicine

1497727374 208000000X 020 Physicians 049 Pediatrics

1497727945 207RC0000X 020 Physicians 006 Cardiovascular Disease

1497729107 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1497729289 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497732374 207R00000X 020 Physicians 011 Internal Medicine

1497733273 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497733455 207RC0000X 020 Physicians 006 Cardiovascular Disease

1497733521 207RP1001X 020 Physicians 029 Pulmonary Diseases

1497734123 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497734594 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497734958 207W00000X 020 Physicians 018 Ophthalmology

1497735401 207RC0000X 020 Physicians 006 Cardiovascular Disease

1497735401 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1497744924 207W00000X 020 Physicians 018 Ophthalmology

1497747984 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1497752810 207X00000X 020 Physicians 020 Orthopedic Surgery

1497759898 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497765937 207P00000X 020 Physicians 270 Emergency Medicine

1497770739 111N00000X 011 Chiropractic Providers 047 Chiropractor

272 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1497771786 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497772032 207R00000X 020 Physicians 011 Internal Medicine

1497772354 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497773030 208600000X 020 Physicians 275 Surgery

1497773097 207Q00000X 020 Physicians 173 Family Medicine

1497775027 207P00000X 020 Physicians 270 Emergency Medicine

1497775068 2085R0202X 020 Physicians 167 Diagnostic Radiology

1497775100 207Q00000X 020 Physicians 173 Family Medicine

1497776611 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1497776736 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1497778302 207Y00000X 020 Physicians 217 Otolaryngology

1497779128 207X00000X 020 Physicians 020 Orthopedic Surgery

1497782718 207X00000X 020 Physicians 020 Orthopedic Surgery

1497785158 111N00000X 011 Chiropractic Providers 047 Chiropractor

1497790927 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1497794416 207X00000X 020 Physicians 020 Orthopedic Surgery

1497794515 207P00000X 020 Physicians 270 Emergency Medicine

1497808422 207T00000X 020 Physicians 014 Neurological Surgery

1497812341 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1497826549 207X00000X 020 Physicians 020 Orthopedic Surgery

1497830145 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1497831580 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497832513 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1497833933 207R00000X 020 Physicians 011 Internal Medicine

1497833933 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1497839120 2080P0202X 020 Physicians 221 Pediatric Cardiology

1497840631 207W00000X 020 Physicians 018 Ophthalmology

1497845093 2084N0400X 020 Physicians 013 Neurology

1497846299 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497847321 207RC0200X 020 Physicians 206 Critical Care Medicine

1497848311 208000000X 020 Physicians 049 Pediatrics

273 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1497849509 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1497853147 207RC0200X 020 Physicians 206 Critical Care Medicine

1497853147 207RP1001X 020 Physicians 029 Pulmonary Diseases

1497853147 207R00000X 020 Physicians 011 Internal Medicine

1497856504 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1497858880 111N00000X 011 Chiropractic Providers 047 Chiropractor

1497862692 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1497871966 207Y00000X 020 Physicians 217 Otolaryngology

1497880934 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1497889091 122300000X 012 Dental Providers 019 Dentists

1497891253 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1497905996 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1497917397 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497920821 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1497920821 208000000X 020 Physicians 049 Pediatrics

1497921308 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1497931455 207L00000X 020 Physicians 005 Anesthesiology

1497938161 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1497938369 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1497940142 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1497942866 207RN0300X 020 Physicians 105 Nephrology

1497944615 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1497945158 2084P0800X 020 Physicians 121 Psychiatry

1497948731 207V00000X 020 Physicians 016 OB/GYN

1497952261 122300000X 012 Dental Providers 019 Dentists

1497957625 207P00000X 020 Physicians 270 Emergency Medicine

1497958979 207ZP0101X 020 Physicians 022 Pathology

1497962096 207P00000X 020 Physicians 270 Emergency Medicine

1497968226 1223P0221X 012 Dental Providers 063 Pedodontics

1497969570 207Q00000X 020 Physicians 173 Family Medicine

1497974794 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

274 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1497977011 207V00000X 020 Physicians 016 OB/GYN

1497981435 122300000X 012 Dental Providers 019 Dentists

1497981989 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1497982169 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1497987226 207P00000X 020 Physicians 270 Emergency Medicine

1497987812 207Q00000X 020 Physicians 173 Family Medicine

1497989602 111N00000X 011 Chiropractic Providers 047 Chiropractor

1497992275 207ZC0006X 020 Physicians 021 Clinical Pathology

1497995849 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508006693 207R00000X 020 Physicians 011 Internal Medicine

1508006693 208000000X 020 Physicians 049 Pediatrics

1508019779 207X00000X 020 Physicians 020 Orthopedic Surgery

1508020827 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508021742 2084N0400X 020 Physicians 013 Neurology

1508029224 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1508032103 2085R0202X 020 Physicians 167 Diagnostic Radiology

1508032129 208600000X 020 Physicians 275 Surgery

1508048521 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1508061136 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1508066457 207VX0000X 020 Physicians 211 Obstetrics

1508068289 122300000X 012 Dental Providers 019 Dentists

1508068503 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508074162 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508078346 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1508078734 122300000X 012 Dental Providers 019 Dentists

1508078734 1223G0001X 012 Dental Providers 001 General Practice

1508085895 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1508086463 183500000X 018 Pharmacy 253 Pharmacist

1508087511 207RS0012X 020 Physicians 614 Internal Medicine; Sleep Medicine

1508087511 207RP1001X 020 Physicians 029 Pulmonary Diseases

1508087511 207RC0200X 020 Physicians 206 Critical Care Medicine

275 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508089475 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1508091786 207W00000X 020 Physicians 018 Ophthalmology

1508092933 208M00000X 020 Physicians 344 Hospitalist

1508092933 207R00000X 020 Physicians 011 Internal Medicine

1508093196 208600000X 020 Physicians 275 Surgery

1508097247 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1508098864 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1508109661 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1508115403 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1508127812 111N00000X 011 Chiropractic Providers 047 Chiropractor

1508129198 207P00000X 020 Physicians 270 Emergency Medicine

1508136003 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1508136003 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508137480 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1508137480 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1508150046 208200000X 020 Physicians 024 Plastic Surgery

1508154691 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1508155847 207L00000X 020 Physicians 005 Anesthesiology

1508165713 207R00000X 020 Physicians 011 Internal Medicine

1508171208 207RN0300X 020 Physicians 105 Nephrology

1508172313 2085R0202X 020 Physicians 167 Diagnostic Radiology

1508173832 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508173980 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508176025 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508178666 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508179854 207Q00000X 020 Physicians 173 Family Medicine

1508182742 2085R0202X 020 Physicians 167 Diagnostic Radiology

1508182999 207P00000X 020 Physicians 270 Emergency Medicine

1508185166 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508186362 207Q00000X 020 Physicians 173 Family Medicine

1508205360 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

276 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508206749 207Q00000X 020 Physicians 173 Family Medicine

1508213380 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508213380 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1508214487 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508215344 207R00000X 020 Physicians 011 Internal Medicine

1508216599 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508217183 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508217373 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508219775 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1508219775 237700000X 023 Speech Language and Hearing Svc Prov 512 Hearing Services Specialist

1508224254 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1508238601 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1508242397 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1508244336 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508245143 207P00000X 020 Physicians 270 Emergency Medicine

1508249707 207Q00000X 020 Physicians 173 Family Medicine

1508264367 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508265984 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508268491 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508269564 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508271115 207Q00000X 020 Physicians 173 Family Medicine

1508272899 207T00000X 020 Physicians 014 Neurological Surgery

1508273418 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1508274408 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508274994 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1508279522 207RG0100X 020 Physicians 010 Gastroenterology

1508286139 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1508286139 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1508286998 1223P0700X 012 Dental Providers 066 Prosthodontics

1508289794 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508298589 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

277 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508301292 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1508302100 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1508324997 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1508329574 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1508333527 111N00000X 011 Chiropractic Providers 047 Chiropractor

1508334921 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1508335274 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508342700 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508344177 183500000X 018 Pharmacy 253 Pharmacist

1508356213 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1508362146 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1508374455 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1508376021 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1508381815 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1508403346 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508420670 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1508485681 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1508490574 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1508801002 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508802596 207R00000X 020 Physicians 011 Internal Medicine

1508806993 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508807116 207Q00000X 020 Physicians 173 Family Medicine

1508807884 208100000X 020 Physicians 025 Physical Medicine and Rehab

1508813452 2080P0202X 020 Physicians 221 Pediatric Cardiology

1508817149 207Q00000X 020 Physicians 173 Family Medicine

1508821414 207R00000X 020 Physicians 011 Internal Medicine

1508826447 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1508827858 207Q00000X 020 Physicians 173 Family Medicine

1508828948 207Q00000X 020 Physicians 173 Family Medicine

1508830092 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1508835513 208D00000X 020 Physicians 001 General Practice

278 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508836511 2085R0202X 020 Physicians 167 Diagnostic Radiology

1508836586 207P00000X 020 Physicians 270 Emergency Medicine

1508838483 207ZP0101X 020 Physicians 022 Pathology

1508839127 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1508840430 207RG0100X 020 Physicians 010 Gastroenterology

1508842048 207RC0000X 020 Physicians 006 Cardiovascular Disease

1508842154 207X00000X 020 Physicians 020 Orthopedic Surgery

1508842287 207L00000X 020 Physicians 005 Anesthesiology

1508843525 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508843871 207RI0200X 020 Physicians 185 Infectious Diseases

1508849548 207Y00000X 020 Physicians 217 Otolaryngology

1508849753 207Q00000X 020 Physicians 173 Family Medicine

1508851387 207W00000X 020 Physicians 018 Ophthalmology

1508854407 207P00000X 020 Physicians 270 Emergency Medicine

1508862194 207X00000X 020 Physicians 020 Orthopedic Surgery

1508870544 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1508870544 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1508876921 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1508878364 207W00000X 020 Physicians 018 Ophthalmology

1508882135 207Q00000X 020 Physicians 173 Family Medicine

1508883117 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1508883117 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508883463 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1508883463 364SP0809X 036 Phys Assts and Advanced Nursing Provs 547 Clinical Nurse Specialist Psychiatric/M

1508884016 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1508884172 207Q00000X 020 Physicians 173 Family Medicine

1508885914 207Q00000X 020 Physicians 173 Family Medicine

1508892241 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1508894643 207W00000X 020 Physicians 018 Ophthalmology

1508895954 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508899139 207R00000X 020 Physicians 011 Internal Medicine

279 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508899139 207RH0003X 020 Physicians 179 Hematology/Oncology

1508903253 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1508903857 2088P0231X 020 Physicians 246 Pediatric Urology

1508905423 122300000X 012 Dental Providers 019 Dentists

1508907882 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1508909540 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1508909540 2084P0800X 020 Physicians 121 Psychiatry

1508912288 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1508917659 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1508918277 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1508919572 208600000X 020 Physicians 275 Surgery

1508931064 111N00000X 011 Chiropractic Providers 047 Chiropractor

1508931676 207W00000X 020 Physicians 018 Ophthalmology

1508937657 207P00000X 020 Physicians 270 Emergency Medicine

1508940891 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1508940891 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1508940891 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1508942897 208600000X 020 Physicians 275 Surgery

1508945684 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1508951856 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1508954959 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1508956269 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1508956269 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1508958935 207P00000X 020 Physicians 270 Emergency Medicine

1508958935 208D00000X 020 Physicians 001 General Practice

1508959453 208000000X 020 Physicians 049 Pediatrics

1508963562 207RN0300X 020 Physicians 105 Nephrology

1508963950 208D00000X 020 Physicians 001 General Practice

1508964388 207P00000X 020 Physicians 270 Emergency Medicine

1508965492 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1508966011 207R00000X 020 Physicians 011 Internal Medicine

280 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1508966524 207L00000X 020 Physicians 005 Anesthesiology

1508974361 207Y00000X 020 Physicians 217 Otolaryngology

1518015627 2085R0202X 020 Physicians 167 Diagnostic Radiology

1518016187 207RG0100X 020 Physicians 010 Gastroenterology

1518022722 207R00000X 020 Physicians 011 Internal Medicine

1518044577 207Q00000X 020 Physicians 173 Family Medicine

1518045921 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1518046275 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518046747 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518052042 207Q00000X 020 Physicians 173 Family Medicine

1518057413 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518057975 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1518057975 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1518057975 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1518069145 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518078583 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1518078583 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1518079011 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1518083120 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1518084045 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1518084045 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1518092741 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518111558 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1518114594 208M00000X 020 Physicians 344 Hospitalist

1518116680 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518116680 207R00000X 020 Physicians 011 Internal Medicine

1518119536 207RG0100X 020 Physicians 010 Gastroenterology

1518120955 208100000X 020 Physicians 025 Physical Medicine and Rehab

1518121615 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1518123355 207RN0300X 020 Physicians 105 Nephrology

1518125152 207L00000X 020 Physicians 005 Anesthesiology

281 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1518126622 208000000X 020 Physicians 049 Pediatrics

1518126622 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1518129071 2086S0102X 020 Physicians 539 Surgical Critical Care

1518129071 208600000X 020 Physicians 275 Surgery

1518131093 207Q00000X 020 Physicians 173 Family Medicine

1518136159 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518143007 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518150580 207R00000X 020 Physicians 011 Internal Medicine

1518152289 2084P0800X 020 Physicians 121 Psychiatry

1518157395 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1518157395 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1518157395 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1518159680 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518160738 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1518160738 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1518165539 2084N0400X 020 Physicians 013 Neurology

1518168350 2084N0400X 020 Physicians 013 Neurology

1518172782 207RX0202X 020 Physicians 529 Medical Oncology

1518190651 111N00000X 011 Chiropractic Providers 047 Chiropractor

1518192145 2084P0800X 020 Physicians 121 Psychiatry

1518193622 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1518194943 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1518195205 207R00000X 020 Physicians 011 Internal Medicine

1518196518 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518200914 208600000X 020 Physicians 275 Surgery

1518205202 1223X0400X 012 Dental Providers 515 Orthodontics & Dentofacial Orthopedics

1518212893 207W00000X 020 Physicians 018 Ophthalmology

1518227073 207P00000X 020 Physicians 270 Emergency Medicine

1518240332 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1518242692 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518253731 207L00000X 020 Physicians 005 Anesthesiology

282 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1518263789 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1518263797 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1518285725 2084N0400X 020 Physicians 013 Neurology

1518288208 208000000X 020 Physicians 049 Pediatrics

1518288299 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518288406 207RR0500X 020 Physicians 267 Rheumatology

1518288497 207Y00000X 020 Physicians 217 Otolaryngology

1518291293 208M00000X 020 Physicians 344 Hospitalist

1518291293 208000000X 020 Physicians 049 Pediatrics

1518298728 207R00000X 020 Physicians 011 Internal Medicine

1518298728 207RG0100X 020 Physicians 010 Gastroenterology

1518300011 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518306703 208000000X 020 Physicians 049 Pediatrics

1518311224 208000000X 020 Physicians 049 Pediatrics

1518319169 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518322122 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1518338581 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1518338581 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1518341296 111N00000X 011 Chiropractic Providers 047 Chiropractor

1518347707 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1518347707 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1518349299 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518349372 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1518358704 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518362821 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1518367861 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1518371327 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1518372408 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518375138 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1518376391 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1518388099 207R00000X 020 Physicians 011 Internal Medicine

283 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1518388099 208M00000X 020 Physicians 344 Hospitalist

1518391192 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1518397231 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1518406826 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1518413483 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518416502 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1518416502 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1518443530 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1518445956 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1518447895 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518451434 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518455872 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1518466317 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518485556 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518488071 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1518494145 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518494848 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1518502020 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1518510718 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1518511492 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1518511799 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1518511799 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1518518091 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1518580091 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1518905017 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1518906007 2080P0202X 020 Physicians 221 Pediatric Cardiology

1518906437 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1518907740 207L00000X 020 Physicians 005 Anesthesiology

1518908862 207R00000X 020 Physicians 011 Internal Medicine

1518915511 2084P0800X 020 Physicians 121 Psychiatry

1518916832 208800000X 020 Physicians 034 Urology

284 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1518917277 207RN0300X 020 Physicians 105 Nephrology

1518922475 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518922921 207R00000X 020 Physicians 011 Internal Medicine

1518922921 207RN0300X 020 Physicians 105 Nephrology

1518923085 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518923994 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518925882 207L00000X 020 Physicians 005 Anesthesiology

1518926534 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518926534 207R00000X 020 Physicians 011 Internal Medicine

1518930262 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1518931245 2080P0008X 020 Physicians 233 Pediatric Neurodevelopment

1518931914 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1518931914 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1518933209 207P00000X 020 Physicians 270 Emergency Medicine

1518933530 208600000X 020 Physicians 275 Surgery

1518934389 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1518934736 207RG0100X 020 Physicians 010 Gastroenterology

1518934777 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1518934777 207ZP0101X 020 Physicians 436 Anatomic Pathology

1518936863 208000000X 020 Physicians 049 Pediatrics

1518937002 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1518937911 207Q00000X 020 Physicians 173 Family Medicine

1518939974 207X00000X 020 Physicians 020 Orthopedic Surgery

1518940428 2085R0202X 020 Physicians 167 Diagnostic Radiology

1518942861 2085R0202X 020 Physicians 167 Diagnostic Radiology

1518942861 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1518944883 2084P0800X 020 Physicians 121 Psychiatry

1518945054 207RX0202X 020 Physicians 529 Medical Oncology

1518945369 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1518945815 207RC0000X 020 Physicians 006 Cardiovascular Disease

1518945815 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

285 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1518946474 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1518948199 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1518966241 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1518967066 111N00000X 011 Chiropractic Providers 047 Chiropractor

1518970607 2085R0202X 020 Physicians 167 Diagnostic Radiology

1518980846 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1518980846 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1518985118 2084P0800X 020 Physicians 121 Psychiatry

1518987668 2085R0202X 020 Physicians 167 Diagnostic Radiology

1518991678 207W00000X 020 Physicians 018 Ophthalmology

1518993369 2086X0206X 020 Physicians 276 Surgical Oncology

1518995158 207RI0011X 020 Physicians 188 Interventional Cardiology

1518995521 208G00000X 020 Physicians 033 Thoracic Surgery

1518997691 207RN0300X 020 Physicians 105 Nephrology

1528005535 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528006699 207W00000X 020 Physicians 018 Ophthalmology

1528007630 207Q00000X 020 Physicians 173 Family Medicine

1528008299 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1528008299 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1528008562 207L00000X 020 Physicians 005 Anesthesiology

1528009123 207V00000X 020 Physicians 016 OB/GYN

1528011533 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1528013307 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1528020849 207RC0000X 020 Physicians 006 Cardiovascular Disease

1528026853 207PE0004X 020 Physicians 093 Emergency Medical Services

1528031549 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528033933 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528035243 207L00000X 020 Physicians 005 Anesthesiology

1528039765 207Y00000X 020 Physicians 217 Otolaryngology

1528046000 207Q00000X 020 Physicians 173 Family Medicine

1528046612 2085R0202X 020 Physicians 167 Diagnostic Radiology

286 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1528046752 207RG0100X 020 Physicians 010 Gastroenterology

1528047453 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528052594 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528053717 207W00000X 020 Physicians 018 Ophthalmology

1528056595 208800000X 020 Physicians 034 Urology

1528058070 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528059375 207Q00000X 020 Physicians 173 Family Medicine

1528060886 207V00000X 020 Physicians 016 OB/GYN

1528064144 207T00000X 020 Physicians 014 Neurological Surgery

1528070323 207P00000X 020 Physicians 270 Emergency Medicine

1528070844 207Y00000X 020 Physicians 217 Otolaryngology

1528078458 207RC0000X 020 Physicians 006 Cardiovascular Disease

1528080199 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1528080256 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1528080868 208000000X 020 Physicians 049 Pediatrics

1528081528 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1528085065 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1528086170 207Q00000X 020 Physicians 173 Family Medicine

1528092772 207Q00000X 020 Physicians 173 Family Medicine

1528092772 208M00000X 020 Physicians 344 Hospitalist

1528093077 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1528094943 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528099272 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1528115052 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1528121258 1223P0221X 012 Dental Providers 063 Pedodontics

1528123486 208600000X 020 Physicians 275 Surgery

1528123486 2086S0120X 020 Physicians 245 Pediatric Surgery

1528124468 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528136017 111N00000X 011 Chiropractic Providers 047 Chiropractor

1528138542 207Q00000X 020 Physicians 173 Family Medicine

1528140019 207RN0300X 020 Physicians 105 Nephrology

287 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1528151099 207Q00000X 020 Physicians 173 Family Medicine

1528158490 207P00000X 020 Physicians 270 Emergency Medicine

1528167244 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528171873 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528171964 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1528171964 207ZP0101X 020 Physicians 022 Pathology

1528175155 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528176278 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528187150 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1528187846 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1528187911 207P00000X 020 Physicians 270 Emergency Medicine

1528187994 183500000X 018 Pharmacy 253 Pharmacist

1528199650 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1528199650 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1528199650 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528201381 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1528201381 208000000X 020 Physicians 049 Pediatrics

1528210242 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1528210879 2085N0700X 020 Physicians 204 Neuroradiology

1528210879 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528216926 207R00000X 020 Physicians 011 Internal Medicine

1528216926 207RN0300X 020 Physicians 105 Nephrology

1528217908 2084N0400X 020 Physicians 013 Neurology

1528218625 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1528221538 208000000X 020 Physicians 049 Pediatrics

1528221538 2080P0210X 020 Physicians 232 Pediatric Nephrology

1528221769 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1528222601 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528222999 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1528235934 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528238599 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

288 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1528243573 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528243573 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1528260536 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528268539 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1528276458 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1528277100 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1528278215 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528281136 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1528288081 207P00000X 020 Physicians 270 Emergency Medicine

1528288800 208000000X 020 Physicians 049 Pediatrics

1528294501 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1528295185 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528296258 207P00000X 020 Physicians 270 Emergency Medicine

1528299922 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528300167 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528307972 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528308681 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528309788 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1528320546 2080P0202X 020 Physicians 221 Pediatric Cardiology

1528321767 207W00000X 020 Physicians 018 Ophthalmology

1528322765 207P00000X 020 Physicians 270 Emergency Medicine

1528322880 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1528326873 207QS0010X 020 Physicians 273 Sports Medicine

1528327251 207P00000X 020 Physicians 270 Emergency Medicine

1528328754 2085R0202X 020 Physicians 167 Diagnostic Radiology

1528344926 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528351442 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528355500 207Q00000X 020 Physicians 173 Family Medicine

1528355591 207Q00000X 020 Physicians 173 Family Medicine

1528356110 207W00000X 020 Physicians 018 Ophthalmology

1528360054 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

289 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1528382603 208100000X 020 Physicians 025 Physical Medicine and Rehab

1528384005 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1528384054 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528384088 207V00000X 020 Physicians 016 OB/GYN

1528384435 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528385432 207L00000X 020 Physicians 005 Anesthesiology

1528389277 207R00000X 020 Physicians 011 Internal Medicine

1528389327 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1528389574 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1528397288 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1528397288 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1528397999 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1528399417 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1528400785 208000000X 020 Physicians 049 Pediatrics

1528400785 2080P0202X 020 Physicians 221 Pediatric Cardiology

1528400868 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528410636 208M00000X 020 Physicians 344 Hospitalist

1528416658 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1528419181 207RH0003X 020 Physicians 179 Hematology/Oncology

1528422565 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528435369 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1528446093 207P00000X 020 Physicians 270 Emergency Medicine

1528446341 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1528465796 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1528465994 207RH0003X 020 Physicians 179 Hematology/Oncology

1528469251 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1528470572 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1528471703 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528471810 207RC0000X 020 Physicians 006 Cardiovascular Disease

1528474053 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1528474392 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

290 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1528485141 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528486792 208600000X 020 Physicians 275 Surgery

1528491800 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528499852 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1528501418 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1528504420 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528513975 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1528527157 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1528532470 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528536935 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1528536935 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528536935 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1528544392 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1528544491 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1528544491 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1528549607 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1528569662 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1528577814 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1528583846 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528587714 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1528594926 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1528595790 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1528597507 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1528605409 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1528616018 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1538103155 208G00000X 020 Physicians 033 Thoracic Surgery

1538103577 208800000X 020 Physicians 034 Urology

1538109335 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538112057 207P00000X 020 Physicians 270 Emergency Medicine

1538115274 207L00000X 020 Physicians 005 Anesthesiology

1538115993 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

291 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538116595 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538116975 207Q00000X 020 Physicians 173 Family Medicine

1538118401 207RH0000X 020 Physicians 178 Hematology

1538118401 207RX0202X 020 Physicians 529 Medical Oncology

1538121116 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538121959 2085P0229X 020 Physicians 241 Pediatric Radiology

1538122171 208000000X 020 Physicians 049 Pediatrics

1538122171 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1538124524 207L00000X 020 Physicians 005 Anesthesiology

1538129614 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538132113 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538132782 208000000X 020 Physicians 049 Pediatrics

1538134630 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538139639 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1538142690 208600000X 020 Physicians 275 Surgery

1538146261 2084P0800X 020 Physicians 121 Psychiatry

1538146600 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1538146626 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538147848 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1538148481 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538149018 207RG0100X 020 Physicians 010 Gastroenterology

1538149620 208100000X 020 Physicians 025 Physical Medicine and Rehab

1538156799 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538164231 208800000X 020 Physicians 034 Urology

1538164421 207RI0011X 020 Physicians 188 Interventional Cardiology

1538165253 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1538166624 111N00000X 011 Chiropractic Providers 047 Chiropractor

1538166657 208800000X 020 Physicians 034 Urology

1538174073 2084N0400X 020 Physicians 013 Neurology

1538179833 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538180864 2084N0400X 020 Physicians 013 Neurology

292 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538183223 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538183249 207Q00000X 020 Physicians 173 Family Medicine

1538184023 208M00000X 020 Physicians 344 Hospitalist

1538184569 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538187125 207Q00000X 020 Physicians 173 Family Medicine

1538187125 207PE0004X 020 Physicians 093 Emergency Medical Services

1538187265 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1538187786 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538188230 2084P0800X 020 Physicians 121 Psychiatry

1538188511 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538197181 207R00000X 020 Physicians 011 Internal Medicine

1538200381 208600000X 020 Physicians 275 Surgery

1538204078 111N00000X 011 Chiropractic Providers 047 Chiropractor

1538205539 2080P0008X 020 Physicians 233 Pediatric Neurodevelopment

1538208806 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1538208806 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1538218391 2084P0800X 020 Physicians 121 Psychiatry

1538218391 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1538219340 207P00000X 020 Physicians 270 Emergency Medicine

1538220199 207R00000X 020 Physicians 011 Internal Medicine

1538222054 207RG0100X 020 Physicians 010 Gastroenterology

1538222104 208G00000X 020 Physicians 033 Thoracic Surgery

1538222351 207L00000X 020 Physicians 005 Anesthesiology

1538230677 207Q00000X 020 Physicians 173 Family Medicine

1538234455 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538243837 207V00000X 020 Physicians 016 OB/GYN

1538247721 208G00000X 020 Physicians 033 Thoracic Surgery

1538250550 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538255468 2080P0202X 020 Physicians 221 Pediatric Cardiology

1538255898 208000000X 020 Physicians 049 Pediatrics

1538259411 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

293 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538262860 207Y00000X 020 Physicians 217 Otolaryngology

1538269568 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1538271507 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538280680 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538285366 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538286216 207RN0300X 020 Physicians 105 Nephrology

1538286216 2080P0210X 020 Physicians 232 Pediatric Nephrology

1538287305 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538287883 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1538291422 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1538296751 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538297601 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538308069 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1538308242 207N00000X 020 Physicians 007 Dermatology

1538310792 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538312590 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538314695 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1538320932 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1538321765 208M00000X 020 Physicians 344 Hospitalist

1538322631 207L00000X 020 Physicians 005 Anesthesiology

1538326301 2080P0202X 020 Physicians 221 Pediatric Cardiology

1538330980 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1538330980 208000000X 020 Physicians 049 Pediatrics

1538334628 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538336938 208200000X 020 Physicians 024 Plastic Surgery

1538338835 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538343819 183500000X 018 Pharmacy 253 Pharmacist

1538348529 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538357785 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1538359906 207RC0000X 020 Physicians 006 Cardiovascular Disease

1538363635 2085R0202X 020 Physicians 167 Diagnostic Radiology

294 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538366752 2085R0202X 020 Physicians 167 Diagnostic Radiology

1538368295 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1538369244 111N00000X 011 Chiropractic Providers 047 Chiropractor

1538369871 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1538375456 207RI0200X 020 Physicians 185 Infectious Diseases

1538375456 207R00000X 020 Physicians 011 Internal Medicine

1538377916 207X00000X 020 Physicians 020 Orthopedic Surgery

1538380365 207P00000X 020 Physicians 270 Emergency Medicine

1538387139 2085P0229X 020 Physicians 241 Pediatric Radiology

1538387253 208000000X 020 Physicians 049 Pediatrics

1538391628 208000000X 020 Physicians 049 Pediatrics

1538391628 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1538395660 208M00000X 020 Physicians 344 Hospitalist

1538395660 208000000X 020 Physicians 049 Pediatrics

1538395660 207R00000X 020 Physicians 011 Internal Medicine

1538397070 207X00000X 020 Physicians 020 Orthopedic Surgery

1538399613 208M00000X 020 Physicians 344 Hospitalist

1538399613 207P00000X 020 Physicians 270 Emergency Medicine

1538399613 207R00000X 020 Physicians 011 Internal Medicine

1538424536 207RH0003X 020 Physicians 179 Hematology/Oncology

1538451216 208M00000X 020 Physicians 344 Hospitalist

1538455316 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538455704 207RG0100X 020 Physicians 010 Gastroenterology

1538455704 207R00000X 020 Physicians 011 Internal Medicine

1538463989 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538465562 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1538466263 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1538470562 2084N0400X 020 Physicians 013 Neurology

1538471248 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1538472659 207R00000X 020 Physicians 011 Internal Medicine

1538480835 207L00000X 020 Physicians 005 Anesthesiology

295 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538481957 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1538486154 111N00000X 011 Chiropractic Providers 047 Chiropractor

1538492921 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538493374 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538496997 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1538501036 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1538501226 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538502711 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1538504782 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1538506696 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538506696 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538509427 207T00000X 020 Physicians 014 Neurological Surgery

1538509641 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538513155 207Q00000X 020 Physicians 173 Family Medicine

1538513544 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1538520622 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538529805 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1538538707 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538541958 208600000X 020 Physicians 275 Surgery

1538545918 208M00000X 020 Physicians 344 Hospitalist

1538546551 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538548649 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1538549829 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1538549829 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1538550512 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538551080 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538551684 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1538555263 208100000X 020 Physicians 025 Physical Medicine and Rehab

1538557038 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1538561253 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538561592 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

296 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538571021 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1538573613 207P00000X 020 Physicians 270 Emergency Medicine

1538576871 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538576871 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538582911 208000000X 020 Physicians 049 Pediatrics

1538582911 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1538584842 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1538589163 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538591557 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538591557 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1538592803 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538593140 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538594379 207W00000X 020 Physicians 018 Ophthalmology

1538594759 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538603535 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538607338 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538620083 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1538630652 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538631395 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1538644331 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538644331 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1538647722 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538650726 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1538662093 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1538664149 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538668355 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1538676853 111N00000X 011 Chiropractic Providers 047 Chiropractor

1538684980 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1538689294 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1538689294 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538699566 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

297 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1538700992 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1538702485 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1538707898 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1538711684 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1538712120 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1538788096 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1538790803 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1538797931 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1548204795 207R00000X 020 Physicians 011 Internal Medicine

1548217268 207Q00000X 020 Physicians 173 Family Medicine

1548217987 207Q00000X 020 Physicians 173 Family Medicine

1548220320 207V00000X 020 Physicians 016 OB/GYN

1548221088 208800000X 020 Physicians 034 Urology

1548221096 207Q00000X 020 Physicians 173 Family Medicine

1548222425 207RR0500X 020 Physicians 267 Rheumatology

1548222458 207P00000X 020 Physicians 270 Emergency Medicine

1548226061 207Q00000X 020 Physicians 173 Family Medicine

1548227846 208000000X 020 Physicians 049 Pediatrics

1548228497 207R00000X 020 Physicians 011 Internal Medicine

1548229875 207X00000X 020 Physicians 020 Orthopedic Surgery

1548231541 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548233091 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1548234578 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1548239072 207T00000X 020 Physicians 014 Neurological Surgery

1548247406 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1548247406 207RH0003X 020 Physicians 179 Hematology/Oncology

1548248362 207L00000X 020 Physicians 005 Anesthesiology

1548248990 208100000X 020 Physicians 025 Physical Medicine and Rehab

1548249956 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548251408 208000000X 020 Physicians 049 Pediatrics

1548261357 207Q00000X 020 Physicians 173 Family Medicine

298 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1548264435 207Y00000X 020 Physicians 217 Otolaryngology

1548272263 111N00000X 011 Chiropractic Providers 047 Chiropractor

1548279003 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548279581 208000000X 020 Physicians 049 Pediatrics

1548280464 207RC0000X 020 Physicians 006 Cardiovascular Disease

1548283153 207L00000X 020 Physicians 005 Anesthesiology

1548287634 207L00000X 020 Physicians 005 Anesthesiology

1548287634 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1548288335 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548288863 207RC0000X 020 Physicians 006 Cardiovascular Disease

1548290380 207P00000X 020 Physicians 270 Emergency Medicine

1548293350 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548297302 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1548301161 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1548302599 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1548306319 111N00000X 011 Chiropractic Providers 047 Chiropractor

1548306392 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1548308919 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1548308919 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1548314107 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1548315435 207RH0003X 020 Physicians 179 Hematology/Oncology

1548315484 207ZC0006X 020 Physicians 021 Clinical Pathology

1548329923 207P00000X 020 Physicians 270 Emergency Medicine

1548338601 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1548338601 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1548345291 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1548347651 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1548347651 208000000X 020 Physicians 049 Pediatrics

1548348410 207RH0003X 020 Physicians 179 Hematology/Oncology

1548351547 207L00000X 020 Physicians 005 Anesthesiology

1548355787 111N00000X 011 Chiropractic Providers 047 Chiropractor

299 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1548361769 122300000X 012 Dental Providers 019 Dentists

1548362502 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548369606 2084P0800X 020 Physicians 121 Psychiatry

1548370752 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1548371792 122300000X 012 Dental Providers 019 Dentists

1548372840 207L00000X 020 Physicians 005 Anesthesiology

1548375603 207RC0000X 020 Physicians 006 Cardiovascular Disease

1548377971 2084P0800X 020 Physicians 121 Psychiatry

1548385065 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1548385065 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1548396054 207VX0201X 020 Physicians 307 Gynecologic Oncology

1548400260 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548407372 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548407554 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548420904 207RI0011X 020 Physicians 188 Interventional Cardiology

1548420979 207L00000X 020 Physicians 005 Anesthesiology

1548423932 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548423940 208G00000X 020 Physicians 033 Thoracic Surgery

1548426943 207RI0011X 020 Physicians 188 Interventional Cardiology

1548426943 207RC0000X 020 Physicians 006 Cardiovascular Disease

1548428188 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1548430234 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1548434772 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1548451073 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548451248 122300000X 012 Dental Providers 019 Dentists

1548451248 1223P0221X 012 Dental Providers 063 Pedodontics

1548452394 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1548454952 207X00000X 020 Physicians 020 Orthopedic Surgery

1548456155 2084N0400X 020 Physicians 013 Neurology

1548458656 208000000X 020 Physicians 049 Pediatrics

1548459829 1223G0001X 012 Dental Providers 001 General Practice

300 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1548466899 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548467426 208000000X 020 Physicians 049 Pediatrics

1548467426 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1548468812 207P00000X 020 Physicians 270 Emergency Medicine

1548469208 207V00000X 020 Physicians 016 OB/GYN

1548473580 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1548473580 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1548473580 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1548473598 111N00000X 011 Chiropractic Providers 047 Chiropractor

1548477870 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1548478639 2085R0202X 020 Physicians 167 Diagnostic Radiology

1548490741 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1548495534 208000000X 020 Physicians 049 Pediatrics

1548507197 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548510142 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548516032 207R00000X 020 Physicians 011 Internal Medicine

1548522287 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1548526254 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548530280 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1548533102 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548536493 122300000X 012 Dental Providers 019 Dentists

1548536493 1223G0001X 012 Dental Providers 001 General Practice

1548537616 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1548548498 207Q00000X 020 Physicians 173 Family Medicine

1548552565 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548558166 207RH0003X 020 Physicians 179 Hematology/Oncology

1548572274 2084P0800X 020 Physicians 121 Psychiatry

1548572688 2084P0800X 020 Physicians 121 Psychiatry

1548574015 207Q00000X 020 Physicians 173 Family Medicine

1548591225 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1548593205 207ZP0101X 020 Physicians 022 Pathology

301 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1548598808 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1548600679 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548604184 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1548606304 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1548607690 2084P0800X 020 Physicians 121 Psychiatry

1548609910 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1548613193 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548625528 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1548630627 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1548635014 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548638349 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1548639578 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1548640949 2084P0800X 020 Physicians 121 Psychiatry

1548640956 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1548640956 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1548640956 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1548642077 207RC0000X 020 Physicians 006 Cardiovascular Disease

1548647340 207R00000X 020 Physicians 011 Internal Medicine

1548647415 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548648413 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1548654585 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548658792 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1548658792 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1548661218 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1548666282 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1548669641 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548680937 208000000X 020 Physicians 049 Pediatrics

1548682453 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1548688203 208600000X 020 Physicians 275 Surgery

1548688278 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1548690597 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

302 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1548690597 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1548694664 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1548694664 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1548694664 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1548713357 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1548713753 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1548714876 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1548728629 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1548728629 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1548732910 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1548735913 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1548743636 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548743636 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1548746308 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548757214 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1548759806 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1548761422 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1548777352 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1548777584 111N00000X 011 Chiropractic Providers 047 Chiropractor

1548778798 183500000X 018 Pharmacy 253 Pharmacist

1548783269 207Q00000X 020 Physicians 173 Family Medicine

1548783962 207Q00000X 020 Physicians 173 Family Medicine

1548786643 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1548800535 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1548811169 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1548812704 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1548824501 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1548893183 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558300707 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1558301762 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558308528 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

303 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558308817 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1558311928 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558316620 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558317388 207Q00000X 020 Physicians 173 Family Medicine

1558317644 207Q00000X 020 Physicians 173 Family Medicine

1558317826 207RC0200X 020 Physicians 206 Critical Care Medicine

1558317826 207RP1001X 020 Physicians 029 Pulmonary Diseases

1558317826 207R00000X 020 Physicians 011 Internal Medicine

1558317826 2084S0012X 020 Physicians 521 Sleep Medicine

1558318428 207R00000X 020 Physicians 011 Internal Medicine

1558323246 208600000X 020 Physicians 275 Surgery

1558330100 208000000X 020 Physicians 049 Pediatrics

1558330266 207VX0000X 020 Physicians 211 Obstetrics

1558331272 207P00000X 020 Physicians 270 Emergency Medicine

1558332163 2084N0400X 020 Physicians 013 Neurology

1558333005 2084N0400X 020 Physicians 013 Neurology

1558333005 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1558333294 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1558333294 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1558333922 207RC0000X 020 Physicians 006 Cardiovascular Disease

1558334326 207L00000X 020 Physicians 005 Anesthesiology

1558335422 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558335935 207RH0000X 020 Physicians 178 Hematology

1558340497 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558340927 207ZH0000X 020 Physicians 560 Hematology; Pathology

1558343061 207R00000X 020 Physicians 011 Internal Medicine

1558343707 111N00000X 011 Chiropractic Providers 047 Chiropractor

1558346882 207L00000X 020 Physicians 005 Anesthesiology

1558347765 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1558348193 207L00000X 020 Physicians 005 Anesthesiology

1558349324 207R00000X 020 Physicians 011 Internal Medicine

304 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558349506 207L00000X 020 Physicians 005 Anesthesiology

1558365106 207Q00000X 020 Physicians 173 Family Medicine

1558366500 207RC0000X 020 Physicians 006 Cardiovascular Disease

1558366500 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1558367789 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558381939 207P00000X 020 Physicians 270 Emergency Medicine

1558382770 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1558383653 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558385377 122300000X 012 Dental Providers 019 Dentists

1558386466 207Q00000X 020 Physicians 173 Family Medicine

1558389197 207L00000X 020 Physicians 005 Anesthesiology

1558389296 207R00000X 020 Physicians 011 Internal Medicine

1558390294 207P00000X 020 Physicians 270 Emergency Medicine

1558390336 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1558392068 208100000X 020 Physicians 025 Physical Medicine and Rehab

1558395129 207RP1001X 020 Physicians 029 Pulmonary Diseases

1558401554 207Q00000X 020 Physicians 173 Family Medicine

1558417527 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558418079 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558422329 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1558424150 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558440040 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558444216 207RI0011X 020 Physicians 188 Interventional Cardiology

1558447961 207L00000X 020 Physicians 005 Anesthesiology

1558448712 208200000X 020 Physicians 024 Plastic Surgery

1558450841 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1558452359 208000000X 020 Physicians 049 Pediatrics

1558452565 207RN0300X 020 Physicians 105 Nephrology

1558457135 208G00000X 020 Physicians 033 Thoracic Surgery

1558458265 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1558459032 2085R0202X 020 Physicians 167 Diagnostic Radiology

305 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558459867 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558469916 207R00000X 020 Physicians 011 Internal Medicine

1558469916 207RC0200X 020 Physicians 206 Critical Care Medicine

1558471573 207V00000X 020 Physicians 016 OB/GYN

1558474106 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1558480087 2084N0400X 020 Physicians 013 Neurology

1558487165 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558500199 2084P0800X 020 Physicians 121 Psychiatry

1558502336 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1558502336 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1558507418 111N00000X 011 Chiropractic Providers 047 Chiropractor

1558508341 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1558510792 207V00000X 020 Physicians 016 OB/GYN

1558514562 208000000X 020 Physicians 049 Pediatrics

1558514562 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1558522003 208M00000X 020 Physicians 344 Hospitalist

1558522797 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558523944 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558535963 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1558542738 2088P0231X 020 Physicians 246 Pediatric Urology

1558545541 207L00000X 020 Physicians 005 Anesthesiology

1558546259 111N00000X 011 Chiropractic Providers 047 Chiropractor

1558554758 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1558555144 207L00000X 020 Physicians 005 Anesthesiology

1558562736 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1558562736 207ZP0101X 020 Physicians 436 Anatomic Pathology

1558564567 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1558564880 208000000X 020 Physicians 049 Pediatrics

1558564880 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1558565085 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1558565762 2085N0700X 020 Physicians 204 Neuroradiology

306 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558569533 207P00000X 020 Physicians 270 Emergency Medicine

1558571950 207VE0102X 020 Physicians 530 Reproductive Endocrinology

1558572743 207RG0100X 020 Physicians 010 Gastroenterology

1558577882 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558587717 207Q00000X 020 Physicians 173 Family Medicine

1558588780 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1558589994 207R00000X 020 Physicians 011 Internal Medicine

1558590992 207L00000X 020 Physicians 005 Anesthesiology

1558591131 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558591131 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558591792 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558601864 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558617779 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558618884 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1558620328 208600000X 020 Physicians 275 Surgery

1558620799 207Q00000X 020 Physicians 173 Family Medicine

1558641951 207R00000X 020 Physicians 011 Internal Medicine

1558650994 207L00000X 020 Physicians 005 Anesthesiology

1558652404 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558659086 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558659292 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558667113 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1558669119 1223X0400X 012 Dental Providers 064 Orthodontics

1558676544 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558676817 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558677310 207RP1001X 020 Physicians 029 Pulmonary Diseases

1558677690 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1558681791 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1558682203 207RC0000X 020 Physicians 006 Cardiovascular Disease

1558682575 207ZP0101X 020 Physicians 022 Pathology

1558682575 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

307 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558682575 207ZP0101X 020 Physicians 436 Anatomic Pathology

1558686030 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558700435 207L00000X 020 Physicians 005 Anesthesiology

1558701672 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1558705863 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558728444 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1558730861 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558730929 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558746081 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1558746560 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1558749481 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1558763102 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558764365 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558775429 207R00000X 020 Physicians 011 Internal Medicine

1558777235 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558785311 2085R0202X 020 Physicians 167 Diagnostic Radiology

1558788166 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1558791145 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1558791400 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558794552 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558799015 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558799015 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1558799189 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1558803148 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1558807073 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1558811893 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1558813048 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1558827188 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1558833905 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1558833905 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1558851543 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

308 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1558854653 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1558861872 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1558861872 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1558879940 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1558890236 111N00000X 011 Chiropractic Providers 047 Chiropractor

1558892109 207Y00000X 020 Physicians 217 Otolaryngology

1558892802 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1558895664 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1558897066 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1558912857 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1558915421 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1558915421 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1558918045 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1558928812 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1558928812 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1558928812 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1558996207 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1568016806 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1568022697 122300000X 012 Dental Providers 019 Dentists

1568023299 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1568024487 208600000X 020 Physicians 275 Surgery

1568413631 207P00000X 020 Physicians 270 Emergency Medicine

1568416485 207P00000X 020 Physicians 270 Emergency Medicine

1568424356 207RH0003X 020 Physicians 179 Hematology/Oncology

1568424356 207RX0202X 020 Physicians 529 Medical Oncology

1568424356 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1568424356 207R00000X 020 Physicians 011 Internal Medicine

1568429173 122300000X 012 Dental Providers 019 Dentists

1568434090 207RH0003X 020 Physicians 179 Hematology/Oncology

1568434090 207RH0000X 020 Physicians 178 Hematology

1568436236 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

309 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568436632 207RC0000X 020 Physicians 006 Cardiovascular Disease

1568436939 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1568438893 207Q00000X 020 Physicians 173 Family Medicine

1568440873 207RC0000X 020 Physicians 006 Cardiovascular Disease

1568441244 207R00000X 020 Physicians 011 Internal Medicine

1568441962 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568446359 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1568446391 207V00000X 020 Physicians 016 OB/GYN

1568448900 208G00000X 020 Physicians 033 Thoracic Surgery

1568448926 207VF0040X 020 Physicians 565 Female Pelvic Medicine & Reconstructive

1568448926 208800000X 020 Physicians 034 Urology

1568449247 207RG0100X 020 Physicians 010 Gastroenterology

1568451375 2084N0400X 020 Physicians 013 Neurology

1568452191 1223G0001X 012 Dental Providers 001 General Practice

1568457927 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1568459113 207R00000X 020 Physicians 011 Internal Medicine

1568459113 208000000X 020 Physicians 049 Pediatrics

1568463321 2086S0102X 020 Physicians 539 Surgical Critical Care

1568480267 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1568480416 207RC0200X 020 Physicians 206 Critical Care Medicine

1568480416 207RP1001X 020 Physicians 029 Pulmonary Diseases

1568482081 2085R0202X 020 Physicians 167 Diagnostic Radiology

1568483816 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1568484129 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568484129 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1568486371 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1568487098 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568488971 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1568490662 207ZN0500X 020 Physicians 203 Neuropathology

1568490845 207ZP0101X 020 Physicians 022 Pathology

1568491652 207L00000X 020 Physicians 005 Anesthesiology

310 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568506988 207Q00000X 020 Physicians 173 Family Medicine

1568511517 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1568521037 207L00000X 020 Physicians 005 Anesthesiology

1568526119 2086X0206X 020 Physicians 276 Surgical Oncology

1568533586 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1568543932 2080P0202X 020 Physicians 221 Pediatric Cardiology

1568545531 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568549574 207X00000X 020 Physicians 020 Orthopedic Surgery

1568551588 111N00000X 011 Chiropractic Providers 047 Chiropractor

1568552065 2080P0202X 020 Physicians 221 Pediatric Cardiology

1568553360 207P00000X 020 Physicians 270 Emergency Medicine

1568553576 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568554285 207W00000X 020 Physicians 018 Ophthalmology

1568558559 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568558559 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1568559235 2086S0120X 020 Physicians 245 Pediatric Surgery

1568559888 207RR0500X 020 Physicians 267 Rheumatology

1568562098 208G00000X 020 Physicians 033 Thoracic Surgery

1568565364 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1568569085 2084N0400X 020 Physicians 013 Neurology

1568571818 207P00000X 020 Physicians 270 Emergency Medicine

1568578169 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568589083 2085R0202X 020 Physicians 167 Diagnostic Radiology

1568589174 207R00000X 020 Physicians 011 Internal Medicine

1568606259 2084N0400X 020 Physicians 013 Neurology

1568611044 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568612968 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1568613735 208000000X 020 Physicians 049 Pediatrics

1568616670 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568620086 207L00000X 020 Physicians 005 Anesthesiology

1568620227 207Q00000X 020 Physicians 173 Family Medicine

311 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568625671 207L00000X 020 Physicians 005 Anesthesiology

1568628063 208M00000X 020 Physicians 344 Hospitalist

1568628170 207T00000X 020 Physicians 014 Neurological Surgery

1568628303 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1568635068 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568638294 237700000X 023 Speech Language and Hearing Svc Prov 512 Hearing Services Specialist

1568647048 207R00000X 020 Physicians 011 Internal Medicine

1568650919 207RP1001X 020 Physicians 029 Pulmonary Diseases

1568658201 207RC0000X 020 Physicians 006 Cardiovascular Disease

1568658201 204F00000X 020 Physicians 279 Transplant Surgery

1568662195 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1568662252 2085R0202X 020 Physicians 167 Diagnostic Radiology

1568662971 207T00000X 020 Physicians 014 Neurological Surgery

1568664514 207Q00000X 020 Physicians 173 Family Medicine

1568666923 2084N0400X 020 Physicians 013 Neurology

1568669398 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568676245 207RC0200X 020 Physicians 206 Critical Care Medicine

1568677755 207RN0300X 020 Physicians 105 Nephrology

1568680429 111N00000X 011 Chiropractic Providers 047 Chiropractor

1568680866 2084P0015X 020 Physicians 618 Psychiatry & Neurology;Psychosomatic Med

1568683043 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568683886 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568692671 208600000X 020 Physicians 275 Surgery

1568693695 207Q00000X 020 Physicians 173 Family Medicine

1568697829 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1568704286 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1568705002 208000000X 020 Physicians 049 Pediatrics

1568706349 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568717957 2085R0202X 020 Physicians 167 Diagnostic Radiology

1568718179 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568721009 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

312 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568721009 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1568721009 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568721850 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1568730026 111N00000X 011 Chiropractic Providers 047 Chiropractor

1568737187 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568741007 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1568741007 2084N0400X 020 Physicians 013 Neurology

1568741007 208000000X 020 Physicians 049 Pediatrics

1568748424 2088P0231X 020 Physicians 246 Pediatric Urology

1568750081 207L00000X 020 Physicians 005 Anesthesiology

1568753606 207RC0000X 020 Physicians 006 Cardiovascular Disease

1568754521 2085R0202X 020 Physicians 167 Diagnostic Radiology

1568755965 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1568755965 208000000X 020 Physicians 049 Pediatrics

1568759868 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1568769941 207X00000X 020 Physicians 020 Orthopedic Surgery

1568775773 111N00000X 011 Chiropractic Providers 047 Chiropractor

1568775906 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568776771 207RH0003X 020 Physicians 179 Hematology/Oncology

1568776904 2084N0400X 020 Physicians 013 Neurology

1568776904 2084N0008X 020 Physicians 630 Psychiatry&Neurology; Neuromuscular Med

1568777449 207RH0003X 020 Physicians 179 Hematology/Oncology

1568778991 208000000X 020 Physicians 049 Pediatrics

1568787943 207P00000X 020 Physicians 270 Emergency Medicine

1568789006 207RI0200X 020 Physicians 185 Infectious Diseases

1568791994 207P00000X 020 Physicians 270 Emergency Medicine

1568797124 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1568801256 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1568805927 207T00000X 020 Physicians 014 Neurological Surgery

1568812253 2084P0800X 020 Physicians 121 Psychiatry

1568812295 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

313 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568813525 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1568814358 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568815959 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1568815959 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1568817708 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1568817708 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1568822823 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568843878 1223G0001X 012 Dental Providers 001 General Practice

1568859809 2084P0800X 020 Physicians 121 Psychiatry

1568861144 207R00000X 020 Physicians 011 Internal Medicine

1568861607 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1568868545 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1568868545 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568868545 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1568868545 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1568869014 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568871036 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1568875102 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568877322 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568879260 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1568889871 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568892586 207RI0011X 020 Physicians 188 Interventional Cardiology

1568913077 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568915411 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568915742 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1568918001 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568918001 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1568918001 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1568919454 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1568922490 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1568924835 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

314 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1568925121 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568941110 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1568941110 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1568943405 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568951283 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568962363 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1568967446 2084P0800X 020 Physicians 121 Psychiatry

1568968394 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1568972164 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1568972164 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1568978203 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1568978203 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1568983922 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568987741 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1568988897 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1568990786 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1568996700 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1568998391 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578000857 2080P0202X 020 Physicians 221 Pediatric Cardiology

1578000857 208G00000X 020 Physicians 033 Thoracic Surgery

1578011193 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1578016044 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1578038956 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1578038956 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578041273 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578041349 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1578041349 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1578041653 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1578043063 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1578045456 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578048625 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

315 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578052239 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1578074555 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1578074555 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1578074555 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1578090288 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1578100483 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578100483 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1578100806 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578106431 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1578116406 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578122552 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578123725 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1578124988 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1578127080 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1578127288 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578129383 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1578195210 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578500252 208000000X 020 Physicians 049 Pediatrics

1578501672 207R00000X 020 Physicians 011 Internal Medicine

1578503520 207Q00000X 020 Physicians 173 Family Medicine

1578504643 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578504643 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1578505491 207L00000X 020 Physicians 005 Anesthesiology

1578508958 208000000X 020 Physicians 049 Pediatrics

1578509733 207W00000X 020 Physicians 018 Ophthalmology

1578510046 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578515300 208000000X 020 Physicians 049 Pediatrics

1578519922 207R00000X 020 Physicians 011 Internal Medicine

1578522009 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1578528576 207Q00000X 020 Physicians 173 Family Medicine

1578529392 208800000X 020 Physicians 034 Urology

316 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578530556 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1578535506 207N00000X 020 Physicians 007 Dermatology

1578536728 207RH0003X 020 Physicians 179 Hematology/Oncology

1578536926 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578536926 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1578537460 207P00000X 020 Physicians 270 Emergency Medicine

1578538534 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1578538534 207PE0004X 020 Physicians 093 Emergency Medical Services

1578538773 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1578539037 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1578539615 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1578540902 207L00000X 020 Physicians 005 Anesthesiology

1578541454 207X00000X 020 Physicians 020 Orthopedic Surgery

1578542585 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578542890 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1578543716 207RP1001X 020 Physicians 029 Pulmonary Diseases

1578543716 207RC0200X 020 Physicians 206 Critical Care Medicine

1578548533 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578552477 208M00000X 020 Physicians 344 Hospitalist

1578552477 207R00000X 020 Physicians 011 Internal Medicine

1578567319 207Q00000X 020 Physicians 173 Family Medicine

1578568978 207W00000X 020 Physicians 018 Ophthalmology

1578571436 2084N0400X 020 Physicians 013 Neurology

1578571436 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1578573275 207R00000X 020 Physicians 011 Internal Medicine

1578574232 207RC0000X 020 Physicians 006 Cardiovascular Disease

1578575346 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1578575353 111N00000X 011 Chiropractic Providers 047 Chiropractor

1578578449 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1578580247 208000000X 020 Physicians 049 Pediatrics

1578580577 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

317 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578581146 207Q00000X 020 Physicians 173 Family Medicine

1578584793 207P00000X 020 Physicians 270 Emergency Medicine

1578584793 207RC0200X 020 Physicians 206 Critical Care Medicine

1578584819 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1578585113 111N00000X 011 Chiropractic Providers 047 Chiropractor

1578585121 208800000X 020 Physicians 034 Urology

1578590881 208600000X 020 Physicians 275 Surgery

1578593026 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578595773 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578596789 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1578596789 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1578598587 111N00000X 011 Chiropractic Providers 047 Chiropractor

1578599643 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1578602967 122300000X 012 Dental Providers 019 Dentists

1578603163 207R00000X 020 Physicians 011 Internal Medicine

1578603379 111N00000X 011 Chiropractic Providers 047 Chiropractor

1578614624 122300000X 012 Dental Providers 019 Dentists

1578619185 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578623005 208000000X 020 Physicians 049 Pediatrics

1578626198 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578626982 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1578632717 207X00000X 020 Physicians 020 Orthopedic Surgery

1578644647 2084N0400X 020 Physicians 013 Neurology

1578644647 2084S0012X 020 Physicians 521 Sleep Medicine

1578644647 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1578644647 208000000X 020 Physicians 049 Pediatrics

1578645321 1223G0001X 012 Dental Providers 001 General Practice

1578649513 207R00000X 020 Physicians 011 Internal Medicine

1578654182 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578654588 207Q00000X 020 Physicians 173 Family Medicine

1578654935 207R00000X 020 Physicians 011 Internal Medicine

318 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578657011 1223G0001X 012 Dental Providers 001 General Practice

1578661229 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1578662433 207RI0011X 020 Physicians 188 Interventional Cardiology

1578662482 208600000X 020 Physicians 275 Surgery

1578668174 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1578668653 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1578674511 207Q00000X 020 Physicians 173 Family Medicine

1578675138 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578679130 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1578683215 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1578684056 207N00000X 020 Physicians 007 Dermatology

1578686549 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1578707717 207L00000X 020 Physicians 005 Anesthesiology

1578708228 207RP1001X 020 Physicians 029 Pulmonary Diseases

1578714606 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1578720520 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1578720520 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1578721478 208M00000X 020 Physicians 344 Hospitalist

1578721478 207R00000X 020 Physicians 011 Internal Medicine

1578722187 207RI0200X 020 Physicians 185 Infectious Diseases

1578723789 207Q00000X 020 Physicians 173 Family Medicine

1578729455 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578729976 207P00000X 020 Physicians 270 Emergency Medicine

1578734844 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1578739405 207Q00000X 020 Physicians 173 Family Medicine

1578754388 207V00000X 020 Physicians 016 OB/GYN

1578755740 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578755757 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1578756045 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1578756508 207X00000X 020 Physicians 020 Orthopedic Surgery

1578758926 207Q00000X 020 Physicians 173 Family Medicine

319 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578761045 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578761649 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1578762357 208600000X 020 Physicians 275 Surgery

1578762548 207RN0300X 020 Physicians 105 Nephrology

1578762548 207R00000X 020 Physicians 011 Internal Medicine

1578770350 207P00000X 020 Physicians 270 Emergency Medicine

1578772471 207R00000X 020 Physicians 011 Internal Medicine

1578784112 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578790655 207ZP0213X 020 Physicians 238 Pediatric Pathology

1578796637 122300000X 012 Dental Providers 019 Dentists

1578802765 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1578804167 1223X0400X 012 Dental Providers 064 Orthodontics

1578810214 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1578817466 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1578824637 207RC0200X 020 Physicians 206 Critical Care Medicine

1578824637 207RP1001X 020 Physicians 029 Pulmonary Diseases

1578824637 208000000X 020 Physicians 049 Pediatrics

1578824637 207R00000X 020 Physicians 011 Internal Medicine

1578825824 207R00000X 020 Physicians 011 Internal Medicine

1578829032 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1578834545 1223G0001X 012 Dental Providers 001 General Practice

1578834545 122300000X 012 Dental Providers 019 Dentists

1578838090 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1578839015 207R00000X 020 Physicians 011 Internal Medicine

1578839015 207RC0000X 020 Physicians 006 Cardiovascular Disease

1578844379 2085R0202X 020 Physicians 167 Diagnostic Radiology

1578849642 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1578849642 208000000X 020 Physicians 049 Pediatrics

1578850038 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1578852471 208600000X 020 Physicians 275 Surgery

1578856746 207L00000X 020 Physicians 005 Anesthesiology

320 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1578872651 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1578877973 208D00000X 020 Physicians 001 General Practice

1578884847 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1578892303 111N00000X 011 Chiropractic Providers 047 Chiropractor

1578903548 208600000X 020 Physicians 275 Surgery

1578904777 208600000X 020 Physicians 275 Surgery

1578906475 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1578906475 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1578913034 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1578915013 1223G0001X 012 Dental Providers 001 General Practice

1578922597 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578927349 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1578934436 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578934436 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1578934584 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1578937983 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1578944179 122300000X 012 Dental Providers 019 Dentists

1578953642 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578962130 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1578966057 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1578971941 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1578971941 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1578971941 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1578975173 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1578979241 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1578985602 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1578997151 122300000X 012 Dental Providers 019 Dentists

1588000939 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588004592 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1588006738 111N00000X 011 Chiropractic Providers 047 Chiropractor

1588008551 163W00000X 016 Nursing Service Providers 129 Registered Nurse

321 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588014740 207Q00000X 020 Physicians 173 Family Medicine

1588017479 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1588018014 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588025712 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588029748 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1588033476 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1588034094 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588044432 2084P0800X 020 Physicians 121 Psychiatry

1588046064 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588051270 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588064299 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588066153 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1588066369 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588074124 207Q00000X 020 Physicians 173 Family Medicine

1588082622 207P00000X 020 Physicians 270 Emergency Medicine

1588086904 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1588092803 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1588092803 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1588097091 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1588111371 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588136444 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1588140024 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588141915 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1588142863 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588144539 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588145270 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1588146674 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1588150494 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1588160063 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588162614 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588163968 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

322 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588163968 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1588178305 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1588182471 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1588194021 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588207823 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1588210041 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1588214852 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588215495 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1588216469 207Q00000X 020 Physicians 173 Family Medicine

1588225239 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588601553 207P00000X 020 Physicians 270 Emergency Medicine

1588606735 207Q00000X 020 Physicians 173 Family Medicine

1588611230 207P00000X 020 Physicians 270 Emergency Medicine

1588614614 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588618086 207P00000X 020 Physicians 270 Emergency Medicine

1588620728 207Q00000X 020 Physicians 173 Family Medicine

1588626436 207V00000X 020 Physicians 016 OB/GYN

1588633838 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1588634992 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1588635783 111N00000X 011 Chiropractic Providers 047 Chiropractor

1588635833 207L00000X 020 Physicians 005 Anesthesiology

1588636427 207QS0010X 020 Physicians 273 Sports Medicine

1588638076 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1588640528 207RP1001X 020 Physicians 029 Pulmonary Diseases

1588641237 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588641674 207N00000X 020 Physicians 007 Dermatology

1588643456 207RP1001X 020 Physicians 029 Pulmonary Diseases

1588643605 2084N0400X 020 Physicians 013 Neurology

1588644553 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588644777 207RI0200X 020 Physicians 185 Infectious Diseases

1588644926 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

323 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588649495 207V00000X 020 Physicians 016 OB/GYN

1588649495 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1588655443 208600000X 020 Physicians 275 Surgery

1588655443 2086S0120X 020 Physicians 245 Pediatric Surgery

1588664700 207RI0011X 020 Physicians 188 Interventional Cardiology

1588669907 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1588673412 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588681449 207R00000X 020 Physicians 011 Internal Medicine

1588681449 207RI0011X 020 Physicians 188 Interventional Cardiology

1588681449 207RC0000X 020 Physicians 006 Cardiovascular Disease

1588681571 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1588682165 2085N0700X 020 Physicians 204 Neuroradiology

1588682165 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588685010 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1588685705 208M00000X 020 Physicians 344 Hospitalist

1588685903 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1588690903 207Q00000X 020 Physicians 173 Family Medicine

1588698088 208000000X 020 Physicians 049 Pediatrics

1588698195 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588714463 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1588715130 1223X0400X 012 Dental Providers 515 Orthodontics & Dentofacial Orthopedics

1588720189 2084P0800X 020 Physicians 121 Psychiatry

1588720544 208100000X 020 Physicians 025 Physical Medicine and Rehab

1588721146 207RP1001X 020 Physicians 029 Pulmonary Diseases

1588735005 208000000X 020 Physicians 049 Pediatrics

1588740740 207RN0300X 020 Physicians 105 Nephrology

1588743561 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588746515 207Q00000X 020 Physicians 173 Family Medicine

1588750897 111N00000X 011 Chiropractic Providers 047 Chiropractor

1588752836 208600000X 020 Physicians 275 Surgery

1588752919 207V00000X 020 Physicians 016 OB/GYN

324 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588755383 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588756175 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588761001 208G00000X 020 Physicians 033 Thoracic Surgery

1588764385 207T00000X 020 Physicians 014 Neurological Surgery

1588764476 207R00000X 020 Physicians 011 Internal Medicine

1588766059 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588776603 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1588776736 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588777569 2084P0800X 020 Physicians 121 Psychiatry

1588778179 207L00000X 020 Physicians 005 Anesthesiology

1588778351 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1588781090 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588781942 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1588781942 207UN0901X 020 Physicians 597 Nuclear Medicine; Nuclear Cardiology

1588800882 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1588807143 2084V0102X 020 Physicians 552 Vascular Neurology

1588807143 2084N0400X 020 Physicians 013 Neurology

1588807911 207L00000X 020 Physicians 005 Anesthesiology

1588810204 122300000X 012 Dental Providers 019 Dentists

1588812812 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1588815039 208000000X 020 Physicians 049 Pediatrics

1588815039 208M00000X 020 Physicians 344 Hospitalist

1588815641 208600000X 020 Physicians 275 Surgery

1588821573 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1588825723 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1588826648 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1588829295 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1588829485 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1588830418 207P00000X 020 Physicians 270 Emergency Medicine

1588831713 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1588835185 2084P0800X 020 Physicians 121 Psychiatry

325 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588841373 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1588847578 207RN0300X 020 Physicians 105 Nephrology

1588853915 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588854608 2084N0400X 020 Physicians 013 Neurology

1588854699 207P00000X 020 Physicians 270 Emergency Medicine

1588861934 207RP1001X 020 Physicians 029 Pulmonary Diseases

1588866354 208G00000X 020 Physicians 033 Thoracic Surgery

1588868616 208G00000X 020 Physicians 033 Thoracic Surgery

1588869846 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588873186 207X00000X 020 Physicians 020 Orthopedic Surgery

1588873335 208000000X 020 Physicians 049 Pediatrics

1588873335 2080P0210X 020 Physicians 232 Pediatric Nephrology

1588874788 207L00000X 020 Physicians 005 Anesthesiology

1588907232 207L00000X 020 Physicians 005 Anesthesiology

1588916357 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1588916464 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1588922231 2085R0202X 020 Physicians 167 Diagnostic Radiology

1588922249 207Q00000X 020 Physicians 173 Family Medicine

1588925531 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1588927131 208M00000X 020 Physicians 344 Hospitalist

1588929822 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1588929822 207ZP0101X 020 Physicians 022 Pathology

1588932206 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1588944763 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1588945919 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1588949630 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1588949648 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1588950562 207P00000X 020 Physicians 270 Emergency Medicine

1588952642 207R00000X 020 Physicians 011 Internal Medicine

1588955199 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1588956122 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

326 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1588958490 208000000X 020 Physicians 049 Pediatrics

1588958490 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1588961072 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1588966303 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1588974596 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1588982037 207L00000X 020 Physicians 005 Anesthesiology

1588984033 122300000X 012 Dental Providers 019 Dentists

1588984033 1223G0001X 012 Dental Providers 001 General Practice

1588994099 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1588998918 207R00000X 020 Physicians 011 Internal Medicine

1598009441 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598010316 207P00000X 020 Physicians 270 Emergency Medicine

1598017832 207R00000X 020 Physicians 011 Internal Medicine

1598017832 208M00000X 020 Physicians 344 Hospitalist

1598019507 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598026171 207V00000X 020 Physicians 016 OB/GYN

1598041162 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598045338 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598050189 2084P0800X 020 Physicians 121 Psychiatry

1598052425 207P00000X 020 Physicians 270 Emergency Medicine

1598056483 2086S0129X 020 Physicians 289 Vascular Surgery

1598056525 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1598057390 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598058059 207P00000X 020 Physicians 270 Emergency Medicine

1598063380 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1598070567 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1598071185 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598072035 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1598089062 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1598090250 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598095697 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

327 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1598103327 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598104812 183500000X 018 Pharmacy 253 Pharmacist

1598105934 207X00000X 020 Physicians 020 Orthopedic Surgery

1598106486 207RC0200X 020 Physicians 206 Critical Care Medicine

1598108631 207V00000X 020 Physicians 016 OB/GYN

1598115149 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1598118424 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598125817 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598141939 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1598142424 208M00000X 020 Physicians 344 Hospitalist

1598145088 1223G0001X 012 Dental Providers 001 General Practice

1598147787 122300000X 012 Dental Providers 019 Dentists

1598148918 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1598149262 207V00000X 020 Physicians 016 OB/GYN

1598150385 208000000X 020 Physicians 049 Pediatrics

1598156481 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598164105 207R00000X 020 Physicians 011 Internal Medicine

1598168395 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598168601 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598169336 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598172322 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598177891 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1598184921 208M00000X 020 Physicians 344 Hospitalist

1598185043 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598185712 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1598189052 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1598189052 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1598191439 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1598201303 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1598203895 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598204489 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

328 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1598223232 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1598223232 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1598231664 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1598231664 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1598232183 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1598253452 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1598255374 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1598256943 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1598259145 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1598259814 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1598261950 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1598288003 111N00000X 011 Chiropractic Providers 047 Chiropractor

1598288318 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598315681 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598324790 207Q00000X 020 Physicians 173 Family Medicine

1598384539 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1598392508 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1598393993 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1598700882 208600000X 020 Physicians 275 Surgery

1598701898 207X00000X 020 Physicians 020 Orthopedic Surgery

1598705758 208000000X 020 Physicians 049 Pediatrics

1598708273 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1598710154 208600000X 020 Physicians 275 Surgery

1598710782 208M00000X 020 Physicians 344 Hospitalist

1598710790 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598712515 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1598714016 207Q00000X 020 Physicians 173 Family Medicine

1598715344 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598721359 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1598722464 207R00000X 020 Physicians 011 Internal Medicine

1598725640 207R00000X 020 Physicians 011 Internal Medicine

329 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1598725640 207RI0200X 020 Physicians 185 Infectious Diseases

1598726259 207RC0000X 020 Physicians 006 Cardiovascular Disease

1598729253 207RC0000X 020 Physicians 006 Cardiovascular Disease

1598731606 207RI0200X 020 Physicians 185 Infectious Diseases

1598732877 207RH0000X 020 Physicians 178 Hematology

1598736662 207X00000X 020 Physicians 020 Orthopedic Surgery

1598739070 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598739625 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598741605 207ZP0101X 020 Physicians 022 Pathology

1598742785 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598743072 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598743767 208200000X 020 Physicians 024 Plastic Surgery

1598743833 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598744153 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598747099 207RX0202X 020 Physicians 529 Medical Oncology

1598756082 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598756595 2086S0129X 020 Physicians 289 Vascular Surgery

1598764847 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598768251 207Q00000X 020 Physicians 173 Family Medicine

1598781353 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598781379 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1598783151 208000000X 020 Physicians 049 Pediatrics

1598783169 207Q00000X 020 Physicians 173 Family Medicine

1598783631 207R00000X 020 Physicians 011 Internal Medicine

1598788390 207Q00000X 020 Physicians 173 Family Medicine

1598788523 207P00000X 020 Physicians 270 Emergency Medicine

1598793226 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598795767 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598797896 2085R0202X 020 Physicians 167 Diagnostic Radiology

1598799892 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1598801516 208100000X 020 Physicians 025 Physical Medicine and Rehab

330 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1598819856 207R00000X 020 Physicians 011 Internal Medicine

1598830051 207W00000X 020 Physicians 018 Ophthalmology

1598832701 111N00000X 011 Chiropractic Providers 047 Chiropractor

1598833980 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598837031 207Q00000X 020 Physicians 173 Family Medicine

1598838666 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598847931 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1598848426 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598849184 111N00000X 011 Chiropractic Providers 047 Chiropractor

1598851503 208800000X 020 Physicians 034 Urology

1598857088 207L00000X 020 Physicians 005 Anesthesiology

1598857922 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1598859365 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1598863326 207T00000X 020 Physicians 014 Neurological Surgery

1598867608 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1598874216 207P00000X 020 Physicians 270 Emergency Medicine

1598876898 207ZP0101X 020 Physicians 436 Anatomic Pathology

1598879769 2084P0800X 020 Physicians 121 Psychiatry

1598891178 207V00000X 020 Physicians 016 OB/GYN

1598896623 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1598907461 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1598909087 208100000X 020 Physicians 025 Physical Medicine and Rehab

1598911182 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1598911182 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1598920969 207R00000X 020 Physicians 011 Internal Medicine

1598920969 208M00000X 020 Physicians 344 Hospitalist

1598920969 207RN0300X 020 Physicians 105 Nephrology

1598930331 207R00000X 020 Physicians 011 Internal Medicine

1598938045 208100000X 020 Physicians 025 Physical Medicine and Rehab

1598949927 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1598953846 207Y00000X 020 Physicians 217 Otolaryngology

331 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1598956393 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1598957441 207RI0200X 020 Physicians 185 Infectious Diseases

1598958613 207L00000X 020 Physicians 005 Anesthesiology

1598960965 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1598962656 207RG0100X 020 Physicians 010 Gastroenterology

1598964595 208000000X 020 Physicians 049 Pediatrics

1598978876 207P00000X 020 Physicians 270 Emergency Medicine

1598982068 207XP3100X 020 Physicians 237 Pediatric Orthopedics

1598982068 207X00000X 020 Physicians 020 Orthopedic Surgery

1598986200 207VX0201X 020 Physicians 307 Gynecologic Oncology

1598995722 2084N0400X 020 Physicians 013 Neurology

1598997199 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1609002633 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1609003516 207Q00000X 020 Physicians 173 Family Medicine

1609004845 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609005487 207W00000X 020 Physicians 018 Ophthalmology

1609010164 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1609010578 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1609023290 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609030717 207L00000X 020 Physicians 005 Anesthesiology

1609035120 207R00000X 020 Physicians 011 Internal Medicine

1609037035 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609039742 208G00000X 020 Physicians 033 Thoracic Surgery

1609040427 207N00000X 020 Physicians 007 Dermatology

1609040765 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609040781 208000000X 020 Physicians 049 Pediatrics

1609042167 207P00000X 020 Physicians 270 Emergency Medicine

1609050756 2084P0800X 020 Physicians 121 Psychiatry

1609051242 2084N0400X 020 Physicians 013 Neurology

1609054337 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1609056316 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

332 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1609068717 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609068832 207R00000X 020 Physicians 011 Internal Medicine

1609069558 207V00000X 020 Physicians 016 OB/GYN

1609070226 122300000X 012 Dental Providers 019 Dentists

1609073915 208000000X 020 Physicians 049 Pediatrics

1609073915 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1609074236 207W00000X 020 Physicians 018 Ophthalmology

1609076355 207R00000X 020 Physicians 011 Internal Medicine

1609076355 207RI0008X 020 Physicians 340 Hepatology

1609078302 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609086214 208000000X 020 Physicians 049 Pediatrics

1609089085 1223G0001X 012 Dental Providers 001 General Practice

1609093608 207P00000X 020 Physicians 270 Emergency Medicine

1609102599 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609108166 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609118710 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609129709 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609131887 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609157189 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609160647 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609165455 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609167980 208100000X 020 Physicians 025 Physical Medicine and Rehab

1609170620 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609175470 208M00000X 020 Physicians 344 Hospitalist

1609180561 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1609180561 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1609184043 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609193440 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1609205988 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1609213529 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609214576 2085R0202X 020 Physicians 167 Diagnostic Radiology

333 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1609215151 207Q00000X 020 Physicians 173 Family Medicine

1609218833 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609221639 207Q00000X 020 Physicians 173 Family Medicine

1609224229 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609225143 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1609227909 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609229129 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1609232529 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1609232529 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1609241405 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1609244177 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609246438 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609246677 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1609246677 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1609246677 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1609250265 207Q00000X 020 Physicians 173 Family Medicine

1609252279 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609269869 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1609269869 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1609286087 207RN0300X 020 Physicians 105 Nephrology

1609294081 208M00000X 020 Physicians 344 Hospitalist

1609296045 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1609296136 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1609318906 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1609327386 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1609327386 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609343896 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609352657 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609354141 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1609354893 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609365154 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

334 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1609368844 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1609389279 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1609392109 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1609392109 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1609393990 1223G0001X 012 Dental Providers 001 General Practice

1609396639 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1609421890 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1609431147 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609437714 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609437714 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1609803394 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609808534 207RG0100X 020 Physicians 010 Gastroenterology

1609815927 208000000X 020 Physicians 049 Pediatrics

1609815927 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1609817139 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609818061 2086S0120X 020 Physicians 245 Pediatric Surgery

1609818061 208600000X 020 Physicians 275 Surgery

1609819754 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609821230 207P00000X 020 Physicians 270 Emergency Medicine

1609828995 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609829621 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609835628 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609838481 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1609839463 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609840958 207RG0100X 020 Physicians 010 Gastroenterology

1609844166 207P00000X 020 Physicians 270 Emergency Medicine

1609845460 208G00000X 020 Physicians 033 Thoracic Surgery

1609849298 2086S0105X 020 Physicians 546 Surgery of the Hand

1609849298 207X00000X 020 Physicians 020 Orthopedic Surgery

1609849751 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1609852938 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

335 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1609852938 207ZP0101X 020 Physicians 436 Anatomic Pathology

1609853787 2083P0901X 020 Physicians 569 Public Health & General Preventative Med

1609855295 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609855873 207Q00000X 020 Physicians 173 Family Medicine

1609856830 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609872043 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609876127 207Q00000X 020 Physicians 173 Family Medicine

1609878347 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609884147 208000000X 020 Physicians 049 Pediatrics

1609894039 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609894203 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609895879 207Q00000X 020 Physicians 173 Family Medicine

1609897883 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609912450 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609922384 2086S0120X 020 Physicians 245 Pediatric Surgery

1609926690 208600000X 020 Physicians 275 Surgery

1609929033 111N00000X 011 Chiropractic Providers 047 Chiropractor

1609938182 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1609940360 122300000X 012 Dental Providers 019 Dentists

1609949767 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1609952365 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1609958347 208000000X 020 Physicians 049 Pediatrics

1609958347 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1609964238 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1609967785 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1609968031 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1609970250 207Q00000X 020 Physicians 173 Family Medicine

1609974195 2085R0202X 020 Physicians 167 Diagnostic Radiology

1609977107 208100000X 020 Physicians 025 Physical Medicine and Rehab

1609977313 111N00000X 011 Chiropractic Providers 047 Chiropractor

1609979830 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

336 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1609988088 207X00000X 020 Physicians 020 Orthopedic Surgery

1609989268 207P00000X 020 Physicians 270 Emergency Medicine

1609992254 207Y00000X 020 Physicians 217 Otolaryngology

1609995976 122300000X 012 Dental Providers 019 Dentists

1619002458 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1619003381 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619008919 1223G0001X 012 Dental Providers 001 General Practice

1619015104 207T00000X 020 Physicians 014 Neurological Surgery

1619016458 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619016458 2085N0700X 020 Physicians 204 Neuroradiology

1619017787 207T00000X 020 Physicians 014 Neurological Surgery

1619019585 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1619023918 207R00000X 020 Physicians 011 Internal Medicine

1619032661 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619041860 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619048766 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619050028 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1619054327 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1619067584 207R00000X 020 Physicians 011 Internal Medicine

1619075298 111N00000X 011 Chiropractic Providers 047 Chiropractor

1619075546 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1619076122 207R00000X 020 Physicians 011 Internal Medicine

1619077625 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619078474 207R00000X 020 Physicians 011 Internal Medicine

1619080751 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619082989 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1619085032 207V00000X 020 Physicians 016 OB/GYN

1619089109 207Q00000X 020 Physicians 173 Family Medicine

1619102068 2080P0201X 020 Physicians 108 Pediatric Allergy

1619102068 207K00000X 020 Physicians 003 Allergy & Immunology

1619102068 208000000X 020 Physicians 049 Pediatrics

337 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1619104445 207R00000X 020 Physicians 011 Internal Medicine

1619107380 207V00000X 020 Physicians 016 OB/GYN

1619107448 207L00000X 020 Physicians 005 Anesthesiology

1619108099 207R00000X 020 Physicians 011 Internal Medicine

1619108420 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619109972 207Q00000X 020 Physicians 173 Family Medicine

1619109972 207R00000X 020 Physicians 011 Internal Medicine

1619121662 111N00000X 011 Chiropractic Providers 047 Chiropractor

1619132834 207Q00000X 020 Physicians 173 Family Medicine

1619132834 208M00000X 020 Physicians 344 Hospitalist

1619134178 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1619134178 208000000X 020 Physicians 049 Pediatrics

1619152097 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1619156411 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1619157609 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619164654 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1619170115 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619172145 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1619178258 207RI0011X 020 Physicians 188 Interventional Cardiology

1619178258 207RC0000X 020 Physicians 006 Cardiovascular Disease

1619187523 207P00000X 020 Physicians 270 Emergency Medicine

1619189842 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619190188 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1619195617 2084P0800X 020 Physicians 121 Psychiatry

1619208675 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619210325 207P00000X 020 Physicians 270 Emergency Medicine

1619214368 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1619227212 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1619229952 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1619232758 2084P0800X 020 Physicians 121 Psychiatry

1619233632 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

338 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1619238078 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1619251063 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1619264942 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619268042 207L00000X 020 Physicians 005 Anesthesiology

1619275013 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619281987 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1619283298 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619288164 1223G0001X 012 Dental Providers 001 General Practice

1619288602 207V00000X 020 Physicians 016 OB/GYN

1619288867 207T00000X 020 Physicians 014 Neurological Surgery

1619289493 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1619290590 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619290590 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1619293164 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1619293164 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1619293164 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1619298155 2080P0202X 020 Physicians 221 Pediatric Cardiology

1619298205 207RI0200X 020 Physicians 185 Infectious Diseases

1619300464 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1619301405 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1619309291 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1619309291 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1619309630 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1619310612 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619310612 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1619311974 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619317724 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1619318847 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619325297 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1619326717 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1619336443 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

339 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1619340247 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1619347069 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619351145 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1619352002 207Q00000X 020 Physicians 173 Family Medicine

1619355617 207WX0107X 020 Physicians 616 Retina Specialist

1619358850 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1619359254 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1619359353 183500000X 018 Pharmacy 253 Pharmacist

1619370046 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619372323 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1619379070 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619379203 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619379294 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619380318 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1619384427 207R00000X 020 Physicians 011 Internal Medicine

1619392008 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619404241 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619407327 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1619417235 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1619420999 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1619423167 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1619439593 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1619439593 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1619441573 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1619446929 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1619454691 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1619464294 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1619479169 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1619482080 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619487519 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1619502382 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

340 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1619505641 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1619508587 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1619525862 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1619531068 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619534062 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1619904794 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1619905924 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619908993 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1619912169 208600000X 020 Physicians 275 Surgery

1619912326 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1619912326 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1619914645 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619916848 208G00000X 020 Physicians 033 Thoracic Surgery

1619920345 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1619925484 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1619928173 2084P0800X 020 Physicians 121 Psychiatry

1619930609 2084P0800X 020 Physicians 121 Psychiatry

1619931847 207RC0000X 020 Physicians 006 Cardiovascular Disease

1619938867 2084N0400X 020 Physicians 013 Neurology

1619940210 207Y00000X 020 Physicians 217 Otolaryngology

1619940483 207K00000X 020 Physicians 003 Allergy & Immunology

1619941010 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1619941010 207RH0003X 020 Physicians 179 Hematology/Oncology

1619942588 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1619947207 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619948213 208M00000X 020 Physicians 344 Hospitalist

1619948213 207R00000X 020 Physicians 011 Internal Medicine

1619948460 111N00000X 011 Chiropractic Providers 047 Chiropractor

1619949815 207RG0100X 020 Physicians 010 Gastroenterology

1619954922 207ZH0000X 020 Physicians 560 Hematology; Pathology

1619955663 207L00000X 020 Physicians 005 Anesthesiology

341 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1619955739 207L00000X 020 Physicians 005 Anesthesiology

1619955747 207RI0200X 020 Physicians 185 Infectious Diseases

1619957834 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619958337 2080P0202X 020 Physicians 221 Pediatric Cardiology

1619961091 207R00000X 020 Physicians 011 Internal Medicine

1619961919 207V00000X 020 Physicians 016 OB/GYN

1619964665 208C00000X 020 Physicians 101 Colon and Rectal Surgery

1619973294 207RC0200X 020 Physicians 206 Critical Care Medicine

1619973294 207R00000X 020 Physicians 011 Internal Medicine

1619988508 207Q00000X 020 Physicians 173 Family Medicine

1619989605 207R00000X 020 Physicians 011 Internal Medicine

1619991973 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1619995628 2085R0202X 020 Physicians 167 Diagnostic Radiology

1619997848 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1629001656 2084P0800X 020 Physicians 121 Psychiatry

1629004247 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629004569 207R00000X 020 Physicians 011 Internal Medicine

1629008768 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629010335 2080P0006X 020 Physicians 223 Pediatric Developmental & Beha

1629010335 208000000X 020 Physicians 049 Pediatrics

1629012695 207V00000X 020 Physicians 016 OB/GYN

1629015300 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629017785 207Q00000X 020 Physicians 173 Family Medicine

1629022801 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629025895 207R00000X 020 Physicians 011 Internal Medicine

1629028329 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629028717 122300000X 012 Dental Providers 019 Dentists

1629031166 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1629037031 207Q00000X 020 Physicians 173 Family Medicine

1629037445 208600000X 020 Physicians 275 Surgery

1629037445 2086S0129X 020 Physicians 289 Vascular Surgery

342 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629040993 207R00000X 020 Physicians 011 Internal Medicine

1629042866 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629044680 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1629054069 207RP1001X 020 Physicians 029 Pulmonary Diseases

1629054838 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629056551 208200000X 020 Physicians 024 Plastic Surgery

1629056924 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1629056924 2086S0105X 020 Physicians 546 Surgery of the Hand

1629058250 207ZP0101X 020 Physicians 022 Pathology

1629058250 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1629062138 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629067327 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629070297 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1629080692 208000000X 020 Physicians 049 Pediatrics

1629090196 207RC0000X 020 Physicians 006 Cardiovascular Disease

1629090261 208800000X 020 Physicians 034 Urology

1629096268 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1629096268 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629096367 207V00000X 020 Physicians 016 OB/GYN

1629096946 207L00000X 020 Physicians 005 Anesthesiology

1629097332 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1629099858 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1629117890 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629121595 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1629121595 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629125604 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1629131891 111N00000X 011 Chiropractic Providers 047 Chiropractor

1629134069 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1629143169 207RH0003X 020 Physicians 179 Hematology/Oncology

1629147095 208000000X 020 Physicians 049 Pediatrics

1629147723 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

343 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629150040 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1629150248 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1629150370 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1629155643 208000000X 020 Physicians 049 Pediatrics

1629156427 208600000X 020 Physicians 275 Surgery

1629157458 111N00000X 011 Chiropractic Providers 047 Chiropractor

1629157714 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629160080 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1629160080 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629162706 207Q00000X 020 Physicians 173 Family Medicine

1629164371 208D00000X 020 Physicians 001 General Practice

1629167978 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1629173299 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1629174701 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1629174750 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629178256 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629179106 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629203815 207Q00000X 020 Physicians 173 Family Medicine

1629203815 207RS0010X 020 Physicians 639 Internal Medicine; Sports Medicine

1629203815 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1629203815 207QS0010X 020 Physicians 273 Sports Medicine

1629204920 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1629204920 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1629208079 364SA2200X 036 Phys Assts and Advanced Nursing Provs 550 Clinical Nurse Specialist Adult Health

1629209366 208G00000X 020 Physicians 033 Thoracic Surgery

1629209796 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629211503 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1629214184 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629219720 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629219753 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1629224167 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

344 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629230081 207Q00000X 020 Physicians 173 Family Medicine

1629236369 207P00000X 020 Physicians 270 Emergency Medicine

1629236690 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1629239397 207RG0100X 020 Physicians 010 Gastroenterology

1629239637 1223G0001X 012 Dental Providers 001 General Practice

1629243415 207V00000X 020 Physicians 016 OB/GYN

1629244892 207PE0004X 020 Physicians 093 Emergency Medical Services

1629245915 2080P0202X 020 Physicians 221 Pediatric Cardiology

1629256318 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629256391 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629256391 2085N0904X 020 Physicians 495 Nuclear Radiology

1629256581 207L00000X 020 Physicians 005 Anesthesiology

1629257514 207Q00000X 020 Physicians 173 Family Medicine

1629257514 208M00000X 020 Physicians 344 Hospitalist

1629257514 208D00000X 020 Physicians 001 General Practice

1629260161 207Q00000X 020 Physicians 173 Family Medicine

1629265814 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1629269121 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1629270608 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1629277587 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629278783 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1629285051 207P00000X 020 Physicians 270 Emergency Medicine

1629289939 207T00000X 020 Physicians 014 Neurological Surgery

1629295498 111N00000X 011 Chiropractic Providers 047 Chiropractor

1629304738 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1629304738 207R00000X 020 Physicians 011 Internal Medicine

1629319082 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1629323027 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629323241 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1629323605 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629323605 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

345 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629336474 208600000X 020 Physicians 275 Surgery

1629336615 207R00000X 020 Physicians 011 Internal Medicine

1629345723 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1629345723 208000000X 020 Physicians 049 Pediatrics

1629360144 2084N0400X 020 Physicians 013 Neurology

1629363429 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629368519 2085R0202X 020 Physicians 167 Diagnostic Radiology

1629369830 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1629381314 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629394390 2084N0400X 020 Physicians 013 Neurology

1629394572 207Q00000X 020 Physicians 173 Family Medicine

1629397070 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629399167 208000000X 020 Physicians 049 Pediatrics

1629401567 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1629403746 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1629411152 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1629411574 207Q00000X 020 Physicians 173 Family Medicine

1629412648 207ZP0101X 020 Physicians 022 Pathology

1629412648 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1629415294 207VX0000X 020 Physicians 211 Obstetrics

1629421342 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1629421342 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1629423371 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629424627 208M00000X 020 Physicians 344 Hospitalist

1629424627 207R00000X 020 Physicians 011 Internal Medicine

1629428594 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629433982 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629448139 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629449418 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629451869 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629452198 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

346 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629452198 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1629453444 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629457023 207RC0000X 020 Physicians 006 Cardiovascular Disease

1629457056 208M00000X 020 Physicians 344 Hospitalist

1629457056 207R00000X 020 Physicians 011 Internal Medicine

1629463369 2084P0800X 020 Physicians 121 Psychiatry

1629468582 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629470281 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629471479 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1629471479 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1629471479 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1629471750 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1629471750 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1629487160 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629492715 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1629492715 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1629495346 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1629500988 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1629501762 207W00000X 020 Physicians 018 Ophthalmology

1629519426 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1629528591 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1629528591 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629533138 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629533724 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1629533724 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1629534193 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629551536 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1629552559 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629555966 207Q00000X 020 Physicians 173 Family Medicine

1629557624 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1629562020 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

347 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1629562020 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1629562541 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629571443 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1629581707 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1629585427 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1629590724 183500000X 018 Pharmacy 253 Pharmacist

1629593017 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1629595228 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1629600507 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1629601190 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1629614912 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1629616693 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629628748 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1629633151 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1629637624 207Q00000X 020 Physicians 173 Family Medicine

1629639919 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639101959 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639108814 208800000X 020 Physicians 034 Urology

1639110265 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1639110356 207R00000X 020 Physicians 011 Internal Medicine

1639110356 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1639113749 207Q00000X 020 Physicians 173 Family Medicine

1639114424 207X00000X 020 Physicians 020 Orthopedic Surgery

1639115868 208600000X 020 Physicians 275 Surgery

1639117435 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639117625 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1639118771 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1639121304 207N00000X 020 Physicians 007 Dermatology

1639124647 208G00000X 020 Physicians 033 Thoracic Surgery

1639126071 207Q00000X 020 Physicians 173 Family Medicine

1639131014 2084P0800X 020 Physicians 121 Psychiatry

348 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1639131345 207RC0000X 020 Physicians 006 Cardiovascular Disease

1639139405 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639139892 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639140007 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1639141559 207RC0000X 020 Physicians 006 Cardiovascular Disease

1639143134 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639145758 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1639149891 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1639151954 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1639154982 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639155856 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1639156920 207Y00000X 020 Physicians 217 Otolaryngology

1639157696 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1639157803 208100000X 020 Physicians 025 Physical Medicine and Rehab

1639157928 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1639158686 207P00000X 020 Physicians 270 Emergency Medicine

1639158819 207L00000X 020 Physicians 005 Anesthesiology

1639159338 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1639159452 207L00000X 020 Physicians 005 Anesthesiology

1639159486 207RC0000X 020 Physicians 006 Cardiovascular Disease

1639164890 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639170269 111N00000X 011 Chiropractic Providers 047 Chiropractor

1639170418 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1639180425 207R00000X 020 Physicians 011 Internal Medicine

1639181464 111N00000X 011 Chiropractic Providers 047 Chiropractor

1639192008 207Q00000X 020 Physicians 173 Family Medicine

1639192479 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639195357 207RR0500X 020 Physicians 267 Rheumatology

1639196454 207Y00000X 020 Physicians 217 Otolaryngology

1639197213 207Q00000X 020 Physicians 173 Family Medicine

1639197338 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

349 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1639204506 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1639207657 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1639213994 208000000X 020 Physicians 049 Pediatrics

1639213994 207R00000X 020 Physicians 011 Internal Medicine

1639222110 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639233109 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639245822 207T00000X 020 Physicians 014 Neurological Surgery

1639248719 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1639251143 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639256688 207Y00000X 020 Physicians 217 Otolaryngology

1639259310 208200000X 020 Physicians 024 Plastic Surgery

1639259310 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1639260425 207Q00000X 020 Physicians 173 Family Medicine

1639264328 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639265994 207Q00000X 020 Physicians 173 Family Medicine

1639270069 207Q00000X 020 Physicians 173 Family Medicine

1639275944 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639275944 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639284870 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1639287535 122300000X 012 Dental Providers 019 Dentists

1639289382 207RG0100X 020 Physicians 010 Gastroenterology

1639294259 208100000X 020 Physicians 025 Physical Medicine and Rehab

1639303050 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639304470 207R00000X 020 Physicians 011 Internal Medicine

1639309560 207R00000X 020 Physicians 011 Internal Medicine

1639309727 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639313091 208M00000X 020 Physicians 344 Hospitalist

1639313539 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1639322837 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639327885 207RP1001X 020 Physicians 029 Pulmonary Diseases

1639328420 207R00000X 020 Physicians 011 Internal Medicine

350 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1639338189 207R00000X 020 Physicians 011 Internal Medicine

1639345804 207P00000X 020 Physicians 270 Emergency Medicine

1639346315 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1639346653 207P00000X 020 Physicians 270 Emergency Medicine

1639352198 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639352719 208600000X 020 Physicians 275 Surgery

1639359987 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1639361272 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1639363948 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639364581 207RI0011X 020 Physicians 188 Interventional Cardiology

1639371669 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639374960 207Q00000X 020 Physicians 173 Family Medicine

1639383888 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1639389133 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639389679 2086S0127X 020 Physicians 633 Trauma Surgery

1639389679 208600000X 020 Physicians 275 Surgery

1639399405 207Q00000X 020 Physicians 173 Family Medicine

1639408180 207R00000X 020 Physicians 011 Internal Medicine

1639409071 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1639418452 207V00000X 020 Physicians 016 OB/GYN

1639425556 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1639430721 208M00000X 020 Physicians 344 Hospitalist

1639430721 208000000X 020 Physicians 049 Pediatrics

1639431026 208600000X 020 Physicians 275 Surgery

1639434806 2080P0202X 020 Physicians 221 Pediatric Cardiology

1639436132 208000000X 020 Physicians 049 Pediatrics

1639437346 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1639442411 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639442411 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639449218 207P00000X 020 Physicians 270 Emergency Medicine

1639457112 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

351 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1639462450 2085R0202X 020 Physicians 167 Diagnostic Radiology

1639465115 207P00000X 020 Physicians 270 Emergency Medicine

1639465909 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1639466527 207L00000X 020 Physicians 005 Anesthesiology

1639475940 207R00000X 020 Physicians 011 Internal Medicine

1639478290 208600000X 020 Physicians 275 Surgery

1639486368 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639489966 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639490048 2080P0202X 020 Physicians 221 Pediatric Cardiology

1639498777 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1639499940 207P00000X 020 Physicians 270 Emergency Medicine

1639504871 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639506181 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639509557 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1639510316 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1639511934 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1639511975 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1639516529 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1639518442 208000000X 020 Physicians 049 Pediatrics

1639518442 2080P0202X 020 Physicians 221 Pediatric Cardiology

1639522360 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639532963 207RN0300X 020 Physicians 105 Nephrology

1639534928 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1639534928 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1639539497 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639539794 1223G0001X 012 Dental Providers 001 General Practice

1639548795 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639551377 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1639559198 122300000X 012 Dental Providers 019 Dentists

1639571292 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1639587850 208M00000X 020 Physicians 344 Hospitalist

352 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1639587975 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1639596190 207R00000X 020 Physicians 011 Internal Medicine

1639598998 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1639598998 101Y00000X 010 Behav Health & Social Svc Prov 152 Counselor

1639598998 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1639599863 208M00000X 020 Physicians 344 Hospitalist

1639599863 208000000X 020 Physicians 049 Pediatrics

1639604697 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1639611437 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639627979 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639629231 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1639654312 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1639663958 122300000X 012 Dental Providers 019 Dentists

1639679624 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1639683691 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1639686397 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1639691975 207Q00000X 020 Physicians 173 Family Medicine

1639693864 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639698608 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1639715303 111N00000X 011 Chiropractic Providers 047 Chiropractor

1639718257 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1639724099 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1639728918 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1639733926 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1639733926 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1649203316 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649209776 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649210832 207Q00000X 020 Physicians 173 Family Medicine

1649215070 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1649215732 1223P0221X 012 Dental Providers 063 Pedodontics

1649215732 122300000X 012 Dental Providers 019 Dentists

353 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649217043 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1649219106 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649219924 111N00000X 011 Chiropractic Providers 047 Chiropractor

1649222720 207RX0202X 020 Physicians 529 Medical Oncology

1649222902 207WX0107X 020 Physicians 616 Retina Specialist

1649222902 207W00000X 020 Physicians 018 Ophthalmology

1649223611 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1649224197 207L00000X 020 Physicians 005 Anesthesiology

1649224809 207N00000X 020 Physicians 007 Dermatology

1649225129 2080P0202X 020 Physicians 221 Pediatric Cardiology

1649226598 208000000X 020 Physicians 049 Pediatrics

1649226986 2080P0202X 020 Physicians 221 Pediatric Cardiology

1649226986 208000000X 020 Physicians 049 Pediatrics

1649229261 207RN0300X 020 Physicians 105 Nephrology

1649229261 207R00000X 020 Physicians 011 Internal Medicine

1649231192 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1649240094 207RG0100X 020 Physicians 010 Gastroenterology

1649240235 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1649240557 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1649240557 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1649243288 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1649243841 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1649244641 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649244658 2084N0400X 020 Physicians 013 Neurology

1649244989 207X00000X 020 Physicians 020 Orthopedic Surgery

1649244989 207R00000X 020 Physicians 011 Internal Medicine

1649245838 207Y00000X 020 Physicians 217 Otolaryngology

1649246752 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649249723 207W00000X 020 Physicians 018 Ophthalmology

1649250168 207PE0004X 020 Physicians 093 Emergency Medical Services

1649251224 2085R0202X 020 Physicians 167 Diagnostic Radiology

354 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649258526 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1649259227 207VF0040X 020 Physicians 565 Female Pelvic Medicine & Reconstructive

1649259227 207VX0000X 020 Physicians 211 Obstetrics

1649259557 208200000X 020 Physicians 024 Plastic Surgery

1649259870 208100000X 020 Physicians 025 Physical Medicine and Rehab

1649261256 207RG0100X 020 Physicians 010 Gastroenterology

1649269291 207R00000X 020 Physicians 011 Internal Medicine

1649270398 208G00000X 020 Physicians 033 Thoracic Surgery

1649271610 111N00000X 011 Chiropractic Providers 047 Chiropractor

1649274333 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649274481 207Q00000X 020 Physicians 173 Family Medicine

1649276858 111N00000X 011 Chiropractic Providers 047 Chiropractor

1649280843 207VX0201X 020 Physicians 307 Gynecologic Oncology

1649280843 207V00000X 020 Physicians 016 OB/GYN

1649281361 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1649281361 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1649284647 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1649291360 208000000X 020 Physicians 049 Pediatrics

1649291865 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1649291865 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649297318 208600000X 020 Physicians 275 Surgery

1649298290 207PE0004X 020 Physicians 093 Emergency Medical Services

1649298290 207P00000X 020 Physicians 270 Emergency Medicine

1649298290 207Q00000X 020 Physicians 173 Family Medicine

1649298381 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1649298381 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1649298555 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649298688 2084P0800X 020 Physicians 121 Psychiatry

1649298720 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1649298720 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1649320987 2084N0400X 020 Physicians 013 Neurology

355 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649331562 122300000X 012 Dental Providers 019 Dentists

1649332115 2084P0800X 020 Physicians 121 Psychiatry

1649332461 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649335498 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1649336504 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649349234 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1649349234 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1649351115 207W00000X 020 Physicians 018 Ophthalmology

1649357112 2084P0800X 020 Physicians 121 Psychiatry

1649365990 207RG0100X 020 Physicians 010 Gastroenterology

1649367343 207Q00000X 020 Physicians 173 Family Medicine

1649368374 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1649368374 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649368374 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1649369588 207P00000X 020 Physicians 270 Emergency Medicine

1649373879 122300000X 012 Dental Providers 019 Dentists

1649381203 207P00000X 020 Physicians 270 Emergency Medicine

1649382292 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1649384405 2084N0400X 020 Physicians 013 Neurology

1649388133 207RI0200X 020 Physicians 185 Infectious Diseases

1649390378 2086S0120X 020 Physicians 245 Pediatric Surgery

1649392739 207L00000X 020 Physicians 005 Anesthesiology

1649406703 2084P0800X 020 Physicians 121 Psychiatry

1649433293 208000000X 020 Physicians 049 Pediatrics

1649433293 207R00000X 020 Physicians 011 Internal Medicine

1649433608 207Y00000X 020 Physicians 217 Otolaryngology

1649435058 2084N0400X 020 Physicians 013 Neurology

1649438342 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1649441304 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1649444167 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649444167 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

356 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649444761 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649449943 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1649449943 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649452020 207RC0000X 020 Physicians 006 Cardiovascular Disease

1649453119 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1649460551 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649467697 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649468497 207RC0000X 020 Physicians 006 Cardiovascular Disease

1649473141 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1649476177 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1649478090 207Q00000X 020 Physicians 173 Family Medicine

1649479296 207Q00000X 020 Physicians 173 Family Medicine

1649492489 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649493628 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649504242 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649505090 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1649525080 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649525825 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1649534470 207Q00000X 020 Physicians 173 Family Medicine

1649542317 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649560319 208000000X 020 Physicians 049 Pediatrics

1649560392 122300000X 012 Dental Providers 019 Dentists

1649560541 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649562356 207Q00000X 020 Physicians 173 Family Medicine

1649562471 207L00000X 020 Physicians 005 Anesthesiology

1649562984 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1649562984 2085R0202X 020 Physicians 167 Diagnostic Radiology

1649568858 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1649579327 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1649583006 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1649596990 207X00000X 020 Physicians 020 Orthopedic Surgery

357 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649604869 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1649606609 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1649606609 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1649610056 111N00000X 011 Chiropractic Providers 047 Chiropractor

1649610742 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1649611534 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649620675 207R00000X 020 Physicians 011 Internal Medicine

1649639873 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1649646340 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1649659053 207R00000X 020 Physicians 011 Internal Medicine

1649672205 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649672759 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1649673146 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649679804 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649680901 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649680901 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1649682253 207L00000X 020 Physicians 005 Anesthesiology

1649683798 208600000X 020 Physicians 275 Surgery

1649687880 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649687880 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1649690355 208000000X 020 Physicians 049 Pediatrics

1649691692 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649698523 2084P0800X 020 Physicians 121 Psychiatry

1649714221 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649721168 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649729088 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1649744822 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1649755166 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1649756131 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1649764770 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1649792169 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

358 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1649793860 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649795147 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1649799495 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1649799495 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1649813940 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1649824996 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1649828583 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1649828583 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1649839846 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1649839903 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659300374 207QA0401X 020 Physicians 562 Family Medicine; Addiction Medicine

1659300713 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1659309128 208G00000X 020 Physicians 033 Thoracic Surgery

1659310191 207V00000X 020 Physicians 016 OB/GYN

1659311033 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659315117 207Q00000X 020 Physicians 173 Family Medicine

1659317428 207P00000X 020 Physicians 270 Emergency Medicine

1659323970 207R00000X 020 Physicians 011 Internal Medicine

1659325249 207P00000X 020 Physicians 270 Emergency Medicine

1659328375 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659328482 207L00000X 020 Physicians 005 Anesthesiology

1659328516 207W00000X 020 Physicians 018 Ophthalmology

1659328615 2084P0800X 020 Physicians 121 Psychiatry

1659328722 207Q00000X 020 Physicians 173 Family Medicine

1659329787 207L00000X 020 Physicians 005 Anesthesiology

1659331213 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659343168 207X00000X 020 Physicians 020 Orthopedic Surgery

1659345668 207RC0000X 020 Physicians 006 Cardiovascular Disease

1659347458 2083P0500X 020 Physicians 257 Preventive Med/Occupational-Environ Med

1659350825 207RP1001X 020 Physicians 029 Pulmonary Diseases

1659355659 2085R0202X 020 Physicians 167 Diagnostic Radiology

359 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1659357259 2084P0800X 020 Physicians 121 Psychiatry

1659357804 2085N0700X 020 Physicians 204 Neuroradiology

1659357804 2085R0202X 020 Physicians 167 Diagnostic Radiology

1659359321 2085R0202X 020 Physicians 167 Diagnostic Radiology

1659359834 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659367621 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1659372548 208000000X 020 Physicians 049 Pediatrics

1659374130 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1659375137 207P00000X 020 Physicians 270 Emergency Medicine

1659392652 207RN0300X 020 Physicians 105 Nephrology

1659392652 208000000X 020 Physicians 049 Pediatrics

1659392652 2080P0210X 020 Physicians 232 Pediatric Nephrology

1659392652 207R00000X 020 Physicians 011 Internal Medicine

1659393239 207Q00000X 020 Physicians 173 Family Medicine

1659393734 207P00000X 020 Physicians 270 Emergency Medicine

1659398196 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1659398196 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1659398329 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1659398329 208000000X 020 Physicians 049 Pediatrics

1659398659 207Q00000X 020 Physicians 173 Family Medicine

1659399350 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1659399350 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1659402873 204F00000X 020 Physicians 279 Transplant Surgery

1659404556 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1659417939 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659427680 207P00000X 020 Physicians 270 Emergency Medicine

1659435204 207R00000X 020 Physicians 011 Internal Medicine

1659435204 208M00000X 020 Physicians 344 Hospitalist

1659445989 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1659445989 208100000X 020 Physicians 025 Physical Medicine and Rehab

1659446730 207Q00000X 020 Physicians 173 Family Medicine

360 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1659452811 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1659455616 2088P0231X 020 Physicians 246 Pediatric Urology

1659455962 207L00000X 020 Physicians 005 Anesthesiology

1659460723 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1659462455 207RP1001X 020 Physicians 029 Pulmonary Diseases

1659462455 207R00000X 020 Physicians 011 Internal Medicine

1659462901 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1659469351 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1659469385 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1659476588 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1659477206 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1659491090 208000000X 020 Physicians 049 Pediatrics

1659492189 207P00000X 020 Physicians 270 Emergency Medicine

1659500155 207R00000X 020 Physicians 011 Internal Medicine

1659500197 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1659500718 207X00000X 020 Physicians 020 Orthopedic Surgery

1659504900 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659506186 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1659507226 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659508331 207W00000X 020 Physicians 018 Ophthalmology

1659513364 207RI0200X 020 Physicians 185 Infectious Diseases

1659515039 208000000X 020 Physicians 049 Pediatrics

1659520732 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1659525640 208200000X 020 Physicians 024 Plastic Surgery

1659528537 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1659528537 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1659552412 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1659556512 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659563039 207W00000X 020 Physicians 018 Ophthalmology

1659564011 207P00000X 020 Physicians 270 Emergency Medicine

1659565208 207RP1001X 020 Physicians 029 Pulmonary Diseases

361 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1659569200 207T00000X 020 Physicians 014 Neurological Surgery

1659573657 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659581361 2080P0202X 020 Physicians 221 Pediatric Cardiology

1659585156 208000000X 020 Physicians 049 Pediatrics

1659585156 207R00000X 020 Physicians 011 Internal Medicine

1659589240 207T00000X 020 Physicians 014 Neurological Surgery

1659590115 207P00000X 020 Physicians 270 Emergency Medicine

1659596765 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659597714 207P00000X 020 Physicians 270 Emergency Medicine

1659600054 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1659605558 2084P0800X 020 Physicians 121 Psychiatry

1659617173 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1659617173 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1659622173 1223P0221X 012 Dental Providers 063 Pedodontics

1659630366 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1659634822 207RX0202X 020 Physicians 529 Medical Oncology

1659635738 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1659640159 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659642304 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659651933 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1659663557 208000000X 020 Physicians 049 Pediatrics

1659683654 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1659688034 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659690618 208600000X 020 Physicians 275 Surgery

1659692630 208800000X 020 Physicians 034 Urology

1659692929 207X00000X 020 Physicians 020 Orthopedic Surgery

1659696896 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1659699833 207P00000X 020 Physicians 270 Emergency Medicine

1659703668 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659704930 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1659710523 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

362 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1659722254 207R00000X 020 Physicians 011 Internal Medicine

1659723047 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1659723815 207Q00000X 020 Physicians 173 Family Medicine

1659723815 208M00000X 020 Physicians 344 Hospitalist

1659725752 207R00000X 020 Physicians 011 Internal Medicine

1659752020 2084P0800X 020 Physicians 121 Psychiatry

1659756328 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1659757896 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1659758381 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1659773273 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659774214 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659776805 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659778876 111N00000X 011 Chiropractic Providers 047 Chiropractor

1659780658 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1659782258 208M00000X 020 Physicians 344 Hospitalist

1659782258 207R00000X 020 Physicians 011 Internal Medicine

1659786929 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659788164 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1659795995 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1659802668 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659811016 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1659814184 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659816395 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659816809 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1659816809 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1659820116 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659827848 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1659832996 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1659841542 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659843001 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1659843001 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

363 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1659847572 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1659848034 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1659854917 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1659856136 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1659856136 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1659856136 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1659859767 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1659860120 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1659877181 208000000X 020 Physicians 049 Pediatrics

1659877181 2080P0202X 020 Physicians 221 Pediatric Cardiology

1659883833 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1659889798 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1659896835 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1659898799 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1659903094 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1659932457 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1659932580 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1669010583 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1669017265 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669028700 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1669031043 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1669032728 207Q00000X 020 Physicians 173 Family Medicine

1669037123 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1669400503 207RC0000X 020 Physicians 006 Cardiovascular Disease

1669402624 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1669408662 207T00000X 020 Physicians 014 Neurological Surgery

1669408753 207Q00000X 020 Physicians 173 Family Medicine

1669412375 2084P0800X 020 Physicians 121 Psychiatry

1669412474 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669412573 207P00000X 020 Physicians 270 Emergency Medicine

1669412789 207L00000X 020 Physicians 005 Anesthesiology

364 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1669412870 207RG0100X 020 Physicians 010 Gastroenterology

1669414223 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669422770 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669424180 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669427688 207R00000X 020 Physicians 011 Internal Medicine

1669431706 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1669433488 207Q00000X 020 Physicians 173 Family Medicine

1669438610 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669446134 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669446712 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669452017 208100000X 020 Physicians 025 Physical Medicine and Rehab

1669452561 208000000X 020 Physicians 049 Pediatrics

1669459665 207RI0200X 020 Physicians 185 Infectious Diseases

1669459715 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669459939 207RC0000X 020 Physicians 006 Cardiovascular Disease

1669469672 208800000X 020 Physicians 034 Urology

1669474201 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669478582 208000000X 020 Physicians 049 Pediatrics

1669480133 207RH0000X 020 Physicians 178 Hematology

1669480521 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1669483038 207R00000X 020 Physicians 011 Internal Medicine

1669483046 207X00000X 020 Physicians 020 Orthopedic Surgery

1669489597 2084N0400X 020 Physicians 013 Neurology

1669490231 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669490264 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1669493888 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669494209 207RH0003X 020 Physicians 179 Hematology/Oncology

1669494233 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1669499331 207K00000X 020 Physicians 003 Allergy & Immunology

1669499521 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669512760 2085R0202X 020 Physicians 167 Diagnostic Radiology

365 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1669514295 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1669516852 208800000X 020 Physicians 034 Urology

1669518999 111N00000X 011 Chiropractic Providers 047 Chiropractor

1669522520 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1669523718 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1669523718 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669530259 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1669543013 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1669552006 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1669554341 1223G0001X 012 Dental Providers 001 General Practice

1669558128 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669558318 111N00000X 011 Chiropractic Providers 047 Chiropractor

1669563771 207R00000X 020 Physicians 011 Internal Medicine

1669563771 207RH0003X 020 Physicians 179 Hematology/Oncology

1669563771 207RX0202X 020 Physicians 529 Medical Oncology

1669568176 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1669572574 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1669578753 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1669579090 207RH0003X 020 Physicians 179 Hematology/Oncology

1669579975 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669581765 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1669583183 207Q00000X 020 Physicians 173 Family Medicine

1669586491 207PE0004X 020 Physicians 093 Emergency Medical Services

1669588430 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1669600185 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1669602918 208M00000X 020 Physicians 344 Hospitalist

1669602918 207R00000X 020 Physicians 011 Internal Medicine

1669603403 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669609301 207RC0000X 020 Physicians 006 Cardiovascular Disease

1669613089 208000000X 020 Physicians 049 Pediatrics

1669616850 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

366 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1669617676 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1669621306 207RI0200X 020 Physicians 185 Infectious Diseases

1669629549 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669629549 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1669631859 1223G0001X 012 Dental Providers 001 General Practice

1669634184 2085R0202X 020 Physicians 167 Diagnostic Radiology

1669635819 207R00000X 020 Physicians 011 Internal Medicine

1669636205 207P00000X 020 Physicians 270 Emergency Medicine

1669638292 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669646923 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669656922 207RP1001X 020 Physicians 029 Pulmonary Diseases

1669656922 207R00000X 020 Physicians 011 Internal Medicine

1669656922 207RC0200X 020 Physicians 206 Critical Care Medicine

1669662284 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1669664629 207X00000X 020 Physicians 020 Orthopedic Surgery

1669666228 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669666228 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1669674586 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1669678777 208M00000X 020 Physicians 344 Hospitalist

1669681631 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1669682837 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1669682837 207RH0003X 020 Physicians 179 Hematology/Oncology

1669687711 207RC0000X 020 Physicians 006 Cardiovascular Disease

1669687711 207R00000X 020 Physicians 011 Internal Medicine

1669691200 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1669693982 207PE0004X 020 Physicians 093 Emergency Medical Services

1669693982 207P00000X 020 Physicians 270 Emergency Medicine

1669702536 111N00000X 011 Chiropractic Providers 047 Chiropractor

1669704300 1223G0001X 012 Dental Providers 001 General Practice

1669704300 122300000X 012 Dental Providers 019 Dentists

1669707964 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

367 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1669715355 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1669716338 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1669726113 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1669728929 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669731741 207Q00000X 020 Physicians 173 Family Medicine

1669734547 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1669735486 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669750469 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669751962 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1669751962 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1669756755 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1669756755 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1669764502 207Q00000X 020 Physicians 173 Family Medicine

1669765434 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1669765905 207Q00000X 020 Physicians 173 Family Medicine

1669766283 207Q00000X 020 Physicians 173 Family Medicine

1669769998 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1669777561 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1669777561 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1669785556 207X00000X 020 Physicians 020 Orthopedic Surgery

1669793352 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669794830 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1669801106 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1669812665 207Q00000X 020 Physicians 173 Family Medicine

1669832275 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1669832671 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669835088 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669835765 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669837431 111N00000X 011 Chiropractic Providers 047 Chiropractor

1669839353 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1669840757 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

368 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1669847067 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669854196 207Q00000X 020 Physicians 173 Family Medicine

1669855151 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669855854 122300000X 012 Dental Providers 019 Dentists

1669855854 1223G0001X 012 Dental Providers 001 General Practice

1669858874 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1669858874 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669873964 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1669875092 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1669880381 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1669880381 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1669882734 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669884920 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669888566 207RR0500X 020 Physicians 267 Rheumatology

1669888913 207Q00000X 020 Physicians 173 Family Medicine

1669890745 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1669901591 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669910220 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1669929683 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669939658 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1669939658 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1669943122 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1669948048 111N00000X 011 Chiropractic Providers 047 Chiropractor

1669948345 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669966156 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669982591 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1669986311 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1669987004 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1669992244 207Q00000X 020 Physicians 173 Family Medicine

1669992384 208600000X 020 Physicians 275 Surgery

1669994380 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

369 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679003594 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1679004899 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1679024335 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1679027338 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1679028591 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679029581 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1679035182 183500000X 018 Pharmacy 253 Pharmacist

1679035562 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1679044697 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679045330 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1679050165 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679052609 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1679084842 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1679084842 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1679087597 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1679087597 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1679089742 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1679089742 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1679093504 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679096069 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1679097463 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679107015 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1679129555 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679508089 111N00000X 011 Chiropractic Providers 047 Chiropractor

1679510622 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679511356 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679512586 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1679514194 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679514285 207Q00000X 020 Physicians 173 Family Medicine

1679518484 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679524896 207Q00000X 020 Physicians 173 Family Medicine

370 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679525950 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679528830 207RH0003X 020 Physicians 179 Hematology/Oncology

1679531719 122300000X 012 Dental Providers 019 Dentists

1679532287 207RC0000X 020 Physicians 006 Cardiovascular Disease

1679532758 207P00000X 020 Physicians 270 Emergency Medicine

1679533053 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679540884 207P00000X 020 Physicians 270 Emergency Medicine

1679541841 207R00000X 020 Physicians 011 Internal Medicine

1679541841 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1679541841 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1679545198 207W00000X 020 Physicians 018 Ophthalmology

1679545354 2084N0400X 020 Physicians 013 Neurology

1679548598 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1679548598 208000000X 020 Physicians 049 Pediatrics

1679549471 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679550024 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679550206 208000000X 020 Physicians 049 Pediatrics

1679550206 2080P0201X 020 Physicians 108 Pediatric Allergy

1679550529 207V00000X 020 Physicians 016 OB/GYN

1679550685 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679550776 207L00000X 020 Physicians 005 Anesthesiology

1679550958 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1679551329 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1679551709 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1679551998 207RC0000X 020 Physicians 006 Cardiovascular Disease

1679557391 208800000X 020 Physicians 034 Urology

1679559058 208600000X 020 Physicians 275 Surgery

1679559264 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679559355 208600000X 020 Physicians 275 Surgery

1679559975 207WX0107X 020 Physicians 616 Retina Specialist

1679559975 207W00000X 020 Physicians 018 Ophthalmology

371 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679561963 207RN0300X 020 Physicians 105 Nephrology

1679562953 208M00000X 020 Physicians 344 Hospitalist

1679565774 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1679569578 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679577480 2080S0010X 020 Physicians 244 Pediatric Sports Medicine

1679577480 208000000X 020 Physicians 049 Pediatrics

1679577480 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1679577480 207X00000X 020 Physicians 020 Orthopedic Surgery

1679587422 208800000X 020 Physicians 034 Urology

1679589303 207Q00000X 020 Physicians 173 Family Medicine

1679593206 207Q00000X 020 Physicians 173 Family Medicine

1679594774 208800000X 020 Physicians 034 Urology

1679594915 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679599864 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679602999 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1679622039 1223G0001X 012 Dental Providers 001 General Practice

1679626972 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679629646 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679635312 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679636534 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679639785 207Q00000X 020 Physicians 173 Family Medicine

1679642896 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1679648745 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1679648745 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1679654305 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1679654883 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1679660377 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1679661003 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1679663744 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679666317 207RC0000X 020 Physicians 006 Cardiovascular Disease

1679669139 2084P0800X 020 Physicians 121 Psychiatry

372 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679669261 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679671762 208M00000X 020 Physicians 344 Hospitalist

1679671762 207R00000X 020 Physicians 011 Internal Medicine

1679674501 2084N0400X 020 Physicians 013 Neurology

1679684781 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1679693147 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1679693428 207T00000X 020 Physicians 014 Neurological Surgery

1679693774 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1679705107 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679707533 207P00000X 020 Physicians 270 Emergency Medicine

1679714620 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679718571 111N00000X 011 Chiropractic Providers 047 Chiropractor

1679724041 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1679725436 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679728786 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679744593 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1679746218 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679746218 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1679771521 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679776470 2080P0202X 020 Physicians 221 Pediatric Cardiology

1679779474 2084N0400X 020 Physicians 013 Neurology

1679787055 207W00000X 020 Physicians 018 Ophthalmology

1679790224 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1679794382 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1679794614 2080P0202X 020 Physicians 221 Pediatric Cardiology

1679796429 207NP0225X 020 Physicians 222 Pediatric Dermatology

1679796999 208G00000X 020 Physicians 033 Thoracic Surgery

1679800924 2086S0102X 020 Physicians 539 Surgical Critical Care

1679800924 208600000X 020 Physicians 275 Surgery

1679801153 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679801153 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

373 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679808752 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1679821334 2084P0800X 020 Physicians 121 Psychiatry

1679830855 207RR0500X 020 Physicians 267 Rheumatology

1679831424 207L00000X 020 Physicians 005 Anesthesiology

1679833396 207Q00000X 020 Physicians 173 Family Medicine

1679833826 207R00000X 020 Physicians 011 Internal Medicine

1679835615 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1679836803 208600000X 020 Physicians 275 Surgery

1679837561 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1679840102 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1679846745 111N00000X 011 Chiropractic Providers 047 Chiropractor

1679846869 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679850192 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679852917 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679853246 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1679856363 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1679860548 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1679861520 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679864201 2080S0012X 020 Physicians 558 Pediatric Sleep Medicine

1679864375 207RR0500X 020 Physicians 267 Rheumatology

1679864441 2084P0800X 020 Physicians 121 Psychiatry

1679868343 207L00000X 020 Physicians 005 Anesthesiology

1679869390 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679873525 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1679873525 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1679875991 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1679883680 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1679886923 122300000X 012 Dental Providers 019 Dentists

1679891535 207X00000X 020 Physicians 020 Orthopedic Surgery

1679891907 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1679891907 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

374 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679897383 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1679899116 208000000X 020 Physicians 049 Pediatrics

1679899389 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679901235 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1679907307 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1679909436 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1679909436 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1679911622 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679911622 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679912133 208600000X 020 Physicians 275 Surgery

1679916423 2085R0202X 020 Physicians 167 Diagnostic Radiology

1679918486 208000000X 020 Physicians 049 Pediatrics

1679920706 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679923940 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679923940 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679925275 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1679931067 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679933345 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679942213 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1679942833 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679945331 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679951495 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1679952998 207L00000X 020 Physicians 005 Anesthesiology

1679955280 207W00000X 020 Physicians 018 Ophthalmology

1679955629 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679956635 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1679956635 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1679958524 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1679958979 183500000X 018 Pharmacy 253 Pharmacist

1679975205 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1679983068 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

375 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1679984314 207Y00000X 020 Physicians 217 Otolaryngology

1679987333 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1679987747 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1679993182 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1689000432 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1689000473 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689007809 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1689007809 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1689010035 207Q00000X 020 Physicians 173 Family Medicine

1689018152 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689026478 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1689042830 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1689056111 207P00000X 020 Physicians 270 Emergency Medicine

1689058604 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689059586 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689076242 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689079691 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1689082398 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1689098717 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689110553 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689118119 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1689118739 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1689125304 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1689140733 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1689140733 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1689156655 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689167678 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1689171837 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1689184160 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1689193021 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1689197162 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

376 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1689197162 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689199002 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689211237 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1689216756 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1689229346 183500000X 018 Pharmacy 253 Pharmacist

1689235467 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1689239576 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1689239709 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1689600652 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689601502 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689601965 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1689606873 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1689607418 207Q00000X 020 Physicians 173 Family Medicine

1689608192 208600000X 020 Physicians 275 Surgery

1689608952 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1689612806 207L00000X 020 Physicians 005 Anesthesiology

1689614794 208100000X 020 Physicians 025 Physical Medicine and Rehab

1689615619 2084P0800X 020 Physicians 121 Psychiatry

1689616914 207R00000X 020 Physicians 011 Internal Medicine

1689619470 207Q00000X 020 Physicians 173 Family Medicine

1689620379 207L00000X 020 Physicians 005 Anesthesiology

1689621187 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689622094 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689633885 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689640963 208600000X 020 Physicians 275 Surgery

1689644908 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1689644965 2086S0120X 020 Physicians 245 Pediatric Surgery

1689645731 207ZP0101X 020 Physicians 436 Anatomic Pathology

1689646093 207NP0225X 020 Physicians 222 Pediatric Dermatology

1689646093 207N00000X 020 Physicians 007 Dermatology

1689646168 2084P0800X 020 Physicians 121 Psychiatry

377 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1689648107 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1689648107 208000000X 020 Physicians 049 Pediatrics

1689649220 207L00000X 020 Physicians 005 Anesthesiology

1689649279 207RC0000X 020 Physicians 006 Cardiovascular Disease

1689651044 2080P0008X 020 Physicians 233 Pediatric Neurodevelopment

1689651044 2084N0400X 020 Physicians 013 Neurology

1689651093 207RN0300X 020 Physicians 105 Nephrology

1689651689 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1689652109 2084P0800X 020 Physicians 121 Psychiatry

1689652224 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1689652489 2083P0500X 020 Physicians 257 Preventive Med/Occupational-Environ Med

1689652596 208100000X 020 Physicians 025 Physical Medicine and Rehab

1689652901 208100000X 020 Physicians 025 Physical Medicine and Rehab

1689653842 207Y00000X 020 Physicians 217 Otolaryngology

1689653891 207RC0000X 020 Physicians 006 Cardiovascular Disease

1689658841 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689658841 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1689658841 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689659427 208600000X 020 Physicians 275 Surgery

1689660151 208000000X 020 Physicians 049 Pediatrics

1689660151 208M00000X 020 Physicians 344 Hospitalist

1689660276 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689662983 207Q00000X 020 Physicians 173 Family Medicine

1689662983 207PE0004X 020 Physicians 093 Emergency Medical Services

1689663528 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1689664534 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689666927 207RR0500X 020 Physicians 267 Rheumatology

1689667115 208600000X 020 Physicians 275 Surgery

1689667909 207L00000X 020 Physicians 005 Anesthesiology

1689669327 207VX0000X 020 Physicians 211 Obstetrics

1689677288 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

378 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1689679631 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689682882 1223G0001X 012 Dental Providers 001 General Practice

1689682882 122300000X 012 Dental Providers 019 Dentists

1689684300 207L00000X 020 Physicians 005 Anesthesiology

1689690919 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689691222 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689691545 207L00000X 020 Physicians 005 Anesthesiology

1689691545 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1689697682 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689718280 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1689723629 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1689728818 2084P0800X 020 Physicians 121 Psychiatry

1689747982 2080P0210X 020 Physicians 232 Pediatric Nephrology

1689754590 208000000X 020 Physicians 049 Pediatrics

1689761785 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1689763922 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689764433 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1689771396 208G00000X 020 Physicians 033 Thoracic Surgery

1689771461 208100000X 020 Physicians 025 Physical Medicine and Rehab

1689778060 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689779951 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1689780124 2084P0800X 020 Physicians 121 Psychiatry

1689780124 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1689781171 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689781908 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1689785982 207L00000X 020 Physicians 005 Anesthesiology

1689791709 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1689804684 207L00000X 020 Physicians 005 Anesthesiology

1689804692 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1689805228 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689808057 2080P0202X 020 Physicians 221 Pediatric Cardiology

379 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1689817488 207P00000X 020 Physicians 270 Emergency Medicine

1689818650 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1689821621 1223P0221X 012 Dental Providers 063 Pedodontics

1689829202 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1689832107 2084N0400X 020 Physicians 013 Neurology

1689834392 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1689848046 208M00000X 020 Physicians 344 Hospitalist

1689860298 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1689865081 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1689865727 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1689866626 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1689867137 208000000X 020 Physicians 049 Pediatrics

1689867137 207R00000X 020 Physicians 011 Internal Medicine

1689871204 207V00000X 020 Physicians 016 OB/GYN

1689872756 207RC0000X 020 Physicians 006 Cardiovascular Disease

1689872756 207RI0011X 020 Physicians 188 Interventional Cardiology

1689873275 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1689876682 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1689878746 207RC0000X 020 Physicians 006 Cardiovascular Disease

1689878902 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689886699 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689889594 2085R0202X 020 Physicians 167 Diagnostic Radiology

1689891673 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1689893976 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689903577 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1689905648 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1689920779 207RP1001X 020 Physicians 029 Pulmonary Diseases

1689920779 207R00000X 020 Physicians 011 Internal Medicine

1689926727 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689928491 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1689936171 2085R0202X 020 Physicians 167 Diagnostic Radiology

380 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1689938797 207R00000X 020 Physicians 011 Internal Medicine

1689938797 208M00000X 020 Physicians 344 Hospitalist

1689941999 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1689946451 207R00000X 020 Physicians 011 Internal Medicine

1689949026 207V00000X 020 Physicians 016 OB/GYN

1689966087 2084P0800X 020 Physicians 121 Psychiatry

1689968521 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1689969362 208000000X 020 Physicians 049 Pediatrics

1689985079 207RN0300X 020 Physicians 105 Nephrology

1689991028 207R00000X 020 Physicians 011 Internal Medicine

1689991416 111N00000X 011 Chiropractic Providers 047 Chiropractor

1689998262 207K00000X 020 Physicians 003 Allergy & Immunology

1699009969 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1699012625 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1699018317 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1699020883 208M00000X 020 Physicians 344 Hospitalist

1699024679 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699027474 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1699031567 207N00000X 020 Physicians 007 Dermatology

1699036392 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1699040105 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699045666 207R00000X 020 Physicians 011 Internal Medicine

1699050377 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1699062240 207P00000X 020 Physicians 270 Emergency Medicine

1699063461 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699063875 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699064055 207V00000X 020 Physicians 016 OB/GYN

1699066357 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1699067132 207P00000X 020 Physicians 270 Emergency Medicine

1699069138 2084P0800X 020 Physicians 121 Psychiatry

1699069930 207R00000X 020 Physicians 011 Internal Medicine

381 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699081539 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1699081539 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1699081539 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1699081539 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1699086124 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699090068 208000000X 020 Physicians 049 Pediatrics

1699094748 207P00000X 020 Physicians 270 Emergency Medicine

1699098814 207P00000X 020 Physicians 270 Emergency Medicine

1699099812 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699100248 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699113183 207V00000X 020 Physicians 016 OB/GYN

1699116368 2084S0012X 020 Physicians 521 Sleep Medicine

1699116368 207RS0012X 020 Physicians 614 Internal Medicine; Sleep Medicine

1699117143 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699120709 122300000X 012 Dental Providers 019 Dentists

1699125765 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1699129569 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1699129676 208800000X 020 Physicians 034 Urology

1699132464 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1699144329 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1699147819 111N00000X 011 Chiropractic Providers 047 Chiropractor

1699169698 207P00000X 020 Physicians 270 Emergency Medicine

1699171074 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1699174326 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1699174326 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1699174508 207V00000X 020 Physicians 016 OB/GYN

1699178087 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699178707 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699181495 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1699186098 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699186155 207W00000X 020 Physicians 018 Ophthalmology

382 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699194233 207P00000X 020 Physicians 270 Emergency Medicine

1699199026 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1699204917 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699205856 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699215574 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1699218636 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699218867 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1699226944 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699231266 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699234989 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699247247 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1699247247 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1699256537 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699257261 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699265298 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1699281220 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699292052 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1699296277 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699296806 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1699299719 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1699306423 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699314617 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699325191 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1699328070 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1699336479 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1699703819 207P00000X 020 Physicians 270 Emergency Medicine

1699705368 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699705582 207R00000X 020 Physicians 011 Internal Medicine

1699707794 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1699709220 208100000X 020 Physicians 025 Physical Medicine and Rehab

1699712802 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

383 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699714238 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699718403 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699720631 207RI0011X 020 Physicians 188 Interventional Cardiology

1699720995 207R00000X 020 Physicians 011 Internal Medicine

1699726083 207L00000X 020 Physicians 005 Anesthesiology

1699726349 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1699726752 208G00000X 020 Physicians 033 Thoracic Surgery

1699727602 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1699727958 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1699727958 207X00000X 020 Physicians 020 Orthopedic Surgery

1699731158 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1699735837 207R00000X 020 Physicians 011 Internal Medicine

1699738070 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1699741652 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1699741884 111N00000X 011 Chiropractic Providers 047 Chiropractor

1699744227 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1699744227 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1699745158 207RC0200X 020 Physicians 206 Critical Care Medicine

1699745158 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1699745653 2085R0202X 020 Physicians 167 Diagnostic Radiology

1699745877 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1699747030 207RG0100X 020 Physicians 010 Gastroenterology

1699747071 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699747097 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1699747477 207RC0000X 020 Physicians 006 Cardiovascular Disease

1699748517 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699748566 207X00000X 020 Physicians 020 Orthopedic Surgery

1699748640 207L00000X 020 Physicians 005 Anesthesiology

1699749507 207P00000X 020 Physicians 270 Emergency Medicine

1699749606 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1699750968 207X00000X 020 Physicians 020 Orthopedic Surgery

384 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699751610 207RC0000X 020 Physicians 006 Cardiovascular Disease

1699752121 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1699752964 207RC0200X 020 Physicians 206 Critical Care Medicine

1699755256 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699755256 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1699758318 207RP1001X 020 Physicians 029 Pulmonary Diseases

1699758318 207RC0200X 020 Physicians 206 Critical Care Medicine

1699777391 207P00000X 020 Physicians 270 Emergency Medicine

1699791095 2084N0400X 020 Physicians 013 Neurology

1699792556 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699792606 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1699793265 207Q00000X 020 Physicians 173 Family Medicine

1699799957 207RP1001X 020 Physicians 029 Pulmonary Diseases

1699806265 2085R0202X 020 Physicians 167 Diagnostic Radiology

1699808402 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699811364 207Q00000X 020 Physicians 173 Family Medicine

1699811364 207R00000X 020 Physicians 011 Internal Medicine

1699812602 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699813741 2084N0400X 020 Physicians 013 Neurology

1699829093 122300000X 012 Dental Providers 019 Dentists

1699838300 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1699843078 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699844167 208000000X 020 Physicians 049 Pediatrics

1699855635 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1699861195 111N00000X 011 Chiropractic Providers 047 Chiropractor

1699861955 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699863274 2080P0210X 020 Physicians 232 Pediatric Nephrology

1699863860 207L00000X 020 Physicians 005 Anesthesiology

1699867028 207L00000X 020 Physicians 005 Anesthesiology

1699867580 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699870253 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

385 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699871061 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1699875419 111N00000X 011 Chiropractic Providers 047 Chiropractor

1699875625 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1699876862 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1699878405 207Q00000X 020 Physicians 173 Family Medicine

1699879213 122300000X 012 Dental Providers 019 Dentists

1699883363 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1699883363 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1699887018 208100000X 020 Physicians 025 Physical Medicine and Rehab

1699897868 183500000X 018 Pharmacy 253 Pharmacist

1699899609 208200000X 020 Physicians 024 Plastic Surgery

1699903930 2085R0202X 020 Physicians 167 Diagnostic Radiology

1699905018 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699905398 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1699905489 207P00000X 020 Physicians 270 Emergency Medicine

1699908145 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1699909663 207P00000X 020 Physicians 270 Emergency Medicine

1699921627 2085P0229X 020 Physicians 241 Pediatric Radiology

1699921627 2085R0202X 020 Physicians 167 Diagnostic Radiology

1699921692 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1699926881 207P00000X 020 Physicians 270 Emergency Medicine

1699927566 208800000X 020 Physicians 034 Urology

1699929281 207RX0202X 020 Physicians 529 Medical Oncology

1699929281 207R00000X 020 Physicians 011 Internal Medicine

1699938365 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1699938365 207RC0000X 020 Physicians 006 Cardiovascular Disease

1699938738 207R00000X 020 Physicians 011 Internal Medicine

1699939314 207RG0100X 020 Physicians 010 Gastroenterology

1699943811 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1699943811 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1699947929 207L00000X 020 Physicians 005 Anesthesiology

386 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1699954990 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1699963108 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1699963207 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1699966085 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1699967810 208000000X 020 Physicians 049 Pediatrics

1699975052 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1699980847 208000000X 020 Physicians 049 Pediatrics

1699980847 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1699982835 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1699986646 207L00000X 020 Physicians 005 Anesthesiology

1699989731 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1699989764 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1700011459 207Q00000X 020 Physicians 173 Family Medicine

1700012739 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1700013539 207R00000X 020 Physicians 011 Internal Medicine

1700021714 207X00000X 020 Physicians 020 Orthopedic Surgery

1700023512 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700027166 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700034188 207Q00000X 020 Physicians 173 Family Medicine

1700036944 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700041241 207X00000X 020 Physicians 020 Orthopedic Surgery

1700046927 207Q00000X 020 Physicians 173 Family Medicine

1700047057 207RC0200X 020 Physicians 206 Critical Care Medicine

1700047057 2084A2900X 020 Physicians 612 Psychiatry&Neurology; Neurocritical Care

1700050796 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700050796 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1700056488 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1700058849 207R00000X 020 Physicians 011 Internal Medicine

1700074341 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1700074341 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1700076536 207P00000X 020 Physicians 270 Emergency Medicine

387 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1700078953 1223G0001X 012 Dental Providers 001 General Practice

1700078953 122300000X 012 Dental Providers 019 Dentists

1700079266 208600000X 020 Physicians 275 Surgery

1700081882 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1700088283 122300000X 012 Dental Providers 019 Dentists

1700094018 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1700094935 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700097995 122300000X 012 Dental Providers 019 Dentists

1700111788 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1700114998 2086S0102X 020 Physicians 539 Surgical Critical Care

1700116712 207RG0100X 020 Physicians 010 Gastroenterology

1700119351 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700125796 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700127743 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700142668 2084N0400X 020 Physicians 013 Neurology

1700149028 2080P0202X 020 Physicians 221 Pediatric Cardiology

1700152568 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1700162955 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700164928 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700172855 207RI0200X 020 Physicians 185 Infectious Diseases

1700175643 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1700176500 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700179231 2084N0400X 020 Physicians 013 Neurology

1700191947 207RH0003X 020 Physicians 179 Hematology/Oncology

1700191947 207R00000X 020 Physicians 011 Internal Medicine

1700194479 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1700198660 208M00000X 020 Physicians 344 Hospitalist

1700198660 207Q00000X 020 Physicians 173 Family Medicine

1700198660 207P00000X 020 Physicians 270 Emergency Medicine

1700215225 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700215225 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

388 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1700220779 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700221017 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1700222064 207Q00000X 020 Physicians 173 Family Medicine

1700227469 207Q00000X 020 Physicians 173 Family Medicine

1700237054 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700238037 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700238714 208M00000X 020 Physicians 344 Hospitalist

1700244696 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700245016 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1700252632 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700255296 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1700260205 122300000X 012 Dental Providers 019 Dentists

1700262664 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700264314 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700267440 1223G0001X 012 Dental Providers 001 General Practice

1700271012 207R00000X 020 Physicians 011 Internal Medicine

1700275336 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700284411 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700289097 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700291895 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700292208 208M00000X 020 Physicians 344 Hospitalist

1700293289 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700307170 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1700307170 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700313541 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700326774 183500000X 018 Pharmacy 253 Pharmacist

1700343076 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1700362969 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700371952 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700385887 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700390978 111N00000X 011 Chiropractic Providers 047 Chiropractor

389 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1700392305 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1700405685 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700410305 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1700414364 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1700420288 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1700420288 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1700427440 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700446192 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1700446200 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700802634 208000000X 020 Physicians 049 Pediatrics

1700802972 207RH0003X 020 Physicians 179 Hematology/Oncology

1700808375 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700811148 111N00000X 011 Chiropractic Providers 047 Chiropractor

1700811338 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1700811460 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1700816311 207V00000X 020 Physicians 016 OB/GYN

1700820933 207P00000X 020 Physicians 270 Emergency Medicine

1700823598 207R00000X 020 Physicians 011 Internal Medicine

1700824984 207R00000X 020 Physicians 011 Internal Medicine

1700825981 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700825981 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1700828027 207Y00000X 020 Physicians 217 Otolaryngology

1700828050 207RG0100X 020 Physicians 010 Gastroenterology

1700828225 208000000X 020 Physicians 049 Pediatrics

1700829520 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700831716 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700833720 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700833845 207RI0200X 020 Physicians 185 Infectious Diseases

1700836673 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700836673 363LX0106X 036 Phys Assts and Advanced Nursing Provs 536 Nurse Practitioner; Occupational Health

1700837259 207K00000X 020 Physicians 003 Allergy & Immunology

390 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1700849486 204F00000X 020 Physicians 279 Transplant Surgery

1700849833 207Q00000X 020 Physicians 173 Family Medicine

1700850294 207L00000X 020 Physicians 005 Anesthesiology

1700854478 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1700854502 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700854544 207P00000X 020 Physicians 270 Emergency Medicine

1700856804 207RH0000X 020 Physicians 178 Hematology

1700856804 207RX0202X 020 Physicians 529 Medical Oncology

1700856804 207RH0003X 020 Physicians 179 Hematology/Oncology

1700856911 207Q00000X 020 Physicians 173 Family Medicine

1700858248 2084P0800X 020 Physicians 121 Psychiatry

1700858990 207ZP0101X 020 Physicians 022 Pathology

1700859659 207RI0011X 020 Physicians 188 Interventional Cardiology

1700862232 207R00000X 020 Physicians 011 Internal Medicine

1700863362 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700863578 2085P0229X 020 Physicians 241 Pediatric Radiology

1700865938 208800000X 020 Physicians 034 Urology

1700866332 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700866993 207RG0100X 020 Physicians 010 Gastroenterology

1700867397 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700871688 207R00000X 020 Physicians 011 Internal Medicine

1700877875 207X00000X 020 Physicians 020 Orthopedic Surgery

1700880796 207Q00000X 020 Physicians 173 Family Medicine

1700885233 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700885308 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1700887312 208000000X 020 Physicians 049 Pediatrics

1700887312 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1700899143 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1700899580 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1700905874 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1700905874 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

391 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1700912672 111N00000X 011 Chiropractic Providers 047 Chiropractor

1700925864 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700930054 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1700930344 2085R0202X 020 Physicians 167 Diagnostic Radiology

1700931888 207P00000X 020 Physicians 270 Emergency Medicine

1700935517 207X00000X 020 Physicians 020 Orthopedic Surgery

1700938990 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1700939287 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700940467 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1700940467 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1700944915 207Y00000X 020 Physicians 217 Otolaryngology

1700945474 207P00000X 020 Physicians 270 Emergency Medicine

1700945474 208600000X 020 Physicians 275 Surgery

1700953726 208D00000X 020 Physicians 001 General Practice

1700954369 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1700954633 207Q00000X 020 Physicians 173 Family Medicine

1700961620 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1700963840 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1700965753 208000000X 020 Physicians 049 Pediatrics

1700965753 208M00000X 020 Physicians 344 Hospitalist

1700967890 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1700969227 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1700971199 207L00000X 020 Physicians 005 Anesthesiology

1700972973 208000000X 020 Physicians 049 Pediatrics

1700993813 111N00000X 011 Chiropractic Providers 047 Chiropractor

1700993847 207L00000X 020 Physicians 005 Anesthesiology

1700996857 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1700997780 208800000X 020 Physicians 034 Urology

1710031224 207RI0200X 020 Physicians 185 Infectious Diseases

1710042817 207V00000X 020 Physicians 016 OB/GYN

1710047600 207RC0200X 020 Physicians 206 Critical Care Medicine

392 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710047600 207RP1001X 020 Physicians 029 Pulmonary Diseases

1710048434 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710051081 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1710051628 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710052626 207Q00000X 020 Physicians 173 Family Medicine

1710056130 207QG0300X 020 Physicians 586 Family Medicine; Geriatric Medicine

1710056130 207Q00000X 020 Physicians 173 Family Medicine

1710063771 111N00000X 011 Chiropractic Providers 047 Chiropractor

1710064274 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1710068978 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1710073077 207Y00000X 020 Physicians 217 Otolaryngology

1710079645 208600000X 020 Physicians 275 Surgery

1710083175 111N00000X 011 Chiropractic Providers 047 Chiropractor

1710090485 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1710098587 207X00000X 020 Physicians 020 Orthopedic Surgery

1710099114 207Q00000X 020 Physicians 173 Family Medicine

1710115449 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1710115910 207RC0200X 020 Physicians 206 Critical Care Medicine

1710116918 2085R0202X 020 Physicians 167 Diagnostic Radiology

1710116967 207RX0202X 020 Physicians 529 Medical Oncology

1710116967 207RH0000X 020 Physicians 178 Hematology

1710116967 207RH0003X 020 Physicians 179 Hematology/Oncology

1710117312 207Q00000X 020 Physicians 173 Family Medicine

1710118526 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710118526 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710121116 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1710121116 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1710121504 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710121637 2085P0229X 020 Physicians 241 Pediatric Radiology

1710125893 208800000X 020 Physicians 034 Urology

1710131693 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

393 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710136205 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710138375 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710139068 207R00000X 020 Physicians 011 Internal Medicine

1710140843 208M00000X 020 Physicians 344 Hospitalist

1710141502 2084N0400X 020 Physicians 013 Neurology

1710150867 207L00000X 020 Physicians 005 Anesthesiology

1710152442 207R00000X 020 Physicians 011 Internal Medicine

1710153580 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1710157631 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1710159363 207RG0100X 020 Physicians 010 Gastroenterology

1710159579 1223X0400X 012 Dental Providers 064 Orthodontics

1710159975 207R00000X 020 Physicians 011 Internal Medicine

1710159975 207RN0300X 020 Physicians 105 Nephrology

1710160379 2084N0400X 020 Physicians 013 Neurology

1710165287 208M00000X 020 Physicians 344 Hospitalist

1710165287 207R00000X 020 Physicians 011 Internal Medicine

1710165832 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1710172960 2085R0202X 020 Physicians 167 Diagnostic Radiology

1710179312 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710180971 208600000X 020 Physicians 275 Surgery

1710182308 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1710182621 207RI0200X 020 Physicians 185 Infectious Diseases

1710183041 2084N0400X 020 Physicians 013 Neurology

1710187430 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1710187687 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1710193727 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1710194352 207R00000X 020 Physicians 011 Internal Medicine

1710203401 208600000X 020 Physicians 275 Surgery

1710205042 208100000X 020 Physicians 025 Physical Medicine and Rehab

1710211800 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710229190 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

394 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710232772 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1710232772 207L00000X 020 Physicians 005 Anesthesiology

1710232863 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710246053 208600000X 020 Physicians 275 Surgery

1710248992 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710249750 208000000X 020 Physicians 049 Pediatrics

1710253752 2084N0400X 020 Physicians 013 Neurology

1710255724 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1710270384 2085R0202X 020 Physicians 167 Diagnostic Radiology

1710272042 207X00000X 020 Physicians 020 Orthopedic Surgery

1710272588 2084P0800X 020 Physicians 121 Psychiatry

1710274667 207P00000X 020 Physicians 270 Emergency Medicine

1710296876 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1710300876 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1710301916 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1710303805 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1710305271 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1710306683 2085R0202X 020 Physicians 167 Diagnostic Radiology

1710310917 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1710319397 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1710319397 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1710320411 207Q00000X 020 Physicians 173 Family Medicine

1710320411 207R00000X 020 Physicians 011 Internal Medicine

1710320411 207QH0002X 020 Physicians 590 Family Medicine; Hospice & Palliative Me

1710320411 207RH0002X 020 Physicians 591 Internal Medicine; Hospice & Palliative

1710320890 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1710320890 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1710321526 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710323142 207W00000X 020 Physicians 018 Ophthalmology

1710323399 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1710327051 1223G0001X 012 Dental Providers 001 General Practice

395 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710328083 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1710330006 207R00000X 020 Physicians 011 Internal Medicine

1710330006 207Q00000X 020 Physicians 173 Family Medicine

1710330832 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710337092 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1710338892 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710339817 2084P0800X 020 Physicians 121 Psychiatry

1710350350 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1710350350 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1710350350 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1710353602 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710364260 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1710372362 2084P0800X 020 Physicians 121 Psychiatry

1710380779 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1710389580 2084N0400X 020 Physicians 013 Neurology

1710392238 207L00000X 020 Physicians 005 Anesthesiology

1710392253 208600000X 020 Physicians 275 Surgery

1710392600 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710398920 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1710403803 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1710403803 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1710403803 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1710403811 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1710405428 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1710410972 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1710410972 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1710439260 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710442314 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1710456397 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1710469408 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1710473764 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

396 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710478748 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1710478748 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1710487004 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1710487004 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710517255 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1710522651 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710531389 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710548862 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710904487 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1710904487 207PS0010X 020 Physicians 605 Emergency Medicine; Sports Medicine

1710905385 208600000X 020 Physicians 275 Surgery

1710905450 207L00000X 020 Physicians 005 Anesthesiology

1710908447 2084N0400X 020 Physicians 013 Neurology

1710908942 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1710909353 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1710909353 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1710911037 207Q00000X 020 Physicians 173 Family Medicine

1710912399 207RP1001X 020 Physicians 029 Pulmonary Diseases

1710914361 208600000X 020 Physicians 275 Surgery

1710920905 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1710924378 207Q00000X 020 Physicians 173 Family Medicine

1710926456 207P00000X 020 Physicians 270 Emergency Medicine

1710926878 2085R0202X 020 Physicians 167 Diagnostic Radiology

1710928387 207P00000X 020 Physicians 270 Emergency Medicine

1710928528 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1710928528 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1710929443 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1710934609 207Q00000X 020 Physicians 173 Family Medicine

1710940275 207RP1001X 020 Physicians 029 Pulmonary Diseases

1710946124 207RI0200X 020 Physicians 185 Infectious Diseases

1710946728 207Q00000X 020 Physicians 173 Family Medicine

397 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1710946736 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710946835 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1710948161 207R00000X 020 Physicians 011 Internal Medicine

1710948872 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1710950308 208100000X 020 Physicians 025 Physical Medicine and Rehab

1710950472 207RC0000X 020 Physicians 006 Cardiovascular Disease

1710950886 207RN0300X 020 Physicians 105 Nephrology

1710950969 207RI0200X 020 Physicians 185 Infectious Diseases

1710950985 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1710950985 207RC0000X 020 Physicians 006 Cardiovascular Disease

1710951926 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710954144 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1710954920 207P00000X 020 Physicians 270 Emergency Medicine

1710957030 2084N0400X 020 Physicians 013 Neurology

1710961495 1223G0001X 012 Dental Providers 001 General Practice

1710963707 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1710963731 207RN0300X 020 Physicians 105 Nephrology

1710963921 2084N0400X 020 Physicians 013 Neurology

1710966619 207X00000X 020 Physicians 020 Orthopedic Surgery

1710966999 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1720005275 208800000X 020 Physicians 034 Urology

1720010853 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1720010952 208000000X 020 Physicians 049 Pediatrics

1720013253 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720013436 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720015597 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720015894 2086S0102X 020 Physicians 539 Surgical Critical Care

1720018245 207Q00000X 020 Physicians 173 Family Medicine

1720020696 207L00000X 020 Physicians 005 Anesthesiology

1720022296 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720024474 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

398 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720025034 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1720025455 2086S0129X 020 Physicians 289 Vascular Surgery

1720026768 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720026768 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720027634 207L00000X 020 Physicians 005 Anesthesiology

1720028038 207Q00000X 020 Physicians 173 Family Medicine

1720029390 207Q00000X 020 Physicians 173 Family Medicine

1720034622 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1720034739 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720038029 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720038441 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1720039407 207L00000X 020 Physicians 005 Anesthesiology

1720044183 2085N0700X 020 Physicians 204 Neuroradiology

1720044183 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720044183 2085U0001X 020 Physicians 583 Radiology; Diagnostic Ultrasound

1720044183 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1720044357 207Y00000X 020 Physicians 217 Otolaryngology

1720046022 207Q00000X 020 Physicians 173 Family Medicine

1720049695 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1720050560 207P00000X 020 Physicians 270 Emergency Medicine

1720050560 208600000X 020 Physicians 275 Surgery

1720050560 208D00000X 020 Physicians 001 General Practice

1720052194 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720058043 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1720058852 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1720059132 207RI0200X 020 Physicians 185 Infectious Diseases

1720059132 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1720059918 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1720065220 207RC0000X 020 Physicians 006 Cardiovascular Disease

1720065220 2080P0202X 020 Physicians 221 Pediatric Cardiology

1720066491 207P00000X 020 Physicians 270 Emergency Medicine

399 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720066848 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720067499 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720067770 2085N0904X 020 Physicians 495 Nuclear Radiology

1720067770 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720068562 207V00000X 020 Physicians 016 OB/GYN

1720075666 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720078405 1223G0001X 012 Dental Providers 001 General Practice

1720078728 207Q00000X 020 Physicians 173 Family Medicine

1720079809 2085R0202X 020 Physicians 167 Diagnostic Radiology

1720081490 207R00000X 020 Physicians 011 Internal Medicine

1720081490 207RN0300X 020 Physicians 105 Nephrology

1720082639 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720084569 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720092596 207R00000X 020 Physicians 011 Internal Medicine

1720092596 207RC0200X 020 Physicians 206 Critical Care Medicine

1720093172 207R00000X 020 Physicians 011 Internal Medicine

1720095482 2084S0012X 020 Physicians 521 Sleep Medicine

1720095482 207QS1201X 020 Physicians 603 Family Medicine; Sleep Medicine

1720098833 207RP1001X 020 Physicians 029 Pulmonary Diseases

1720104144 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720108384 208600000X 020 Physicians 275 Surgery

1720123714 207X00000X 020 Physicians 020 Orthopedic Surgery

1720124001 207P00000X 020 Physicians 270 Emergency Medicine

1720124571 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1720124589 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1720131451 208200000X 020 Physicians 024 Plastic Surgery

1720132319 207R00000X 020 Physicians 011 Internal Medicine

1720138100 207RC0000X 020 Physicians 006 Cardiovascular Disease

1720143423 111N00000X 011 Chiropractic Providers 047 Chiropractor

1720150642 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1720151913 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

400 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720156136 207RG0100X 020 Physicians 010 Gastroenterology

1720159973 207R00000X 020 Physicians 011 Internal Medicine

1720163470 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1720170822 208100000X 020 Physicians 025 Physical Medicine and Rehab

1720171986 2086S0120X 020 Physicians 245 Pediatric Surgery

1720174089 207Q00000X 020 Physicians 173 Family Medicine

1720176308 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1720183171 208G00000X 020 Physicians 033 Thoracic Surgery

1720186653 207L00000X 020 Physicians 005 Anesthesiology

1720187016 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1720187669 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720199755 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1720199755 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1720209414 207V00000X 020 Physicians 016 OB/GYN

1720214026 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1720221252 208G00000X 020 Physicians 033 Thoracic Surgery

1720222805 207P00000X 020 Physicians 270 Emergency Medicine

1720223787 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1720228448 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720249451 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1720252216 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1720255367 2084N0400X 020 Physicians 013 Neurology

1720255367 207R00000X 020 Physicians 011 Internal Medicine

1720255656 2088P0231X 020 Physicians 246 Pediatric Urology

1720269749 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1720269749 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1720270895 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1720273436 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720284508 207Y00000X 020 Physicians 217 Otolaryngology

1720285323 207Y00000X 020 Physicians 217 Otolaryngology

1720287394 207P00000X 020 Physicians 270 Emergency Medicine

401 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720291701 1223G0001X 012 Dental Providers 001 General Practice

1720291701 122300000X 012 Dental Providers 019 Dentists

1720297427 208000000X 020 Physicians 049 Pediatrics

1720304439 2080P0202X 020 Physicians 221 Pediatric Cardiology

1720304942 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720309685 208800000X 020 Physicians 034 Urology

1720311921 207L00000X 020 Physicians 005 Anesthesiology

1720312481 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1720330178 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720333917 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1720335953 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1720336753 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1720344096 2084P0800X 020 Physicians 121 Psychiatry

1720349541 207Q00000X 020 Physicians 173 Family Medicine

1720351935 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1720355175 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720355233 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1720355233 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720355233 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720371602 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1720373996 2084P0800X 020 Physicians 121 Psychiatry

1720374960 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720375116 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1720376452 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720376825 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720376825 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1720377674 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720379506 208000000X 020 Physicians 049 Pediatrics

1720382153 111N00000X 011 Chiropractic Providers 047 Chiropractor

1720383763 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720391220 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

402 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720391428 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1720395114 207L00000X 020 Physicians 005 Anesthesiology

1720399454 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1720402126 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1720407364 2084P0800X 020 Physicians 121 Psychiatry

1720408131 207P00000X 020 Physicians 270 Emergency Medicine

1720411853 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1720412323 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1720413966 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1720413966 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720414832 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720426802 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1720428519 207YS0123X 020 Physicians 301 Facial Plastic Surgery

1720428519 207Y00000X 020 Physicians 217 Otolaryngology

1720435175 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1720435175 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1720455991 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1720475767 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720482813 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1720484918 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720487861 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1720490550 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1720493463 207R00000X 020 Physicians 011 Internal Medicine

1720493760 207R00000X 020 Physicians 011 Internal Medicine

1720494222 2084N0400X 020 Physicians 013 Neurology

1720495252 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1720496789 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1720498868 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1720503436 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1720506637 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720515935 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

403 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1720521818 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720523145 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1720523145 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1720537061 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1720555998 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720560600 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1720568785 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1720568785 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1720591555 207Q00000X 020 Physicians 173 Family Medicine

1720611171 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1720612633 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1720616352 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1720621162 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1720637630 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1720645922 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1730100959 208600000X 020 Physicians 275 Surgery

1730102070 207RH0000X 020 Physicians 178 Hematology

1730106329 207Q00000X 020 Physicians 173 Family Medicine

1730106402 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730109257 207Q00000X 020 Physicians 173 Family Medicine

1730109885 207L00000X 020 Physicians 005 Anesthesiology

1730111477 207T00000X 020 Physicians 014 Neurological Surgery

1730113671 2085R0202X 020 Physicians 167 Diagnostic Radiology

1730120882 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1730122623 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730123191 2085R0202X 020 Physicians 167 Diagnostic Radiology

1730123316 207P00000X 020 Physicians 270 Emergency Medicine

1730123852 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1730125816 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730130493 207X00000X 020 Physicians 020 Orthopedic Surgery

1730134545 207L00000X 020 Physicians 005 Anesthesiology

404 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1730135070 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1730135815 207P00000X 020 Physicians 270 Emergency Medicine

1730136656 208600000X 020 Physicians 275 Surgery

1730139940 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1730140476 207R00000X 020 Physicians 011 Internal Medicine

1730140476 207RN0300X 020 Physicians 105 Nephrology

1730141466 2084N0400X 020 Physicians 013 Neurology

1730151259 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730152034 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1730152455 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1730152893 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730153503 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730153503 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1730154303 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1730156795 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730156928 122300000X 012 Dental Providers 019 Dentists

1730159526 207R00000X 020 Physicians 011 Internal Medicine

1730159955 2085R0202X 020 Physicians 167 Diagnostic Radiology

1730165770 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730165911 2085R0202X 020 Physicians 167 Diagnostic Radiology

1730167073 2085R0202X 020 Physicians 167 Diagnostic Radiology

1730167719 207R00000X 020 Physicians 011 Internal Medicine

1730168220 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1730168915 2084N0400X 020 Physicians 013 Neurology

1730169251 208M00000X 020 Physicians 344 Hospitalist

1730169251 207Q00000X 020 Physicians 173 Family Medicine

1730169806 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730169947 207ZP0101X 020 Physicians 022 Pathology

1730174137 207P00000X 020 Physicians 270 Emergency Medicine

1730174152 208600000X 020 Physicians 275 Surgery

1730184078 207RN0300X 020 Physicians 105 Nephrology

405 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1730184623 207R00000X 020 Physicians 011 Internal Medicine

1730191990 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730193269 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1730193962 207RG0100X 020 Physicians 010 Gastroenterology

1730198383 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730198946 208M00000X 020 Physicians 344 Hospitalist

1730206137 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1730213398 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1730250879 207P00000X 020 Physicians 270 Emergency Medicine

1730250879 207Q00000X 020 Physicians 173 Family Medicine

1730253428 1223G0001X 012 Dental Providers 001 General Practice

1730254418 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1730260803 208600000X 020 Physicians 275 Surgery

1730260803 2086S0120X 020 Physicians 245 Pediatric Surgery

1730262510 208000000X 020 Physicians 049 Pediatrics

1730265752 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1730265760 207RC0000X 020 Physicians 006 Cardiovascular Disease

1730270539 207Y00000X 020 Physicians 217 Otolaryngology

1730270901 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1730271404 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1730271909 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1730271958 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1730274085 208600000X 020 Physicians 275 Surgery

1730276619 122300000X 012 Dental Providers 019 Dentists

1730285222 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1730285222 208000000X 020 Physicians 049 Pediatrics

1730295940 207V00000X 020 Physicians 016 OB/GYN

1730319492 207RC0200X 020 Physicians 206 Critical Care Medicine

1730323304 207N00000X 020 Physicians 007 Dermatology

1730331117 111N00000X 011 Chiropractic Providers 047 Chiropractor

1730334384 207R00000X 020 Physicians 011 Internal Medicine

406 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1730342072 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1730345067 207L00000X 020 Physicians 005 Anesthesiology

1730348319 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1730349929 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1730355744 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730356833 1223X0400X 012 Dental Providers 064 Orthodontics

1730367939 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1730369935 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1730373580 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1730373580 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1730379348 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730387549 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730387606 207R00000X 020 Physicians 011 Internal Medicine

1730390485 207N00000X 020 Physicians 007 Dermatology

1730413238 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1730416660 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1730435850 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1730440140 207RH0003X 020 Physicians 179 Hematology/Oncology

1730443557 2084P0800X 020 Physicians 121 Psychiatry

1730446204 2084P0800X 020 Physicians 121 Psychiatry

1730446477 207Q00000X 020 Physicians 173 Family Medicine

1730452046 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730453648 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1730454273 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730455908 207L00000X 020 Physicians 005 Anesthesiology

1730462409 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1730462409 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1730465568 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730471293 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1730476425 208000000X 020 Physicians 049 Pediatrics

1730487851 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

407 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1730490426 207L00000X 020 Physicians 005 Anesthesiology

1730497660 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1730499492 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1730503004 111N00000X 011 Chiropractic Providers 047 Chiropractor

1730510629 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1730510736 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1730511825 122300000X 012 Dental Providers 019 Dentists

1730520230 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1730523739 207L00000X 020 Physicians 005 Anesthesiology

1730523739 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1730532805 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1730535386 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1730535386 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1730541954 208000000X 020 Physicians 049 Pediatrics

1730543711 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1730560236 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730560319 207X00000X 020 Physicians 020 Orthopedic Surgery

1730564402 207Q00000X 020 Physicians 173 Family Medicine

1730566035 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1730566340 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1730569195 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1730584566 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730585985 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1730591280 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730593930 207Q00000X 020 Physicians 173 Family Medicine

1730597006 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1730601774 111N00000X 011 Chiropractic Providers 047 Chiropractor

1730606286 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1730620105 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1730637646 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730660515 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

408 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1730666272 208600000X 020 Physicians 275 Surgery

1730693581 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1730695412 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1730698408 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730722950 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1730726662 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730735036 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1730735838 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1730741992 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1730748948 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1740200336 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1740202381 207P00000X 020 Physicians 270 Emergency Medicine

1740205756 208000000X 020 Physicians 049 Pediatrics

1740207281 208600000X 020 Physicians 275 Surgery

1740207380 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740207414 207P00000X 020 Physicians 270 Emergency Medicine

1740207414 207PE0004X 020 Physicians 093 Emergency Medical Services

1740207414 207Q00000X 020 Physicians 173 Family Medicine

1740207745 207RN0300X 020 Physicians 105 Nephrology

1740207745 207R00000X 020 Physicians 011 Internal Medicine

1740208396 207R00000X 020 Physicians 011 Internal Medicine

1740217330 207RC0000X 020 Physicians 006 Cardiovascular Disease

1740218916 207L00000X 020 Physicians 005 Anesthesiology

1740224260 208600000X 020 Physicians 275 Surgery

1740224906 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1740225366 207L00000X 020 Physicians 005 Anesthesiology

1740231877 208200000X 020 Physicians 024 Plastic Surgery

1740234947 111N00000X 011 Chiropractic Providers 047 Chiropractor

1740237791 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1740250752 207T00000X 020 Physicians 014 Neurological Surgery

1740252220 207P00000X 020 Physicians 270 Emergency Medicine

409 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1740254515 2086S0129X 020 Physicians 289 Vascular Surgery

1740254739 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740256163 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1740259241 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1740261841 207RC0000X 020 Physicians 006 Cardiovascular Disease

1740266543 207RH0000X 020 Physicians 178 Hematology

1740266790 2084N0400X 020 Physicians 013 Neurology

1740266998 207RC0000X 020 Physicians 006 Cardiovascular Disease

1740266998 207RI0011X 020 Physicians 188 Interventional Cardiology

1740269240 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740269794 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740270339 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1740273374 2080P0202X 020 Physicians 221 Pediatric Cardiology

1740275296 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740275908 207W00000X 020 Physicians 018 Ophthalmology

1740277896 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740293380 207P00000X 020 Physicians 270 Emergency Medicine

1740294099 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740294172 207P00000X 020 Physicians 270 Emergency Medicine

1740298546 122300000X 012 Dental Providers 019 Dentists

1740305473 207Y00000X 020 Physicians 217 Otolaryngology

1740327493 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1740328384 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1740328640 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1740329788 207L00000X 020 Physicians 005 Anesthesiology

1740333079 207V00000X 020 Physicians 016 OB/GYN

1740333616 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740333616 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740338425 111N00000X 011 Chiropractic Providers 047 Chiropractor

1740344811 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1740353374 111N00000X 011 Chiropractic Providers 047 Chiropractor

410 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1740354646 208000000X 020 Physicians 049 Pediatrics

1740354984 207P00000X 020 Physicians 270 Emergency Medicine

1740360619 207RG0100X 020 Physicians 010 Gastroenterology

1740360734 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1740361450 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1740364991 122300000X 012 Dental Providers 019 Dentists

1740365485 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1740367135 208600000X 020 Physicians 275 Surgery

1740371756 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740372036 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1740372960 207R00000X 020 Physicians 011 Internal Medicine

1740382456 2084P0800X 020 Physicians 121 Psychiatry

1740388941 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1740391044 207ZP0101X 020 Physicians 436 Anatomic Pathology

1740394824 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740397538 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1740402858 208600000X 020 Physicians 275 Surgery

1740410638 207RG0100X 020 Physicians 010 Gastroenterology

1740410810 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1740410984 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1740416502 207P00000X 020 Physicians 270 Emergency Medicine

1740418094 208100000X 020 Physicians 025 Physical Medicine and Rehab

1740419662 2084P0800X 020 Physicians 121 Psychiatry

1740423870 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740426568 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1740430016 207P00000X 020 Physicians 270 Emergency Medicine

1740430016 207PE0005X 020 Physicians 638 Undersea and Hyperbaric Medicine

1740432558 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1740432772 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1740440429 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1740449040 207Q00000X 020 Physicians 173 Family Medicine

411 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1740451871 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1740452093 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1740454412 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740455302 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740457902 207PE0004X 020 Physicians 093 Emergency Medical Services

1740459551 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740462464 207RG0100X 020 Physicians 010 Gastroenterology

1740462464 207R00000X 020 Physicians 011 Internal Medicine

1740465830 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1740486778 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1740487172 207P00000X 020 Physicians 270 Emergency Medicine

1740489350 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740490333 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1740495654 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740498104 2084N0400X 020 Physicians 013 Neurology

1740501386 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740505031 207L00000X 020 Physicians 005 Anesthesiology

1740507490 207T00000X 020 Physicians 014 Neurological Surgery

1740512557 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1740521178 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1740522259 208000000X 020 Physicians 049 Pediatrics

1740523935 2084N0400X 020 Physicians 013 Neurology

1740529403 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1740530054 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1740540707 207X00000X 020 Physicians 020 Orthopedic Surgery

1740551365 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1740557602 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1740571413 207R00000X 020 Physicians 011 Internal Medicine

1740571413 208M00000X 020 Physicians 344 Hospitalist

1740572049 2085R0202X 020 Physicians 167 Diagnostic Radiology

1740572080 2085R0202X 020 Physicians 167 Diagnostic Radiology

412 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1740575000 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740575125 207ZP0101X 020 Physicians 436 Anatomic Pathology

1740575851 207X00000X 020 Physicians 020 Orthopedic Surgery

1740576115 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740586841 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740591627 2084N0400X 020 Physicians 013 Neurology

1740595552 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1740599513 208000000X 020 Physicians 049 Pediatrics

1740599513 2080P0202X 020 Physicians 221 Pediatric Cardiology

1740604867 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1740615236 208M00000X 020 Physicians 344 Hospitalist

1740623065 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740629351 207Q00000X 020 Physicians 173 Family Medicine

1740635580 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740651421 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1740651421 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740676063 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740683796 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1740686971 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740692409 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740692482 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740692482 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740696483 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740713239 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1740714161 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1740714161 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1740747286 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1740748763 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1740753573 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740769496 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1740769496 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

413 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1740770304 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1740779388 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1740785427 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1740789684 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1740789726 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1740793769 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1740799600 207R00000X 020 Physicians 011 Internal Medicine

1740813146 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1740822584 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1740827633 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1740832450 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1750300612 207R00000X 020 Physicians 011 Internal Medicine

1750300612 208M00000X 020 Physicians 344 Hospitalist

1750302097 208M00000X 020 Physicians 344 Hospitalist

1750302527 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1750302527 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1750302972 207Q00000X 020 Physicians 173 Family Medicine

1750303327 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750303392 207Q00000X 020 Physicians 173 Family Medicine

1750307740 207Q00000X 020 Physicians 173 Family Medicine

1750308383 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750308425 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1750308755 2084N0400X 020 Physicians 013 Neurology

1750308755 2084P0800X 020 Physicians 121 Psychiatry

1750309324 208000000X 020 Physicians 049 Pediatrics

1750312708 208000000X 020 Physicians 049 Pediatrics

1750313045 207ZP0101X 020 Physicians 436 Anatomic Pathology

1750317632 207Q00000X 020 Physicians 173 Family Medicine

1750318952 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750324349 207RX0202X 020 Physicians 529 Medical Oncology

1750324349 207R00000X 020 Physicians 011 Internal Medicine

414 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750328399 207L00000X 020 Physicians 005 Anesthesiology

1750330338 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1750333167 2084N0400X 020 Physicians 013 Neurology

1750338232 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750339586 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750340360 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750341889 207RC0000X 020 Physicians 006 Cardiovascular Disease

1750343877 111N00000X 011 Chiropractic Providers 047 Chiropractor

1750345252 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1750348124 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750351144 111N00000X 011 Chiropractic Providers 047 Chiropractor

1750351748 207P00000X 020 Physicians 270 Emergency Medicine

1750351805 207RI0200X 020 Physicians 185 Infectious Diseases

1750353298 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750354411 207RC0000X 020 Physicians 006 Cardiovascular Disease

1750355707 207RC0000X 020 Physicians 006 Cardiovascular Disease

1750356440 207RC0000X 020 Physicians 006 Cardiovascular Disease

1750356622 208600000X 020 Physicians 275 Surgery

1750358446 207T00000X 020 Physicians 014 Neurological Surgery

1750360731 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750361697 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750361788 207RG0100X 020 Physicians 010 Gastroenterology

1750367322 207Q00000X 020 Physicians 173 Family Medicine

1750367322 207P00000X 020 Physicians 270 Emergency Medicine

1750367512 2084N0400X 020 Physicians 013 Neurology

1750368171 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1750368692 208600000X 020 Physicians 275 Surgery

1750369526 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750369872 208600000X 020 Physicians 275 Surgery

1750369872 2086S0127X 020 Physicians 633 Trauma Surgery

1750369989 2085R0202X 020 Physicians 167 Diagnostic Radiology

415 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750370029 207RG0100X 020 Physicians 010 Gastroenterology

1750375390 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750382933 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750385399 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750386892 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750390027 207RN0300X 020 Physicians 105 Nephrology

1750390258 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750393922 2084S0012X 020 Physicians 521 Sleep Medicine

1750393922 207RC0200X 020 Physicians 206 Critical Care Medicine

1750393922 207RP1001X 020 Physicians 029 Pulmonary Diseases

1750395570 207R00000X 020 Physicians 011 Internal Medicine

1750397063 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750412888 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1750415873 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1750425708 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1750425708 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1750427589 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750429510 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750435053 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750435269 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1750437356 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750460044 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1750461166 2080P0202X 020 Physicians 221 Pediatric Cardiology

1750461166 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1750466801 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1750470746 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750471058 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750472767 207Q00000X 020 Physicians 173 Family Medicine

1750472866 208600000X 020 Physicians 275 Surgery

1750476727 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1750476727 207ZC0006X 020 Physicians 021 Clinical Pathology

416 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750478780 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750478780 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1750479127 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1750486528 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750487252 208600000X 020 Physicians 275 Surgery

1750488227 208600000X 020 Physicians 275 Surgery

1750492104 207L00000X 020 Physicians 005 Anesthesiology

1750492856 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1750493052 208600000X 020 Physicians 275 Surgery

1750493052 208G00000X 020 Physicians 033 Thoracic Surgery

1750493169 111N00000X 011 Chiropractic Providers 047 Chiropractor

1750500054 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750500088 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1750503611 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1750512109 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1750512133 207V00000X 020 Physicians 016 OB/GYN

1750517306 207L00000X 020 Physicians 005 Anesthesiology

1750519070 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750519153 2084N0400X 020 Physicians 013 Neurology

1750519963 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750523353 207P00000X 020 Physicians 270 Emergency Medicine

1750523775 208M00000X 020 Physicians 344 Hospitalist

1750523775 207Q00000X 020 Physicians 173 Family Medicine

1750525580 208000000X 020 Physicians 049 Pediatrics

1750544151 207NP0225X 020 Physicians 222 Pediatric Dermatology

1750544151 207N00000X 020 Physicians 007 Dermatology

1750544581 207V00000X 020 Physicians 016 OB/GYN

1750561759 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750566618 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750571063 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1750571063 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

417 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750574927 207RR0500X 020 Physicians 267 Rheumatology

1750578175 2084P0800X 020 Physicians 121 Psychiatry

1750582300 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1750585501 207X00000X 020 Physicians 020 Orthopedic Surgery

1750586772 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750588703 208M00000X 020 Physicians 344 Hospitalist

1750591632 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1750599064 207X00000X 020 Physicians 020 Orthopedic Surgery

1750599916 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1750607248 2085N0700X 020 Physicians 204 Neuroradiology

1750609541 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750614582 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750615225 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750616835 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1750617783 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1750619730 1223X0400X 012 Dental Providers 064 Orthodontics

1750632352 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1750636932 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1750636940 122300000X 012 Dental Providers 019 Dentists

1750637013 111N00000X 011 Chiropractic Providers 047 Chiropractor

1750647566 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1750648366 207N00000X 020 Physicians 007 Dermatology

1750648531 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1750652350 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1750668083 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750669214 207RH0003X 020 Physicians 179 Hematology/Oncology

1750675500 207X00000X 020 Physicians 020 Orthopedic Surgery

1750676201 208800000X 020 Physicians 034 Urology

1750676342 207Q00000X 020 Physicians 173 Family Medicine

1750679080 207R00000X 020 Physicians 011 Internal Medicine

1750683389 111N00000X 011 Chiropractic Providers 047 Chiropractor

418 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750693784 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750693826 207ZP0101X 020 Physicians 022 Pathology

1750693826 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1750693826 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1750698585 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750708244 207R00000X 020 Physicians 011 Internal Medicine

1750721593 2085R0202X 020 Physicians 167 Diagnostic Radiology

1750722484 207T00000X 020 Physicians 014 Neurological Surgery

1750727004 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1750727749 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1750728606 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1750730834 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1750730834 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1750730966 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1750733911 207Q00000X 020 Physicians 173 Family Medicine

1750735106 208000000X 020 Physicians 049 Pediatrics

1750749131 171M00000X 010 Behav Health & Social Svc Prov 489 Case Aide

1750749131 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1750750709 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1750753604 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1750767737 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1750776530 207P00000X 020 Physicians 270 Emergency Medicine

1750776530 207PE0004X 020 Physicians 093 Emergency Medical Services

1750780185 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750784005 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1750792966 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750799235 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1750799391 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1750827911 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1750827911 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1750827911 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

419 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1750843660 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1750845988 111N00000X 011 Chiropractic Providers 047 Chiropractor

1750866935 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1750874335 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1750875308 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1750913133 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750924080 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1750927554 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1750933636 207Q00000X 020 Physicians 173 Family Medicine

1750936332 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1750939922 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1750943783 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1750947404 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1750947404 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1750949855 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760015598 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1760026355 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760027007 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1760031850 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760040950 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760048284 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1760400352 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760402267 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1760403984 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1760405534 207P00000X 020 Physicians 270 Emergency Medicine

1760405898 207N00000X 020 Physicians 007 Dermatology

1760409627 207R00000X 020 Physicians 011 Internal Medicine

1760409767 207R00000X 020 Physicians 011 Internal Medicine

1760411664 207W00000X 020 Physicians 018 Ophthalmology

1760411888 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1760413124 207R00000X 020 Physicians 011 Internal Medicine

420 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1760413124 207RP1001X 020 Physicians 029 Pulmonary Diseases

1760416374 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760423354 2084N0400X 020 Physicians 013 Neurology

1760424048 207P00000X 020 Physicians 270 Emergency Medicine

1760425037 111N00000X 011 Chiropractic Providers 047 Chiropractor

1760426035 207RG0100X 020 Physicians 010 Gastroenterology

1760429138 2085R0202X 020 Physicians 167 Diagnostic Radiology

1760433163 207ZP0101X 020 Physicians 022 Pathology

1760437198 208600000X 020 Physicians 275 Surgery

1760439061 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1760439087 207L00000X 020 Physicians 005 Anesthesiology

1760445910 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760449417 111N00000X 011 Chiropractic Providers 047 Chiropractor

1760453203 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1760455679 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760456198 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760456453 207RC0000X 020 Physicians 006 Cardiovascular Disease

1760462295 207RG0100X 020 Physicians 010 Gastroenterology

1760466361 207N00000X 020 Physicians 007 Dermatology

1760468078 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1760470926 207R00000X 020 Physicians 011 Internal Medicine

1760483788 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1760488746 207RN0300X 020 Physicians 105 Nephrology

1760488746 207R00000X 020 Physicians 011 Internal Medicine

1760492490 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1760492490 207RC0200X 020 Physicians 206 Critical Care Medicine

1760492904 207RC0000X 020 Physicians 006 Cardiovascular Disease

1760494900 208M00000X 020 Physicians 344 Hospitalist

1760495840 207V00000X 020 Physicians 016 OB/GYN

1760496509 2084P0800X 020 Physicians 121 Psychiatry

1760496509 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

421 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1760497150 2085R0202X 020 Physicians 167 Diagnostic Radiology

1760510978 208G00000X 020 Physicians 033 Thoracic Surgery

1760510978 2086S0102X 020 Physicians 539 Surgical Critical Care

1760510978 208600000X 020 Physicians 275 Surgery

1760511752 111N00000X 011 Chiropractic Providers 047 Chiropractor

1760516124 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760518062 207P00000X 020 Physicians 270 Emergency Medicine

1760529036 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1760538359 2080P0202X 020 Physicians 221 Pediatric Cardiology

1760540801 207P00000X 020 Physicians 270 Emergency Medicine

1760545966 2085R0202X 020 Physicians 167 Diagnostic Radiology

1760552376 209800000X 020 Physicians 375 Legal Medicine

1760560346 207R00000X 020 Physicians 011 Internal Medicine

1760560346 207RP1001X 020 Physicians 029 Pulmonary Diseases

1760562466 208000000X 020 Physicians 049 Pediatrics

1760565634 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1760568869 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760570196 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760570998 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1760571285 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1760571830 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1760571830 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1760572713 208600000X 020 Physicians 275 Surgery

1760572770 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1760581276 208600000X 020 Physicians 275 Surgery

1760581664 207R00000X 020 Physicians 011 Internal Medicine

1760581714 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760589345 207V00000X 020 Physicians 016 OB/GYN

1760589568 207X00000X 020 Physicians 020 Orthopedic Surgery

1760595979 207R00000X 020 Physicians 011 Internal Medicine

1760601066 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

422 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1760608178 2085R0202X 020 Physicians 167 Diagnostic Radiology

1760612964 208600000X 020 Physicians 275 Surgery

1760617641 208600000X 020 Physicians 275 Surgery

1760620025 111N00000X 011 Chiropractic Providers 047 Chiropractor

1760630685 2086S0129X 020 Physicians 289 Vascular Surgery

1760640494 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1760656193 207R00000X 020 Physicians 011 Internal Medicine

1760656193 208M00000X 020 Physicians 344 Hospitalist

1760659353 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760677249 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1760679179 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1760680615 2084N0400X 020 Physicians 013 Neurology

1760696900 207R00000X 020 Physicians 011 Internal Medicine

1760700777 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1760707723 208000000X 020 Physicians 049 Pediatrics

1760708010 2084P0800X 020 Physicians 121 Psychiatry

1760710016 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1760720395 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1760720395 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1760720528 1223G0001X 012 Dental Providers 001 General Practice

1760722078 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760738678 208M00000X 020 Physicians 344 Hospitalist

1760741482 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1760745228 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760747653 183500000X 018 Pharmacy 253 Pharmacist

1760753917 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1760757744 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1760759302 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1760765416 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1760765416 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1760765416 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

423 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1760772842 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760773824 207V00000X 020 Physicians 016 OB/GYN

1760774178 207V00000X 020 Physicians 016 OB/GYN

1760777031 364SP0807X 036 Phys Assts and Advanced Nursing Provs 629 Clinical Nurse Specialist Child&Adol

1760777031 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1760777031 364SP0809X 036 Phys Assts and Advanced Nursing Provs 547 Clinical Nurse Specialist Psychiatric/M

1760777031 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1760777510 207R00000X 020 Physicians 011 Internal Medicine

1760779979 207RH0003X 020 Physicians 179 Hematology/Oncology

1760782098 122300000X 012 Dental Providers 019 Dentists

1760786032 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1760798177 2084N0400X 020 Physicians 013 Neurology

1760798177 2084V0102X 020 Physicians 552 Vascular Neurology

1760801187 208000000X 020 Physicians 049 Pediatrics

1760801484 207P00000X 020 Physicians 270 Emergency Medicine

1760802086 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760802508 2084N0400X 020 Physicians 013 Neurology

1760802524 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760807382 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1760808869 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1760808869 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760814222 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1760814222 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1760815492 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760821474 207R00000X 020 Physicians 011 Internal Medicine

1760834550 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1760861652 208100000X 020 Physicians 025 Physical Medicine and Rehab

1760869945 111N00000X 011 Chiropractic Providers 047 Chiropractor

1760884035 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760892822 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760892954 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

424 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1760897813 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1760898159 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1760899082 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760899652 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1760911101 207Q00000X 020 Physicians 173 Family Medicine

1760918502 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760929509 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1760933402 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760961627 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1760968085 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1760971196 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1760991426 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1760991426 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1760998470 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1770003329 208600000X 020 Physicians 275 Surgery

1770010217 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770018228 2084P0800X 020 Physicians 121 Psychiatry

1770034027 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770034910 183500000X 018 Pharmacy 253 Pharmacist

1770035925 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1770037368 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770057135 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770058232 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1770063703 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770072878 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1770089120 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1770090094 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770094229 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1770096786 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1770096786 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1770097107 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

425 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770111940 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1770123010 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1770138026 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770146003 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1770148371 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1770148371 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1770500639 207RH0003X 020 Physicians 179 Hematology/Oncology

1770500761 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1770501322 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770502064 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770504995 2080P0202X 020 Physicians 221 Pediatric Cardiology

1770509382 207R00000X 020 Physicians 011 Internal Medicine

1770510414 207L00000X 020 Physicians 005 Anesthesiology

1770510828 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1770510828 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1770514390 207Q00000X 020 Physicians 173 Family Medicine

1770514861 207P00000X 020 Physicians 270 Emergency Medicine

1770516478 207N00000X 020 Physicians 007 Dermatology

1770518599 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770522351 111N00000X 011 Chiropractic Providers 047 Chiropractor

1770526865 207P00000X 020 Physicians 270 Emergency Medicine

1770530909 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770534372 2085N0904X 020 Physicians 495 Nuclear Radiology

1770534372 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770536807 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1770536807 208000000X 020 Physicians 049 Pediatrics

1770539892 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1770540254 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770540288 208000000X 020 Physicians 049 Pediatrics

1770548794 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770549032 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

426 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770549941 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770552317 207R00000X 020 Physicians 011 Internal Medicine

1770552317 207RH0003X 020 Physicians 179 Hematology/Oncology

1770552317 207RX0202X 020 Physicians 529 Medical Oncology

1770552648 207RC0000X 020 Physicians 006 Cardiovascular Disease

1770553992 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770554453 111N00000X 011 Chiropractic Providers 047 Chiropractor

1770556409 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770558033 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1770558249 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1770558520 208600000X 020 Physicians 275 Surgery

1770562639 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770567604 208200000X 020 Physicians 024 Plastic Surgery

1770567604 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1770568172 208000000X 020 Physicians 049 Pediatrics

1770568172 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1770568735 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770569683 207RC0000X 020 Physicians 006 Cardiovascular Disease

1770571457 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770575185 207RH0000X 020 Physicians 178 Hematology

1770577967 207V00000X 020 Physicians 016 OB/GYN

1770584500 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1770584500 122300000X 012 Dental Providers 019 Dentists

1770586034 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770588550 183500000X 018 Pharmacy 253 Pharmacist

1770603813 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1770603888 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1770603888 207L00000X 020 Physicians 005 Anesthesiology

1770613259 2084P0800X 020 Physicians 121 Psychiatry

1770617458 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1770618944 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

427 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770627721 2084N0400X 020 Physicians 013 Neurology

1770627721 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1770627721 2084S0012X 020 Physicians 521 Sleep Medicine

1770629164 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1770645087 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1770649626 207R00000X 020 Physicians 011 Internal Medicine

1770654972 207RI0200X 020 Physicians 185 Infectious Diseases

1770657132 207Q00000X 020 Physicians 173 Family Medicine

1770657157 207RC0000X 020 Physicians 006 Cardiovascular Disease

1770661183 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1770662116 207P00000X 020 Physicians 270 Emergency Medicine

1770666422 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770668196 111N00000X 011 Chiropractic Providers 047 Chiropractor

1770679037 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770679037 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770682726 207Q00000X 020 Physicians 173 Family Medicine

1770685265 207P00000X 020 Physicians 270 Emergency Medicine

1770688376 207W00000X 020 Physicians 018 Ophthalmology

1770689945 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770701419 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1770702060 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1770721763 183500000X 018 Pharmacy 253 Pharmacist

1770726044 207V00000X 020 Physicians 016 OB/GYN

1770729337 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1770729659 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770730566 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1770731473 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1770738353 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1770740417 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1770743858 2086S0129X 020 Physicians 289 Vascular Surgery

1770744112 2084N0400X 020 Physicians 013 Neurology

428 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770744963 208800000X 020 Physicians 034 Urology

1770745978 207N00000X 020 Physicians 007 Dermatology

1770745978 207ND0900X 020 Physicians 260 Dermatopathology

1770752594 207RG0100X 020 Physicians 010 Gastroenterology

1770756272 1223G0001X 012 Dental Providers 001 General Practice

1770757221 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770759227 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1770759227 207R00000X 020 Physicians 011 Internal Medicine

1770760605 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770763062 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770776114 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770788085 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1770792731 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770797151 208000000X 020 Physicians 049 Pediatrics

1770797342 208M00000X 020 Physicians 344 Hospitalist

1770797359 207RG0100X 020 Physicians 010 Gastroenterology

1770797912 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1770797912 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1770807182 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1770823031 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770825382 208000000X 020 Physicians 049 Pediatrics

1770826778 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1770829970 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1770831158 208M00000X 020 Physicians 344 Hospitalist

1770834707 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1770849911 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1770849911 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1770859845 2084P0800X 020 Physicians 121 Psychiatry

1770860199 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1770860322 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770862815 207R00000X 020 Physicians 011 Internal Medicine

429 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770864142 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770867517 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1770873374 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1770876252 207L00000X 020 Physicians 005 Anesthesiology

1770876815 2084N0400X 020 Physicians 013 Neurology

1770879892 2085N0700X 020 Physicians 204 Neuroradiology

1770879892 2085R0202X 020 Physicians 167 Diagnostic Radiology

1770890030 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1770899577 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1770899981 207V00000X 020 Physicians 016 OB/GYN

1770904708 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770905614 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1770905614 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1770906760 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1770908808 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1770910044 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1770911562 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770919441 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1770924300 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1770928590 207X00000X 020 Physicians 020 Orthopedic Surgery

1770928780 208600000X 020 Physicians 275 Surgery

1770930273 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1770931453 208800000X 020 Physicians 034 Urology

1770935488 207R00000X 020 Physicians 011 Internal Medicine

1770936254 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1770936254 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1770947319 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1770947434 208800000X 020 Physicians 034 Urology

1770952111 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1770965972 207Q00000X 020 Physicians 173 Family Medicine

1770967408 2084N0400X 020 Physicians 013 Neurology

430 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1770968232 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770972184 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770975278 207Q00000X 020 Physicians 173 Family Medicine

1770979585 207R00000X 020 Physicians 011 Internal Medicine

1770986101 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1770986630 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770988024 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1770990509 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1780002139 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1780002139 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780009837 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1780015727 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780016592 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1780024695 207P00000X 020 Physicians 270 Emergency Medicine

1780027268 207P00000X 020 Physicians 270 Emergency Medicine

1780028530 207Q00000X 020 Physicians 173 Family Medicine

1780028530 208M00000X 020 Physicians 344 Hospitalist

1780035543 208M00000X 020 Physicians 344 Hospitalist

1780040634 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780044354 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1780048454 1223G0001X 012 Dental Providers 001 General Practice

1780048702 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780049973 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780051706 111N00000X 011 Chiropractic Providers 047 Chiropractor

1780054106 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780055749 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1780055749 171M00000X 010 Behav Health & Social Svc Prov 489 Case Aide

1780063321 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1780084293 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1780087015 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1780087106 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

431 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1780110056 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780120980 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780123380 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780133611 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1780133900 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780143610 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780146050 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1780150086 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1780150086 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1780163774 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1780175752 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780177089 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1780183574 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780189928 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780190736 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1780220350 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1780230938 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1780232371 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1780234377 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1780600254 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780602342 207R00000X 020 Physicians 011 Internal Medicine

1780604488 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1780605022 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780605022 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780611947 207V00000X 020 Physicians 016 OB/GYN

1780613042 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1780613042 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780614172 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780618249 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1780620765 207T00000X 020 Physicians 014 Neurological Surgery

1780627489 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

432 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1780629055 207P00000X 020 Physicians 270 Emergency Medicine

1780629311 207Q00000X 020 Physicians 173 Family Medicine

1780630855 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1780634568 207X00000X 020 Physicians 020 Orthopedic Surgery

1780638981 207Q00000X 020 Physicians 173 Family Medicine

1780644476 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1780649715 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780652404 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780655845 207X00000X 020 Physicians 020 Orthopedic Surgery

1780658351 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1780658377 2084N0400X 020 Physicians 013 Neurology

1780658377 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1780658377 2084P0800X 020 Physicians 121 Psychiatry

1780661256 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780661702 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780662114 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1780662114 207V00000X 020 Physicians 016 OB/GYN

1780662544 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780663260 208G00000X 020 Physicians 033 Thoracic Surgery

1780663328 207L00000X 020 Physicians 005 Anesthesiology

1780663450 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780664284 207RH0003X 020 Physicians 179 Hematology/Oncology

1780664284 207R00000X 020 Physicians 011 Internal Medicine

1780664417 207L00000X 020 Physicians 005 Anesthesiology

1780664664 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780668798 2085R0202X 020 Physicians 167 Diagnostic Radiology

1780680777 207RI0011X 020 Physicians 188 Interventional Cardiology

1780680777 207RC0000X 020 Physicians 006 Cardiovascular Disease

1780685651 207Y00000X 020 Physicians 217 Otolaryngology

1780689539 207Q00000X 020 Physicians 173 Family Medicine

1780693424 2085N0700X 020 Physicians 204 Neuroradiology

433 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1780700369 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1780705426 208100000X 020 Physicians 025 Physical Medicine and Rehab

1780714998 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1780718841 111N00000X 011 Chiropractic Providers 047 Chiropractor

1780720201 207W00000X 020 Physicians 018 Ophthalmology

1780720201 207WX0107X 020 Physicians 616 Retina Specialist

1780723239 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1780728147 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1780732297 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1780755835 207V00000X 020 Physicians 016 OB/GYN

1780758151 207V00000X 020 Physicians 016 OB/GYN

1780758417 207V00000X 020 Physicians 016 OB/GYN

1780758847 111N00000X 011 Chiropractic Providers 047 Chiropractor

1780760868 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1780763193 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780767616 207Q00000X 020 Physicians 173 Family Medicine

1780767616 207P00000X 020 Physicians 270 Emergency Medicine

1780767921 183500000X 018 Pharmacy 253 Pharmacist

1780768176 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1780776559 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780776559 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780777615 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1780777615 2084P0800X 020 Physicians 121 Psychiatry

1780778886 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1780790394 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780791707 208600000X 020 Physicians 275 Surgery

1780795773 208000000X 020 Physicians 049 Pediatrics

1780795773 208M00000X 020 Physicians 344 Hospitalist

1780796300 207L00000X 020 Physicians 005 Anesthesiology

1780798207 207P00000X 020 Physicians 270 Emergency Medicine

1780815795 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

434 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1780817858 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780818328 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1780818336 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780826867 207N00000X 020 Physicians 007 Dermatology

1780832204 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780832634 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1780832634 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780833483 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1780837641 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780842963 207L00000X 020 Physicians 005 Anesthesiology

1780848952 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780849265 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1780856997 2080P0202X 020 Physicians 221 Pediatric Cardiology

1780862862 207W00000X 020 Physicians 018 Ophthalmology

1780867283 207L00000X 020 Physicians 005 Anesthesiology

1780868786 207RI0011X 020 Physicians 188 Interventional Cardiology

1780868786 2080P0202X 020 Physicians 221 Pediatric Cardiology

1780877787 111N00000X 011 Chiropractic Providers 047 Chiropractor

1780881391 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1780883587 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1780885947 122300000X 012 Dental Providers 019 Dentists

1780886887 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1780903047 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1780906768 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1780919340 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1780927087 207P00000X 020 Physicians 270 Emergency Medicine

1780946756 2084N0400X 020 Physicians 013 Neurology

1780957084 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1780975771 207P00000X 020 Physicians 270 Emergency Medicine

1780979682 207RG0100X 020 Physicians 010 Gastroenterology

1790002129 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

435 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790002913 207RI0200X 020 Physicians 185 Infectious Diseases

1790005122 207P00000X 020 Physicians 270 Emergency Medicine

1790006658 207RC0000X 020 Physicians 006 Cardiovascular Disease

1790006658 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1790009595 2080P0202X 020 Physicians 221 Pediatric Cardiology

1790010338 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1790021228 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1790030187 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1790039071 2084P0800X 020 Physicians 121 Psychiatry

1790044014 207P00000X 020 Physicians 270 Emergency Medicine

1790048932 207R00000X 020 Physicians 011 Internal Medicine

1790048940 207R00000X 020 Physicians 011 Internal Medicine

1790060150 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1790064913 208000000X 020 Physicians 049 Pediatrics

1790064913 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1790077584 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1790077873 207X00000X 020 Physicians 020 Orthopedic Surgery

1790096741 207P00000X 020 Physicians 270 Emergency Medicine

1790099380 2084N0400X 020 Physicians 013 Neurology

1790109593 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790114155 207R00000X 020 Physicians 011 Internal Medicine

1790116499 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790119824 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1790124469 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1790130078 207P00000X 020 Physicians 270 Emergency Medicine

1790145043 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1790149466 207Y00000X 020 Physicians 217 Otolaryngology

1790150332 207T00000X 020 Physicians 014 Neurological Surgery

1790152155 207Y00000X 020 Physicians 217 Otolaryngology

1790160570 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790160778 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

436 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790160778 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1790161412 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1790163566 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1790163566 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1790163665 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1790176055 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1790185239 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1790188035 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1790191435 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1790193258 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1790195923 208000000X 020 Physicians 049 Pediatrics

1790195923 207R00000X 020 Physicians 011 Internal Medicine

1790211167 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790216844 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1790232171 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1790236925 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1790236925 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790237774 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1790243426 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1790253433 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1790256329 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790260867 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1790260867 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1790267193 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1790267342 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1790267342 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790275196 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1790289353 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790296754 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1790330553 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1790330884 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

437 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790341972 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1790345346 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1790347268 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1790701241 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790702447 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1790703114 207PE0004X 020 Physicians 093 Emergency Medical Services

1790703338 207X00000X 020 Physicians 020 Orthopedic Surgery

1790703353 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1790703395 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1790705168 208200000X 020 Physicians 024 Plastic Surgery

1790707537 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1790709673 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1790721967 207R00000X 020 Physicians 011 Internal Medicine

1790722635 207P00000X 020 Physicians 270 Emergency Medicine

1790722635 207Q00000X 020 Physicians 173 Family Medicine

1790725711 207P00000X 020 Physicians 270 Emergency Medicine

1790728210 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1790730265 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1790731214 207V00000X 020 Physicians 016 OB/GYN

1790731735 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790738003 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1790738821 208000000X 020 Physicians 049 Pediatrics

1790738821 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1790741999 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1790743268 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790748796 207RC0000X 020 Physicians 006 Cardiovascular Disease

1790755130 207L00000X 020 Physicians 005 Anesthesiology

1790756096 207V00000X 020 Physicians 016 OB/GYN

1790756302 207N00000X 020 Physicians 007 Dermatology

1790757201 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790757672 207RH0000X 020 Physicians 178 Hematology

438 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790757672 207RH0003X 020 Physicians 179 Hematology/Oncology

1790758456 111N00000X 011 Chiropractic Providers 047 Chiropractor

1790759090 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1790760064 2085R0202X 020 Physicians 167 Diagnostic Radiology

1790762029 207Q00000X 020 Physicians 173 Family Medicine

1790762086 207RG0100X 020 Physicians 010 Gastroenterology

1790762458 207L00000X 020 Physicians 005 Anesthesiology

1790763290 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1790763290 122300000X 012 Dental Providers 019 Dentists

1790764496 207X00000X 020 Physicians 020 Orthopedic Surgery

1790764959 2085R0202X 020 Physicians 167 Diagnostic Radiology

1790765865 207RI0200X 020 Physicians 185 Infectious Diseases

1790765865 207R00000X 020 Physicians 011 Internal Medicine

1790779197 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1790779197 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790789543 207Q00000X 020 Physicians 173 Family Medicine

1790789576 207Q00000X 020 Physicians 173 Family Medicine

1790792836 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1790796548 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1790796548 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1790804409 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1790805810 183500000X 018 Pharmacy 253 Pharmacist

1790808897 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1790819894 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1790819894 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1790819894 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790832756 207N00000X 020 Physicians 007 Dermatology

1790835445 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1790839934 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1790839934 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1790844181 208800000X 020 Physicians 034 Urology

439 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790846822 207R00000X 020 Physicians 011 Internal Medicine

1790854594 207X00000X 020 Physicians 020 Orthopedic Surgery

1790855252 207Q00000X 020 Physicians 173 Family Medicine

1790858884 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1790862738 208000000X 020 Physicians 049 Pediatrics

1790865673 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1790865921 122300000X 012 Dental Providers 019 Dentists

1790865921 1223G0001X 012 Dental Providers 001 General Practice

1790868156 2085P0229X 020 Physicians 241 Pediatric Radiology

1790868156 2085R0202X 020 Physicians 167 Diagnostic Radiology

1790868925 207RG0100X 020 Physicians 010 Gastroenterology

1790870384 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1790871051 2085R0202X 020 Physicians 167 Diagnostic Radiology

1790871713 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1790879880 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1790882967 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790884575 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790889152 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1790893899 122300000X 012 Dental Providers 019 Dentists

1790895456 208000000X 020 Physicians 049 Pediatrics

1790896561 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1790897460 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1790897817 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1790910180 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1790910446 207QS0010X 020 Physicians 520 Family Medicine; Sports Medicine

1790912954 111N00000X 011 Chiropractic Providers 047 Chiropractor

1790914554 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790921252 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1790923100 207RI0200X 020 Physicians 185 Infectious Diseases

1790923191 207P00000X 020 Physicians 270 Emergency Medicine

1790933588 207RH0000X 020 Physicians 178 Hematology

440 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1790933588 207RX0202X 020 Physicians 529 Medical Oncology

1790940658 208M00000X 020 Physicians 344 Hospitalist

1790940658 207P00000X 020 Physicians 270 Emergency Medicine

1790940658 207R00000X 020 Physicians 011 Internal Medicine

1790952612 207Q00000X 020 Physicians 173 Family Medicine

1790952836 208000000X 020 Physicians 049 Pediatrics

1790955599 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1790959047 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1790968261 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1790970341 207R00000X 020 Physicians 011 Internal Medicine

1790972446 207R00000X 020 Physicians 011 Internal Medicine

1790977718 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1790977957 207L00000X 020 Physicians 005 Anesthesiology

1790980340 122300000X 012 Dental Providers 019 Dentists

1790990919 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1790990976 207RI0200X 020 Physicians 185 Infectious Diseases

1790993103 122300000X 012 Dental Providers 019 Dentists

1790997393 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1790998730 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801002340 208600000X 020 Physicians 275 Surgery

1801004866 207Y00000X 020 Physicians 217 Otolaryngology

1801013172 2080P0202X 020 Physicians 221 Pediatric Cardiology

1801018841 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801019997 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1801019997 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1801019997 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1801024294 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801033642 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1801033824 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1801034889 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801038450 207X00000X 020 Physicians 020 Orthopedic Surgery

441 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801048350 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801058383 208600000X 020 Physicians 275 Surgery

1801063607 207ZC0500X 020 Physicians 631 Pathology;Cytopathology

1801063607 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1801063607 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1801063730 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801072020 364SA2200X 036 Phys Assts and Advanced Nursing Provs 550 Clinical Nurse Specialist Adult Health

1801073614 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801074554 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1801079231 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801079942 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801082482 207P00000X 020 Physicians 270 Emergency Medicine

1801090410 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801091806 207P00000X 020 Physicians 270 Emergency Medicine

1801093026 208800000X 020 Physicians 034 Urology

1801101878 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801104039 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801104039 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801104039 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1801107388 2084N0400X 020 Physicians 013 Neurology

1801110101 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1801117346 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1801117346 208000000X 020 Physicians 049 Pediatrics

1801117585 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801117585 2085N0700X 020 Physicians 204 Neuroradiology

1801133558 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1801133806 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801135850 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801141049 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801141502 2080P0202X 020 Physicians 221 Pediatric Cardiology

1801142674 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

442 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801150339 207RC0000X 020 Physicians 006 Cardiovascular Disease

1801151006 208000000X 020 Physicians 049 Pediatrics

1801171129 208000000X 020 Physicians 049 Pediatrics

1801174644 207Q00000X 020 Physicians 173 Family Medicine

1801174768 207Q00000X 020 Physicians 173 Family Medicine

1801174768 208M00000X 020 Physicians 344 Hospitalist

1801181235 1223G0001X 012 Dental Providers 001 General Practice

1801182613 207Y00000X 020 Physicians 217 Otolaryngology

1801183637 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801187232 2084P0800X 020 Physicians 121 Psychiatry

1801189550 207RG0100X 020 Physicians 010 Gastroenterology

1801189931 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801200290 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801201439 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801201439 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801204318 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1801208129 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1801211545 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801215470 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1801216205 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801216411 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801229182 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801231048 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1801244405 207Q00000X 020 Physicians 173 Family Medicine

1801246855 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801255823 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1801258280 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801258280 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801262100 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1801263884 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1801263884 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

443 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801266671 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801275128 208800000X 020 Physicians 034 Urology

1801275706 207R00000X 020 Physicians 011 Internal Medicine

1801275706 208M00000X 020 Physicians 344 Hospitalist

1801280524 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801282959 208M00000X 020 Physicians 344 Hospitalist

1801285366 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801287339 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801287529 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801287875 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801290119 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801290150 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801290846 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801295217 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1801299946 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801300413 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801315643 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1801316237 2084P0800X 020 Physicians 121 Psychiatry

1801316716 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801317417 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801332762 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1801338504 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801348370 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801349550 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1801357116 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1801391248 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1801439633 183500000X 018 Pharmacy 253 Pharmacist

1801455449 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801802293 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1801804588 207Q00000X 020 Physicians 173 Family Medicine

1801810791 207RC0200X 020 Physicians 206 Critical Care Medicine

444 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801811971 207Q00000X 020 Physicians 173 Family Medicine

1801812029 207L00000X 020 Physicians 005 Anesthesiology

1801812029 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1801814454 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801814470 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1801814470 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1801823711 207X00000X 020 Physicians 020 Orthopedic Surgery

1801827266 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1801828645 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1801830005 207L00000X 020 Physicians 005 Anesthesiology

1801830054 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1801830054 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801833421 207P00000X 020 Physicians 270 Emergency Medicine

1801833967 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801834775 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801836481 207L00000X 020 Physicians 005 Anesthesiology

1801837349 2085N0700X 020 Physicians 204 Neuroradiology

1801837349 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801842174 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1801842174 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1801843891 207L00000X 020 Physicians 005 Anesthesiology

1801848171 207W00000X 020 Physicians 018 Ophthalmology

1801848171 207WX0107X 020 Physicians 616 Retina Specialist

1801849781 2080H0002X 020 Physicians 542 Pediatric Hospice & Palliative Medicine

1801849971 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801850649 207L00000X 020 Physicians 005 Anesthesiology

1801851209 2084P0800X 020 Physicians 121 Psychiatry

1801853197 208G00000X 020 Physicians 033 Thoracic Surgery

1801853197 208600000X 020 Physicians 275 Surgery

1801853775 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1801855317 207RC0000X 020 Physicians 006 Cardiovascular Disease

445 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801858428 208200000X 020 Physicians 024 Plastic Surgery

1801860184 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801860978 207RI0200X 020 Physicians 185 Infectious Diseases

1801862115 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801862990 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1801863899 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801865365 2084N0400X 020 Physicians 013 Neurology

1801865548 207RH0003X 020 Physicians 179 Hematology/Oncology

1801868062 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801869227 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801869649 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801872734 207L00000X 020 Physicians 005 Anesthesiology

1801873658 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801873922 2084N0400X 020 Physicians 013 Neurology

1801874169 207RG0100X 020 Physicians 010 Gastroenterology

1801874417 207P00000X 020 Physicians 270 Emergency Medicine

1801874920 207X00000X 020 Physicians 020 Orthopedic Surgery

1801875901 207X00000X 020 Physicians 020 Orthopedic Surgery

1801875935 207RG0100X 020 Physicians 010 Gastroenterology

1801876974 207T00000X 020 Physicians 014 Neurological Surgery

1801878483 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1801879192 2085R0202X 020 Physicians 167 Diagnostic Radiology

1801879242 207RG0100X 020 Physicians 010 Gastroenterology

1801879242 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1801880687 208600000X 020 Physicians 275 Surgery

1801881594 208000000X 020 Physicians 049 Pediatrics

1801886445 207Y00000X 020 Physicians 217 Otolaryngology

1801888334 208000000X 020 Physicians 049 Pediatrics

1801888342 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801893490 207W00000X 020 Physicians 018 Ophthalmology

1801901186 207L00000X 020 Physicians 005 Anesthesiology

446 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1801907118 207ZP0101X 020 Physicians 436 Anatomic Pathology

1801908231 207RR0500X 020 Physicians 267 Rheumatology

1801908421 207L00000X 020 Physicians 005 Anesthesiology

1801909718 207V00000X 020 Physicians 016 OB/GYN

1801915426 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1801938519 208G00000X 020 Physicians 033 Thoracic Surgery

1801942495 2086S0120X 020 Physicians 245 Pediatric Surgery

1801956792 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801970215 207P00000X 020 Physicians 270 Emergency Medicine

1801970215 207Q00000X 020 Physicians 173 Family Medicine

1801972161 207T00000X 020 Physicians 014 Neurological Surgery

1801977798 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1801978473 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1801979745 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1801986484 207RC0000X 020 Physicians 006 Cardiovascular Disease

1801986484 207R00000X 020 Physicians 011 Internal Medicine

1801987813 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1801994629 207Q00000X 020 Physicians 173 Family Medicine

1801994710 207L00000X 020 Physicians 005 Anesthesiology

1801995501 207R00000X 020 Physicians 011 Internal Medicine

1801997143 111N00000X 011 Chiropractic Providers 047 Chiropractor

1801997739 2084P0800X 020 Physicians 121 Psychiatry

1811003478 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1811007966 207R00000X 020 Physicians 011 Internal Medicine

1811008543 208G00000X 020 Physicians 033 Thoracic Surgery

1811008543 208600000X 020 Physicians 275 Surgery

1811026446 207RC0200X 020 Physicians 206 Critical Care Medicine

1811031826 111N00000X 011 Chiropractic Providers 047 Chiropractor

1811036247 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811039464 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811043300 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

447 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811049950 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811054463 207L00000X 020 Physicians 005 Anesthesiology

1811063555 207R00000X 020 Physicians 011 Internal Medicine

1811064876 207RI0200X 020 Physicians 185 Infectious Diseases

1811065766 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811068950 208000000X 020 Physicians 049 Pediatrics

1811073174 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1811078298 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811083173 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1811084882 207P00000X 020 Physicians 270 Emergency Medicine

1811085137 2084N0400X 020 Physicians 013 Neurology

1811085970 207V00000X 020 Physicians 016 OB/GYN

1811086416 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1811086416 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1811087323 207ZC0006X 020 Physicians 021 Clinical Pathology

1811087323 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1811088602 207R00000X 020 Physicians 011 Internal Medicine

1811088610 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811093255 207Q00000X 020 Physicians 173 Family Medicine

1811095193 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1811100118 207RC0000X 020 Physicians 006 Cardiovascular Disease

1811100118 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1811101116 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811103989 207RI0200X 020 Physicians 185 Infectious Diseases

1811122476 122300000X 012 Dental Providers 019 Dentists

1811124357 207RH0000X 020 Physicians 178 Hematology

1811125073 208600000X 020 Physicians 275 Surgery

1811127814 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1811127905 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811130917 2084P0800X 020 Physicians 121 Psychiatry

1811134976 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

448 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811147762 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1811149156 207N00000X 020 Physicians 007 Dermatology

1811159403 207P00000X 020 Physicians 270 Emergency Medicine

1811159403 207PE0004X 020 Physicians 093 Emergency Medical Services

1811164007 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811164205 207L00000X 020 Physicians 005 Anesthesiology

1811167711 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811167976 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1811173834 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811174857 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811175193 208600000X 020 Physicians 275 Surgery

1811188022 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1811191695 122300000X 012 Dental Providers 019 Dentists

1811194491 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811195985 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811198278 207P00000X 020 Physicians 270 Emergency Medicine

1811201361 207RC0200X 020 Physicians 206 Critical Care Medicine

1811202260 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1811216229 207RI0011X 020 Physicians 188 Interventional Cardiology

1811216229 207R00000X 020 Physicians 011 Internal Medicine

1811216229 207RC0000X 020 Physicians 006 Cardiovascular Disease

1811218308 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1811223597 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1811228075 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1811230287 207L00000X 020 Physicians 005 Anesthesiology

1811231962 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1811237043 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1811237753 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1811239106 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1811250772 2080P0202X 020 Physicians 221 Pediatric Cardiology

1811254022 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

449 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811257330 207R00000X 020 Physicians 011 Internal Medicine

1811263627 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1811265903 111N00000X 011 Chiropractic Providers 047 Chiropractor

1811271745 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811274038 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1811285588 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1811293244 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1811299266 363LW0102X 036 Phys Assts and Advanced Nursing Provs 470 Nurse Practitioner- Women's Health

1811302623 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811303944 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811308828 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1811320302 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811326127 207RG0100X 020 Physicians 010 Gastroenterology

1811326705 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1811327224 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1811328800 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1811328800 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1811330079 207RH0000X 020 Physicians 178 Hematology

1811330079 207RX0202X 020 Physicians 529 Medical Oncology

1811331119 208000000X 020 Physicians 049 Pediatrics

1811331432 2084P0800X 020 Physicians 121 Psychiatry

1811334030 207Q00000X 020 Physicians 173 Family Medicine

1811335391 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1811339369 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811363104 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811375835 207P00000X 020 Physicians 270 Emergency Medicine

1811382781 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811385354 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811392657 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1811394554 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1811398365 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

450 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811398365 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811400799 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811401797 111N00000X 011 Chiropractic Providers 047 Chiropractor

1811403850 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811413222 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811414857 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1811414857 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1811414857 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1811417900 207Q00000X 020 Physicians 173 Family Medicine

1811418684 207Q00000X 020 Physicians 173 Family Medicine

1811419989 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811436918 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1811442205 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811449341 111N00000X 011 Chiropractic Providers 047 Chiropractor

1811454242 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1811466444 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1811470438 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1811470438 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1811471881 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811474182 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1811482334 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811489743 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811489990 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1811516586 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1811531478 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1811541477 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1811545437 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811909302 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811913379 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811914583 207RH0003X 020 Physicians 179 Hematology/Oncology

1811916125 2080P0202X 020 Physicians 221 Pediatric Cardiology

451 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811921596 2084P0800X 020 Physicians 121 Psychiatry

1811924467 207T00000X 020 Physicians 014 Neurological Surgery

1811925282 207L00000X 020 Physicians 005 Anesthesiology

1811932387 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1811932551 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811933310 2085P0229X 020 Physicians 241 Pediatric Radiology

1811939713 208000000X 020 Physicians 049 Pediatrics

1811939713 207Q00000X 020 Physicians 173 Family Medicine

1811950231 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811950744 207Y00000X 020 Physicians 217 Otolaryngology

1811951528 207V00000X 020 Physicians 016 OB/GYN

1811953987 207RC0000X 020 Physicians 006 Cardiovascular Disease

1811957012 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1811960115 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811966617 207XX0801X 020 Physicians 632 Orthopaedic Trauma

1811966617 207X00000X 020 Physicians 020 Orthopedic Surgery

1811967037 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1811969827 207RC0000X 020 Physicians 006 Cardiovascular Disease

1811969967 207RC0000X 020 Physicians 006 Cardiovascular Disease

1811973027 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1811973837 2084N0400X 020 Physicians 013 Neurology

1811975121 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811976285 207Y00000X 020 Physicians 217 Otolaryngology

1811976442 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1811977358 207L00000X 020 Physicians 005 Anesthesiology

1811977481 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1811977689 207L00000X 020 Physicians 005 Anesthesiology

1811977887 208100000X 020 Physicians 025 Physical Medicine and Rehab

1811981681 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1811981681 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1811986102 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

452 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1811986102 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1811991607 207Q00000X 020 Physicians 173 Family Medicine

1811994858 2085R0202X 020 Physicians 167 Diagnostic Radiology

1811998685 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1811998685 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821001447 207PE0004X 020 Physicians 093 Emergency Medical Services

1821010406 208M00000X 020 Physicians 344 Hospitalist

1821010406 208000000X 020 Physicians 049 Pediatrics

1821010489 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821015595 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1821020538 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821023342 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821025636 207P00000X 020 Physicians 270 Emergency Medicine

1821026246 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821026485 207Q00000X 020 Physicians 173 Family Medicine

1821032053 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1821034448 207P00000X 020 Physicians 270 Emergency Medicine

1821040403 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1821040783 207R00000X 020 Physicians 011 Internal Medicine

1821044926 207W00000X 020 Physicians 018 Ophthalmology

1821054347 2084N0400X 020 Physicians 013 Neurology

1821055138 208600000X 020 Physicians 275 Surgery

1821059767 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821061540 208000000X 020 Physicians 049 Pediatrics

1821062167 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821062506 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821063421 207RI0200X 020 Physicians 185 Infectious Diseases

1821064288 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1821075250 207L00000X 020 Physicians 005 Anesthesiology

1821075268 208100000X 020 Physicians 025 Physical Medicine and Rehab

1821076068 2085R0202X 020 Physicians 167 Diagnostic Radiology

453 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1821076712 208000000X 020 Physicians 049 Pediatrics

1821076878 207L00000X 020 Physicians 005 Anesthesiology

1821077843 207L00000X 020 Physicians 005 Anesthesiology

1821077876 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821078262 208100000X 020 Physicians 025 Physical Medicine and Rehab

1821088014 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821091620 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821099466 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1821106485 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821115726 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821117797 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1821121088 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821127036 207Q00000X 020 Physicians 173 Family Medicine

1821132283 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1821137795 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821138538 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821140427 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821142449 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1821143629 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821144635 2086X0206X 020 Physicians 276 Surgical Oncology

1821148784 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821152869 1223P0221X 012 Dental Providers 063 Pedodontics

1821170101 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1821172057 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821172404 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821172727 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821174178 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1821179847 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821180282 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1821182924 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1821183179 207Q00000X 020 Physicians 173 Family Medicine

454 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1821184060 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1821184060 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821187428 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1821196577 207Q00000X 020 Physicians 173 Family Medicine

1821207689 207RP1001X 020 Physicians 029 Pulmonary Diseases

1821213067 207P00000X 020 Physicians 270 Emergency Medicine

1821213067 207PE0004X 020 Physicians 093 Emergency Medical Services

1821213067 208D00000X 020 Physicians 001 General Practice

1821213562 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821224577 1223G0001X 012 Dental Providers 001 General Practice

1821224940 2080P0204X 020 Physicians 561 Pediatric Emergency Medicine; Pediatrics

1821225111 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1821225541 207RP1001X 020 Physicians 029 Pulmonary Diseases

1821226424 1223G0001X 012 Dental Providers 001 General Practice

1821226424 122300000X 012 Dental Providers 019 Dentists

1821226887 207P00000X 020 Physicians 270 Emergency Medicine

1821230574 207R00000X 020 Physicians 011 Internal Medicine

1821232661 207V00000X 020 Physicians 016 OB/GYN

1821237116 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1821245135 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1821248451 208000000X 020 Physicians 049 Pediatrics

1821254939 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821261256 207R00000X 020 Physicians 011 Internal Medicine

1821276668 207X00000X 020 Physicians 020 Orthopedic Surgery

1821277328 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1821282773 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821284746 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821288929 207RC0000X 020 Physicians 006 Cardiovascular Disease

1821290826 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1821294695 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821295106 111N00000X 011 Chiropractic Providers 047 Chiropractor

455 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1821298100 207Q00000X 020 Physicians 173 Family Medicine

1821300153 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821301482 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1821309337 207L00000X 020 Physicians 005 Anesthesiology

1821329079 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1821340548 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1821343112 208000000X 020 Physicians 049 Pediatrics

1821345844 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821350679 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1821350679 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1821355488 207R00000X 020 Physicians 011 Internal Medicine

1821357427 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821369786 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1821379462 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821380007 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1821380577 2085R0202X 020 Physicians 167 Diagnostic Radiology

1821382508 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1821383993 207R00000X 020 Physicians 011 Internal Medicine

1821404260 207Q00000X 020 Physicians 173 Family Medicine

1821411356 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1821430943 1223P0221X 012 Dental Providers 063 Pedodontics

1821433475 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821444100 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1821446782 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821449414 207R00000X 020 Physicians 011 Internal Medicine

1821449455 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1821453606 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821457037 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821470162 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1821470907 213ES0131X 021 Podiatric Medicine & Surgery Service 540 Surgery Foot

1821471871 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

456 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1821472143 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1821472143 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821472531 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821475906 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1821483728 207V00000X 020 Physicians 016 OB/GYN

1821484957 208M00000X 020 Physicians 344 Hospitalist

1821484957 207P00000X 020 Physicians 270 Emergency Medicine

1821491093 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1821495284 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1821501743 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1821508466 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821508698 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1821508698 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1821510223 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1821526500 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821532862 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1821541343 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1821541343 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821544651 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821563230 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1821571530 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1821572090 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821583873 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1821591546 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821593005 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1821619404 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821628942 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1821630047 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821631839 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1821631839 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1821634718 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

457 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1821639899 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821645342 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821648833 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1821650904 208600000X 020 Physicians 275 Surgery

1821654518 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1821657388 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1821657842 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1821658758 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1831101120 1223X0400X 012 Dental Providers 515 Orthodontics & Dentofacial Orthopedics

1831105303 207R00000X 020 Physicians 011 Internal Medicine

1831108455 2084N0400X 020 Physicians 013 Neurology

1831109818 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1831110055 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831110055 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1831110626 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1831114628 2083P0500X 020 Physicians 257 Preventive Med/Occupational-Environ Med

1831117415 207Q00000X 020 Physicians 173 Family Medicine

1831117480 2084P0800X 020 Physicians 121 Psychiatry

1831122738 207RC0000X 020 Physicians 006 Cardiovascular Disease

1831123744 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831124031 2085N0700X 020 Physicians 204 Neuroradiology

1831124916 208800000X 020 Physicians 034 Urology

1831125657 207Q00000X 020 Physicians 173 Family Medicine

1831132406 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831133347 207X00000X 020 Physicians 020 Orthopedic Surgery

1831137660 207Q00000X 020 Physicians 173 Family Medicine

1831140201 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1831140441 2085R0202X 020 Physicians 167 Diagnostic Radiology

1831141175 207X00000X 020 Physicians 020 Orthopedic Surgery

1831141449 207Q00000X 020 Physicians 173 Family Medicine

1831142702 2084P0800X 020 Physicians 121 Psychiatry

458 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1831145945 207L00000X 020 Physicians 005 Anesthesiology

1831146596 208M00000X 020 Physicians 344 Hospitalist

1831148899 2086S0102X 020 Physicians 539 Surgical Critical Care

1831150986 208600000X 020 Physicians 275 Surgery

1831151042 207RC0000X 020 Physicians 006 Cardiovascular Disease

1831152388 207Q00000X 020 Physicians 173 Family Medicine

1831154376 2084P0800X 020 Physicians 121 Psychiatry

1831154376 2084P2900X 020 Physicians 570 Psychiatry & Neurology; Pain Medicine

1831154376 207R00000X 020 Physicians 011 Internal Medicine

1831161777 1223G0001X 012 Dental Providers 001 General Practice

1831163260 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831166289 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1831172832 2085R0202X 020 Physicians 167 Diagnostic Radiology

1831173178 207RG0100X 020 Physicians 010 Gastroenterology

1831175900 208000000X 020 Physicians 049 Pediatrics

1831177021 207RC0000X 020 Physicians 006 Cardiovascular Disease

1831177021 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1831177765 2084N0400X 020 Physicians 013 Neurology

1831179126 207L00000X 020 Physicians 005 Anesthesiology

1831179530 207L00000X 020 Physicians 005 Anesthesiology

1831181924 207V00000X 020 Physicians 016 OB/GYN

1831188127 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831191782 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1831196484 207X00000X 020 Physicians 020 Orthopedic Surgery

1831196732 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831196732 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1831196732 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1831199850 2084N0400X 020 Physicians 013 Neurology

1831201870 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831213198 111N00000X 011 Chiropractic Providers 047 Chiropractor

1831217462 111N00000X 011 Chiropractic Providers 047 Chiropractor

459 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1831221233 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1831223940 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1831223940 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1831224047 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1831224641 207Y00000X 020 Physicians 217 Otolaryngology

1831227560 2086S0102X 020 Physicians 539 Surgical Critical Care

1831243005 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831248558 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831252626 208000000X 020 Physicians 049 Pediatrics

1831271287 111N00000X 011 Chiropractic Providers 047 Chiropractor

1831271444 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1831271444 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1831279603 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831280692 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831280841 2084P0800X 020 Physicians 121 Psychiatry

1831283936 207RP1001X 020 Physicians 029 Pulmonary Diseases

1831285964 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1831288190 183500000X 018 Pharmacy 253 Pharmacist

1831290311 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1831291012 207L00000X 020 Physicians 005 Anesthesiology

1831294289 207ZP0101X 020 Physicians 022 Pathology

1831300128 207RG0100X 020 Physicians 010 Gastroenterology

1831302009 207RC0000X 020 Physicians 006 Cardiovascular Disease

1831302009 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1831307891 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1831312933 2080P0202X 020 Physicians 221 Pediatric Cardiology

1831316066 207RG0100X 020 Physicians 010 Gastroenterology

1831323021 122300000X 012 Dental Providers 019 Dentists

1831327964 207R00000X 020 Physicians 011 Internal Medicine

1831330851 2085R0202X 020 Physicians 167 Diagnostic Radiology

1831337302 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

460 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1831346873 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1831346873 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1831350826 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1831352947 2085R0202X 020 Physicians 167 Diagnostic Radiology

1831354679 207RP1001X 020 Physicians 029 Pulmonary Diseases

1831354679 207RC0200X 020 Physicians 206 Critical Care Medicine

1831366855 207L00000X 020 Physicians 005 Anesthesiology

1831374446 111N00000X 011 Chiropractic Providers 047 Chiropractor

1831375815 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1831379767 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1831379809 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1831381482 208800000X 020 Physicians 034 Urology

1831383678 207R00000X 020 Physicians 011 Internal Medicine

1831386077 2086S0102X 020 Physicians 539 Surgical Critical Care

1831386077 208600000X 020 Physicians 275 Surgery

1831389279 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1831394402 2085R0202X 020 Physicians 167 Diagnostic Radiology

1831396712 207Y00000X 020 Physicians 217 Otolaryngology

1831400589 208000000X 020 Physicians 049 Pediatrics

1831401058 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1831430644 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831441443 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831452168 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1831458504 122300000X 012 Dental Providers 019 Dentists

1831459106 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1831459908 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1831459908 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1831465269 207R00000X 020 Physicians 011 Internal Medicine

1831485564 207P00000X 020 Physicians 270 Emergency Medicine

1831495761 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1831498286 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

461 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1831501782 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1831504844 2084N0400X 020 Physicians 013 Neurology

1831506716 208M00000X 020 Physicians 344 Hospitalist

1831507250 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1831514355 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831528306 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831538180 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1831542539 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1831543388 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831547231 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1831549948 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831551605 207R00000X 020 Physicians 011 Internal Medicine

1831559038 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1831577550 207P00000X 020 Physicians 270 Emergency Medicine

1831578541 207Q00000X 020 Physicians 173 Family Medicine

1831578665 208M00000X 020 Physicians 344 Hospitalist

1831585462 208M00000X 020 Physicians 344 Hospitalist

1831593052 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1831598747 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1831602713 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1831605682 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1831609601 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831609601 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1831613942 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1831616507 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1831619105 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831622125 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831623990 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831631977 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1831633106 111N00000X 011 Chiropractic Providers 047 Chiropractor

1831633783 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

462 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1831637651 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1831637651 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1831640853 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1831643436 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831643899 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1831647668 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1831647940 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1831661123 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1831663699 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831666197 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1831673714 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1831678036 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1831678036 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1831680438 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1831735257 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1831753631 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1831756543 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1831757632 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1841203445 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1841205689 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1841207982 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1841210143 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1841210259 207Q00000X 020 Physicians 173 Family Medicine

1841212404 207W00000X 020 Physicians 018 Ophthalmology

1841212412 208600000X 020 Physicians 275 Surgery

1841217320 207Q00000X 020 Physicians 173 Family Medicine

1841217551 208800000X 020 Physicians 034 Urology

1841217700 207P00000X 020 Physicians 270 Emergency Medicine

1841217700 207R00000X 020 Physicians 011 Internal Medicine

1841217841 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1841226305 207RC0200X 020 Physicians 206 Critical Care Medicine

463 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841226305 207RP1001X 020 Physicians 029 Pulmonary Diseases

1841231065 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1841232618 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841239480 207R00000X 020 Physicians 011 Internal Medicine

1841241346 207P00000X 020 Physicians 270 Emergency Medicine

1841242807 207P00000X 020 Physicians 270 Emergency Medicine

1841244605 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1841245743 207RC0000X 020 Physicians 006 Cardiovascular Disease

1841248903 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841249166 207RC0000X 020 Physicians 006 Cardiovascular Disease

1841249166 208M00000X 020 Physicians 344 Hospitalist

1841249166 207R00000X 020 Physicians 011 Internal Medicine

1841249166 207P00000X 020 Physicians 270 Emergency Medicine

1841249166 207RI0200X 020 Physicians 185 Infectious Diseases

1841252467 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841252467 207U00000X 020 Physicians 103 Nuclear Medicine

1841261179 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841261328 207RG0100X 020 Physicians 010 Gastroenterology

1841263381 207X00000X 020 Physicians 020 Orthopedic Surgery

1841264892 207Q00000X 020 Physicians 173 Family Medicine

1841265543 207R00000X 020 Physicians 011 Internal Medicine

1841266103 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1841266103 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1841270238 207RP1001X 020 Physicians 029 Pulmonary Diseases

1841270980 2084N0400X 020 Physicians 013 Neurology

1841273281 207Y00000X 020 Physicians 217 Otolaryngology

1841276854 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841277134 207RP1001X 020 Physicians 029 Pulmonary Diseases

1841277134 207RC0200X 020 Physicians 206 Critical Care Medicine

1841277142 207N00000X 020 Physicians 007 Dermatology

1841277878 2085R0202X 020 Physicians 167 Diagnostic Radiology

464 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841278009 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841278132 208800000X 020 Physicians 034 Urology

1841278132 2088P0231X 020 Physicians 246 Pediatric Urology

1841278678 207RX0202X 020 Physicians 529 Medical Oncology

1841279494 2084N0400X 020 Physicians 013 Neurology

1841279973 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841282423 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841287810 2080P0202X 020 Physicians 221 Pediatric Cardiology

1841287810 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1841289592 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1841292778 207P00000X 020 Physicians 270 Emergency Medicine

1841295722 208M00000X 020 Physicians 344 Hospitalist

1841296696 207V00000X 020 Physicians 016 OB/GYN

1841296696 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1841312873 207P00000X 020 Physicians 270 Emergency Medicine

1841314077 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1841327665 207RH0003X 020 Physicians 179 Hematology/Oncology

1841331139 207RP1001X 020 Physicians 029 Pulmonary Diseases

1841343712 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1841346814 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841355039 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1841365053 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1841374030 207Q00000X 020 Physicians 173 Family Medicine

1841379641 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841381589 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841381951 207L00000X 020 Physicians 005 Anesthesiology

1841384781 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841384781 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1841388444 208000000X 020 Physicians 049 Pediatrics

1841388444 207R00000X 020 Physicians 011 Internal Medicine

1841389095 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

465 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841389160 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841389780 207RG0100X 020 Physicians 010 Gastroenterology

1841390762 207Q00000X 020 Physicians 173 Family Medicine

1841397627 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841398278 207R00000X 020 Physicians 011 Internal Medicine

1841398278 207P00000X 020 Physicians 270 Emergency Medicine

1841398278 208M00000X 020 Physicians 344 Hospitalist

1841398666 207Q00000X 020 Physicians 173 Family Medicine

1841408200 2085R0202X 020 Physicians 167 Diagnostic Radiology

1841412590 208600000X 020 Physicians 275 Surgery

1841413507 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1841426863 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1841427473 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841428885 207P00000X 020 Physicians 270 Emergency Medicine

1841429214 122300000X 012 Dental Providers 019 Dentists

1841429321 207Q00000X 020 Physicians 173 Family Medicine

1841429719 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1841429784 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841433034 2084N0400X 020 Physicians 013 Neurology

1841440179 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1841441482 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841442191 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1841442191 207L00000X 020 Physicians 005 Anesthesiology

1841442209 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1841443025 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1841444197 208G00000X 020 Physicians 033 Thoracic Surgery

1841446606 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841447166 207N00000X 020 Physicians 007 Dermatology

1841447711 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841449527 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841450822 207L00000X 020 Physicians 005 Anesthesiology

466 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841452828 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841452828 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1841454634 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1841455623 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1841456324 208000000X 020 Physicians 049 Pediatrics

1841457389 208000000X 020 Physicians 049 Pediatrics

1841461084 207VX0201X 020 Physicians 307 Gynecologic Oncology

1841466794 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841470325 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841476413 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841477650 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1841483096 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841490554 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1841490554 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1841492378 207RN0300X 020 Physicians 105 Nephrology

1841495710 207X00000X 020 Physicians 020 Orthopedic Surgery

1841498052 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841498052 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1841501236 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841501236 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1841508769 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841510104 207V00000X 020 Physicians 016 OB/GYN

1841513504 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1841518578 207R00000X 020 Physicians 011 Internal Medicine

1841526688 111N00000X 011 Chiropractic Providers 047 Chiropractor

1841530193 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841532942 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1841544160 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1841550357 207R00000X 020 Physicians 011 Internal Medicine

1841550415 207R00000X 020 Physicians 011 Internal Medicine

1841553070 207L00000X 020 Physicians 005 Anesthesiology

467 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841553427 2084N0400X 020 Physicians 013 Neurology

1841553427 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1841554714 207Q00000X 020 Physicians 173 Family Medicine

1841563186 207T00000X 020 Physicians 014 Neurological Surgery

1841583820 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841586559 208000000X 020 Physicians 049 Pediatrics

1841587615 122300000X 012 Dental Providers 019 Dentists

1841589561 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1841596590 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1841597150 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841598794 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841603305 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1841606910 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841606910 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1841610805 111N00000X 011 Chiropractic Providers 047 Chiropractor

1841619384 122300000X 012 Dental Providers 019 Dentists

1841624780 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841632528 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1841636180 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1841636180 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841638806 2084P0800X 020 Physicians 121 Psychiatry

1841642212 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841651981 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1841658903 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1841661998 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1841670494 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841672235 207R00000X 020 Physicians 011 Internal Medicine

1841675378 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841675527 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1841679347 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1841679347 208000000X 020 Physicians 049 Pediatrics

468 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1841689437 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841690476 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1841690476 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1841693280 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841693579 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841696523 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841696523 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1841696523 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1841697133 207RI0200X 020 Physicians 185 Infectious Diseases

1841700770 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1841700770 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1841700770 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1841716412 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1841719010 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841731643 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1841732443 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1841732864 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1841742533 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1841742533 363LP0222X 036 Phys Assts and Advanced Nursing Provs 635 Nurse Practitioner Pediatrics CritCare

1841754983 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841758687 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1841763232 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841764180 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1841776291 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841782687 207Q00000X 020 Physicians 173 Family Medicine

1841839933 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1841847688 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1841849320 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1841855541 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1841855657 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851304158 2085R0202X 020 Physicians 167 Diagnostic Radiology

469 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851310213 2080P0202X 020 Physicians 221 Pediatric Cardiology

1851311146 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851312078 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851313449 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1851314173 2084N0400X 020 Physicians 013 Neurology

1851316673 207L00000X 020 Physicians 005 Anesthesiology

1851318844 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851319438 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851319529 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851329478 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851331441 207RG0100X 020 Physicians 010 Gastroenterology

1851334387 207P00000X 020 Physicians 270 Emergency Medicine

1851334858 2084P0800X 020 Physicians 121 Psychiatry

1851337554 207Q00000X 020 Physicians 173 Family Medicine

1851338198 208000000X 020 Physicians 049 Pediatrics

1851339436 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851340988 208600000X 020 Physicians 275 Surgery

1851341366 207RG0100X 020 Physicians 010 Gastroenterology

1851342877 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1851349500 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851350110 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851352504 2084P0800X 020 Physicians 121 Psychiatry

1851357131 207R00000X 020 Physicians 011 Internal Medicine

1851363121 207R00000X 020 Physicians 011 Internal Medicine

1851363634 207R00000X 020 Physicians 011 Internal Medicine

1851363717 208200000X 020 Physicians 024 Plastic Surgery

1851364202 207R00000X 020 Physicians 011 Internal Medicine

1851364210 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851364863 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851366223 207RN0300X 020 Physicians 105 Nephrology

1851366439 207R00000X 020 Physicians 011 Internal Medicine

470 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851367924 208000000X 020 Physicians 049 Pediatrics

1851370704 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851371223 207RG0100X 020 Physicians 010 Gastroenterology

1851375489 207RI0200X 020 Physicians 185 Infectious Diseases

1851376529 207P00000X 020 Physicians 270 Emergency Medicine

1851379861 207Q00000X 020 Physicians 173 Family Medicine

1851380125 207R00000X 020 Physicians 011 Internal Medicine

1851387658 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851393144 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851394662 207R00000X 020 Physicians 011 Internal Medicine

1851394662 207RH0003X 020 Physicians 179 Hematology/Oncology

1851397509 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1851399364 207W00000X 020 Physicians 018 Ophthalmology

1851403802 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851408413 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851408728 207V00000X 020 Physicians 016 OB/GYN

1851408728 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1851408991 1223G0001X 012 Dental Providers 001 General Practice

1851422398 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1851435804 207V00000X 020 Physicians 016 OB/GYN

1851452312 207RC0200X 020 Physicians 206 Critical Care Medicine

1851456610 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1851464309 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851465223 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1851465975 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851482657 207L00000X 020 Physicians 005 Anesthesiology

1851483242 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851487276 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1851493050 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851497721 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851498638 207W00000X 020 Physicians 018 Ophthalmology

471 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851502157 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1851508170 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851510150 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851518690 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851520282 208000000X 020 Physicians 049 Pediatrics

1851520647 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851523500 207RC0000X 020 Physicians 006 Cardiovascular Disease

1851526230 208000000X 020 Physicians 049 Pediatrics

1851531008 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1851531206 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851545842 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1851549984 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1851549984 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1851552137 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851553879 2084N0400X 020 Physicians 013 Neurology

1851554828 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851559579 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851562375 207R00000X 020 Physicians 011 Internal Medicine

1851565022 207RI0011X 020 Physicians 188 Interventional Cardiology

1851565022 207RC0000X 020 Physicians 006 Cardiovascular Disease

1851574453 207RP1001X 020 Physicians 029 Pulmonary Diseases

1851580476 207V00000X 020 Physicians 016 OB/GYN

1851583512 2085P0229X 020 Physicians 241 Pediatric Radiology

1851593958 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851602387 207P00000X 020 Physicians 270 Emergency Medicine

1851602999 207RP1001X 020 Physicians 029 Pulmonary Diseases

1851604367 208800000X 020 Physicians 034 Urology

1851612204 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851618383 207L00000X 020 Physicians 005 Anesthesiology

1851624514 207RI0200X 020 Physicians 185 Infectious Diseases

1851624944 207V00000X 020 Physicians 016 OB/GYN

472 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851626899 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1851633804 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851634984 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851642847 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851653430 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1851653570 208D00000X 020 Physicians 001 General Practice

1851654834 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1851656995 207L00000X 020 Physicians 005 Anesthesiology

1851659254 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1851659254 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1851659254 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851661102 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851663983 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851664304 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1851665814 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851670707 208100000X 020 Physicians 025 Physical Medicine and Rehab

1851679047 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851684120 2085R0202X 020 Physicians 167 Diagnostic Radiology

1851689772 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1851694806 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1851695563 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851696082 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1851698344 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851700140 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851711303 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851736391 207P00000X 020 Physicians 270 Emergency Medicine

1851737589 111N00000X 011 Chiropractic Providers 047 Chiropractor

1851740633 122300000X 012 Dental Providers 019 Dentists

1851740633 1223G0001X 012 Dental Providers 001 General Practice

1851743314 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1851746374 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

473 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851763866 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1851771539 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1851771539 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1851771539 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1851774822 207Q00000X 020 Physicians 173 Family Medicine

1851774905 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851781082 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1851784987 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1851784987 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1851784987 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1851785281 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851785281 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1851794036 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1851794234 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1851794960 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851801781 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1851801781 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851801781 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1851806517 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1851807507 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1851814636 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1851823892 2084P0800X 020 Physicians 121 Psychiatry

1851826218 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1851829642 207Q00000X 020 Physicians 173 Family Medicine

1851842017 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1851848907 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851848998 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851857833 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1851873046 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1851874416 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851874507 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

474 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1851881593 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1851890396 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1851923288 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1851931182 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1851935456 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1851953806 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1851958755 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1861043168 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1861043234 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1861044562 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861054157 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861054777 208600000X 020 Physicians 275 Surgery

1861409252 207P00000X 020 Physicians 270 Emergency Medicine

1861409740 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861410417 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861411076 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861412991 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861413502 2084N0400X 020 Physicians 013 Neurology

1861414435 207R00000X 020 Physicians 011 Internal Medicine

1861417107 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861419293 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861419723 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861419723 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1861420648 207R00000X 020 Physicians 011 Internal Medicine

1861425472 207V00000X 020 Physicians 016 OB/GYN

1861427700 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1861428500 207RI0200X 020 Physicians 185 Infectious Diseases

1861429201 207Q00000X 020 Physicians 173 Family Medicine

1861429870 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1861430605 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1861433690 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

475 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1861435943 208800000X 020 Physicians 034 Urology

1861441230 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861442493 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861446924 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861449019 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861452500 207X00000X 020 Physicians 020 Orthopedic Surgery

1861455198 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861461329 207R00000X 020 Physicians 011 Internal Medicine

1861465874 207L00000X 020 Physicians 005 Anesthesiology

1861468332 111N00000X 011 Chiropractic Providers 047 Chiropractor

1861469744 207RC0000X 020 Physicians 006 Cardiovascular Disease

1861470817 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861471260 207X00000X 020 Physicians 020 Orthopedic Surgery

1861471351 207RP1001X 020 Physicians 029 Pulmonary Diseases

1861471633 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861471658 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861471765 207RG0100X 020 Physicians 010 Gastroenterology

1861471765 207R00000X 020 Physicians 011 Internal Medicine

1861472052 207L00000X 020 Physicians 005 Anesthesiology

1861472284 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1861473225 207L00000X 020 Physicians 005 Anesthesiology

1861473753 207Q00000X 020 Physicians 173 Family Medicine

1861474017 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861478745 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861485187 207R00000X 020 Physicians 011 Internal Medicine

1861495459 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861503492 207R00000X 020 Physicians 011 Internal Medicine

1861504847 208600000X 020 Physicians 275 Surgery

1861506669 208800000X 020 Physicians 034 Urology

1861518193 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1861518193 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

476 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1861524076 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861536427 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861538191 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1861539702 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861540973 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861545675 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1861556136 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1861556557 2084S0012X 020 Physicians 521 Sleep Medicine

1861557977 207Q00000X 020 Physicians 173 Family Medicine

1861565152 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1861565459 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1861568289 207X00000X 020 Physicians 020 Orthopedic Surgery

1861573420 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1861577512 2080P0202X 020 Physicians 221 Pediatric Cardiology

1861582124 207P00000X 020 Physicians 270 Emergency Medicine

1861589152 1223X0400X 012 Dental Providers 064 Orthodontics

1861595662 207Y00000X 020 Physicians 217 Otolaryngology

1861595662 207YP0228X 020 Physicians 140 Pediatric Otolaryngology

1861595753 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1861596140 122300000X 012 Dental Providers 019 Dentists

1861596355 207X00000X 020 Physicians 020 Orthopedic Surgery

1861599649 2084P0800X 020 Physicians 121 Psychiatry

1861599730 111N00000X 011 Chiropractic Providers 047 Chiropractor

1861611139 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861611154 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861619439 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1861619900 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861621153 207R00000X 020 Physicians 011 Internal Medicine

1861622060 208M00000X 020 Physicians 344 Hospitalist

1861623456 208000000X 020 Physicians 049 Pediatrics

1861624264 208600000X 020 Physicians 275 Surgery

477 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1861628059 2086S0129X 020 Physicians 289 Vascular Surgery

1861628711 2084N0400X 020 Physicians 013 Neurology

1861629578 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1861629578 208000000X 020 Physicians 049 Pediatrics

1861631244 2086S0120X 020 Physicians 245 Pediatric Surgery

1861633653 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1861637852 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861649071 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861657868 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861662348 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1861662348 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1861669400 207R00000X 020 Physicians 011 Internal Medicine

1861672628 207X00000X 020 Physicians 020 Orthopedic Surgery

1861675779 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861679987 208000000X 020 Physicians 049 Pediatrics

1861681801 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1861681801 208000000X 020 Physicians 049 Pediatrics

1861690661 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861690752 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1861692519 207RC0000X 020 Physicians 006 Cardiovascular Disease

1861693038 111N00000X 011 Chiropractic Providers 047 Chiropractor

1861695363 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861696569 2080P0202X 020 Physicians 221 Pediatric Cardiology

1861703134 207R00000X 020 Physicians 011 Internal Medicine

1861703134 208M00000X 020 Physicians 344 Hospitalist

1861707531 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861714875 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861716037 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1861724387 2084V0102X 020 Physicians 552 Vascular Neurology

1861724387 2084N0400X 020 Physicians 013 Neurology

1861732166 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

478 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1861749079 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861757692 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861758773 208M00000X 020 Physicians 344 Hospitalist

1861760605 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1861768343 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861784589 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861786246 2084N0400X 020 Physicians 013 Neurology

1861801763 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861802415 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861808651 207T00000X 020 Physicians 014 Neurological Surgery

1861809717 2084N0400X 020 Physicians 013 Neurology

1861810129 2085R0202X 020 Physicians 167 Diagnostic Radiology

1861810137 207X00000X 020 Physicians 020 Orthopedic Surgery

1861810137 2081S0010X 020 Physicians 548 Physical Medicine & Rehabilitation; Spor

1861810137 207XX0005X 020 Physicians 526 Orthopaedic Surgery;Sports Medicine

1861810137 208100000X 020 Physicians 025 Physical Medicine and Rehab

1861812216 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1861816902 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1861830275 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1861831067 207RC0000X 020 Physicians 006 Cardiovascular Disease

1861831752 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1861831877 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861832487 208000000X 020 Physicians 049 Pediatrics

1861844631 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861844904 111N00000X 011 Chiropractic Providers 047 Chiropractor

1861856536 207R00000X 020 Physicians 011 Internal Medicine

1861860322 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1861863813 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1861864415 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1861864415 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1861870404 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

479 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1861870693 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861884819 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861885303 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1861888588 208M00000X 020 Physicians 344 Hospitalist

1861895963 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1861899460 111N00000X 011 Chiropractic Providers 047 Chiropractor

1861901175 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1861910101 1223D0001X 012 Dental Providers 498 Dental Public Health

1861927311 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1861938128 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1861938128 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1861938128 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1861939639 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1861943979 183500000X 018 Pharmacy 253 Pharmacist

1861948119 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1861963209 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1861968166 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1861971640 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1861973190 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1861987158 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1861988974 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1861992653 183500000X 018 Pharmacy 253 Pharmacist

1861996910 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871001495 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871005843 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871013342 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871013938 208600000X 020 Physicians 275 Surgery

1871014563 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871017616 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871024919 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871028514 111N00000X 011 Chiropractic Providers 047 Chiropractor

480 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1871029132 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1871029132 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871030437 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1871030437 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871038984 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871038984 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1871042036 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871047670 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871079079 122300000X 012 Dental Providers 019 Dentists

1871079541 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871092130 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871115683 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1871125914 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1871139782 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1871148882 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1871149633 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1871154211 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871158725 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1871158725 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1871159855 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1871502740 207Q00000X 020 Physicians 173 Family Medicine

1871511410 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871511444 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1871513259 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871515361 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1871516781 207P00000X 020 Physicians 270 Emergency Medicine

1871517086 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871517482 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871517532 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1871520114 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1871520635 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

481 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1871521245 207R00000X 020 Physicians 011 Internal Medicine

1871525337 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1871525386 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1871533851 207P00000X 020 Physicians 270 Emergency Medicine

1871534214 207RP1001X 020 Physicians 029 Pulmonary Diseases

1871537357 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1871537357 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871537357 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1871537357 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1871537449 207P00000X 020 Physicians 270 Emergency Medicine

1871537498 2084P0800X 020 Physicians 121 Psychiatry

1871537514 207Q00000X 020 Physicians 173 Family Medicine

1871539304 207Q00000X 020 Physicians 173 Family Medicine

1871540435 207P00000X 020 Physicians 270 Emergency Medicine

1871546358 207R00000X 020 Physicians 011 Internal Medicine

1871547125 207P00000X 020 Physicians 270 Emergency Medicine

1871552323 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1871553313 207Q00000X 020 Physicians 173 Family Medicine

1871561126 208800000X 020 Physicians 034 Urology

1871563569 207RG0100X 020 Physicians 010 Gastroenterology

1871565564 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871565606 207T00000X 020 Physicians 014 Neurological Surgery

1871565929 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1871566166 207RP1001X 020 Physicians 029 Pulmonary Diseases

1871566174 207ZP0101X 020 Physicians 022 Pathology

1871567826 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1871570234 207X00000X 020 Physicians 020 Orthopedic Surgery

1871571083 2085R0202X 020 Physicians 167 Diagnostic Radiology

1871571125 2085R0202X 020 Physicians 167 Diagnostic Radiology

1871572537 2085R0202X 020 Physicians 167 Diagnostic Radiology

1871572818 2085R0202X 020 Physicians 167 Diagnostic Radiology

482 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1871572842 207RI0200X 020 Physicians 185 Infectious Diseases

1871572909 207VX0201X 020 Physicians 307 Gynecologic Oncology

1871573477 207L00000X 020 Physicians 005 Anesthesiology

1871579862 207RC0000X 020 Physicians 006 Cardiovascular Disease

1871580407 208600000X 020 Physicians 275 Surgery

1871590547 207Y00000X 020 Physicians 217 Otolaryngology

1871603167 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1871603167 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1871605279 208G00000X 020 Physicians 033 Thoracic Surgery

1871607945 207RI0200X 020 Physicians 185 Infectious Diseases

1871612010 207RC0000X 020 Physicians 006 Cardiovascular Disease

1871632273 122300000X 012 Dental Providers 019 Dentists

1871638460 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1871649459 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1871649459 208000000X 020 Physicians 049 Pediatrics

1871649459 2080T0002X 020 Physicians 231 Pediatric Medical Toxicology

1871651943 207Y00000X 020 Physicians 217 Otolaryngology

1871656959 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1871656959 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1871656959 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1871658625 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871662411 208G00000X 020 Physicians 033 Thoracic Surgery

1871665125 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871676676 2084N0400X 020 Physicians 013 Neurology

1871679910 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1871680488 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1871683557 207RC0000X 020 Physicians 006 Cardiovascular Disease

1871686386 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1871691543 207Q00000X 020 Physicians 173 Family Medicine

1871695098 207T00000X 020 Physicians 014 Neurological Surgery

1871698209 122300000X 012 Dental Providers 019 Dentists

483 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1871712166 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1871714808 207Q00000X 020 Physicians 173 Family Medicine

1871714949 207R00000X 020 Physicians 011 Internal Medicine

1871721811 208M00000X 020 Physicians 344 Hospitalist

1871722413 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1871722520 2084N0400X 020 Physicians 013 Neurology

1871725614 2085R0202X 020 Physicians 167 Diagnostic Radiology

1871725705 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1871735738 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871735738 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871740902 208000000X 020 Physicians 049 Pediatrics

1871759639 207R00000X 020 Physicians 011 Internal Medicine

1871762997 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1871766022 207T00000X 020 Physicians 014 Neurological Surgery

1871768192 207P00000X 020 Physicians 270 Emergency Medicine

1871772285 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1871783704 207V00000X 020 Physicians 016 OB/GYN

1871790832 111N00000X 011 Chiropractic Providers 047 Chiropractor

1871798751 207X00000X 020 Physicians 020 Orthopedic Surgery

1871803528 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1871805044 2085R0202X 020 Physicians 167 Diagnostic Radiology

1871806117 208600000X 020 Physicians 275 Surgery

1871812602 207P00000X 020 Physicians 270 Emergency Medicine

1871813386 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871814863 208000000X 020 Physicians 049 Pediatrics

1871819979 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1871823021 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1871830422 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871843672 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1871848358 2084P0800X 020 Physicians 121 Psychiatry

1871848358 207R00000X 020 Physicians 011 Internal Medicine

484 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1871848366 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871851279 111N00000X 011 Chiropractic Providers 047 Chiropractor

1871852327 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1871853010 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871857839 207L00000X 020 Physicians 005 Anesthesiology

1871862417 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1871869172 207R00000X 020 Physicians 011 Internal Medicine

1871889642 207Q00000X 020 Physicians 173 Family Medicine

1871892315 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1871893032 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871893552 207R00000X 020 Physicians 011 Internal Medicine

1871904292 208M00000X 020 Physicians 344 Hospitalist

1871906313 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871915033 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871915405 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871920397 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1871922666 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871926113 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871930651 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1871937656 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1871957449 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1871960096 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871970103 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1871975490 207Q00000X 020 Physicians 173 Family Medicine

1871976340 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1871976340 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1871979229 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1871989996 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1871996298 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1871998781 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1871998781 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

485 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881000131 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881003242 208100000X 020 Physicians 025 Physical Medicine and Rehab

1881005718 207L00000X 020 Physicians 005 Anesthesiology

1881014728 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881014843 208100000X 020 Physicians 025 Physical Medicine and Rehab

1881015444 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1881026466 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1881026466 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1881026698 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881026805 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881033751 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1881035095 208600000X 020 Physicians 275 Surgery

1881035640 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1881035640 208000000X 020 Physicians 049 Pediatrics

1881043768 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1881045169 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1881045169 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1881050193 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1881058196 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1881060374 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1881060374 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881060630 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881061786 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881063006 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881064566 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881065563 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1881073633 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1881076685 208000000X 020 Physicians 049 Pediatrics

1881080232 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1881081412 208M00000X 020 Physicians 344 Hospitalist

1881081412 207R00000X 020 Physicians 011 Internal Medicine

486 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881081891 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881085389 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881088383 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881093029 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881094837 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1881094928 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1881097665 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881110864 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881112399 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1881112886 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881116945 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881137594 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881145779 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1881145779 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1881145779 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1881148005 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881148906 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881156743 111N00000X 011 Chiropractic Providers 047 Chiropractor

1881159069 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1881167815 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881179794 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1881193134 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881193803 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881223790 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1881225837 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881228377 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881239143 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1881247575 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1881247575 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881255503 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881256402 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

487 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881600898 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1881600898 208000000X 020 Physicians 049 Pediatrics

1881611572 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1881611770 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881616266 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881616381 207RG0100X 020 Physicians 010 Gastroenterology

1881620771 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1881620805 207Q00000X 020 Physicians 173 Family Medicine

1881625150 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881625150 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1881625150 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881626422 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881629442 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881630051 207Q00000X 020 Physicians 173 Family Medicine

1881632586 207Q00000X 020 Physicians 173 Family Medicine

1881633634 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881638583 207X00000X 020 Physicians 020 Orthopedic Surgery

1881640233 207Q00000X 020 Physicians 173 Family Medicine

1881640233 202K00000X 020 Physicians 012 Phlebology

1881640522 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1881643377 207R00000X 020 Physicians 011 Internal Medicine

1881643682 122300000X 012 Dental Providers 019 Dentists

1881647774 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881647865 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1881647865 208000000X 020 Physicians 049 Pediatrics

1881652493 207Q00000X 020 Physicians 173 Family Medicine

1881654184 207R00000X 020 Physicians 011 Internal Medicine

1881656692 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881658532 208G00000X 020 Physicians 033 Thoracic Surgery

1881659720 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881660397 207P00000X 020 Physicians 270 Emergency Medicine

488 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881661551 207PE0004X 020 Physicians 093 Emergency Medical Services

1881666022 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881666329 207L00000X 020 Physicians 005 Anesthesiology

1881667657 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1881667970 207L00000X 020 Physicians 005 Anesthesiology

1881668366 207RH0000X 020 Physicians 178 Hematology

1881668911 207V00000X 020 Physicians 016 OB/GYN

1881670867 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1881671063 207RC0200X 020 Physicians 206 Critical Care Medicine

1881671063 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1881672632 207RC0000X 020 Physicians 006 Cardiovascular Disease

1881672632 2080P0202X 020 Physicians 221 Pediatric Cardiology

1881673119 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881673218 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881673374 2085N0700X 020 Physicians 204 Neuroradiology

1881673374 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881674018 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1881677094 122300000X 012 Dental Providers 019 Dentists

1881683696 207R00000X 020 Physicians 011 Internal Medicine

1881687135 111N00000X 011 Chiropractic Providers 047 Chiropractor

1881696052 207T00000X 020 Physicians 014 Neurological Surgery

1881703734 207RN0300X 020 Physicians 105 Nephrology

1881705465 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881707602 207RC0200X 020 Physicians 206 Critical Care Medicine

1881707602 2084S0012X 020 Physicians 521 Sleep Medicine

1881707602 207RP1001X 020 Physicians 029 Pulmonary Diseases

1881708279 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1881717973 207T00000X 020 Physicians 014 Neurological Surgery

1881724060 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1881725828 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1881725828 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

489 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881725828 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1881729010 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881755387 207L00000X 020 Physicians 005 Anesthesiology

1881755528 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881755528 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1881762730 207R00000X 020 Physicians 011 Internal Medicine

1881765915 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1881765915 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1881771939 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881771947 208000000X 020 Physicians 049 Pediatrics

1881773299 207R00000X 020 Physicians 011 Internal Medicine

1881775039 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881775138 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1881779528 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1881780146 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881780807 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881781656 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1881782258 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881786218 207Q00000X 020 Physicians 173 Family Medicine

1881786853 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881794642 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881794717 207RI0011X 020 Physicians 188 Interventional Cardiology

1881797462 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881801694 207T00000X 020 Physicians 014 Neurological Surgery

1881802742 111N00000X 011 Chiropractic Providers 047 Chiropractor

1881805380 208800000X 020 Physicians 034 Urology

1881813079 207Q00000X 020 Physicians 173 Family Medicine

1881813178 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1881815769 111N00000X 011 Chiropractic Providers 047 Chiropractor

1881820074 207R00000X 020 Physicians 011 Internal Medicine

1881821619 2084P0800X 020 Physicians 121 Psychiatry

490 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881822757 207P00000X 020 Physicians 270 Emergency Medicine

1881830768 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1881830768 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881831279 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1881831436 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881836872 207ZH0000X 020 Physicians 560 Hematology; Pathology

1881836872 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1881836872 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1881836872 207ZP0101X 020 Physicians 022 Pathology

1881836872 207ZP0101X 020 Physicians 436 Anatomic Pathology

1881838175 207L00000X 020 Physicians 005 Anesthesiology

1881843100 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1881854792 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881857019 207RH0003X 020 Physicians 179 Hematology/Oncology

1881857019 207R00000X 020 Physicians 011 Internal Medicine

1881861235 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1881865392 207RC0200X 020 Physicians 206 Critical Care Medicine

1881865392 207R00000X 020 Physicians 011 Internal Medicine

1881868826 2084P0800X 020 Physicians 121 Psychiatry

1881871275 207ZP0101X 020 Physicians 022 Pathology

1881871275 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1881873776 207Q00000X 020 Physicians 173 Family Medicine

1881876472 111N00000X 011 Chiropractic Providers 047 Chiropractor

1881886497 207X00000X 020 Physicians 020 Orthopedic Surgery

1881888600 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881888741 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1881889673 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1881894152 207Q00000X 020 Physicians 173 Family Medicine

1881896223 207RC0000X 020 Physicians 006 Cardiovascular Disease

1881899557 207RC0200X 020 Physicians 206 Critical Care Medicine

1881899557 2084S0012X 020 Physicians 521 Sleep Medicine

491 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1881899557 207R00000X 020 Physicians 011 Internal Medicine

1881899557 207RP1001X 020 Physicians 029 Pulmonary Diseases

1881919272 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881919322 208000000X 020 Physicians 049 Pediatrics

1881944718 208000000X 020 Physicians 049 Pediatrics

1881947695 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881950673 207L00000X 020 Physicians 005 Anesthesiology

1881955797 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1881959849 207ZH0000X 020 Physicians 560 Hematology; Pathology

1881959849 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1881967198 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881972420 183500000X 018 Pharmacy 253 Pharmacist

1881973048 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1881980415 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1881980894 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1881981561 207Q00000X 020 Physicians 173 Family Medicine

1881985182 2085R0202X 020 Physicians 167 Diagnostic Radiology

1881986180 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1881986230 207L00000X 020 Physicians 005 Anesthesiology

1881991727 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1881999225 111N00000X 011 Chiropractic Providers 047 Chiropractor

1891011342 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1891016366 207RP1001X 020 Physicians 029 Pulmonary Diseases

1891016549 207RP1001X 020 Physicians 029 Pulmonary Diseases

1891027884 207Q00000X 020 Physicians 173 Family Medicine

1891033049 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891034724 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1891034724 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1891038998 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1891040689 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891051694 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

492 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1891052171 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1891053799 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891056982 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1891056982 208000000X 020 Physicians 049 Pediatrics

1891062089 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891063590 2086S0122X 020 Physicians 525 Plastic and Reconstructive Surgery

1891068045 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891070959 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891073185 364SA2200X 036 Phys Assts and Advanced Nursing Provs 550 Clinical Nurse Specialist Adult Health

1891073185 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1891087573 207Q00000X 020 Physicians 173 Family Medicine

1891088035 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891097374 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891116851 111N00000X 011 Chiropractic Providers 047 Chiropractor

1891127742 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1891129425 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1891131512 208000000X 020 Physicians 049 Pediatrics

1891131512 208M00000X 020 Physicians 344 Hospitalist

1891132718 207L00000X 020 Physicians 005 Anesthesiology

1891132718 207RC0200X 020 Physicians 206 Critical Care Medicine

1891134219 2084N0008X 020 Physicians 630 Psychiatry&Neurology; Neuromuscular Med

1891134219 2084N0400X 020 Physicians 013 Neurology

1891138749 207L00000X 020 Physicians 005 Anesthesiology

1891144085 207Q00000X 020 Physicians 173 Family Medicine

1891153649 122300000X 012 Dental Providers 019 Dentists

1891161071 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891170932 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1891171112 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891172540 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1891179701 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1891190245 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

493 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1891198271 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1891198461 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1891198933 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1891205878 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1891206215 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1891213328 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1891215836 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891215836 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891224127 111N00000X 011 Chiropractic Providers 047 Chiropractor

1891235255 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1891235255 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1891245759 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1891245759 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1891245759 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1891253282 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1891265757 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1891282778 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891289120 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1891293965 183500000X 018 Pharmacy 253 Pharmacist

1891338752 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1891351177 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1891357596 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1891357596 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891357745 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1891702064 207RP1001X 020 Physicians 029 Pulmonary Diseases

1891707774 1223G0001X 012 Dental Providers 001 General Practice

1891709952 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891710570 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891710604 207R00000X 020 Physicians 011 Internal Medicine

1891710604 208M00000X 020 Physicians 344 Hospitalist

1891714259 2080P0202X 020 Physicians 221 Pediatric Cardiology

494 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1891715256 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1891717112 208600000X 020 Physicians 275 Surgery

1891717468 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891717468 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891718615 207P00000X 020 Physicians 270 Emergency Medicine

1891721841 208600000X 020 Physicians 275 Surgery

1891721858 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891722518 2084N0400X 020 Physicians 013 Neurology

1891722849 208M00000X 020 Physicians 344 Hospitalist

1891722849 207R00000X 020 Physicians 011 Internal Medicine

1891724902 208D00000X 020 Physicians 001 General Practice

1891728671 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891732293 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891733127 207P00000X 020 Physicians 270 Emergency Medicine

1891733127 208M00000X 020 Physicians 344 Hospitalist

1891738530 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1891745519 207Q00000X 020 Physicians 173 Family Medicine

1891745519 207P00000X 020 Physicians 270 Emergency Medicine

1891750220 207P00000X 020 Physicians 270 Emergency Medicine

1891755567 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891757290 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1891765228 207RP1001X 020 Physicians 029 Pulmonary Diseases

1891765681 207ZH0000X 020 Physicians 560 Hematology; Pathology

1891765681 207ZP0101X 020 Physicians 022 Pathology

1891766655 111N00000X 011 Chiropractic Providers 047 Chiropractor

1891768750 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891769386 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1891769691 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891769766 207RH0000X 020 Physicians 178 Hematology

1891770756 207P00000X 020 Physicians 270 Emergency Medicine

1891772067 207R00000X 020 Physicians 011 Internal Medicine

495 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1891773016 208800000X 020 Physicians 034 Urology

1891774261 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891775508 207RG0100X 020 Physicians 010 Gastroenterology

1891776019 207R00000X 020 Physicians 011 Internal Medicine

1891778148 2084N0400X 020 Physicians 013 Neurology

1891787131 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891789582 208G00000X 020 Physicians 033 Thoracic Surgery

1891790515 207RH0000X 020 Physicians 178 Hematology

1891790515 207RH0003X 020 Physicians 179 Hematology/Oncology

1891790978 207RI0011X 020 Physicians 188 Interventional Cardiology

1891825733 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891828273 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1891832630 207RH0000X 020 Physicians 178 Hematology

1891836557 207Y00000X 020 Physicians 217 Otolaryngology

1891848149 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1891849592 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1891849592 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1891851176 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1891851713 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1891856860 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1891872370 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891881157 208000000X 020 Physicians 049 Pediatrics

1891884136 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891884342 1223G0001X 012 Dental Providers 001 General Practice

1891884342 122300000X 012 Dental Providers 019 Dentists

1891885307 207RP1001X 020 Physicians 029 Pulmonary Diseases

1891885307 207R00000X 020 Physicians 011 Internal Medicine

1891885935 207T00000X 020 Physicians 014 Neurological Surgery

1891888186 208000000X 020 Physicians 049 Pediatrics

1891888582 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891889622 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

496 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1891891214 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1891893723 122300000X 012 Dental Providers 019 Dentists

1891894564 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1891904165 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891906202 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1891918306 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891920542 1223G0001X 012 Dental Providers 001 General Practice

1891924957 2084P0800X 020 Physicians 121 Psychiatry

1891934311 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891934873 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1891938882 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1891942405 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1891944013 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1891952057 207P00000X 020 Physicians 270 Emergency Medicine

1891956215 208600000X 020 Physicians 275 Surgery

1891957650 207RC0000X 020 Physicians 006 Cardiovascular Disease

1891958435 207R00000X 020 Physicians 011 Internal Medicine

1891958435 207RR0500X 020 Physicians 267 Rheumatology

1891970083 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1891981825 207R00000X 020 Physicians 011 Internal Medicine

1891981973 208000000X 020 Physicians 049 Pediatrics

1891988267 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1891990404 2085R0202X 020 Physicians 167 Diagnostic Radiology

1891996179 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1902001373 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1902002850 208M00000X 020 Physicians 344 Hospitalist

1902009491 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902011968 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1902013857 207Q00000X 020 Physicians 173 Family Medicine

1902015217 208800000X 020 Physicians 034 Urology

1902015670 2080P0202X 020 Physicians 221 Pediatric Cardiology

497 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902015688 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902035025 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1902041296 207RC0000X 020 Physicians 006 Cardiovascular Disease

1902042955 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902047814 208G00000X 020 Physicians 033 Thoracic Surgery

1902053242 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902053895 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1902059926 111N00000X 011 Chiropractic Providers 047 Chiropractor

1902067002 2084N0400X 020 Physicians 013 Neurology

1902070519 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902078751 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902092091 2084N0400X 020 Physicians 013 Neurology

1902092091 2084P2900X 020 Physicians 570 Psychiatry & Neurology; Pain Medicine

1902092364 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902092620 207R00000X 020 Physicians 011 Internal Medicine

1902094584 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902098031 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902098668 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1902110232 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1902111990 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902118292 207Q00000X 020 Physicians 173 Family Medicine

1902122104 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1902127640 208100000X 020 Physicians 025 Physical Medicine and Rehab

1902141195 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1902141195 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1902148224 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902148695 207L00000X 020 Physicians 005 Anesthesiology

1902148695 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1902148695 207LP2900X 020 Physicians 624 Anesthesiology; Pain Medicine

1902163561 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902166911 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

498 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902167117 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1902171358 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902171796 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1902177256 207RN0300X 020 Physicians 105 Nephrology

1902181514 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1902187255 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902193816 207X00000X 020 Physicians 020 Orthopedic Surgery

1902197080 208M00000X 020 Physicians 344 Hospitalist

1902197411 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1902201221 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1902201940 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902204084 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1902208564 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902209661 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902210545 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1902210974 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1902210974 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1902211410 207P00000X 020 Physicians 270 Emergency Medicine

1902212426 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1902216260 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1902217045 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902217144 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1902220296 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902227283 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902228547 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1902228547 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1902228547 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1902228547 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1902230600 183500000X 018 Pharmacy 253 Pharmacist

1902238330 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902244379 207L00000X 020 Physicians 005 Anesthesiology

499 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902244940 207Y00000X 020 Physicians 217 Otolaryngology

1902245996 1223G0001X 012 Dental Providers 001 General Practice

1902245996 122300000X 012 Dental Providers 019 Dentists

1902247703 207Q00000X 020 Physicians 173 Family Medicine

1902251440 207Q00000X 020 Physicians 173 Family Medicine

1902257454 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1902260581 207X00000X 020 Physicians 020 Orthopedic Surgery

1902262595 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902268436 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902276835 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1902276843 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1902281439 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1902285331 207P00000X 020 Physicians 270 Emergency Medicine

1902286990 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1902296122 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902318710 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902332422 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1902332760 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902333446 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1902343684 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902347701 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1902380835 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1902382260 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1902384944 207RG0100X 020 Physicians 010 Gastroenterology

1902390172 207Q00000X 020 Physicians 173 Family Medicine

1902391113 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1902434392 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1902436033 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902440449 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1902451024 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902452766 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

500 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902458383 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902459811 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902468978 208600000X 020 Physicians 275 Surgery

1902802812 208100000X 020 Physicians 025 Physical Medicine and Rehab

1902812746 207RC0000X 020 Physicians 006 Cardiovascular Disease

1902812746 207UN0901X 020 Physicians 597 Nuclear Medicine; Nuclear Cardiology

1902815285 207ZC0006X 020 Physicians 021 Clinical Pathology

1902815285 207ZP0101X 020 Physicians 436 Anatomic Pathology

1902815285 207ZH0000X 020 Physicians 560 Hematology; Pathology

1902818933 208M00000X 020 Physicians 344 Hospitalist

1902823677 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1902824600 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

1902824600 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1902826340 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902826449 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1902827918 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1902828593 208M00000X 020 Physicians 344 Hospitalist

1902832041 207RI0200X 020 Physicians 185 Infectious Diseases

1902837420 207R00000X 020 Physicians 011 Internal Medicine

1902837511 207R00000X 020 Physicians 011 Internal Medicine

1902840010 207ZP0101X 020 Physicians 436 Anatomic Pathology

1902841588 208600000X 020 Physicians 275 Surgery

1902841992 207N00000X 020 Physicians 007 Dermatology

1902845456 207Q00000X 020 Physicians 173 Family Medicine

1902846686 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1902847601 207X00000X 020 Physicians 020 Orthopedic Surgery

1902848971 207Q00000X 020 Physicians 173 Family Medicine

1902849904 207L00000X 020 Physicians 005 Anesthesiology

1902856719 207P00000X 020 Physicians 270 Emergency Medicine

1902859242 2080P0008X 020 Physicians 233 Pediatric Neurodevelopment

1902860406 207R00000X 020 Physicians 011 Internal Medicine

501 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902870801 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902872674 207R00000X 020 Physicians 011 Internal Medicine

1902872674 207RN0300X 020 Physicians 105 Nephrology

1902872674 207RC0200X 020 Physicians 206 Critical Care Medicine

1902876642 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902877657 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902880958 207V00000X 020 Physicians 016 OB/GYN

1902882020 2084N0400X 020 Physicians 013 Neurology

1902883192 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1902883192 207X00000X 020 Physicians 020 Orthopedic Surgery

1902883572 2084N0400X 020 Physicians 013 Neurology

1902884554 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1902884554 207ZP0101X 020 Physicians 022 Pathology

1902884737 207VF0040X 020 Physicians 565 Female Pelvic Medicine & Reconstructive

1902890726 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902890973 207PE0004X 020 Physicians 093 Emergency Medical Services

1902890973 207P00000X 020 Physicians 270 Emergency Medicine

1902891310 207X00000X 020 Physicians 020 Orthopedic Surgery

1902906225 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1902912272 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1902912272 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1902917891 2080P0210X 020 Physicians 232 Pediatric Nephrology

1902919376 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902937675 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1902942766 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1902958606 111N00000X 011 Chiropractic Providers 047 Chiropractor

1902966856 2085R0202X 020 Physicians 167 Diagnostic Radiology

1902966856 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1902968431 111N00000X 011 Chiropractic Providers 047 Chiropractor

1902975295 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1902975295 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

502 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1902976871 208M00000X 020 Physicians 344 Hospitalist

1902976871 207R00000X 020 Physicians 011 Internal Medicine

1902978455 207N00000X 020 Physicians 007 Dermatology

1902980907 208600000X 020 Physicians 275 Surgery

1902982481 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1902986698 207R00000X 020 Physicians 011 Internal Medicine

1902988488 122300000X 012 Dental Providers 019 Dentists

1902989486 208000000X 020 Physicians 049 Pediatrics

1902991557 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1902992266 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1902998081 2084P0800X 020 Physicians 121 Psychiatry

1902998081 2084P0804X 020 Physicians 142 Psychiatry; Child/Adolescent

1912004045 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912007642 2086S0129X 020 Physicians 289 Vascular Surgery

1912007642 208G00000X 020 Physicians 033 Thoracic Surgery

1912008335 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1912008921 207RH0003X 020 Physicians 179 Hematology/Oncology

1912019415 208100000X 020 Physicians 025 Physical Medicine and Rehab

1912019480 208000000X 020 Physicians 049 Pediatrics

1912032970 208000000X 020 Physicians 049 Pediatrics

1912046236 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1912049065 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1912054065 111N00000X 011 Chiropractic Providers 047 Chiropractor

1912054214 2084V0102X 020 Physicians 552 Vascular Neurology

1912056268 1223E0200X 012 Dental Providers 062 Endodontics

1912056268 122300000X 012 Dental Providers 019 Dentists

1912060815 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1912063223 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1912069337 207V00000X 020 Physicians 016 OB/GYN

1912077249 207Q00000X 020 Physicians 173 Family Medicine

1912077249 207R00000X 020 Physicians 011 Internal Medicine

503 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912091026 1223G0001X 012 Dental Providers 001 General Practice

1912092818 207P00000X 020 Physicians 270 Emergency Medicine

1912096710 208100000X 020 Physicians 025 Physical Medicine and Rehab

1912098716 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912114034 207RI0011X 020 Physicians 188 Interventional Cardiology

1912114034 2080P0202X 020 Physicians 221 Pediatric Cardiology

1912114208 208000000X 020 Physicians 049 Pediatrics

1912116823 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912121500 207L00000X 020 Physicians 005 Anesthesiology

1912122839 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1912125402 183500000X 018 Pharmacy 253 Pharmacist

1912127424 207Q00000X 020 Physicians 173 Family Medicine

1912129602 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912130295 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1912136284 207T00000X 020 Physicians 014 Neurological Surgery

1912136581 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912137449 207Q00000X 020 Physicians 173 Family Medicine

1912138231 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912139718 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912140716 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1912141243 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912142225 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1912148867 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912150228 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912151358 208M00000X 020 Physicians 344 Hospitalist

1912151358 207R00000X 020 Physicians 011 Internal Medicine

1912152190 1223G0001X 012 Dental Providers 001 General Practice

1912153040 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1912153040 208000000X 020 Physicians 049 Pediatrics

1912158999 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912160540 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

504 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912161357 207Q00000X 020 Physicians 173 Family Medicine

1912167594 2084N0400X 020 Physicians 013 Neurology

1912169384 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912169384 2085N0700X 020 Physicians 204 Neuroradiology

1912170580 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1912170622 207L00000X 020 Physicians 005 Anesthesiology

1912172305 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912177411 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912178948 2086S0102X 020 Physicians 539 Surgical Critical Care

1912178948 208600000X 020 Physicians 275 Surgery

1912182544 111N00000X 011 Chiropractic Providers 047 Chiropractor

1912183476 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912185398 208100000X 020 Physicians 025 Physical Medicine and Rehab

1912188483 2080P0202X 020 Physicians 221 Pediatric Cardiology

1912188913 207P00000X 020 Physicians 270 Emergency Medicine

1912189325 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1912190810 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912196726 207R00000X 020 Physicians 011 Internal Medicine

1912204264 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1912214719 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1912223603 207RC0000X 020 Physicians 006 Cardiovascular Disease

1912224015 208000000X 020 Physicians 049 Pediatrics

1912225061 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1912226440 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912234840 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1912244070 207L00000X 020 Physicians 005 Anesthesiology

1912244898 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912252933 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1912262262 207L00000X 020 Physicians 005 Anesthesiology

1912264086 2084P2900X 020 Physicians 570 Psychiatry & Neurology; Pain Medicine

1912264086 2084N0400X 020 Physicians 013 Neurology

505 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912269952 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912273418 207R00000X 020 Physicians 011 Internal Medicine

1912279423 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1912279910 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1912279910 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1912280710 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912285578 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912285578 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912285867 207Q00000X 020 Physicians 173 Family Medicine

1912288788 183500000X 018 Pharmacy 253 Pharmacist

1912294455 207V00000X 020 Physicians 016 OB/GYN

1912296989 207P00000X 020 Physicians 270 Emergency Medicine

1912304437 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1912306341 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912309584 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912310418 207Q00000X 020 Physicians 173 Family Medicine

1912312786 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1912314337 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1912318155 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912318163 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912318999 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912323171 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912324997 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1912325713 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1912327438 204E00000X 020 Physicians 212 Oral Maxillofacial Surgery

1912327438 1223S0112X 012 Dental Providers 212 Oral Maxillofacial Surgery

1912343542 207R00000X 020 Physicians 011 Internal Medicine

1912346792 207L00000X 020 Physicians 005 Anesthesiology

1912347493 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912347949 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1912349176 207RG0100X 020 Physicians 010 Gastroenterology

506 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912351636 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912354796 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1912358771 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912358953 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912359431 208M00000X 020 Physicians 344 Hospitalist

1912360504 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1912366287 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912376625 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912391285 207N00000X 020 Physicians 007 Dermatology

1912392184 207V00000X 020 Physicians 016 OB/GYN

1912392440 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912393901 207R00000X 020 Physicians 011 Internal Medicine

1912399262 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1912413550 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912420332 207Q00000X 020 Physicians 173 Family Medicine

1912421454 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1912423245 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912445347 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1912446923 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1912450297 122300000X 012 Dental Providers 019 Dentists

1912453846 208600000X 020 Physicians 275 Surgery

1912462813 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1912483157 207Q00000X 020 Physicians 173 Family Medicine

1912489808 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1912490830 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912498593 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912498957 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1912530254 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1912539420 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912549130 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1912557711 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

507 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912569096 208600000X 020 Physicians 275 Surgery

1912569658 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912908401 207RC0000X 020 Physicians 006 Cardiovascular Disease

1912909417 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912914466 207P00000X 020 Physicians 270 Emergency Medicine

1912918772 207Q00000X 020 Physicians 173 Family Medicine

1912925876 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912931783 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912933557 207R00000X 020 Physicians 011 Internal Medicine

1912936329 207Q00000X 020 Physicians 173 Family Medicine

1912937111 207T00000X 020 Physicians 014 Neurological Surgery

1912937657 208800000X 020 Physicians 034 Urology

1912940909 207L00000X 020 Physicians 005 Anesthesiology

1912942566 207Q00000X 020 Physicians 173 Family Medicine

1912943275 207RP1001X 020 Physicians 029 Pulmonary Diseases

1912946997 207L00000X 020 Physicians 005 Anesthesiology

1912947847 208800000X 020 Physicians 034 Urology

1912949744 208800000X 020 Physicians 034 Urology

1912951427 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912958448 207Q00000X 020 Physicians 173 Family Medicine

1912964966 207Q00000X 020 Physicians 173 Family Medicine

1912970617 208G00000X 020 Physicians 033 Thoracic Surgery

1912971318 207R00000X 020 Physicians 011 Internal Medicine

1912971318 207RC0200X 020 Physicians 206 Critical Care Medicine

1912973389 207R00000X 020 Physicians 011 Internal Medicine

1912974213 122300000X 012 Dental Providers 019 Dentists

1912974213 1223G0001X 012 Dental Providers 001 General Practice

1912977133 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1912977224 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1912979345 207Q00000X 020 Physicians 173 Family Medicine

1912979345 208D00000X 020 Physicians 001 General Practice

508 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1912979972 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1912979972 208000000X 020 Physicians 049 Pediatrics

1912981887 207RH0003X 020 Physicians 179 Hematology/Oncology

1912983396 207N00000X 020 Physicians 007 Dermatology

1912983941 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912984071 207RC0000X 020 Physicians 006 Cardiovascular Disease

1912984493 207L00000X 020 Physicians 005 Anesthesiology

1912984923 207RN0300X 020 Physicians 105 Nephrology

1912984923 207R00000X 020 Physicians 011 Internal Medicine

1912985037 2085R0202X 020 Physicians 167 Diagnostic Radiology

1912985730 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1912986092 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1912986183 207RC0000X 020 Physicians 006 Cardiovascular Disease

1912986183 207RA0001X 020 Physicians 615 Advanced Heart Failure & Transplant Card

1912986274 207PE0004X 020 Physicians 093 Emergency Medical Services

1912986944 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1912989203 2084P0800X 020 Physicians 121 Psychiatry

1912989542 207R00000X 020 Physicians 011 Internal Medicine

1912992298 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1912993049 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1922010966 207RC0200X 020 Physicians 206 Critical Care Medicine

1922015346 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1922019041 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922025568 207X00000X 020 Physicians 020 Orthopedic Surgery

1922025691 207RI0200X 020 Physicians 185 Infectious Diseases

1922025691 207R00000X 020 Physicians 011 Internal Medicine

1922025691 207RC0200X 020 Physicians 206 Critical Care Medicine

1922025907 207RH0003X 020 Physicians 179 Hematology/Oncology

1922026574 208000000X 020 Physicians 049 Pediatrics

1922026699 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922027200 208000000X 020 Physicians 049 Pediatrics

509 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1922027200 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1922028117 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1922029479 207Q00000X 020 Physicians 173 Family Medicine

1922032838 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922039684 207RG0100X 020 Physicians 010 Gastroenterology

1922043546 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1922046135 2085R0202X 020 Physicians 167 Diagnostic Radiology

1922047604 2080P0202X 020 Physicians 221 Pediatric Cardiology

1922054048 207RC0000X 020 Physicians 006 Cardiovascular Disease

1922057074 2084P0800X 020 Physicians 121 Psychiatry

1922067776 2080P0210X 020 Physicians 232 Pediatric Nephrology

1922069616 208800000X 020 Physicians 034 Urology

1922070705 207L00000X 020 Physicians 005 Anesthesiology

1922070846 2085R0202X 020 Physicians 167 Diagnostic Radiology

1922071067 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922072925 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922078344 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922079250 207L00000X 020 Physicians 005 Anesthesiology

1922079250 207LC0200X 020 Physicians 573 Anesthesiology; Critical Care Medicine

1922079821 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1922083583 207P00000X 020 Physicians 270 Emergency Medicine

1922084151 207W00000X 020 Physicians 018 Ophthalmology

1922085380 207X00000X 020 Physicians 020 Orthopedic Surgery

1922085414 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1922085430 2081P0010X 020 Physicians 242 Pediatric Rehab Medicine

1922085794 2085P0229X 020 Physicians 241 Pediatric Radiology

1922086958 207V00000X 020 Physicians 016 OB/GYN

1922088442 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1922088855 207Q00000X 020 Physicians 173 Family Medicine

1922091628 207P00000X 020 Physicians 270 Emergency Medicine

1922095363 207R00000X 020 Physicians 011 Internal Medicine

510 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1922107853 207L00000X 020 Physicians 005 Anesthesiology

1922108653 208M00000X 020 Physicians 344 Hospitalist

1922108653 207R00000X 020 Physicians 011 Internal Medicine

1922114826 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1922117670 111N00000X 011 Chiropractic Providers 047 Chiropractor

1922121318 2084P0800X 020 Physicians 121 Psychiatry

1922130798 207L00000X 020 Physicians 005 Anesthesiology

1922132943 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922132943 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1922139526 207P00000X 020 Physicians 270 Emergency Medicine

1922145309 2084P0800X 020 Physicians 121 Psychiatry

1922155043 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922180116 207RH0003X 020 Physicians 179 Hematology/Oncology

1922191378 207P00000X 020 Physicians 270 Emergency Medicine

1922192038 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1922192038 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1922196104 207L00000X 020 Physicians 005 Anesthesiology

1922196351 208000000X 020 Physicians 049 Pediatrics

1922197524 1223G0001X 012 Dental Providers 001 General Practice

1922199231 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1922199728 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1922200724 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922201029 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1922202902 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922216142 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922231950 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1922233915 207P00000X 020 Physicians 270 Emergency Medicine

1922234624 2085R0202X 020 Physicians 167 Diagnostic Radiology

1922235365 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922236793 207RH0003X 020 Physicians 179 Hematology/Oncology

1922236793 207R00000X 020 Physicians 011 Internal Medicine

511 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1922241173 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922250273 207RI0200X 020 Physicians 185 Infectious Diseases

1922250273 207R00000X 020 Physicians 011 Internal Medicine

1922253954 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1922260439 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922265123 207R00000X 020 Physicians 011 Internal Medicine

1922267723 207L00000X 020 Physicians 005 Anesthesiology

1922270834 207L00000X 020 Physicians 005 Anesthesiology

1922272228 207RI0011X 020 Physicians 188 Interventional Cardiology

1922272228 207RC0000X 020 Physicians 006 Cardiovascular Disease

1922275049 207RC0000X 020 Physicians 006 Cardiovascular Disease

1922275304 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1922284579 208800000X 020 Physicians 034 Urology

1922284942 207RH0000X 020 Physicians 178 Hematology

1922308501 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922310812 207P00000X 020 Physicians 270 Emergency Medicine

1922316744 207P00000X 020 Physicians 270 Emergency Medicine

1922318096 2084P0800X 020 Physicians 121 Psychiatry

1922319359 208800000X 020 Physicians 034 Urology

1922325448 207W00000X 020 Physicians 018 Ophthalmology

1922329762 208000000X 020 Physicians 049 Pediatrics

1922342955 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1922345032 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1922349679 208600000X 020 Physicians 275 Surgery

1922351246 2080P0208X 020 Physicians 229 Pediatric Infectious Disease

1922353275 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922365709 208000000X 020 Physicians 049 Pediatrics

1922385442 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922387950 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1922391515 207Q00000X 020 Physicians 173 Family Medicine

1922393685 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

512 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1922393974 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922396480 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922396993 2085R0202X 020 Physicians 167 Diagnostic Radiology

1922398221 2084N0400X 020 Physicians 013 Neurology

1922401009 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922401710 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922404797 111N00000X 011 Chiropractic Providers 047 Chiropractor

1922407030 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922407717 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1922407717 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1922407998 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1922426048 207W00000X 020 Physicians 018 Ophthalmology

1922428242 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922428507 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922434539 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1922441161 207Q00000X 020 Physicians 173 Family Medicine

1922445469 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1922446483 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922452861 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922460757 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922462894 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922475854 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1922477801 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1922479997 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922485531 207R00000X 020 Physicians 011 Internal Medicine

1922486802 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922489236 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1922490101 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1922491877 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922492644 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922493501 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

513 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1922495373 111N00000X 011 Chiropractic Providers 047 Chiropractor

1922496975 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1922496975 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1922509306 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922510007 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1922519479 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922527530 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1922528868 208600000X 020 Physicians 275 Surgery

1922536267 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1922538438 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1922558170 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1922559186 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1922559186 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1922566082 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1922575612 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922587161 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1922590181 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1922590223 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1922595685 208600000X 020 Physicians 275 Surgery

1922598614 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922630532 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1922640507 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1922649995 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1922650753 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1922651439 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1922653146 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1922660273 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1922663640 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1922668938 207Q00000X 020 Physicians 173 Family Medicine

1922669324 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1932107315 207L00000X 020 Physicians 005 Anesthesiology

514 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932108057 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1932113487 207X00000X 020 Physicians 020 Orthopedic Surgery

1932117322 207RG0100X 020 Physicians 010 Gastroenterology

1932117322 207R00000X 020 Physicians 011 Internal Medicine

1932121597 208600000X 020 Physicians 275 Surgery

1932121597 2086S0129X 020 Physicians 289 Vascular Surgery

1932125697 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1932126414 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1932126604 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932126893 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932126893 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1932127537 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1932127669 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932128147 207RC0200X 020 Physicians 206 Critical Care Medicine

1932128147 207PP0204X 020 Physicians 225 Pediatric Emergency Medicine

1932130036 207X00000X 020 Physicians 020 Orthopedic Surgery

1932131836 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1932133543 208G00000X 020 Physicians 033 Thoracic Surgery

1932134426 183500000X 018 Pharmacy 253 Pharmacist

1932139409 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932139409 2085U0001X 020 Physicians 583 Radiology; Diagnostic Ultrasound

1932140050 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1932143880 208600000X 020 Physicians 275 Surgery

1932151586 2084N0400X 020 Physicians 013 Neurology

1932153830 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1932155330 207RC0200X 020 Physicians 206 Critical Care Medicine

1932155330 207R00000X 020 Physicians 011 Internal Medicine

1932155330 207RP1001X 020 Physicians 029 Pulmonary Diseases

1932155587 207T00000X 020 Physicians 014 Neurological Surgery

1932160132 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1932160496 207RC0000X 020 Physicians 006 Cardiovascular Disease

515 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932160611 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1932168325 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1932170057 207X00000X 020 Physicians 020 Orthopedic Surgery

1932171808 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932173622 207R00000X 020 Physicians 011 Internal Medicine

1932174588 207RN0300X 020 Physicians 105 Nephrology

1932174588 207R00000X 020 Physicians 011 Internal Medicine

1932174760 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932179181 207RX0202X 020 Physicians 529 Medical Oncology

1932181849 2084N0400X 020 Physicians 013 Neurology

1932185543 207R00000X 020 Physicians 011 Internal Medicine

1932186103 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1932186103 2084N0400X 020 Physicians 013 Neurology

1932186756 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1932187077 208000000X 020 Physicians 049 Pediatrics

1932187077 2080S0012X 020 Physicians 558 Pediatric Sleep Medicine

1932187077 2080S0010X 020 Physicians 244 Pediatric Sports Medicine

1932187135 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932188935 207RC0000X 020 Physicians 006 Cardiovascular Disease

1932189750 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1932192457 207YX0905X 020 Physicians 549 Otolaryngology/Facial Plastic Surgery

1932193083 207T00000X 020 Physicians 014 Neurological Surgery

1932193737 207W00000X 020 Physicians 018 Ophthalmology

1932193786 2084N0400X 020 Physicians 013 Neurology

1932193786 2084N0402X 020 Physicians 522 Neurology with Spec Qual in Child Neuro

1932197209 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1932200334 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1932205366 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932211208 207L00000X 020 Physicians 005 Anesthesiology

1932216579 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932221975 207R00000X 020 Physicians 011 Internal Medicine

516 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932225778 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932227394 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1932227394 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932230463 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1932239142 2084N0400X 020 Physicians 013 Neurology

1932251139 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1932253200 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1932255619 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932255908 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1932258647 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1932262474 207L00000X 020 Physicians 005 Anesthesiology

1932272952 208000000X 020 Physicians 049 Pediatrics

1932273091 122300000X 012 Dental Providers 019 Dentists

1932274149 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1932275088 208200000X 020 Physicians 024 Plastic Surgery

1932280336 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1932280336 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1932284676 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1932286556 207K00000X 020 Physicians 003 Allergy & Immunology

1932286556 2080P0201X 020 Physicians 108 Pediatric Allergy

1932290046 207R00000X 020 Physicians 011 Internal Medicine

1932290491 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1932292414 207N00000X 020 Physicians 007 Dermatology

1932293727 2084P0800X 020 Physicians 121 Psychiatry

1932296969 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1932298866 207V00000X 020 Physicians 016 OB/GYN

1932303526 207T00000X 020 Physicians 014 Neurological Surgery

1932303633 208000000X 020 Physicians 049 Pediatrics

1932308418 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932313574 208800000X 020 Physicians 034 Urology

1932335338 208D00000X 020 Physicians 001 General Practice

517 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932337706 207Q00000X 020 Physicians 173 Family Medicine

1932337706 208M00000X 020 Physicians 344 Hospitalist

1932338613 208600000X 020 Physicians 275 Surgery

1932338753 207RI0011X 020 Physicians 188 Interventional Cardiology

1932338845 111N00000X 011 Chiropractic Providers 047 Chiropractor

1932340213 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932342730 207VX0201X 020 Physicians 307 Gynecologic Oncology

1932342730 207V00000X 020 Physicians 016 OB/GYN

1932364650 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1932365525 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1932365806 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1932366143 207P00000X 020 Physicians 270 Emergency Medicine

1932368602 207R00000X 020 Physicians 011 Internal Medicine

1932368602 207RI0200X 020 Physicians 185 Infectious Diseases

1932369634 207L00000X 020 Physicians 005 Anesthesiology

1932379229 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932380003 207Q00000X 020 Physicians 173 Family Medicine

1932392438 208M00000X 020 Physicians 344 Hospitalist

1932392438 207P00000X 020 Physicians 270 Emergency Medicine

1932406030 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932407848 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932408812 208M00000X 020 Physicians 344 Hospitalist

1932415320 207R00000X 020 Physicians 011 Internal Medicine

1932420601 207P00000X 020 Physicians 270 Emergency Medicine

1932426004 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932429917 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1932455094 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932462199 207L00000X 020 Physicians 005 Anesthesiology

1932463981 2084N0400X 020 Physicians 013 Neurology

1932469673 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932469673 2085N0700X 020 Physicians 204 Neuroradiology

518 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932472230 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932472875 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932480282 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1932485349 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932487469 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1932491891 207L00000X 020 Physicians 005 Anesthesiology

1932494325 208600000X 020 Physicians 275 Surgery

1932494390 2085R0202X 020 Physicians 167 Diagnostic Radiology

1932500303 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932503406 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1932506581 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1932510070 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932513629 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932513678 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1932518461 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1932520731 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932521283 111N00000X 011 Chiropractic Providers 047 Chiropractor

1932522901 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1932525359 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1932526209 207N00000X 020 Physicians 007 Dermatology

1932532215 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932539079 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932542180 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1932549177 207Q00000X 020 Physicians 173 Family Medicine

1932553443 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1932556446 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1932558285 208M00000X 020 Physicians 344 Hospitalist

1932558285 207R00000X 020 Physicians 011 Internal Medicine

1932561628 207P00000X 020 Physicians 270 Emergency Medicine

1932561842 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932561842 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

519 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1932570876 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1932570876 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1932570876 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1932576451 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1932580917 207Q00000X 020 Physicians 173 Family Medicine

1932581220 207R00000X 020 Physicians 011 Internal Medicine

1932589223 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1932591963 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1932596475 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932596939 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932597507 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1932597507 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1932597507 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1932597770 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932602307 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932612090 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1932633054 183500000X 018 Pharmacy 253 Pharmacist

1932638368 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1932644705 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1932647419 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1932655420 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1932659125 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1932659539 122300000X 012 Dental Providers 019 Dentists

1932687548 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1932691862 207Q00000X 020 Physicians 173 Family Medicine

1932697786 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1932697810 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1932737137 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1932753779 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1942201942 208000000X 020 Physicians 049 Pediatrics

1942202593 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

520 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942206016 2080P0202X 020 Physicians 221 Pediatric Cardiology

1942206016 207RC0000X 020 Physicians 006 Cardiovascular Disease

1942206016 2080P0201X 020 Physicians 108 Pediatric Allergy

1942206990 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942208913 111N00000X 011 Chiropractic Providers 047 Chiropractor

1942213350 207T00000X 020 Physicians 014 Neurological Surgery

1942227582 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1942227939 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1942227939 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942228523 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942228531 207Q00000X 020 Physicians 173 Family Medicine

1942233432 207Q00000X 020 Physicians 173 Family Medicine

1942234851 208600000X 020 Physicians 275 Surgery

1942234851 207RC0200X 020 Physicians 206 Critical Care Medicine

1942236419 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1942236419 208M00000X 020 Physicians 344 Hospitalist

1942236815 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942237946 2086S0102X 020 Physicians 539 Surgical Critical Care

1942240668 207Q00000X 020 Physicians 173 Family Medicine

1942244520 207RC0000X 020 Physicians 006 Cardiovascular Disease

1942244686 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1942244983 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942257944 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942262290 2080P0214X 020 Physicians 240 Pediatric Pulmonology

1942263660 207V00000X 020 Physicians 016 OB/GYN

1942268388 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1942269097 207P00000X 020 Physicians 270 Emergency Medicine

1942270426 207X00000X 020 Physicians 020 Orthopedic Surgery

1942270426 207QA0401X 020 Physicians 562 Family Medicine; Addiction Medicine

1942271580 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942272380 207RC0000X 020 Physicians 006 Cardiovascular Disease

521 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942272380 207RC0001X 020 Physicians 084 Clinical Cardiac Electophysiology

1942272448 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942272950 2084N0400X 020 Physicians 013 Neurology

1942272950 208000000X 020 Physicians 049 Pediatrics

1942279575 207R00000X 020 Physicians 011 Internal Medicine

1942279948 207R00000X 020 Physicians 011 Internal Medicine

1942280375 208800000X 020 Physicians 034 Urology

1942286612 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1942287032 2084N0400X 020 Physicians 013 Neurology

1942287974 208100000X 020 Physicians 025 Physical Medicine and Rehab

1942288162 207RC0000X 020 Physicians 006 Cardiovascular Disease

1942305206 208M00000X 020 Physicians 344 Hospitalist

1942308614 207Q00000X 020 Physicians 173 Family Medicine

1942312459 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942313432 208800000X 020 Physicians 034 Urology

1942321682 207RG0100X 020 Physicians 010 Gastroenterology

1942327689 2084S0012X 020 Physicians 521 Sleep Medicine

1942327689 2084N0400X 020 Physicians 013 Neurology

1942352679 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942352927 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1942369285 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1942370671 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1942373907 1223P0700X 012 Dental Providers 066 Prosthodontics

1942380373 2080P0202X 020 Physicians 221 Pediatric Cardiology

1942382312 111N00000X 011 Chiropractic Providers 047 Chiropractor

1942382452 208000000X 020 Physicians 049 Pediatrics

1942389432 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942390315 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1942391743 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1942392444 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942398375 207Y00000X 020 Physicians 217 Otolaryngology

522 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942400247 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1942400726 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1942405923 208000000X 020 Physicians 049 Pediatrics

1942408273 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942416714 207Y00000X 020 Physicians 217 Otolaryngology

1942422787 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1942425277 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942425384 207Q00000X 020 Physicians 173 Family Medicine

1942426788 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942427117 207T00000X 020 Physicians 014 Neurological Surgery

1942430004 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942430491 208600000X 020 Physicians 275 Surgery

1942437538 207L00000X 020 Physicians 005 Anesthesiology

1942451596 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942455258 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1942455258 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1942455258 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1942461223 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1942461678 207P00000X 020 Physicians 270 Emergency Medicine

1942465067 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1942465067 208000000X 020 Physicians 049 Pediatrics

1942465851 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942475454 2085R0202X 020 Physicians 167 Diagnostic Radiology

1942476825 2084N0400X 020 Physicians 013 Neurology

1942480629 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942483797 207R00000X 020 Physicians 011 Internal Medicine

1942483797 207RP1001X 020 Physicians 029 Pulmonary Diseases

1942495627 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942496492 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1942497243 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1942497243 213ES0103X 021 Podiatric Medicine & Surgery Service 541 Surgery Foot & Ankle

523 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942503172 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942503172 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1942511530 207X00000X 020 Physicians 020 Orthopedic Surgery

1942513973 207X00000X 020 Physicians 020 Orthopedic Surgery

1942514666 207Q00000X 020 Physicians 173 Family Medicine

1942515457 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942520325 2084P0800X 020 Physicians 121 Psychiatry

1942530001 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942533781 363LN0005X 036 Phys Assts and Advanced Nursing Provs 466 Nurse Practitioner- Neonatal-Critcl Care

1942551106 207R00000X 020 Physicians 011 Internal Medicine

1942551106 207Q00000X 020 Physicians 173 Family Medicine

1942566195 207Q00000X 020 Physicians 173 Family Medicine

1942566302 207X00000X 020 Physicians 020 Orthopedic Surgery

1942579966 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1942579966 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1942579966 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1942590948 207L00000X 020 Physicians 005 Anesthesiology

1942596622 207ZP0101X 020 Physicians 022 Pathology

1942596622 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1942596622 207ZH0000X 020 Physicians 560 Hematology; Pathology

1942596820 207RC0000X 020 Physicians 006 Cardiovascular Disease

1942596887 207X00000X 020 Physicians 020 Orthopedic Surgery

1942597349 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1942599048 2084P0800X 020 Physicians 121 Psychiatry

1942599576 207RC0000X 020 Physicians 006 Cardiovascular Disease

1942599576 208000000X 020 Physicians 049 Pediatrics

1942603279 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942606025 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942611553 111N00000X 011 Chiropractic Providers 047 Chiropractor

1942624689 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942625215 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

524 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942625983 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1942629381 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942633227 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942640461 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1942642491 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942648878 207Q00000X 020 Physicians 173 Family Medicine

1942663026 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942671391 111N00000X 011 Chiropractic Providers 047 Chiropractor

1942680889 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1942680889 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1942682851 208M00000X 020 Physicians 344 Hospitalist

1942683990 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942687645 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1942693346 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942693817 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1942697131 207Q00000X 020 Physicians 173 Family Medicine

1942697545 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1942697909 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942698881 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1942698881 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1942714977 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1942724372 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942737820 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1942738752 207R00000X 020 Physicians 011 Internal Medicine

1942740345 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1942745013 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942749247 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942751037 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942752571 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1942755145 101YP2500X 010 Behav Health & Social Svc Prov 194 Counselor Professional

1942755145 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

525 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1942755145 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1942758701 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1942761507 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1942761507 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1942788328 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942789425 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942792411 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1942794441 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1942796115 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1942832456 207XS0106X 020 Physicians 214 Orthopedic Hand Surgery

1942855028 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1942869391 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1952300659 2084N0400X 020 Physicians 013 Neurology

1952301699 207Q00000X 020 Physicians 173 Family Medicine

1952307696 207V00000X 020 Physicians 016 OB/GYN

1952308769 207W00000X 020 Physicians 018 Ophthalmology

1952313975 2085R0202X 020 Physicians 167 Diagnostic Radiology

1952322299 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1952322760 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1952323529 103TC2200X 010 Behav Health & Social Svc Prov 523 Clinical Child & Adolescent

1952328817 207L00000X 020 Physicians 005 Anesthesiology

1952331233 207V00000X 020 Physicians 016 OB/GYN

1952334179 207X00000X 020 Physicians 020 Orthopedic Surgery

1952336265 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952336349 111N00000X 011 Chiropractic Providers 047 Chiropractor

1952336984 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952340689 207P00000X 020 Physicians 270 Emergency Medicine

1952341026 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952345936 207P00000X 020 Physicians 270 Emergency Medicine

1952347957 207QA0505X 020 Physicians 058 Adult Medicine

1952347957 208M00000X 020 Physicians 344 Hospitalist

526 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952347965 208G00000X 020 Physicians 033 Thoracic Surgery

1952348591 207L00000X 020 Physicians 005 Anesthesiology

1952352148 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952354847 207L00000X 020 Physicians 005 Anesthesiology

1952357030 207L00000X 020 Physicians 005 Anesthesiology

1952360711 207N00000X 020 Physicians 007 Dermatology

1952361040 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952361636 207Q00000X 020 Physicians 173 Family Medicine

1952361818 208G00000X 020 Physicians 033 Thoracic Surgery

1952362535 2086S0120X 020 Physicians 245 Pediatric Surgery

1952367864 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952373334 2084N0600X 020 Physicians 534 Clinical Neurophysiology

1952373334 2084N0400X 020 Physicians 013 Neurology

1952375859 207RC0000X 020 Physicians 006 Cardiovascular Disease

1952376790 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1952377293 111N00000X 011 Chiropractic Providers 047 Chiropractor

1952378044 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1952378911 207X00000X 020 Physicians 020 Orthopedic Surgery

1952380800 207RX0202X 020 Physicians 529 Medical Oncology

1952380800 207RH0000X 020 Physicians 178 Hematology

1952383572 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952384836 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952385304 207PE0004X 020 Physicians 093 Emergency Medical Services

1952385304 207P00000X 020 Physicians 270 Emergency Medicine

1952387078 208800000X 020 Physicians 034 Urology

1952398695 207Q00000X 020 Physicians 173 Family Medicine

1952401200 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1952401200 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952404659 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1952404659 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1952407751 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

527 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952408809 207N00000X 020 Physicians 007 Dermatology

1952416224 207LP3000X 020 Physicians 412 Pediatric Anesthesiology

1952420218 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952433351 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952433351 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1952438996 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1952446072 207X00000X 020 Physicians 020 Orthopedic Surgery

1952449522 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952453144 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952454829 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952454829 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952455966 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952463507 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952469165 207Y00000X 020 Physicians 217 Otolaryngology

1952480683 208M00000X 020 Physicians 344 Hospitalist

1952481657 207YX0905X 020 Physicians 549 Otolaryngology/Facial Plastic Surgery

1952481723 207Q00000X 020 Physicians 173 Family Medicine

1952481723 207P00000X 020 Physicians 270 Emergency Medicine

1952483604 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1952483786 207RG0100X 020 Physicians 010 Gastroenterology

1952485740 207RC0000X 020 Physicians 006 Cardiovascular Disease

1952487498 111N00000X 011 Chiropractic Providers 047 Chiropractor

1952493819 2080P0202X 020 Physicians 221 Pediatric Cardiology

1952494585 2085R0202X 020 Physicians 167 Diagnostic Radiology

1952500803 207RR0500X 020 Physicians 267 Rheumatology

1952502700 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1952502700 207R00000X 020 Physicians 011 Internal Medicine

1952505448 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1952506859 2085R0202X 020 Physicians 167 Diagnostic Radiology

1952510513 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1952520249 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

528 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952529992 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1952530156 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952530164 207R00000X 020 Physicians 011 Internal Medicine

1952530750 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952537698 1223G0001X 012 Dental Providers 001 General Practice

1952539223 207N00000X 020 Physicians 007 Dermatology

1952540445 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952542995 2085R0202X 020 Physicians 167 Diagnostic Radiology

1952552937 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1952554826 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952556664 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952557332 2080P0202X 020 Physicians 221 Pediatric Cardiology

1952560831 207RN0300X 020 Physicians 105 Nephrology

1952560831 207R00000X 020 Physicians 011 Internal Medicine

1952563900 207W00000X 020 Physicians 018 Ophthalmology

1952565517 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952567505 207RH0003X 020 Physicians 179 Hematology/Oncology

1952581530 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1952583312 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952594137 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952598856 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952598856 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1952599524 207RC0200X 020 Physicians 206 Critical Care Medicine

1952599524 207RN0300X 020 Physicians 105 Nephrology

1952600223 2084N0400X 020 Physicians 013 Neurology

1952601312 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1952606584 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1952608341 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1952610685 111N00000X 011 Chiropractic Providers 047 Chiropractor

1952619298 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1952621559 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

529 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952628620 208000000X 020 Physicians 049 Pediatrics

1952628620 2080P0202X 020 Physicians 221 Pediatric Cardiology

1952636706 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1952641987 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952652992 207L00000X 020 Physicians 005 Anesthesiology

1952652992 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1952656373 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1952659609 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952659773 208VP0014X 020 Physicians 524 Internventional Pain Medicine

1952659773 207L00000X 020 Physicians 005 Anesthesiology

1952660011 208800000X 020 Physicians 034 Urology

1952665838 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1952671117 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1952675860 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952675860 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1952676421 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1952680944 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1952680944 363LP2300X 036 Phys Assts and Advanced Nursing Provs 469 Nurse Practitioner- Primary Care

1952686206 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952687592 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952693293 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1952696049 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952696320 207V00000X 020 Physicians 016 OB/GYN

1952699282 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952699282 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952705204 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952712861 207W00000X 020 Physicians 018 Ophthalmology

1952718710 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952720401 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1952723702 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952727372 111N00000X 011 Chiropractic Providers 047 Chiropractor

530 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952736464 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1952739419 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952740623 207V00000X 020 Physicians 016 OB/GYN

1952741050 207Q00000X 020 Physicians 173 Family Medicine

1952741324 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952746851 207L00000X 020 Physicians 005 Anesthesiology

1952748758 2084N0400X 020 Physicians 013 Neurology

1952748758 207RN0300X 020 Physicians 105 Nephrology

1952748923 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952750127 208M00000X 020 Physicians 344 Hospitalist

1952750127 207R00000X 020 Physicians 011 Internal Medicine

1952753774 208600000X 020 Physicians 275 Surgery

1952765620 207R00000X 020 Physicians 011 Internal Medicine

1952765620 208M00000X 020 Physicians 344 Hospitalist

1952767253 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952780900 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1952787772 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1952787772 237600000X 023 Speech Language and Hearing Svc Prov 577 Audiologist-Hearing Aid Fitter

1952798183 207P00000X 020 Physicians 270 Emergency Medicine

1952799322 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952808024 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952808107 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1952815557 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952817132 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952818841 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1952820953 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952825952 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952827875 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1952830812 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1952832271 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952835043 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

531 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1952839870 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952843054 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952846495 363AS0400X 036 Phys Assts and Advanced Nursing Provs 519 Physician Assistant; Surgical

1952847956 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952850109 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1952851610 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952858136 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1952866725 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952867178 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952869349 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952877862 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1952880908 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1952880908 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1952880908 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1952884041 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952887192 207Q00000X 020 Physicians 173 Family Medicine

1952893208 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952899908 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952935215 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1952949760 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1952957847 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1952959702 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1952961716 111N00000X 011 Chiropractic Providers 047 Chiropractor

1952962128 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1952962466 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1952966061 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1962032722 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962049445 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962054171 208600000X 020 Physicians 275 Surgery

1962411231 207RH0000X 020 Physicians 178 Hematology

1962411231 207RX0202X 020 Physicians 529 Medical Oncology

532 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962412056 2080P0202X 020 Physicians 221 Pediatric Cardiology

1962414789 111N00000X 011 Chiropractic Providers 047 Chiropractor

1962420299 207Q00000X 020 Physicians 173 Family Medicine

1962422923 207RI0200X 020 Physicians 185 Infectious Diseases

1962422923 208M00000X 020 Physicians 344 Hospitalist

1962422923 207RC0000X 020 Physicians 006 Cardiovascular Disease

1962422923 207P00000X 020 Physicians 270 Emergency Medicine

1962422923 207R00000X 020 Physicians 011 Internal Medicine

1962423202 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1962424440 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962424440 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962424457 208100000X 020 Physicians 025 Physical Medicine and Rehab

1962424523 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962424721 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1962426163 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962427351 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1962427351 2085R0202X 020 Physicians 167 Diagnostic Radiology

1962433623 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962434332 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1962438929 207P00000X 020 Physicians 270 Emergency Medicine

1962439182 208600000X 020 Physicians 275 Surgery

1962444273 363LG0600X 036 Phys Assts and Advanced Nursing Provs 551 Nurse Practitioner Gerontology

1962447656 207Q00000X 020 Physicians 173 Family Medicine

1962453993 207Q00000X 020 Physicians 173 Family Medicine

1962453993 207P00000X 020 Physicians 270 Emergency Medicine

1962454645 2085R0202X 020 Physicians 167 Diagnostic Radiology

1962457598 207K00000X 020 Physicians 003 Allergy & Immunology

1962461616 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1962462085 207RG0100X 020 Physicians 010 Gastroenterology

1962462085 207R00000X 020 Physicians 011 Internal Medicine

1962462085 207RI0008X 020 Physicians 340 Hepatology

533 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962463547 208000000X 020 Physicians 049 Pediatrics

1962464099 207R00000X 020 Physicians 011 Internal Medicine

1962465922 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962468926 2085N0700X 020 Physicians 204 Neuroradiology

1962473058 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962474536 2081P2900X 020 Physicians 532 Physical Medicine & Rehabilitation; Pain

1962475483 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1962475699 207RH0000X 020 Physicians 178 Hematology

1962476341 207RN0300X 020 Physicians 105 Nephrology

1962478651 207RN0300X 020 Physicians 105 Nephrology

1962480681 207RP1001X 020 Physicians 029 Pulmonary Diseases

1962481747 2085R0202X 020 Physicians 167 Diagnostic Radiology

1962482737 2085R0202X 020 Physicians 167 Diagnostic Radiology

1962486969 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962489070 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1962492637 208000000X 020 Physicians 049 Pediatrics

1962492637 207RC0200X 020 Physicians 206 Critical Care Medicine

1962493643 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1962496752 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1962496752 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962497156 207W00000X 020 Physicians 018 Ophthalmology

1962500694 2084P0800X 020 Physicians 121 Psychiatry

1962503896 122300000X 012 Dental Providers 019 Dentists

1962504134 207ZP0213X 020 Physicians 238 Pediatric Pathology

1962510164 207ZP0105X 020 Physicians 136 Clinical Pathology/Laboratory Medicine

1962513713 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1962515874 207RC0000X 020 Physicians 006 Cardiovascular Disease

1962517227 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962518779 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1962523381 207RP1001X 020 Physicians 029 Pulmonary Diseases

1962523381 207R00000X 020 Physicians 011 Internal Medicine

534 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962525501 207W00000X 020 Physicians 018 Ophthalmology

1962529446 207R00000X 020 Physicians 011 Internal Medicine

1962531392 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1962531392 208000000X 020 Physicians 049 Pediatrics

1962536599 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1962573394 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962573394 364SP0808X 036 Phys Assts and Advanced Nursing Provs 537 CNS; Psychiatric/Mental Health

1962573394 363LP0808X 036 Phys Assts and Advanced Nursing Provs 467 Nurse Practitioner- Psych/Mental Health

1962573527 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962577411 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962577486 207RP1001X 020 Physicians 029 Pulmonary Diseases

1962590661 207QS0010X 020 Physicians 273 Sports Medicine

1962590661 2081S0010X 020 Physicians 548 Physical Medicine & Rehabilitation; Spor

1962591974 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1962593517 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962606756 204F00000X 020 Physicians 279 Transplant Surgery

1962612127 208800000X 020 Physicians 034 Urology

1962621250 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1962627398 207Q00000X 020 Physicians 173 Family Medicine

1962629006 207PH0002X 020 Physicians 571 Emergency Medicine; Hospice and Palliati

1962629600 2080P0202X 020 Physicians 221 Pediatric Cardiology

1962634808 207NP0225X 020 Physicians 222 Pediatric Dermatology

1962634808 208000000X 020 Physicians 049 Pediatrics

1962634808 207N00000X 020 Physicians 007 Dermatology

1962635078 364S00000X 036 Phys Assts and Advanced Nursing Provs 036 Clinical Nurse Specialist

1962636167 208600000X 020 Physicians 275 Surgery

1962643031 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1962650838 1223X0400X 012 Dental Providers 064 Orthodontics

1962651661 208600000X 020 Physicians 275 Surgery

1962655308 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1962655506 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

535 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962666404 183500000X 018 Pharmacy 253 Pharmacist

1962674093 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962676635 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962683276 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962689885 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1962694943 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1962694943 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1962705459 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1962706895 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962711739 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962712778 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962721654 207L00000X 020 Physicians 005 Anesthesiology

1962729111 207ZP0101X 020 Physicians 022 Pathology

1962729111 207ZB0001X 020 Physicians 563 Blood Banking & Transfusion Medicine

1962729327 208600000X 020 Physicians 275 Surgery

1962732370 111N00000X 011 Chiropractic Providers 047 Chiropractor

1962735647 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1962738385 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1962738872 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962739904 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1962749226 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962759464 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962767533 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962767772 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1962769059 2085R0202X 020 Physicians 167 Diagnostic Radiology

1962785063 207R00000X 020 Physicians 011 Internal Medicine

1962790832 207R00000X 020 Physicians 011 Internal Medicine

1962790832 208M00000X 020 Physicians 344 Hospitalist

1962797134 122300000X 012 Dental Providers 019 Dentists

1962799114 122300000X 012 Dental Providers 019 Dentists

1962802439 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

536 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962802439 152WC0802X 015 Eye and Vision Service Providers 617 Corneal and Contact Management

1962804591 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1962805119 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962813121 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962833053 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1962833129 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1962834101 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962834101 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1962834242 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1962834549 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1962834549 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1962835546 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962842120 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962842120 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962842492 2084N0400X 020 Physicians 013 Neurology

1962842740 1223G0001X 012 Dental Providers 001 General Practice

1962843177 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1962845065 207L00000X 020 Physicians 005 Anesthesiology

1962846212 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962848531 207N00000X 020 Physicians 007 Dermatology

1962850917 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1962852830 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1962853424 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962854646 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962854935 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962885087 111N00000X 011 Chiropractic Providers 047 Chiropractor

1962886689 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1962910745 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1962919159 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1962920272 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1962921551 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

537 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1962932400 2084P0800X 020 Physicians 121 Psychiatry

1962938563 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1962958298 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962973115 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1962973115 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1962973453 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1962976068 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1962978411 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1962978726 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962979674 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1962981043 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1962981845 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962983163 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1962989459 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962989830 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1962997106 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1962998096 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1962998484 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1972002426 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1972012375 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1972012482 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972024032 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1972028322 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1972039097 1223G0001X 012 Dental Providers 001 General Practice

1972040103 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972047413 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972051019 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972063535 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1972066256 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972074458 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1972079317 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

538 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1972083715 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1972084978 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972092757 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1972123586 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1972156719 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972169803 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1972500718 207Y00000X 020 Physicians 217 Otolaryngology

1972501708 207ZP0101X 020 Physicians 436 Anatomic Pathology

1972501708 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1972507713 207Q00000X 020 Physicians 173 Family Medicine

1972512325 207Y00000X 020 Physicians 217 Otolaryngology

1972512630 207R00000X 020 Physicians 011 Internal Medicine

1972515906 207P00000X 020 Physicians 270 Emergency Medicine

1972517977 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972521524 207Q00000X 020 Physicians 173 Family Medicine

1972521524 208M00000X 020 Physicians 344 Hospitalist

1972521870 207X00000X 020 Physicians 020 Orthopedic Surgery

1972524585 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1972528040 207RC0000X 020 Physicians 006 Cardiovascular Disease

1972528313 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972531226 2084P0800X 020 Physicians 121 Psychiatry

1972531283 207P00000X 020 Physicians 270 Emergency Medicine

1972532240 207X00000X 020 Physicians 020 Orthopedic Surgery

1972534642 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1972534667 2084N0400X 020 Physicians 013 Neurology

1972538064 2085R0202X 020 Physicians 167 Diagnostic Radiology

1972540557 207RN0300X 020 Physicians 105 Nephrology

1972544369 207Q00000X 020 Physicians 173 Family Medicine

1972544708 2084P0800X 020 Physicians 121 Psychiatry

1972546794 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972549970 208M00000X 020 Physicians 344 Hospitalist

539 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1972555191 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972558229 207R00000X 020 Physicians 011 Internal Medicine

1972560761 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1972561108 208800000X 020 Physicians 034 Urology

1972570935 207Q00000X 020 Physicians 173 Family Medicine

1972573863 208100000X 020 Physicians 025 Physical Medicine and Rehab

1972574341 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972575587 207R00000X 020 Physicians 011 Internal Medicine

1972575587 208M00000X 020 Physicians 344 Hospitalist

1972575843 207VM0101X 020 Physicians 404 Maternal & Fetal Medicine

1972576023 207L00000X 020 Physicians 005 Anesthesiology

1972576122 207RC0200X 020 Physicians 206 Critical Care Medicine

1972576122 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1972577757 208600000X 020 Physicians 275 Surgery

1972579118 207R00000X 020 Physicians 011 Internal Medicine

1972581155 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972582161 207RN0300X 020 Physicians 105 Nephrology

1972582344 207X00000X 020 Physicians 020 Orthopedic Surgery

1972582732 2085R0202X 020 Physicians 167 Diagnostic Radiology

1972582849 207L00000X 020 Physicians 005 Anesthesiology

1972583045 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1972588044 2085R0202X 020 Physicians 167 Diagnostic Radiology

1972595379 111N00000X 011 Chiropractic Providers 047 Chiropractor

1972602969 208800000X 020 Physicians 034 Urology

1972603975 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972604981 2080P0216X 020 Physicians 243 Pediatric Rheumatology

1972605087 122300000X 012 Dental Providers 019 Dentists

1972613487 207RI0011X 020 Physicians 188 Interventional Cardiology

1972623148 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1972623148 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1972623296 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

540 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1972623577 207RG0100X 020 Physicians 010 Gastroenterology

1972623577 207R00000X 020 Physicians 011 Internal Medicine

1972629392 207RI0200X 020 Physicians 185 Infectious Diseases

1972639532 1223G0001X 012 Dental Providers 001 General Practice

1972657120 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1972682532 207Q00000X 020 Physicians 173 Family Medicine

1972690865 207P00000X 020 Physicians 270 Emergency Medicine

1972690865 207Q00000X 020 Physicians 173 Family Medicine

1972691236 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1972695211 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972695302 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972697993 207ZB0001X 020 Physicians 563 Blood Banking & Transfusion Medicine

1972697993 207ZP0101X 020 Physicians 436 Anatomic Pathology

1972699239 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972699635 207W00000X 020 Physicians 018 Ophthalmology

1972701217 208M00000X 020 Physicians 344 Hospitalist

1972701217 207R00000X 020 Physicians 011 Internal Medicine

1972710143 2080P0203X 020 Physicians 514 Pediatric Critical Care Medicine

1972713337 207V00000X 020 Physicians 016 OB/GYN

1972718658 207L00000X 020 Physicians 005 Anesthesiology

1972718658 208VP0000X 020 Physicians 219 Otolaryngology; Pain Medicine

1972733186 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972734499 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972736510 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972738219 231H00000X 023 Speech Language and Hearing Svc Prov 087 Audiologist

1972740488 207Q00000X 020 Physicians 173 Family Medicine

1972746568 2080P0210X 020 Physicians 232 Pediatric Nephrology

1972747871 207Y00000X 020 Physicians 217 Otolaryngology

1972756583 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1972761252 207Q00000X 020 Physicians 173 Family Medicine

1972767390 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

541 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1972770188 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972772515 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1972773190 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1972783769 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1972785335 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1972791259 207R00000X 020 Physicians 011 Internal Medicine

1972791895 207RH0003X 020 Physicians 179 Hematology/Oncology

1972795060 207R00000X 020 Physicians 011 Internal Medicine

1972796001 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972797066 207P00000X 020 Physicians 270 Emergency Medicine

1972799328 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972800290 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972807709 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972812063 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1972814473 207RC0000X 020 Physicians 006 Cardiovascular Disease

1972815447 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1972819563 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972824043 207Q00000X 020 Physicians 173 Family Medicine

1972829950 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1972829950 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1972836385 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972841112 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972841799 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1972842698 367A00000X 036 Phys Assts and Advanced Nursing Provs 485 Advanced Practice Midwife

1972849131 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1972852390 207R00000X 020 Physicians 011 Internal Medicine

1972858652 2085R0202X 020 Physicians 167 Diagnostic Radiology

1972862332 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972862332 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972867943 2084N0400X 020 Physicians 013 Neurology

1972868735 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

542 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1972895803 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1972895803 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972906253 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972909091 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1972911469 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1972913119 207Q00000X 020 Physicians 173 Family Medicine

1972918316 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1972918472 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972919538 208800000X 020 Physicians 034 Urology

1972921633 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1972924934 111N00000X 011 Chiropractic Providers 047 Chiropractor

1972935617 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972938843 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972943306 183500000X 018 Pharmacy 253 Pharmacist

1972949154 207ZP0101X 020 Physicians 436 Anatomic Pathology

1972954162 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1972954709 122300000X 012 Dental Providers 019 Dentists

1972955771 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1972965986 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1972965986 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1972967404 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1972974749 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1972985174 207Q00000X 020 Physicians 173 Family Medicine

1972987634 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1972987634 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1972987634 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1972999704 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982007332 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982011763 207Q00000X 020 Physicians 173 Family Medicine

1982011979 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1982011979 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

543 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982012605 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982015202 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1982016960 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1982018198 2084P0800X 020 Physicians 121 Psychiatry

1982018198 2084S0012X 020 Physicians 521 Sleep Medicine

1982020699 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982021549 208M00000X 020 Physicians 344 Hospitalist

1982025680 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1982031571 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1982035838 103TC0700X 010 Behav Health & Social Svc Prov 543 Psychologist Clinical

1982036158 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1982036158 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1982040457 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982042362 1223G0001X 012 Dental Providers 001 General Practice

1982043154 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1982048351 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1982056255 208600000X 020 Physicians 275 Surgery

1982075768 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982081188 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1982088456 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982089272 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982092433 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1982104212 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982109930 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1982117123 106E00000X 010 Behav Health & Social Svc Prov 566 Assistant Behavior Analyst

1982117123 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1982117123 103K00000X 010 Behav Health & Social Svc Prov 567 Behavior Analyst

1982120689 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982128542 207Q00000X 020 Physicians 173 Family Medicine

1982134177 2084P0800X 020 Physicians 121 Psychiatry

1982136511 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

544 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982138285 207RH0000X 020 Physicians 178 Hematology

1982146783 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982153904 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1982153904 164W00000X 016 Nursing Service Providers 130 Licensed Practical Nurse

1982157822 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982168589 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1982185047 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982197133 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982197471 101YP2500X 010 Behav Health & Social Svc Prov 177 Counselor Lic Associate Prof(LAPC)

1982198925 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1982234712 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1982234845 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1982235610 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1982238333 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982266029 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1982601357 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1982612099 207Q00000X 020 Physicians 173 Family Medicine

1982613246 207N00000X 020 Physicians 007 Dermatology

1982617528 2080P0206X 020 Physicians 227 Pediatric Gastroenterology

1982620282 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982621454 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982621926 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1982626479 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982626479 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982626578 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982626610 207RE0101X 020 Physicians 168 Endocrinology Diabetes & Metabolism

1982635165 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982640264 207SG0201X 020 Physicians 109 Clinical Genetics (MD)

1982642773 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982643219 207Q00000X 020 Physicians 173 Family Medicine

1982643276 207L00000X 020 Physicians 005 Anesthesiology

545 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982649455 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982651824 207P00000X 020 Physicians 270 Emergency Medicine

1982654646 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982654869 207K00000X 020 Physicians 003 Allergy & Immunology

1982657128 207Y00000X 020 Physicians 217 Otolaryngology

1982658134 207V00000X 020 Physicians 016 OB/GYN

1982659199 207P00000X 020 Physicians 270 Emergency Medicine

1982659199 207PE0004X 020 Physicians 093 Emergency Medical Services

1982660411 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982660908 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1982660908 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1982661781 208800000X 020 Physicians 034 Urology

1982665139 207RC0000X 020 Physicians 006 Cardiovascular Disease

1982669362 2080P0205X 020 Physicians 226 Pediatric Endocrinology

1982677308 207R00000X 020 Physicians 011 Internal Medicine

1982677324 207L00000X 020 Physicians 005 Anesthesiology

1982677613 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982679049 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982679577 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982679650 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982679817 2080P0207X 020 Physicians 228 Pediatric Hematology-Oncology

1982681136 207K00000X 020 Physicians 003 Allergy & Immunology

1982682209 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982682332 207U00000X 020 Physicians 103 Nuclear Medicine

1982683215 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982684130 207RG0100X 020 Physicians 010 Gastroenterology

1982684973 207RH0000X 020 Physicians 178 Hematology

1982684973 207RH0003X 020 Physicians 179 Hematology/Oncology

1982687422 208000000X 020 Physicians 049 Pediatrics

1982692638 111N00000X 011 Chiropractic Providers 047 Chiropractor

1982693875 207K00000X 020 Physicians 003 Allergy & Immunology

546 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982693875 2080P0201X 020 Physicians 108 Pediatric Allergy

1982703849 207RP1001X 020 Physicians 029 Pulmonary Diseases

1982706800 207ZP0101X 020 Physicians 436 Anatomic Pathology

1982707543 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1982710265 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1982711867 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1982718433 207RG0100X 020 Physicians 010 Gastroenterology

1982725339 2085P0229X 020 Physicians 241 Pediatric Radiology

1982739900 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982740791 122300000X 012 Dental Providers 019 Dentists

1982742870 207V00000X 020 Physicians 016 OB/GYN

1982745964 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982747713 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1982747903 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982751681 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982753489 207P00000X 020 Physicians 270 Emergency Medicine

1982757449 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982757456 1223G0001X 012 Dental Providers 001 General Practice

1982757456 122300000X 012 Dental Providers 019 Dentists

1982773453 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1982782090 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1982787800 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1982790242 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982790242 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982790994 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982790994 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982793386 207ZP0102X 020 Physicians 259 Anatomic / Clinical Pathology

1982794244 207P00000X 020 Physicians 270 Emergency Medicine

1982794343 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1982794343 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1982794343 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

547 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982794343 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

1982794350 111N00000X 011 Chiropractic Providers 047 Chiropractor

1982796314 207X00000X 020 Physicians 020 Orthopedic Surgery

1982798161 208200000X 020 Physicians 024 Plastic Surgery

1982798955 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1982800165 183500000X 018 Pharmacy 253 Pharmacist

1982800645 208000000X 020 Physicians 049 Pediatrics

1982800645 2080P0202X 020 Physicians 221 Pediatric Cardiology

1982803300 207L00000X 020 Physicians 005 Anesthesiology

1982803532 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982805396 207Q00000X 020 Physicians 173 Family Medicine

1982815817 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982818449 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1982822276 106H00000X 010 Behav Health & Social Svc Prov 403 Marriage & Family Therapist

1982825204 2086S0129X 020 Physicians 289 Vascular Surgery

1982836797 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982841615 208100000X 020 Physicians 025 Physical Medicine and Rehab

1982853776 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982853776 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982855888 111N00000X 011 Chiropractic Providers 047 Chiropractor

1982856746 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1982859229 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1982861647 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982882262 207RC0200X 020 Physicians 206 Critical Care Medicine

1982887121 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982892071 122300000X 012 Dental Providers 019 Dentists

1982894010 2084N0400X 020 Physicians 013 Neurology

1982896882 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1982897989 122300000X 012 Dental Providers 019 Dentists

1982901666 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1982913505 207Q00000X 020 Physicians 173 Family Medicine

548 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1982917399 207X00000X 020 Physicians 020 Orthopedic Surgery

1982917506 207RH0003X 020 Physicians 179 Hematology/Oncology

1982921821 207L00000X 020 Physicians 005 Anesthesiology

1982925632 207R00000X 020 Physicians 011 Internal Medicine

1982929758 207R00000X 020 Physicians 011 Internal Medicine

1982931705 207RH0003X 020 Physicians 179 Hematology/Oncology

1982941860 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1982947800 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1982950218 207RI0200X 020 Physicians 185 Infectious Diseases

1982951422 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1982960662 207P00000X 020 Physicians 270 Emergency Medicine

1982962387 207V00000X 020 Physicians 016 OB/GYN

1982973251 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1982982161 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1982983201 2085R0202X 020 Physicians 167 Diagnostic Radiology

1982983201 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1982983300 213E00000X 021 Podiatric Medicine & Surgery Service 120 Podiatrist

1982983789 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1982989711 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1982990057 207W00000X 020 Physicians 018 Ophthalmology

1982991170 207RH0003X 020 Physicians 179 Hematology/Oncology

1982991170 207R00000X 020 Physicians 011 Internal Medicine

1982991717 207L00000X 020 Physicians 005 Anesthesiology

1982995973 207R00000X 020 Physicians 011 Internal Medicine

1982995973 208M00000X 020 Physicians 344 Hospitalist

1982999397 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1992011035 2084P0800X 020 Physicians 121 Psychiatry

1992012710 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1992016562 208000000X 020 Physicians 049 Pediatrics

1992017222 208600000X 020 Physicians 275 Surgery

1992018048 1223G0001X 012 Dental Providers 001 General Practice

549 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992022628 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992027031 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992036701 207L00000X 020 Physicians 005 Anesthesiology

1992041123 208M00000X 020 Physicians 344 Hospitalist

1992041123 207R00000X 020 Physicians 011 Internal Medicine

1992043038 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1992045835 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992051304 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1992054589 207RI0200X 020 Physicians 185 Infectious Diseases

1992056147 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1992056410 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1992056410 103G00000X 010 Behav Health & Social Svc Prov 074 Clinical Neuropsychologist

1992057236 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1992060651 363LN0000X 036 Phys Assts and Advanced Nursing Provs 531 Nurse Practitioner; Neonatal

1992061519 207L00000X 020 Physicians 005 Anesthesiology

1992068555 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1992068555 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1992083679 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992088280 363LP0200X 036 Phys Assts and Advanced Nursing Provs 435 Nurse Practitioner Pediatrics

1992089932 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1992090302 2084N0400X 020 Physicians 013 Neurology

1992093983 2084N0400X 020 Physicians 013 Neurology

1992094387 207P00000X 020 Physicians 270 Emergency Medicine

1992097992 207Q00000X 020 Physicians 173 Family Medicine

1992106835 183500000X 018 Pharmacy 253 Pharmacist

1992112635 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1992113203 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992115737 207Q00000X 020 Physicians 173 Family Medicine

1992123582 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992123913 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992123954 208M00000X 020 Physicians 344 Hospitalist

550 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992123954 208000000X 020 Physicians 049 Pediatrics

1992132492 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1992133441 163W00000X 016 Nursing Service Providers 129 Registered Nurse

1992146021 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1992147243 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1992151500 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1992153019 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992158216 363LA2100X 036 Phys Assts and Advanced Nursing Provs 516 Nurse Practitioner; Acute Care

1992158216 363LA2200X 036 Phys Assts and Advanced Nursing Provs 431 Nurse Practitioner Adult Health

1992166649 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1992170641 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992180541 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992181606 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992181606 224P00000X 022 Resp Devl Rehab and Restore Srvc Prov 115 Prosthetist

1992182158 208000000X 020 Physicians 049 Pediatrics

1992182505 171M00000X 010 Behav Health & Social Svc Prov 489 Case Aide

1992182505 174400000X 010 Behav Health & Social Svc Prov 488 Behavior Modification Specialist

1992182505 104100000X 010 Behav Health & Social Svc Prov 625 Licensed Baccalaureate Social Worker

1992182505 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1992187868 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1992189260 2084P0800X 020 Physicians 121 Psychiatry

1992193403 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992201917 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1992212989 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1992217590 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992221907 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992223721 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1992224190 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1992230163 183500000X 018 Pharmacy 253 Pharmacist

1992239628 101YP2500X 010 Behav Health & Social Svc Prov 190 Counselor Licensed Prof Clinical(LPCC)

1992248819 247200000X 010 Behav Health & Social Svc Prov 492 Mental Health Technician

551 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992248967 208D00000X 020 Physicians 001 General Practice

1992252621 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1992252621 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1992270409 171M00000X 017 Other Service Providers 335 Case Manager/Care Coordinator

1992275671 363L00000X 036 Phys Assts and Advanced Nursing Provs 055 Nurse Practitioner -Advanced Practice

1992282438 208600000X 020 Physicians 275 Surgery

1992282453 208600000X 020 Physicians 275 Surgery

1992284699 106S00000X 010 Behav Health & Social Svc Prov 568 Behavior Technician

1992287957 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

1992287957 104100000X 010 Behav Health & Social Svc Prov 425 Licensed Master Social Worker

1992291843 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992299614 363LX0001X 036 Phys Assts and Advanced Nursing Provs 434 Nurse Practitioner OB/GYN

1992358808 207Q00000X 020 Physicians 173 Family Medicine

1992706709 207P00000X 020 Physicians 270 Emergency Medicine

1992720197 207V00000X 020 Physicians 016 OB/GYN

1992722664 207Q00000X 020 Physicians 173 Family Medicine

1992723530 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

1992723530 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1992723563 207W00000X 020 Physicians 018 Ophthalmology

1992727481 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1992728752 207P00000X 020 Physicians 270 Emergency Medicine

1992728927 208M00000X 020 Physicians 344 Hospitalist

1992729230 2085R0001X 020 Physicians 497 Oncology Radiation - Physician

1992732804 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992735757 207RG0100X 020 Physicians 010 Gastroenterology

1992737878 2080N0001X 020 Physicians 502 Neonatal-Perinatal Medicine

1992739262 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1992739494 207RG0100X 020 Physicians 010 Gastroenterology

1992741052 2080P0210X 020 Physicians 232 Pediatric Nephrology

1992742381 208000000X 020 Physicians 049 Pediatrics

1992742985 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

552 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992745533 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992747042 1041C0700X 010 Behav Health & Social Svc Prov 191 Licensed Clinical Social Worker

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1992751267 208000000X 020 Physicians 049 Pediatrics

1992755151 207R00000X 020 Physicians 011 Internal Medicine

1992756662 363LF0000X 036 Phys Assts and Advanced Nursing Provs 432 Nurse Practitioner Family

1992758833 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992764419 207P00000X 020 Physicians 270 Emergency Medicine

1992764419 207Q00000X 020 Physicians 173 Family Medicine

1992764419 208M00000X 020 Physicians 344 Hospitalist

1992766919 208G00000X 020 Physicians 033 Thoracic Surgery

1992770010 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992770036 207V00000X 020 Physicians 016 OB/GYN

1992773634 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992774020 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1992774327 2084N0400X 020 Physicians 013 Neurology

1992775944 152W00000X 015 Eye and Vision Service Providers 088 Optometrist

1992777528 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992778344 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992782437 207ZP0101X 020 Physicians 022 Pathology

1992783369 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992783369 207U00000X 020 Physicians 103 Nuclear Medicine

1992783823 207N00000X 020 Physicians 007 Dermatology

1992784391 207RH0003X 020 Physicians 179 Hematology/Oncology

1992784391 207RH0000X 020 Physicians 178 Hematology

1992784755 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992784813 133V00000X 013 Dietary & Nutritional Service Providers 056 Licensed Registered Dietician

1992784854 207X00000X 020 Physicians 020 Orthopedic Surgery

1992785182 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992785760 208100000X 020 Physicians 025 Physical Medicine and Rehab

1992791792 2085R0202X 020 Physicians 167 Diagnostic Radiology

553 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992792287 207L00000X 020 Physicians 005 Anesthesiology

1992793673 207Q00000X 020 Physicians 173 Family Medicine

1992800205 207X00000X 020 Physicians 020 Orthopedic Surgery

1992800551 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992825095 101YA0400X 010 Behav Health & Social Svc Prov 155 Counselor Addiction

1992825814 207RN0300X 020 Physicians 105 Nephrology

1992825814 207R00000X 020 Physicians 011 Internal Medicine

1992829295 225X00000X 022 Resp Devl Rehab and Restore Srvc Prov 126 Occupational Therapy

1992837793 207P00000X 020 Physicians 270 Emergency Medicine

1992841753 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992851976 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992858831 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992859664 103T00000X 010 Behav Health & Social Svc Prov 050 Psychologist

1992863310 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992865885 207P00000X 020 Physicians 270 Emergency Medicine

1992882716 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992885602 122300000X 012 Dental Providers 019 Dentists

1992891253 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992891428 1223P0221X 012 Dental Providers 063 Pedodontics

1992892764 207Q00000X 020 Physicians 173 Family Medicine

1992892996 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992892996 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1992893168 163WD0400X 016 Nursing Service Providers 582 Registered Nurse; Diabetes Educator

1992896732 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1992896864 367500000X 036 Phys Assts and Advanced Nursing Provs 341 Certified Registered Nurse Anesthetist

1992901789 2085P0229X 020 Physicians 241 Pediatric Radiology

1992918023 207R00000X 020 Physicians 011 Internal Medicine

1992922082 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992923866 122300000X 012 Dental Providers 019 Dentists

1992925499 363A00000X 036 Phys Assts and Advanced Nursing Provs 255 Physician Assistant

1992925499 363AM0700X 036 Phys Assts and Advanced Nursing Provs 518 Physician Assistant;Medical

554 6/15/2020

ND Medicaid Provider Taxonomy Listing-Individual

NPI Taxonomy Provider Type Provider Type Description Specialty Code Specialty Description

1992926935 111N00000X 011 Chiropractic Providers 047 Chiropractor

1992949325 2085R0204X 020 Physicians 189 Vascular and Interventional Radiology

1992949721 208000000X 020 Physicians 049 Pediatrics

1992951651 2085R0202X 020 Physicians 167 Diagnostic Radiology

1992957930 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992962443 235Z00000X 023 Speech Language and Hearing Svc Prov 272 Speech-Language Pathologist

1992972822 111N00000X 011 Chiropractic Providers 047 Chiropractor

1992976260 225100000X 022 Resp Devl Rehab and Restore Srvc Prov 123 Physical Therapist

1992976716 207NP0225X 020 Physicians 222 Pediatric Dermatology

1992995575 183500000X 018 Pharmacy 253 Pharmacist

555 6/15/2020