MMIS Provider Codes

Code	Description
01	Acute Hospital
03	Acute Rehabilitation Hospital
04	Chronic Rehabilitation Hospital
05	Chronic Hospital
06	Special Other Acute Hospital
07	Special Other Chronic Hospital
08	Urgent Care Center
09	Laboratory
10	Podiatry Provider
11	Vision Care Provider
12	Chiropractor
13	Dental Provider
14	Psychologist
15	Physical Therapist
16	Speech/Language Pathologist
18	Occupational Therapist
19	Audiology Provider
20	Physician
21	Nurse Anesthetist
22	Nurse Midwife
23	Nurse Practitioner
24	Nurse Psychotherapist
27	Mental Health Group Therapy Provider
28	Therapy Group Provider-EPSDT <21
34	Clinic FQHC
35	Clinic, LHD
36	Freestanding Oncology Center
37	Clinic, Rural
38	Clinic, General
39	Ambulatory Surgery Center
40	Autism Waiver
41	Home Health Agency
42	Medical Day Care – Adults
43	Medical Day Care – Children
47	Local Health Department/ Nurse Monitors
50	Substance Use Disorder Program
51	EPSDT Therapeutic Behavioral Services
53	Pediatric Nursing/Home Health Aide Services Agency
54	IMD Residential SUD Adult
55	ICF Addiction
56	ICF – ID
57	Nursing Facility
59	Portable X-Ray
60	Diagnostic Services, Other
61	Dialysis Facility
62	DMS/DME Provider
70	HMO/PACE
71	Hospice Provider
72	HealthChoice Managed Care Organizations
76	Community Options Program
80	Physician Assistant
81	Case Management - Model Waiver
85	Dietician/Nutritionist
86	Brain Injury Waiver
87	REM Case Management Provider
88	Residential Treatment Center
89	1915(i) Facility
90	DDA Services Provider
91	Local Education Agencies/Local Lead Agency
92	ORP- Ordering, Referring, Prescribing
94	Social Worker
AB	ABA Services
AC	Acupuncture
CC	Certified Professional Counselor
CM	Mental Health Case Management Provider
D2	Physician Dentist
DP	Diabetes Prevention Program
HG	1915i for Children, Youth, and Families
MC	Outpatient Mental Health Clinic
MH	Community Based Partial Hospitalization Program
MT	Mobile Treatment Program
PB	Lead Risk Investigator
PH	Pharmacist Prescriber
PR	Psychiatric Rehab Services Facility
RX	Pharmacy
SE	Supported Employment
T1	Ambulance Company
VC	HIV Case Management