awacke1/AllUSPhysiciansNPIbyStateandCountry huggingface dataset:
Code: 253Z00000X
Display Name: In Home Supportive Care Agency
Section: Non-Individual
Grouping: Agencies
Classification: In Home Supportive Care
Definition: An In Home Supportive Care Agency provides services in the patient's home with the goal of enabling the patient to remain at home.  The services provided may include personal care services such as hands-on assistance with activities of daily living (ADLs), e.g., eating, bathing, dressing, and bladder and bowel requirements; homemaker services and instrumental activities of daily living (IADLs), e.g., taking medications, shopping for groceries, laundry, housekeeping, and companionship; and/or supervision or cuing so that a person can perform tasks themselves.
Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: new]
Code: 251300000X
Display Name: Local Education Agency (LEA)
Section: Non-Individual
Grouping: Agencies
Classification: Local Education Agency (LEA)
Definition: The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools.  An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.
Notes: Source: Portions of IDEA Regulations Part B (34 CFR Part 300.18, Assistance to States for the Education of Children with Disabilities) [1/1/2006: new]
Code: 251J00000X
Display Name: Nursing Care Agency
Section: Non-Individual
Grouping: Agencies
Classification: Nursing Care
Definition: A Nursing Care Agency is an entity that provides skilled nursing care through the services of a Registered Nurse (RN) or a Licensed Practical Nurse (LPN), by employees, contracted individuals, or via a registry, in a variety of settings. The agency may engage in providing private duty nursing and/or staffing services.
Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: modified definition]
Code: 251T00000X
Display Name: PACE Provider Organization
Section: Non-Individual
Grouping: Agencies
Classification: Program of All-Inclusive Care for the Elderly (PACE) Provider Organization
Definition: A PACE provider organization is a not-for-profit private or public entity that is primarily engaged in providing PACE services(unique capitated managed care benefits for the frail elderly which include comprehensive medical and social services).  The following characteristics also apply to a PACE organization.  It must:  have a governing board that includes community representation; be able to provide complete PACE services regardless of frequency or duration of services; have a physical site to provide adult day services; have a defined service area; have safeguards against conflict of interest; have demonstrated fiscal soundness and have a formal Participant Bill of Rights.
Notes: Source: Centers for Medicare and Medicaid, PACE Fact Sheet http://www.cms.hhs.gov/PACE/Downloads/PACEFactSheet.pdf [7/1/2006: new]
Code: 251X00000X
Display Name: Supports Brokerage Agency
Section: Non-Individual
Grouping: Agencies
Classification: Supports Brokerage
Definition: A provider of service/function that assists participating individuals to make informed decisions about what will work best for them is consistent with their needs and reflects their individual circumstances. Serving as the agent of the individual, the service is available to assist in identifying immediate and long-term needs, developing options to meet those needs and accessing identified supports and services and may include assistance with recruiting, screening, hiring, and training in-home support providers. A family or person-centered planning approach is used. Supports Brokerage offers practical skills training to enable families and individuals to remain independent. Examples of skills training include providing information on recruiting and hiring personal care workers, managing personal care workers and providing information on effective communication and problem solving. The service/function provides sufficient information to assure that individuals understand the responsibilities involved with self-direction and assist in the development of an effective back-up and emergency plan. Plans may elect to fulfill the requirement of this service/function using a self-directed case manager or creating a distinct service. The Supports Brokerage documents the need for assistive services, planning for and documenting the use of excess funds and locating and maintaining services.
Notes: Source: CMS Independence Plus Waiver template. [7/1/2006: new]
Code: 261Q00000X
Display Name: Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Definition: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
Code: 261QM0855X
Display Name: Adolescent and Children Mental Health Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Adolescent and Children Mental Health
Definition: An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents.  Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.
Notes: [7/1/2003: new]
Code: 261QA0005X
Display Name: Ambulatory Family Planning Facility
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Ambulatory Family Planning Facility
Definition: An abortion/family planning facility where services are provided at a fixed specific location.  An Ambulatory Family Planning Facility does not provide overnight accommodations. The following procedures may be performed at an Ambulatory Family Planning Facility: abortions, laproscopy, hysterectomies, tubule ligation and other related procedures. Abortion is considered voluntary termination of pregnancy.
Code: 261QA0006X
Display Name: Ambulatory Fertility Facility
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Ambulatory Fertility Facility
Definition: A fertility facility, which may be licensed, registered, or certified in some states,  that is not hospital-based, where services are provided at a fixed specific location. An Ambulatory Fertility Facility does not provide overnight accommodations. The following fertility procedures may be performed at an Ambulatory Fertility Facility: In Vitro Fertilization (IVF), Gamete Intrafallopian Transfer (GIFT), Embryo Transfer-Thaw (ET-T), Zygote Intrafallopian Transfer (ZIFT), Donor OOCYTE (DO)
Code: 261QA0900X
Display Name: Amputee Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Amputee
Definition: An entity, facility, or distinct part of a facility providing counseling, fitting, custom design, prescriptive, and training services related to congenital or postoperative absence of all or part of a limb or limbs.
Notes: [7/1/2003: new]
Code: 261QA3000X
Display Name: Augmentative Communication Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Augmentative Communication
Definition: An entity, facility, or distinct part of a facility staffed by audiology and/or speech professionals with special training in the evaluation of a patient's potential for use of an augmentative communication device, determination of the most appropriate device, adjustment and maintenance of the device, and training the patient to use the device.
Notes: [7/1/2003: new]
Code: 261QB0400X
Display Name: Birthing Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Birthing
Definition: A freestanding birth center is a health facility other than a hospital where childbirth is planned to occur away from the pregnant woman's residence, and that provides prenatal, labor and delivery, and postpartum care, as well as other ambulatory services for women and newborns.
Notes: Source: Summarized from Social Security Act [42 U.S.C. 1396d(1)(3)(B)] [1/1/2013: added definition]
Code: 261QC0050X
Display Name: Critical Access Hospital Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Critical Access Hospital
Definition: An outpatient entity, facility, or distinct part of a facility within or affiliated with a Critical Access Hospital that provides access to primary care services for individuals in a small rural community and is Medicare certified.
Notes: [7/1/2003: new]
Code: 261QD1600X
Display Name: Developmental Disabilities Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Developmental Disabilities
Definition: An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
Notes: [7/1/2003: new]
Code: 261QF0050X
Display Name: Non-Surgical Family Planning Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Family Planning, Non-Surgical
Definition: An entity, facility, or distinct part of a facility, or mobile unit providing non-surgical, family planning/reproductive services including physical examination, laboratory services such as PAP or pregnancy tests; pregnancy, pregnancy prevention/contraceptive, and nutritional counseling, and contraceptives or prescriptions for contraceptives.
Notes: [7/1/2003: new]
Code: 261QG0250X
Display Name: Genetics Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Genetics
Definition: An entity, facility, or distinct part of a facility providing analysis of family history, genetic laboratory testing and analysis, diagnosis of genetic trait, prognosis and options.  Laboratory studies may be outsourced.
Notes: [7/1/2003: new]
Code: 261QH0700X
Display Name: Hearing and Speech Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Hearing and Speech
Definition: An entity, facility, or distinct part of a facility providing diagnostic, treatment, prescriptive, and therapy services related to congenital and acquired conditions and diseases that affect hearing capacity and speech ability.
Notes: [7/1/2003: new]
Code: 261QM2500X
Display Name: Medical Specialty Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Medical Specialty
Definition: An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization.  Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer).
Notes: [7/1/2003: new]
Code: 261QM3000X
Display Name: Medically Fragile Infants and Children Day Care
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Medically Fragile Infants and Children Day Care
Definition: An entity, facility, or distinct part of a facility specially equipped and staffed to provide care for medically fragile children with varied and complex care needs (e.g., enteral or parental feeding, ostomy care, respiratory/ventilator care, medications and therapies, etc.).
Notes: [7/1/2003: new]
Code: 261QM1103X
Display Name: Military Ambulatory Procedure Visits Operational (Transportable) Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Military Ambulatory Procedure Visits Operational (Transportable)
Definition: "Non-fixed" facilities or distinct parts of a "non-fixed" facility, providing outpatient surgical procedures requiring medically supervised recovery. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. Includes initial "take home" pharmaceuticals.
Notes: [1/1/2005: new]
Code: 261QM1101X
Display Name: Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Military and U.S. Coast Guard Ambulatory Procedure
Definition: That part of a "fixed" (non-temporary, non-deployed) DoD or Coast Guard entity furnishing surgical procedures requiring medically supervised recovery.  Similar to a civilian ambulatory surgical center.  May be in shared resources with a DoD or Coast Guard Clinic or a DoD Hospital.  Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.  Includes initial "take home" pharmaceuticals.
Notes: Source: TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified]
Code: 261QM1102X
Display Name: Military Outpatient Operational (Transportable) Component Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Military Outpatient Operational (Transportable) Component
Definition: "Non-fixed" facilities or distinct parts of a "non-fixed" facility, providing outpatient medical and dental services, primarily intended for DoD active duty. The entity is funded with other than Defense Health Program funding. Non-DoD active duty may receive services from this entity. "Non-fixed" facilities are generally deployed DoD health care activities, not providing services on or in association with a DoD fort or base. "Non-fixed" facilities include outpatient services furnished onboard ships. "Non-fixed" facilities also include deployed clinics. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.
Notes: [1/1/2005: title modified, definition added]
Code: 261QM1100X
Display Name: Military/U.S. Coast Guard Outpatient Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Military/U.S. Coast Guard Outpatient
Definition: The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries.  A "fixed" facility is a non-temporary, non-deployed facility.  It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility.  It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies.  Does not include items issued directly to a patient from an outpatient pharmacy or patient transport.
Notes: Source: TRICARE Management Activity Uniform Business Office User's Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified]
Code: 261QX0200X
Display Name: Oncology Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Oncology
Definition: An entity, facility, or distinct part of a facility providing diagnostic, treatment and prescriptive services related to cancerous conditions.  Services include chemotherapy infusions and monitoring of implanted chemotherapeutic agents.
Notes: [7/1/2003: new]
Code: 261QS0112X
Display Name: Oral and Maxillofacial Surgery Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Oral and Maxillofacial Surgery
Definition: The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.
Notes: Source: Council on Dental Education and Licensure, American Dental Association
Code: 261QP2000X
Display Name: Physical Therapy Clinic/Center
Section: Non-Individual
Grouping: Ambulatory Health Care Facilities
Classification: Clinic/Center
Specialization: Physical Therapy
Definition: An entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists and physical therapist assistants are licensed health care professionals who are experts in the movement system and help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance.
Notes: Source: Guide to PT Practice 3.0 [1/1/2020: definition added] Additional resources: http://guidetoptpractice.apta.org/ ; American Physical Therapy Association, www.apta.org.
Code: 273100000X
Display Name: Epilepsy Hospital Unit
Section: Non-Individual
Grouping: Hospital Units
Classification: Epilepsy Unit
Definition: An Epilepsy Unit is a distinct unit of a hospital that provides services that may include observation, urgent care, diagnostic testing, treatment, and medication management for patients with seizure disorders.
Notes: Source: National Uniform Claim Committee [7/1/2007: new]
Code: 275N00000X
Display Name: Medicare Defined Swing Bed Hospital Unit
Section: Non-Individual
Grouping: Hospital Units
Classification: Medicare Defined Swing Bed Unit
Definition: A unit of a hospital that has a Medicare provider agreement and has been granted approval from HCFA to provide post-hospital extended care services and be reimbursed as a swing-bed unit.
Notes: Source: Code of Federal Regulations #42, Section 482.66.
Code: 273R00000X
Display Name: Psychiatric Hospital Unit
Section: Non-Individual
Grouping: Hospital Units
Classification: Psychiatric Unit
Definition: In general, a distinct unit of a hospital that provides acute or long-term care to emotionally disturbed patients, including patients admitted for diagnosis and those admitted for treatment of psychiatric problems on the basis of physicians' orders and approved nursing care plans. Long-term care may include intensive supervision to the chronically mentally ill, mentally disordered or other mentally incompetent persons; (2) For Medicare, a distinct part of a general acute care hospital admitting only patients whose admission to the unit is required for active treatment, whose treatment is of an intensity that can be provided only in an inpatient hospital setting, and whose condition is described by a psychiatric principal diagnosis contained in the Third Edition of the American Psychiatric Association Diagnostic and Statistical Manual or in Chapter 5 (Mental Disorders) of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). The unit must furnish, through the use of qualified personnel, psychological services, social work services, psychiatric nursing, occupational therapy, and recreational therapy. The unit must maintain medical records that permit determination of the degree and intensity of treatment provided to individuals who are furnished services in the unit; the unit must meet special staff requirements in that the unit must have adequate numbers of qualified professional and supportive staff to evaluate inpatients, formulate written, individualized, comprehensive treatment plans, provide active treatment measures and engage in discharge planning.
Notes: Source: (1) AHA Annual Survey p. A10 1996 AHA Guide; (2) Code of Federal Regulations #42, Section 412.27.
Code: 273Y00000X
Display Name: Rehabilitation Hospital Unit
Section: Non-Individual
Grouping: Hospital Units
Classification: Rehabilitation Unit
Definition: In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient's condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient's medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services.
Notes: Source: Code of Federal Regulations #42, Section 412.29.
Code: 276400000X
Display Name: Substance Use Disorder Rehabilitation Hospital Unit
Section: Non-Individual
Grouping: Hospital Units
Classification: Rehabilitation, Substance Use Disorder Unit
Definition: A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.)
Notes: Source: Department of Defense Regulation 6010.8-R, Chapter 6.
Code: 281P00000X
Display Name: Chronic Disease Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: Chronic Disease Hospital
Definition: (1) A hospital including a physical plant and personnel that provides multidisciplinary diagnosis and treatment for diseases that have one or more of the following characteristics: is permanent; leaves residual disability; is caused by nonreversible pathological alteration; requires special training of the patient for rehabilitation; and/or may be expected to require a long period of supervision or care. In addition, patients require the safety, security, and shelter of these specialized inpatient or partial hospitalization settings. (2) A hospital that provides medical and skilled nursing services to patients with long-term illnesses who are not in an acute phase but who require an intensity of services not available in nursing homes.
Notes: Source: (1) Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.
Code: 282N00000X
Display Name: General Acute Care Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: General Acute Care Hospital
Definition: An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.
Code: 2865M2000X
Display Name: Military General Acute Care Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: Military Hospital
Specialization: Military General Acute Care Hospital
Definition: A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "fixed" facilities, primarily for DoD beneficiaries. Entity is Defense Health Program (DHP) funded. A "fixed" facility is a non-temporary, non-deployed facility usually used for health care services. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes those services and institutional costs usually included in a Diagnosis Related Group as well as "pass-through" items.
Notes: [1/1/2005: title modified, definition added]
Code: 2865X1600X
Display Name: Operational (Transportable) Military General Acute Care Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: Military Hospital
Specialization: Military General Acute Care Hospital. Operational (Transportable)
Definition: A Department of Defense (DoD) health care organization furnishing inpatient care 24 hours per day in "non-fixed" or deployed facilities. Entity is not Defense Health Program funded. Services are primarily intended for DoD active duty though some services may be furnished for non-DoD active duty. "Non-fixed" facilities are generally deployed DoD health care activities, not providing services on or in association with a DoD fort or base. "Non-fixed" facilities include hospital ships.
Notes: [1/1/2005: title modified, definition added]
Code: 283Q00000X
Display Name: Psychiatric Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: Psychiatric Hospital
Definition: An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.
Notes: Source: Expanded from Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.
Code: 283X00000X
Display Name: Rehabilitation Hospital
Section: Non-Individual
Grouping: Hospitals
Classification: Rehabilitation Hospital
Definition: A hospital or facility that provides health-related, social and/or vocational services to disabled persons to help them attain their maximum functional capacity.
Notes: Source: Joint Commission on Accreditation of Healthcare Organizations, Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Oakbrook Terrace, IL: 1994, p. 323
Code: 282J00000X
Display Name: Religious Nonmedical Health Care Institution
Section: Non-Individual
Grouping: Hospitals
Classification: Religious Nonmedical Health Care Institution
Definition: Furnishes only nonmedical nursing items and services to patients who choose to rely solely upon a religious method of healing, and for whom the acceptance of medical services would be inconsistent with their religious beliefs.  Furnishes nonmedical items and services exclusively through nonmedical nursing personnel who are experienced in caring for the physical needs of nonmedical patients.  For example, caring for the physical needs such as assistance with activities of daily living; assistance in moving, positioning, and ambulation; nutritional needs; and comfort and support measures.  Furnishes nonmedical items and services to inpatients on a 24-hour basis.  Does not furnish, on the basis of religious beliefs, through its personnel or otherwise, medical items and services (including any medical screening, examination, diagnosis, prognosis, treatment, or the administration of drugs) for its patients.
Notes: Source: Centers for Medicare & Medicaid Services, http://www.cms.hhs.gov/CertificationandComplianc/19_RNHCIs.asp#TopOfPage [7/1/2006: new]
Code: 291U00000X
Display Name: Clinical Medical Laboratory
Section: Non-Individual
Grouping: Laboratories
Classification: Clinical Medical Laboratory
Definition: (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.
Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186.
Code: 292200000X
Display Name: Dental Laboratory
Section: Non-Individual
Grouping: Laboratories
Classification: Dental Laboratory
Definition: A commercial laboratory specializing in the construction of dental appliances that conform to a dentist's specifications including the construction of dentures (complete or partial), orthodontic appliances, bridgework, crowns, and inlays.
Notes: Source: Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 1245.
Code: 293D00000X
Display Name: Physiological Laboratory
Section: Non-Individual
Grouping: Laboratories
Classification: Physiological Laboratory
Definition: A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.
Notes: Source: Paraphrased from the Medicare Carrier Manual, Section 2070.5.
Code: 302F00000X
Display Name: Exclusive Provider Organization
Section: Non-Individual
Grouping: Managed Care Organizations
Classification: Exclusive Provider Organization
Definition: (1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations.
Notes: Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 15; (2) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988.
Code: 302R00000X
Display Name: Health Maintenance Organization
Section: Non-Individual
Grouping: Managed Care Organizations
Classification: Health Maintenance Organization
Definition: (1) A form of health insurance in which its members prepay a premium for the HMO's health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model.
Notes: Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 20; (2) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58
Code: 305S00000X
Display Name: Point of Service
Section: Non-Individual
Grouping: Managed Care Organizations
Classification: Point of Service
Definition: This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost.
Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62
Code: 305R00000X
Display Name: Preferred Provider Organization
Section: Non-Individual
Grouping: Managed Care Organizations
Classification: Preferred Provider Organization
Definition: A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level.
Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62
Code: 311500000X
Display Name: Alzheimer Center (Dementia Center)
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Alzheimer Center (Dementia Center)
Definition: A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y):  Admission of residents with dementia (including those with Alzheimer's disease);  Staff who are specially selected, trained, and supervised;  Activities that are specifically designed for the cognitively impaired;  A marketing of a special care unit in brochures;  A high level of family involvement; and  A physical environment designed to keep residents safe and segregated from other populations.
Code: 3104A0630X
Display Name: Assisted Living Facility (Behavioral Disturbances)
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Assisted Living Facility
Specialization: Assisted Living, Behavioral Disturbances
Definition: A facility providing supportive services to individuals who can function independently in most areas of activity, but exhibit abnormal behavioral responses and habits and therefore need special guidance, assistance and/or monitoring to assure safety and well being.  This type of facility requires a staff with special training in dealing with and redirecting negative, violent or destructive behaviors.
Notes: [7/1/2003: new]
Code: 3104A0625X
Display Name: Assisted Living Facility (Mental Illness)
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Assisted Living Facility
Specialization: Assisted Living, Mental Illness
Definition: A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem.  This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies.
Notes: [7/1/2003: new]
Code: 311Z00000X
Display Name: Custodial Care Facility
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Custodial Care Facility
Definition: A facility providing care that serves to assist an individual in the activities of daily living, such as assistance in walking, getting in and out of bed, bathing, dressing, feeding, and using the toilet, preparation of special diets, and supervision of medication that usually can be self-administered. Custodial care essentially is personal care that does not require the continuing attention of trained medical or paramedical personnel.
Notes: Source: Paraphrased from Section 3159 A3 of the Medicare Intermediary Manual.
Code: 311ZA0620X
Display Name: Adult Care Home Facility
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Custodial Care Facility
Specialization: Adult Care Home
Definition: A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment.
Notes: [7/1/2003: new]
Code: 315D00000X
Display Name: Inpatient Hospice
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Hospice, Inpatient
Definition: A provider organization, or distinct part of the organization, which renders an interdisciplinary program providing palliative care, chiefly medical relief of pain and supporting services, which addresses the emotional, social, financial, and legal needs of terminally ill patients and their families where an institutional care environment is required for the patient.
Notes: Source: AHA Guide, American Hospital Association.
Code: 313M00000X
Display Name: Nursing Facility/Intermediate Care Facility
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Nursing Facility/Intermediate Care Facility
Definition: An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
Notes: Source: Paraphrased from Section 1919 (a) of the Social Security Act.
Code: 314000000X
Display Name: Skilled Nursing Facility
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Skilled Nursing Facility
Definition: (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey.
Code: 3140N1450X
Display Name: Pediatric Skilled Nursing Facility
Section: Non-Individual
Grouping: Nursing & Custodial Care Facilities
Classification: Skilled Nursing Facility
Specialization: Nursing Care, Pediatric
Definition: A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment.
Notes: [7/1/2003: new]
Code: 320900000X
Display Name: Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Definition: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
Notes: [7/1/2003: new, 1/1/2021: modified title, modified definition]
Code: 323P00000X
Display Name: Psychiatric Residential Treatment Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Psychiatric Residential Treatment Facility
Definition: A residential treatment facility (RTF) is a facility or distinct part of a facility that provides to children and adolescents, a total, twenty-four hour, therapeutically planned group living and learning situation where distinct and individualized psychotherapeutic interventions can take place. Residential treatment is a specific level of care to be differentiated from acute, intermediate, and long-term hospital care, when the least restrictive environment is maintained to allow for normalization of the patient's surroundings. The RTF must be both physically and programmatically distinct if it is a part or subunit of a larger treatment program. An RTF is organized and professionally staffed to provide residential treatment of mental disorders to children and adolescents who have sufficient intellectual potential to respond to active treatment (that is, for whom it can reasonably be assumed that treatment of the mental disorder will result in an improved ability to function outside the RTF) for whom outpatient treatment, partial hospitalization or protected and structured environment is medically or psychologically necessary
Notes: Source: Champus Policy manual, Volume II, p. 6010.47M dated 9/12/94. Revision: Definition title revised 7/1/03
Code: 322D00000X
Display Name: Emotionally Disturbed Childrens' Residential Treatment Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Residential Treatment Facility, Emotionally Disturbed Children
Definition: A residential facility that provides habilitation services and other care and treatment to children diagnosed with mental health illness, behavioral issues, and intellectual disabilities and are not able to live independently.
Notes: Source: U.S. Department of Defense Regulation 6010.8-R, Chapter 6. [1/1/2021: modified definition]
Code: 320600000X
Display Name: Intellectual and/or Developmental Disabilities Residential Treatment Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Definition: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently.
Notes: [7/1/2003: new. 1/1/2021: modified title and definition]
Code: 320700000X
Display Name: Physical Disabilities Residential Treatment Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Residential Treatment Facility, Physical Disabilities
Definition: A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.
Notes: [7/1/2003: new, 1/1/2021: modified definition]
Code: 324500000X
Display Name: Substance Abuse Rehabilitation Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Substance Abuse Rehabilitation Facility
Definition: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.
Notes: [7/1/2003: modified title, modified definition]
Code: 3245S0500X
Display Name: Children's Substance Abuse Rehabilitation Facility
Section: Non-Individual
Grouping: Residential Treatment Facilities
Classification: Substance Abuse Rehabilitation Facility
Specialization: Substance Abuse Treatment, Children
Definition: A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances.  Medical and supportive counseling services and education services are included.
Notes: [7/1/2003: new]