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| Valid Value Code Set | Valid Value Code | Valid Value Name | Valid Value Description | Effective Start Date | Effective End Date |
|---|---|---|---|---|---|
| PROV-TYPE | 01 | Physician | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 02 | Speech Language Pathologist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 03 | Oral Surgery (Dentist only) | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 04 | Cardiac Rehabilitation and Intensive Cardiac Rehabilitation | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 05 | Anesthesiology Assistant | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 06 | Chiropractic | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 07 | Optometry | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 08 | Certified Nurse Midwife | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 09 | Certified Registered Nurse Anesthetist (CRNA) | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 10 | Mammography Center | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 11 | Independent Diagnostic Testing Facility (IDTF) | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 12 | Podiatry | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 13 | Ambulatory Surgical Center | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 14 | Nurse Practitioner | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 15 | Medical Supply Company with Orthotist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 16 | Medical Supply Company with Prosthetist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 17 | Medical Supply Company with Orthotist-Prosthetist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 18 | Other Medical Supply Company | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 19 | Individual Certified Orthotist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 20 | Individual Certified Prosthetist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 21 | Individual Certified Prosthetist-Orthotist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 22 | Medical Supply Company with Pharmacist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 23 | Ambulance Service Provider | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 24 | Public Health or Welfare Agency | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 25 | Voluntary Health or Charitable Agency | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 26 | Psychologist, Clinical | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 27 | Portable X-Ray Supplier | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 28 | Audiologist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 29 | Physical Therapist in Private Practice | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 30 | Occupational Therapist in Private Practice | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 31 | Clinical Laboratory | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 32 | Clinic or Group Practice | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 33 | Registered Dietitian or Nutrition Professional | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 34 | Mass Immunizer Roster Biller | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 35 | Radiation Therapy Center | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 36 | Slide Preparation Facility | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 37 | Licensed Clinical Social Worker | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 38 | Certified Clinical Nurse Specialist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 39 | Advance Diagnostic Imaging | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 40 | Optician | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 41 | Physician Assistant | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 42 | Hospital-General | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 43 | Skilled Nursing Facility | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 44 | Intermediate Care Nursing Facility | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 45 | Other Nursing Facility | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 46 | Home Health Agency | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 47 | Pharmacy | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 48 | Medical Supply Company with Respiratory Therapist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 49 | Department Store | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 50 | Grocery Store | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 51 | Indian Health Service facility | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 52 | Oxygen supplier | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 53 | Pedorthic personnel | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 54 | Medical supply company with pedorthic personnel | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 55 | Rehabilitation Agency | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 56 | Ocularist | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 57 | All Other | 01/01/0001 | 12/31/9999 | |
| PROV-TYPE | 58 | Institutions for Mental Disease | 01/01/0001 | 12/31/9999 |
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