Taxonomy versus claims-based specialties

Claims-based specialty better categorizes more than 19,000 internal medicine doctors

Six of the 15 pairs of NPI-based and claims-based specialties provide more granular therapy area information for 19,433 providers identified with an internal medicine taxonomy code. These physicians are more accurately described as cardiology, emergency medicine, gastroenterology, physical therapy, and nephrology specialists when their diagnosis and procedure activity are taken into account.

Why are claims-based medical specialties important?

Compared to self-reported taxonomies, claims-based specialties in PhysicianView use healthcare commercial intelligence to better represent the type of clinical activity a provider performs. It allows for categorization of physicians based on their expertise and provides an up-to-date view of the procedures they’re performing.

For example, if a rehabilitative medicine professional association wants to target all physical therapy providers, they would miss nearly 2,800 potential contacts that have an internal medicine or family medicine taxonomy but bill predominantly for physical therapy codes.

Or, if a biopharma company wants to know more about doctors who treat kidney disease patients, they could miss nearly 600 providers with a nephrology claims-based specialty who have a different taxonomy-based specialty.

Is a taxonomy code the same as a specialty?

A medical specialty is the particular field of medicine that a doctor chooses to study and practice within. Definitive Healthcare tracks 46 distinct specialty categories and 128 subspecialty categories within our platform.

A taxonomy code is a unique 10-character code that identifies a provider’s classification and specialty as established by the National Uniform Claim Committee.

What is the difference between taxonomy and NPI?

An NPI is the unique identification number assigned to providers who participate in Medicare. The NPI was standardized through the Health Insurance Portability and Accountability Act.

Providers self-report taxonomy codes when applying for an NPI, which can result in mismatches between their specialties and actual scopes of practice as they progress throughout their careers.

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