Settings
Time zone
(UTC-12:00) International Date Line West
(UTC-11:00) Coordinated Universal Time-11
(UTC-10:00) Hawaii
(UTC-09:00) Alaska
(UTC-08:00) Tijuana, Baja California
(UTC-08:00) Pacific Time (US and Canada)
(UTC-07:00) Arizona
(UTC-07:00) Chihuahua, La Paz, Mazatlan
(UTC-07:00) Mountain Time (US and Canada)
(UTC-06:00) Central America
(UTC-06:00) Central Time (US and Canada)
(UTC-06:00) Guadalajara, Mexico City, Monterrey
(UTC-06:00) Saskatchewan
(UTC-05:00) Bogota, Lima, Quito
(UTC-05:00) Eastern Time (US and Canada) (Form default)
(UTC-05:00) Indiana (East)
(UTC-04:00) Asuncion
(UTC-04:00) Atlantic Time (Canada)
(UTC-04:00) Caracas
(UTC-04:00) Manaus
(UTC-04:00) Georgetown, La Paz, San Juan
(UTC-04:00) Santiago
(UTC-03:30) Newfoundland and Labrador
(UTC-03:00) Brasilia
(UTC-03:00) Cayenne
(UTC-03:00) Buenos Aires
(UTC-03:00) Montevideo
(UTC-02:00) Coordinated Universal Time-02
(UTC-02:00) Greenland
(UTC-02:00) Mid-Atlantic
(UTC-01:00) Azores
(UTC-01:00) Cape Verde Is.
(UTC) Coordinated Universal Time
(UTC) Greenwich Mean Time : Dublin, Edinburgh, Lisbon, London
(UTC) Monrovia, Reykjavik
(UTC) Casablanca
(UTC+01:00) Amsterdam, Berlin, Bern, Rome, Stockholm, Vienna
(UTC+01:00) Belgrade, Bratislava, Budapest, Ljubljana, Prague
(UTC+01:00) Brussels, Copenhagen, Madrid, Paris
(UTC+01:00) Sarajevo, Skopje, Warsaw, Zagreb
(UTC+01:00) West Central Africa
(UTC+02:00) Athens, Bucharest, Istanbul
(UTC+02:00) Beirut
(UTC+02:00) Cairo
(UTC+02:00) Minsk
(UTC+02:00) Harare, Pretoria
(UTC+02:00) Helsinki, Kyiv, Riga, Sofia, Tallinn, Vilnius
(UTC+02:00) Jerusalem
(UTC+02:00) Windhoek
(UTC+03:00) Amman
(UTC+03:00) Baghdad
(UTC+03:00) Kuwait, Riyadh
(UTC+03:00) Moscow, St. Petersburg, Volgograd
(UTC+03:00) Nairobi
(UTC+03:30) Tehran
(UTC+04:00) Abu Dhabi, Muscat
(UTC+04:00) Baku
(UTC+04:00) Port Louis
(UTC+04:00) Tbilisi
(UTC+04:00) Yerevan
(UTC+04:30) Kabul
(UTC+05:00) Tashkent
(UTC+05:00) Ekaterinburg
(UTC+05:00) Islamabad, Karachi
(UTC+05:30) Chennai, Kolkata, Mumbai, New Delhi
(UTC+05:30) Sri Jayawardenepura
(UTC+05:45) Kathmandu
(UTC+06:00) Astana
(UTC+06:00) Dhaka
(UTC+06:30) Yangon (Rangoon)
(UTC+07:00) Bangkok, Hanoi, Jakarta
(UTC+07:00) Krasnoyarsk
(UTC+07:00) Novosibirsk
(UTC+08:00) Beijing, Chongqing, Hong Kong S.A.R., Urumqi
(UTC+08:00) Irkutsk
(UTC+08:00) Kuala Lumpur, Singapore
(UTC+08:00) Perth
(UTC+08:00) Taipei
(UTC+08:00) Ulaanbaatar
(UTC+09:00) Osaka, Sapporo, Tokyo
(UTC+09:00) Seoul
(UTC+09:00) Yakutsk
(UTC+09:30) Adelaide
(UTC+09:30) Darwin
(UTC+10:00) Brisbane
(UTC+10:00) Canberra, Melbourne, Sydney
(UTC+10:00) Guam, Port Moresby
(UTC+10:00) Hobart
(UTC+10:00) Vladivostok
(UTC+11:00) Magadan, Solomon Is., New Caledonia
(UTC+12:00) Auckland, Wellington
(UTC+12:00) Coordinated Universal Time+12
(UTC+12:00) Fiji Is., Marshall Is.
(UTC+12:00) Petropavlovsk-Kamchatsky
(UTC+13:00) Nuku'alofa
(UTC+13:00) Midway Island, Samoa
Taxonomy Change/Update Form
Instructions
The Provider representative filling out and submitting the form must be a representative with authority to make changes/updates to taxonomy information in Cardinal Innovations' provider data system.
Providers should review their provider profiles at NC Tracks to ensure that any taxonomy changes/updates proposed in the form will end up matching their profiles in NC Tracks. Any taxonomy additions made by submittal of this form should be followed up, if necessary, by a Managed Change Request to NC Tracks to add the taxonomy at NC Tracks if not already reflected at NC Tracks.
This form may only be used for change/updates to taxonomies for existing billing locations and/or associated rendering practitioners. If the location or associated practitioner is currently not in the Cardinal Innovations system for the provider, the request will be denied. Additionally, only taxonomies may be updated by use of this form. No other data fields in the system may be changed/updated by this form.
Providers should obtain their Cardinal Innovations provider identification numbers for their site(s) (Provider ID Nos.) for the form from the Cardinal Innovations Provider Direct system. These ID Nos. appear on the Provider Management page in Provider Direct (under the "Admin" tab). For associated practitioners, providers will need the practitioner's NPI No.
The form is separated into sections for additions to Provider site billing taxonomies and additions to associated practitioner rendering taxonomies. Please make sure to fill out the appropriate section for the particular type (billing site versus rendering practitioner) being sought.
Only those Provider sites' and/or associated Practitioners' taxonomies that need changes/updates should be identified in the spaces in the form.
Any taxonomy added to the form for a site or practitioner must be a valid taxonomy recognized by North Carolina's NC Tracks system, otherwise the request to add the taxonomy will be rejected. Providers must choose the taxonomy from the drop-down menu provided in the form.
(Note: Please provide information only for the existing Provider site(s) and associated Practitioners needing changes/updates)
Main provider name
*
Main provider ID #
(available on Provider Direct)
*
Provider and/or sub-site taxonomy
additions
:
Provider ID #
Cardinal Site (main and/or subsite)
Street address
City
State
Select State/Province
-----------------
North Carolina
-----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Puerto Rico
Guam
American Samoa
U.S. Virgin Islands
Northern Mariana Islands
Zip/Postal code
Provider NPI #
Provider taxonomy add.
Please select
101Y00000X
101YA0400X
101YM0800X
101YP2500X
103T00000X
104100000X
1041C0700X
106H00000X
132700000X
163WP0808X
163WP0809X
164W00000X
171M00000X
171W00000X
171WH0202X
193200000X
193400000X
207P00000X
207Q00000X
207QA0505X
207R00000X
207RA0401X
207RC0200X
207RG0300X
208000000X
208000000X
2080A0000X
2080P0006X
2081P2900X
2084A0401X
2084F0202X
2084N0402X
2084P0005X
2084P0015X
2084P0800X
2084P0802X
2084P0804X
2084P0805X
2084S0012X
208800000X
208D00000X
222Z00000X
224Z00000X
2251P0200X
225800000X
225X00000X
225XM0800X
225XP0200X
251300000X
251B00000X
251C00000X
251E00000X
251F00000X
251J00000X
251K00000X
251S00000X
251T00000X
252Y00000X
253Z00000X
261Q00000X
261QA0005X
261QA0600X
261QA1903X
261QA3000X
261QC1500X
261QD1600X
261QF0050X
261QF0400X
261QH0100X
261QM0801X
261QM0850X
261QM0855X
261QM1000X
261QP0905X
261QP2300X
261QR0401X
261QR0401X
261QR0404X
261QR0405X
261QR1300X
273R00000X
275N00000X
282N00000X
282N00000X
282NC0060X
283Q00000X
284300000X
291U00000X
291U00000X
302R00000X
305R00000X
311500000X
311Z00000X
311ZA0620X
313M00000X
315P00000X
320800000X
320900000X
323P00000X
324500000X
332B00000X
332BC3200X
363A00000X
363L00000X
363LA2100X
363LA2200X
363LC0200X
363LC1500X
363LF0000X
363LG0600X
363LP0200X
363LP0200X
363LP0808X
363LP2300X
363LP2300X
363LS0200X
363LW0102X
363LX0106X
364S00000X
364SP0807X
364SP0808X
364SP0809X
364SP0810X
364SP0811X
364SP0812X
364SP0813X
367500000X
367H00000X
374700000X
3747A0650X
385H00000X
385H00000X
385HR2055X
385HR2060X
Provider Taxonomy Effective date
Provider ID #
Cardinal Site (main and/or subsite)
Street address
City
State
Select State/Province
-----------------
North Carolina
-----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Puerto Rico
Guam
American Samoa
U.S. Virgin Islands
Northern Mariana Islands
Zip/Postal code
Provider NPI #
Provider taxonomy add.
Please select
101Y00000X
101YA0400X
101YM0800X
101YP2500X
103T00000X
104100000X
1041C0700X
106H00000X
132700000X
163WP0808X
163WP0809X
164W00000X
171M00000X
171W00000X
171WH0202X
193200000X
193400000X
207P00000X
207Q00000X
207QA0505X
207R00000X
207RA0401X
207RC0200X
207RG0300X
208000000X
208000000X
2080A0000X
2080P0006X
2081P2900X
2084A0401X
2084F0202X
2084N0402X
2084P0005X
2084P0015X
2084P0800X
2084P0802X
2084P0804X
2084P0805X
2084S0012X
208800000X
208D00000X
222Z00000X
224Z00000X
2251P0200X
225800000X
225X00000X
225XM0800X
225XP0200X
251300000X
251B00000X
251C00000X
251E00000X
251F00000X
251J00000X
251K00000X
251S00000X
251T00000X
252Y00000X
253Z00000X
261Q00000X
261QA0005X
261QA0600X
261QA1903X
261QA3000X
261QC1500X
261QD1600X
261QF0050X
261QF0400X
261QH0100X
261QM0801X
261QM0850X
261QM0855X
261QM1000X
261QP0905X
261QP2300X
261QR0401X
261QR0401X
261QR0404X
261QR0405X
261QR1300X
273R00000X
275N00000X
282N00000X
282N00000X
282NC0060X
283Q00000X
284300000X
291U00000X
291U00000X
302R00000X
305R00000X
311500000X
311Z00000X
311ZA0620X
313M00000X
315P00000X
320800000X
320900000X
323P00000X
324500000X
332B00000X
332BC3200X
363A00000X
363L00000X
363LA2100X
363LA2200X
363LC0200X
363LC1500X
363LF0000X
363LG0600X
363LP0200X
363LP0200X
363LP0808X
363LP2300X
363LP2300X
363LS0200X
363LW0102X
363LX0106X
364S00000X
364SP0807X
364SP0808X
364SP0809X
364SP0810X
364SP0811X
364SP0812X
364SP0813X
367500000X
367H00000X
374700000X
3747A0650X
385H00000X
385H00000X
385HR2055X
385HR2060X
Provider Taxonomy Effective date
Add new row
Associated practitioner(s) rendering taxonomy
additions
:
Practitioner first name
Last name
Street address
City
State
Select State/Province
-----------------
North Carolina
-----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Puerto Rico
Guam
American Samoa
U.S. Virgin Islands
Northern Mariana Islands
ZIP code
Practitioner NPI #
Taxonomy Addition
(Must be valid at NC Tracks)
Please select
101Y00000X
101YA0400X
101YM0800X
101YP2500X
103T00000X
104100000X
1041C0700X
106H00000X
132700000X
163WP0808X
163WP0809X
164W00000X
171M00000X
171W00000X
171WH0202X
207P00000X
207Q00000X
207QA0505X
207R00000X
207RA0401X
207RC0200X
207RG0300X
208000000X
208000000X
2080A0000X
2080P0006X
2081P2900X
2084A0401X
2084F0202X
2084N0402X
2084P0005X
2084P0015X
2084P0800X
2084P0802X
2084P0804X
2084P0805X
2084S0012X
208800000X
208D00000X
222Z00000X
224Z00000X
2251P0200X
225800000X
225X00000X
225XM0800X
225XP0200X
251300000X
251B00000X
251C00000X
251E00000X
251F00000X
251J00000X
251K00000X
251T00000X
252Y00000X
253Z00000X
261Q00000X
261QA0005X
261QA0600X
261QA1903X
261QA3000X
261QD1600X
261QM0801X
261QM1000X
261QR0401X
261QR0401X
261QR0404X
261QR0405X
273R00000X
275N00000X
282N00000X
282N00000X
282NC0060X
283Q00000X
284300000X
291U00000X
291U00000X
302R00000X
305R00000X
311500000X
311Z00000X
311ZA0620X
313M00000X
315P00000X
320800000X
320900000X
323P00000X
324500000X
332B00000X
332BC3200X
363A00000X
363L00000X
363LA2100X
363LA2200X
363LC0200X
363LC1500X
363LF0000X
363LG0600X
363LP0200X
363LP0200X
363LP0808X
363LP2300X
363LP2300X
363LS0200X
363LW0102X
363LX0106X
364S00000X
364SP0807X
364SP0808X
364SP0809X
364SP0810X
364SP0811X
364SP0812X
364SP0813X
367500000X
367H00000X
374700000X
3747A0650X
385H00000X
385H00000X
385HR2055X
385HR2060X
Taxonomy Effective date
Practitioner first name
Last name
Street address
City
State
Select State/Province
-----------------
North Carolina
-----------------
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
District of Columbia
Puerto Rico
Guam
American Samoa
U.S. Virgin Islands
Northern Mariana Islands
ZIP code
Practitioner NPI #
Taxonomy Addition
(Must be valid at NC Tracks)
Please select
101Y00000X
101YA0400X
101YM0800X
101YP2500X
103T00000X
104100000X
1041C0700X
106H00000X
132700000X
163WP0808X
163WP0809X
164W00000X
171M00000X
171W00000X
171WH0202X
207P00000X
207Q00000X
207QA0505X
207R00000X
207RA0401X
207RC0200X
207RG0300X
208000000X
208000000X
2080A0000X
2080P0006X
2081P2900X
2084A0401X
2084F0202X
2084N0402X
2084P0005X
2084P0015X
2084P0800X
2084P0802X
2084P0804X
2084P0805X
2084S0012X
208800000X
208D00000X
222Z00000X
224Z00000X
2251P0200X
225800000X
225X00000X
225XM0800X
225XP0200X
251300000X
251B00000X
251C00000X
251E00000X
251F00000X
251J00000X
251K00000X
251T00000X
252Y00000X
253Z00000X
261Q00000X
261QA0005X
261QA0600X
261QA1903X
261QA3000X
261QD1600X
261QM0801X
261QM1000X
261QR0401X
261QR0401X
261QR0404X
261QR0405X
273R00000X
275N00000X
282N00000X
282N00000X
282NC0060X
283Q00000X
284300000X
291U00000X
291U00000X
302R00000X
305R00000X
311500000X
311Z00000X
311ZA0620X
313M00000X
315P00000X
320800000X
320900000X
323P00000X
324500000X
332B00000X
332BC3200X
363A00000X
363L00000X
363LA2100X
363LA2200X
363LC0200X
363LC1500X
363LF0000X
363LG0600X
363LP0200X
363LP0200X
363LP0808X
363LP2300X
363LP2300X
363LS0200X
363LW0102X
363LX0106X
364S00000X
364SP0807X
364SP0808X
364SP0809X
364SP0810X
364SP0811X
364SP0812X
364SP0813X
367500000X
367H00000X
374700000X
3747A0650X
385H00000X
385H00000X
385HR2055X
385HR2060X
Taxonomy Effective date
Add new row
Provider representative information
Provider rep. first name
*
Last name
*
Rep. phone #
*
Rep. email
*
Date submitted
*
By submitting this form the above named representative represents that they have the authority to submit the information on behalf of the provider named above and further represents that the information is true and correct to the best of their knowledge, information and belief.
Note
: If the form does not submit, scroll up to the top form to check for a validation error message.