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Healthcare Insights

Taxonomy versus claims-based specialties

When healthcare providers register for a National Provider Identifier (NPI) number, they select a taxonomy that reflects their specialization and education. This data point, however, may become outdated as a provider finishes training or branches into a sub-specialty focus.

To more accurately reflect a provider’s practice patterns, we assign them a claims-based specialty in our PhysicianView product.

In the list below, we spotlight differences in taxonomy-based specialties and claims-based specialties to see areas where our healthcare commercial intelligence better classifies the providers in our PhysicianView product.

Difference between NPI taxonomy and claims-based specialty by number of providers

Taxonomy codeNPI taxonomy descriptionClaims-based specialtyNumber of providers Explore dataset
207Q00000XFamily PracticePhysical Therapy1426Explore
207Q00000XFamily PracticeEmergency Medicine1375Explore
207R00000XInternal MedicinePhysical Therapy1371Explore
207Q00000XFamily PracticeHospital Medicine1060Explore
208000000XPediatric MedicinePediatric Emergency Medicine1009Explore
207X00000XSurgery - Orthopedic SurgeryPhysical Therapy988Explore
207P00000XFamily PracticeEmergency Medicine921Explore
208000000XPediatric MedicineSpeech Language Pathology852Explore
2085R0202XRadiology - Interventional RadiologyDiagnostic Radiology764Explore
208000000XPediatric MedicinePediatric Physical Therapy706Explore
207L00000XAnesthesiology - AnesthesiologistPediatric Anesthesiology643Explore
207RN0300XInternal MedicineNephrology594Explore
207RC0000XInternal MedicineCardiology582Explore
208000000XPediatric MedicineNeonatal-Perinatal Medicine543Explore
207R00000XInternal MedicineEmergency Medicine517Explore
207RG0100XInternal MedicineGastroenterology505Explore
207P00000XInternal MedicineEmergency Medicine501Explore

Fig 1. Data from the Definitive Healthcare PhysicianView product. Data examines where the taxonomy-based primary specialty is different from the claims-based specialty. Claims-based specialty is a proprietary designation from Definitive Healthcare. Data is sourced from proprietary research, the NPI registry, and Physician Compare. Data accurate as of December 2023.

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.

Learn more

Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians and other healthcare providers.