Section 1115 Waiver Update e-Memo - Provider Enrollment - SUD Provider Type and Taxonomy

Dear Provider:

The MPASS and Conduent Provider Enrollment teams have received numerous inquiries about how to choose a provider type and taxonomy. The MPASS team has created some guidance to assist you with your choices. Please make time to read the steps and use the grid as a guide.

If you have any additional questions, please email


Renee Stangl

Medicaid Program Specialist III

SOA – DHSS – DBH - Medicaid Provider Assistance Services Section

3601 C Street, Suite 878

Anchorage, AK 99503

(907) 269-3794




Dear Provider,

This e-mail has been generated by staff from the Division of Behavioral Health. Please do not reply to this e-mail as replies are not monitored.