ADVANCED INTEGRATED MEDICAL CENTER — NPI 1033674916 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1033674916

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363L00000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner

Box 32 Service Location & ZIP+4

1395 NW MAIN ST, BLACKFOOT, ID, 83221-3936

✓ 9-Digit EDI 837 ZIP+4 (83221-3936)

Practice Phone & Referral Fax

(208) 785-0270

Fax: (208) 785-0683

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1033674916 (ADVANCED INTEGRATED MEDICAL CENTER) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1033674916` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED INTEGRATED MEDICAL CENTER
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: `363L00000X` (Nurse Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1395 NW MAIN ST, BLACKFOOT, ID, 83221-3936
Practice Telephone / Fax	Tel: (208) 785-0270 \| Fax: (208) 785-0683
Administrative Mailing Address	1742 N 500 W APT 102, LOGAN, UT, 84341-2875
Enumeration & Last Sync	Enumerated: 2019-02-05 \| CMS Record Updated: 2020-06-18
Authorized Official	DEE STEVENS (Owner/Operator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1395 NW MAIN ST, BLACKFOOT, ID, 83221-3936

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Plain-English Taxonomy & CMS Crosswalk (363L00000X)

What Does Taxonomy Code 363L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED INTEGRATED MEDICAL CENTER)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: N/A \| License: `Verified` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED INTEGRATED MEDICAL CENTER (NPI #1033674916)