BROWN BEAR EARLY INTERVENTION LLC — NPI 1043017700 (Licensed & Credentialed Behavior Analyst in PARK FOREST, IL)

CMS-1500 Box 24J / 33a • NPI

1043017700

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103K00000X

Licensed & Credentialed Behavior Analyst

Box 32 Service Location & ZIP+4

354 WINONA ST, PARK FOREST, IL, 60466-1520

✓ 9-Digit EDI 837 ZIP+4 (60466-1520)

Practice Phone & Referral Fax

(541) 257-7028

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1043017700 (BROWN BEAR EARLY INTERVENTION LLC) 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	`1043017700` (NPI-2 Organization / Facility)
Provider / Legal Name	BROWN BEAR EARLY INTERVENTION LLC
Plain-English Specialty	Licensed & Credentialed Behavior Analyst NUCC Code: `103K00000X` (Behavior Analyst)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	354 WINONA ST, PARK FOREST, IL, 60466-1520
Practice Telephone / Fax	Tel: (541) 257-7028
Administrative Mailing Address	1407 W 15TH ST APT 214, CHICAGO, IL, 60608-2280
Enumeration & Last Sync	Enumerated: 2025-02-28 \| CMS Record Updated: 2025-02-28
Authorized Official	RAMISH MOHAMMAD (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

354 WINONA ST, PARK FOREST, IL, 60466-1520

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Plain-English Taxonomy & CMS Crosswalk (103K00000X)

What Does Taxonomy Code 103K00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103K00000X translates to:
"Licensed & Credentialed Behavior Analyst"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Behavior Analyst for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BROWN BEAR EARLY INTERVENTION LLC)

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
`103K00000X` — Behavior Analyst Plain English: Licensed & Credentialed Behavior Analyst	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BROWN BEAR EARLY INTERVENTION LLC (NPI #1043017700)