JEFFREY BENSON HARGRAVES, PA-C — NPI 1053040493 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant in COEUR D ALENE, ID)

CMS-1500 Box 24J / 33a • NPI

1053040493

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363A00000X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant

Box 32 Service Location & ZIP+4

1090 W PARK PL, COEUR D ALENE, ID, 83814-2785

✓ 9-Digit EDI 837 ZIP+4 (83814-2785)

Practice Phone & Referral Fax

(208) 620-5250

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053040493 (JEFFREY BENSON HARGRAVES, PA-C) 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

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1053040493` (NPI-1 Individual Practitioner)
Provider / Legal Name	JEFFREY BENSON HARGRAVES, PA-C
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: `363A00000X` (Physician Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1090 W PARK PL, COEUR D ALENE, ID, 83814-2785
Practice Telephone / Fax	Tel: (208) 620-5250
Administrative Mailing Address	1456 N 800 E, SHELLEY, ID, 83274-5014
Enumeration & Last Sync	Enumerated: 2022-06-09 \| CMS Record Updated: 2022-09-13

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1090 W PARK PL, COEUR D ALENE, ID, 83814-2785

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Plain-English Taxonomy & CMS Crosswalk (363A00000X)

What Does Taxonomy Code 363A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JEFFREY BENSON HARGRAVES, PA-C)

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
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JEFFREY BENSON HARGRAVES, PA-C (NPI #1053040493)