KELLY MAE DAMANN — NPI 1053098996 (Licensed & Credentialed Driver in SANDSTONE, MN)

CMS-1500 Box 24J / 33a • NPI

1053098996

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

172A00000X

Licensed & Credentialed Driver

Box 32 Service Location & ZIP+4

606 HIGHWAY 123 W, SANDSTONE, MN, 55072-5060

✓ 9-Digit EDI 837 ZIP+4 (55072-5060)

Practice Phone & Referral Fax

(320) 245-5355

Fax: (320) 216-7638

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1053098996 (KELLY MAE DAMANN) 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	`1053098996` (NPI-1 Individual Practitioner)
Provider / Legal Name	KELLY MAE DAMANN
Plain-English Specialty	Licensed & Credentialed Driver NUCC Code: `172A00000X` (Driver)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	606 HIGHWAY 123 W, SANDSTONE, MN, 55072-5060
Practice Telephone / Fax	Tel: (320) 245-5355 \| Fax: (320) 216-7638
Administrative Mailing Address	PO BOX 26, SANDSTONE, MN, 55072-0026
Enumeration & Last Sync	Enumerated: 2023-07-03 \| CMS Record Updated: 2023-07-03

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

606 HIGHWAY 123 W, SANDSTONE, MN, 55072-5060

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Plain-English Taxonomy & CMS Crosswalk (172A00000X)

What Does Taxonomy Code 172A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 172A00000X translates to:
"Licensed & Credentialed Driver"

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 Driver for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KELLY MAE DAMANN)

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
`172A00000X` — Driver Plain English: Licensed & Credentialed Driver	State: MN \| License: `B752026331714` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KELLY MAE DAMANN (NPI #1053098996)