A BALANCED LIFE HEALTH CARE — NPI 1083040869 (Licensed & Credentialed Health Maintenance Organization in PORTLAND, OR)

CMS-1500 Box 24J / 33a • NPI

1083040869

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

302R00000X

Licensed & Credentialed Health Maintenance Organization

Box 32 Service Location & ZIP+4

2005 SE HAWTHORNE BLVD, 20TH AND SE HAWTHORNE, PORTLAND, OR, 97214-3819

✓ 9-Digit EDI 837 ZIP+4 (97214-3819)

Practice Phone & Referral Fax

(503) 236-4580

Fax: (503) 231-8400

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1083040869 (A BALANCED LIFE HEALTH CARE) 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	`1083040869` (NPI-2 Organization / Facility)
Provider / Legal Name	A BALANCED LIFE HEALTH CARE
Plain-English Specialty	Licensed & Credentialed Health Maintenance Organization NUCC Code: `302R00000X` (Health Maintenance Organization)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2005 SE HAWTHORNE BLVD, 20TH AND SE HAWTHORNE, PORTLAND, OR, 97214-3819
Practice Telephone / Fax	Tel: (503) 236-4580 \| Fax: (503) 231-8400
Administrative Mailing Address	2005 SE HAWTHORNE BLVD., PORTLAND, OR, 97214
Enumeration & Last Sync	Enumerated: 2013-09-24 \| CMS Record Updated: 2013-09-24
Authorized Official	DEBBIE VANETT (Office Manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2005 SE HAWTHORNE BLVD, 20TH AND SE HAWTHORNE, PORTLAND, OR, 97214-3819

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Plain-English Taxonomy & CMS Crosswalk (302R00000X)

What Does Taxonomy Code 302R00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 302R00000X translates to:
"Licensed & Credentialed Health Maintenance Organization"

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 Health Maintenance Organization for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (A BALANCED LIFE HEALTH CARE)

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
`302R00000X` — Health Maintenance Organization Plain English: Licensed & Credentialed Health Maintenance Organization	State: OR \| License: `020704040` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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A BALANCED LIFE HEALTH CARE (NPI #1083040869)