AMY BANNERMAN, Phlebotomist — NPI 1104771450 (Licensed & Credentialed Spec/Tech, Pathology in WALLACE, NC)

CMS-1500 Box 24J / 33a • NPI

1104771450

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

246Q00000X

Licensed & Credentialed Spec/Tech, Pathology

Box 32 Service Location & ZIP+4

133 GLENDALE VILLAGE LN, WALLACE, NC, 28466-1637

✓ 9-Digit EDI 837 ZIP+4 (28466-1637)

Practice Phone & Referral Fax

(910) 787-6633

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104771450 (AMY BANNERMAN, Phlebotomist) 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	`1104771450` (NPI-1 Individual Practitioner)
Provider / Legal Name	AMY BANNERMAN, Phlebotomist
Plain-English Specialty	Licensed & Credentialed Spec/Tech, Pathology NUCC Code: `246Q00000X` (Spec/Tech, Pathology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	133 GLENDALE VILLAGE LN, WALLACE, NC, 28466-1637
Practice Telephone / Fax	Tel: (910) 787-6633
Administrative Mailing Address	133 GLENDALE VILLAGE LN, WALLACE, NC, 28466-1637
Enumeration & Last Sync	Enumerated: 2026-03-02 \| CMS Record Updated: 2026-03-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

133 GLENDALE VILLAGE LN, WALLACE, NC, 28466-1637

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Plain-English Taxonomy & CMS Crosswalk (246Q00000X)

What Does Taxonomy Code 246Q00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 246Q00000X translates to:
"Licensed & Credentialed Spec/Tech, Pathology"

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 Spec/Tech, Pathology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AMY BANNERMAN, Phlebotomist)

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
`246Q00000X` — Spec/Tech, Pathology Plain English: Licensed & Credentialed Spec/Tech, Pathology	State: NC \| License: `Y2G5T7L7` \| Primary: Yes (Primary)

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AMY BANNERMAN, Phlebotomist (NPI #1104771450)