ADVANCED NEUROSCIENCE CLINIC, PA — NPI 1104954049 (Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist) in ODESSA, TX)

CMS-1500 Box 24J / 33a • NPI

1104954049

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

2084N0400X (CMS 13)

Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)

Box 32 Service Location & ZIP+4

601 E 2ND ST STE E, ODESSA, TX, 79761-5435

✓ 9-Digit EDI 837 ZIP+4 (79761-5435)

Practice Phone & Referral Fax

(432) 570-9991

Fax: (432) 687-6299

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104954049 (ADVANCED NEUROSCIENCE CLINIC, PA) 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	`1104954049` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED NEUROSCIENCE CLINIC, PA
Plain-English Specialty	Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist) NUCC Code: `2084N0400X` (Psychiatry & Neurology, Neurology)
Certifying / Licensing Body	American Board of Psychiatry and Neurology (ABPN)
Practice Location Address	601 E 2ND ST STE E, ODESSA, TX, 79761-5435
Practice Telephone / Fax	Tel: (432) 570-9991 \| Fax: (432) 687-6299
Administrative Mailing Address	PO BOX 4100, MIDLAND, TX, 79704-4100
Enumeration & Last Sync	Enumerated: 2007-03-01 \| CMS Record Updated: 2024-10-08
Authorized Official	CHAD HAGGERTON (Business Office Mgr.)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

601 E 2ND ST STE E, ODESSA, TX, 79761-5435

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Plain-English Taxonomy & CMS Crosswalk (2084N0400X)

What Does Taxonomy Code 2084N0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2084N0400X translates to:
"Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 13 (Physician/Neurology) • CMS Code 86 (Physician/Neuropsychiatry)
Certifying / Accrediting Authority: American Board of Psychiatry and Neurology (ABPN)
Clinical Scope: Stroke recovery, chronic or severe migraines, seizures, numbness/tingling in hands or feet (neuropathy), tremors, memory loss, or suspected CSF leak.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED NEUROSCIENCE CLINIC, PA)

Typical CPT / Diagnostic Procedures:

Electroencephalography (EEG — CPT 95816) for Seizure & Epilepsy Evaluation
Electromyography (EMG) & Nerve Conduction Studies (NCS)
Lumbar Puncture & Cerebrospinal Fluid (CSF) Pressure/Analysis
Acute Ischemic Stroke NIHSS Assessment & Neuroimaging Review

Common Therapeutic Classes:

CGRP Antagonists & Triptans (Sumatriptan, Rizatriptan) for Migraine
Antiepileptic Drugs (Levetiracetam, Lamotrigine, Valproate)
Levodopa/Carbidopa (Parkinson's Disease) & Gabapentin/Pregabalin (Neuropathy)
Antiplatelet & Secondary Stroke Prevention Regimens

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2084N0400X` — Psychiatry & Neurology, Neurology Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: TX \| License: `L2914` \| Primary: Yes (Primary)
`2084N0400X` — Psychiatry & Neurology, Neurology Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: TX \| License: `M3833` \| Primary: Secondary
`2084N0600X` — Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: TX \| License: `L2914` \| Primary: Secondary
`2084N0600X` — Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: TX \| License: `M3833` \| Primary: Secondary
`2084S0012X` — Psychiatry & Neurology, Sleep Medicine Plain English: Board-Certified Neurologist (Brain, Spine, Stroke & Nerve Specialist)	State: TX \| License: `L2914` \| Primary: Secondary
`363AM0700X` — Physician Assistant, Medical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical	State: TX \| License: `PA04008` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED NEUROSCIENCE CLINIC, PA (NPI #1104954049)