RONALD J NELSON, Ed.D. — NPI 1104977990 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1104977990

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103TS0200X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, School

Box 32 Service Location & ZIP+4

480 N. BISBEE AVE, WILLCOX, AZ, 85643

Official NPPES Practice Location

Practice Phone & Referral Fax

(520) 384-4211

Fax: (520) 868-5254

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104977990 (RONALD J NELSON, Ed.D.) 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	`1104977990` (NPI-1 Individual Practitioner)
Provider / Legal Name	RONALD J NELSON, Ed.D.
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, School NUCC Code: `103TS0200X` (Psychologist, School)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	480 N. BISBEE AVE, WILLCOX, AZ, 85643
Practice Telephone / Fax	Tel: (520) 384-4211 \| Fax: (520) 868-5254
Administrative Mailing Address	PO BOX 2965, FLORENCE, AZ, 85232-2965
Enumeration & Last Sync	Enumerated: 2007-01-16 \| CMS Record Updated: 2007-07-26

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

480 N. BISBEE AVE, WILLCOX, AZ, 85643

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Plain-English Taxonomy & CMS Crosswalk (103TS0200X)

What Does Taxonomy Code 103TS0200X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TS0200X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, School"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, School for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RONALD J NELSON, Ed.D.)

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
`103TS0200X` — Psychologist, School Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, School	State: AZ \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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RONALD J NELSON, Ed.D. (NPI #1104977990)