BLUE MEDICAL LLC — NPI 1124818729 (Licensed & Credentialed Allopathic & Osteopathic Physicians

CMS-1500 Box 24J / 33a • NPI

1124818729

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

208D00000X (CMS 01)

Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice

Box 32 Service Location & ZIP+4

511 W WOODBINE, NIXA, MO, 65714

Official NPPES Practice Location

Practice Phone & Referral Fax

(417) 444-3501

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1124818729 (BLUE MEDICAL LLC) 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	`1124818729` (NPI-2 Organization / Facility)
Provider / Legal Name	BLUE MEDICAL LLC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice NUCC Code: `208D00000X` (General Practice)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	511 W WOODBINE, NIXA, MO, 65714
Practice Telephone / Fax	Tel: (417) 444-3501
Administrative Mailing Address	4319 S NATIONAL AVE # 309, SPRINGFIELD, MO, 65810-2607
Enumeration & Last Sync	Enumerated: 2025-05-08 \| CMS Record Updated: 2025-10-22
Authorized Official	BRIAN SHEFULSKY (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

511 W WOODBINE, NIXA, MO, 65714

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Plain-English Taxonomy & CMS Crosswalk (208D00000X)

What Does Taxonomy Code 208D00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208D00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 01 (Physician/General Practice) • CMS Code 99 (Physician/Undefined Physician type[6])
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified General Practice for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BLUE MEDICAL LLC)

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
`208D00000X` — General Practice Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BLUE MEDICAL LLC (NPI #1124818729)