JENNIFER DAWN BOSTIC, LAT/ATC, PTA — NPI 1144718537 (Licensed & Credentialed Specialist/Technologist, Athletic Trainer in VERSAILLES, IN)

CMS-1500 Box 24J / 33a • NPI

1144718537

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2255A2300X

Licensed & Credentialed Specialist/Technologist, Athletic Trainer

Box 32 Service Location & ZIP+4

476 W US HIGHWAY 50 STE A, VERSAILLES, IN, 47042-8340

✓ 9-Digit EDI 837 ZIP+4 (47042-8340)

Practice Phone & Referral Fax

(812) 689-1771

Fax: (812) 689-1778

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1144718537 (JENNIFER DAWN BOSTIC, LAT/ATC, PTA) 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	`1144718537` (NPI-1 Individual Practitioner)
Provider / Legal Name	JENNIFER DAWN BOSTIC, LAT/ATC, PTA
Plain-English Specialty	Licensed & Credentialed Specialist/Technologist, Athletic Trainer NUCC Code: `2255A2300X` (Specialist/Technologist, Athletic Trainer)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	476 W US HIGHWAY 50 STE A, VERSAILLES, IN, 47042-8340
Practice Telephone / Fax	Tel: (812) 689-1771 \| Fax: (812) 689-1778
Administrative Mailing Address	476 W US HIGHWAY 50 STE A, VERSAILLES, IN, 47042-8340
Enumeration & Last Sync	Enumerated: 2018-05-01 \| CMS Record Updated: 2018-05-01

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

476 W US HIGHWAY 50 STE A, VERSAILLES, IN, 47042-8340

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Plain-English Taxonomy & CMS Crosswalk (2255A2300X)

What Does Taxonomy Code 2255A2300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2255A2300X translates to:
"Licensed & Credentialed Specialist/Technologist, Athletic Trainer"

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 Specialist/Technologist, Athletic Trainer for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JENNIFER DAWN BOSTIC, LAT/ATC, PTA)

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
`2255A2300X` — Specialist/Technologist, Athletic Trainer Plain English: Licensed & Credentialed Specialist/Technologist, Athletic Trainer	State: IN \| License: `36000064A` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JENNIFER DAWN BOSTIC, LAT/ATC, PTA (NPI #1144718537)