CANTERBURY MANOR NURSING CENTER — NPI 1154454544 (Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies in WATERLOO, IL)

CMS-1500 Box 24J / 33a • NPI

1154454544

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

332B00000X (CMS 54)

Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies

Box 32 Service Location & ZIP+4

718 N MARKET ST, WATERLOO, IL, 62298-1014

✓ 9-Digit EDI 837 ZIP+4 (62298-1014)

Practice Phone & Referral Fax

(618) 939-8565

Fax: (618) 939-3650

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1154454544 (CANTERBURY MANOR NURSING CENTER) 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	`1154454544` (NPI-2 Organization / Facility)
Provider / Legal Name	CANTERBURY MANOR NURSING CENTER
Plain-English Specialty	Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies NUCC Code: `332B00000X` (Durable Medical Equipment & Medical Supplies)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	718 N MARKET ST, WATERLOO, IL, 62298-1014
Practice Telephone / Fax	Tel: (618) 939-8565 \| Fax: (618) 939-3650
Administrative Mailing Address	718 N MARKET ST, WATERLOO, IL, 62298-1014
Enumeration & Last Sync	Enumerated: 2007-03-14 \| CMS Record Updated: 2020-08-22
Authorized Official	DIANA KINGTON (PRESIDENT)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

718 N MARKET ST, WATERLOO, IL, 62298-1014

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Plain-English Taxonomy & CMS Crosswalk (332B00000X)

What Does Taxonomy Code 332B00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 332B00000X translates to:
"Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 54 (Other Medical Supply Company) • CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code 87[3] (All Other Suppliers) • CMS Code A2[9] (Intermediate Care Nursing Facility) • CMS Code A6 (Medical Supply Company with Respiratory Therapist) • CMS Code A7 (Department Store) • CMS Code A8 (Grocery Store) • CMS Code B3 (Medical supply company with pedorthic personnel)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Durable Medical Equipment & Medical Supplies for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CANTERBURY MANOR NURSING CENTER)

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
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CANTERBURY MANOR NURSING CENTER (NPI #1154454544)