CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC — NPI 1174040034 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in INDEPENDENCE, KY)

CMS-1500 Box 24J / 33a • NPI

1174040034

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QR0405X (CMS D5)

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

1974 WALTON NICHOLSON PIKE, INDEPENDENCE, KY, 41051-7906

✓ 9-Digit EDI 837 ZIP+4 (41051-7906)

Practice Phone & Referral Fax

(859) 359-5404

Fax: (859) 359-0739

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1174040034 (CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC) 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.

Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1174040034)

Medicare Beneficiaries

Total Billed Services

623

Distinct CPT/HCPCS Codes

Medicare Allowed Total

$74,646.77

Actual Top Billed CPT / HCPCS Procedures (CMS Part B)

CPT / HCPCS	Clinical Procedure Description	Services
`G2067`	Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm	240
`G2078`	Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure	368

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1174040034` (NPI-2 Organization / Facility)
Provider / Legal Name	CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QR0405X` (Clinic/Center, Rehabilitation, Substance Use Disorder)
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	1974 WALTON NICHOLSON PIKE, INDEPENDENCE, KY, 41051-7906
Practice Telephone / Fax	Tel: (859) 359-5404 \| Fax: (859) 359-0739
Administrative Mailing Address	PO BOX 749057, ATLANTA, GA, 30374-9057
Enumeration & Last Sync	Enumerated: 2017-08-23 \| CMS Record Updated: 2024-11-08
Authorized Official	RUPERT MCCORMAC (Chief Executive Officer)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1974 WALTON NICHOLSON PIKE, INDEPENDENCE, KY, 41051-7906

🗺️ Open in Google Maps 🏥 More Providers in INDEPENDENCE

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Plain-English Taxonomy & CMS Crosswalk (261QR0405X)

What Does Taxonomy Code 261QR0405X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0405X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code D5 (Opioid Treatment Program)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`251S00000X` — Community/Behavioral Health Plain English: Licensed & Credentialed Community/Behavioral Health	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM0801X` — Clinic/Center, Mental Health (Including Community Mental Health Center) Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM1300X` — Clinic/Center, Multi-Specialty Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QM2800X` — Clinic/Center, Methadone Clinic Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QP2300X` — Clinic/Center, Primary Care Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0405X` — Clinic/Center, Rehabilitation, Substance Use Disorder Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CROSSROADS TREATMENT CENTER OF NORTHERN KENTUCKY, PSC (NPI #1174040034)