CMS-1500 Box 24J / 33a • NPI
1174274120
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
103G00000X
Licensed & Credentialed Clinical Neuropsychologist
Box 32 Service Location & ZIP+4
2714 MEMORIAL BLVD, CONNELLSVILLE, PA, 15425-1406
✓ 9-Digit EDI 837 ZIP+4 (15425-1406)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174274120 (STATE OF MIND NEUROPSYCHOLOGY 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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1174274120 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | STATE OF MIND NEUROPSYCHOLOGY LLC |
| Plain-English Specialty | Licensed & Credentialed Clinical Neuropsychologist NUCC Code: 103G00000X (Clinical Neuropsychologist) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2714 MEMORIAL BLVD, CONNELLSVILLE, PA, 15425-1406 |
| Practice Telephone / Fax | Tel: (724) 317-1647 |
| Administrative Mailing Address | PO BOX 420, PERRYOPOLIS, PA, 15473-0420 |
| Enumeration & Last Sync | Enumerated: 2022-01-11 | CMS Record Updated: 2022-01-11 |
| Authorized Official | ALICIA PUSKAR (Owner/Neuropsychologist) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (103G00000X)
What Does Taxonomy Code 103G00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103G00000X translates to:
"Licensed & Credentialed Clinical Neuropsychologist"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (STATE OF MIND NEUROPSYCHOLOGY 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
- 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 |
|---|---|
103T00000X — PsychologistPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist | State: N/A | License: Verified | Primary: Secondary |
103TA0700X — Psychologist, Adult Development & AgingPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Adult Development & Aging | State: N/A | License: Verified | Primary: Secondary |
103TC0700X — Psychologist, ClinicalPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Clinical | State: N/A | License: Verified | Primary: Secondary |
103G00000X — Clinical NeuropsychologistPlain English: Licensed & Credentialed Clinical Neuropsychologist | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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