CMS-1500 Box 24J / 33a • NPI
1174346498
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
363A00000X (CMS 97)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant
Box 32 Service Location & ZIP+4
41715 WINCHESTER RD STE 107, TEMECULA, CA, 92590-4853
✓ 9-Digit EDI 837 ZIP+4 (92590-4853)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174346498 (ADVANCED MANAGEMENT PRACTICE PHYSICIAN ASSISTANT CORPORATION) 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 | 1174346498 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED MANAGEMENT PRACTICE PHYSICIAN ASSISTANT CORPORATION |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: 363A00000X (Physician Assistant) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 41715 WINCHESTER RD STE 107, TEMECULA, CA, 92590-4853 |
| Practice Telephone / Fax | Tel: (951) 501-0049 | Fax: (833) 585-1122 |
| Administrative Mailing Address | 4225 EXECUTIVE SQ STE 600, LA JOLLA, CA, 92037 |
| Enumeration & Last Sync | Enumerated: 2024-11-05 | CMS Record Updated: 2024-12-10 |
| Authorized Official | ALLEN PHELPS (President) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (363A00000X)
What Does Taxonomy Code 363A00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED MANAGEMENT PRACTICE PHYSICIAN ASSISTANT CORPORATION)
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 |
|---|---|
207Q00000X — Family MedicinePlain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) | State: N/A | License: Verified | Primary: Secondary |
363A00000X — Physician AssistantPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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