CMS-1500 Box 24J / 33a • NPI
1174358568
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LA2100X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care
Box 32 Service Location & ZIP+4
100 N MAIN ST, GIDEON, MO, 63848-9253
✓ 9-Digit EDI 837 ZIP+4 (63848-9253)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174358568 (MELISSA LYNN MARINO) 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 | 1174358568 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | MELISSA LYNN MARINO |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care NUCC Code: 363LA2100X (Nurse Practitioner, Acute Care) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 100 N MAIN ST, GIDEON, MO, 63848-9253 |
| Practice Telephone / Fax | Tel: (870) 838-7300 |
| Administrative Mailing Address | 1520 N DIVISION ST, BLYTHEVILLE, AR, 72315-1448 |
| Enumeration & Last Sync | Enumerated: 2024-09-04 | CMS Record Updated: 2026-09-21 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LA2100X)
What Does Taxonomy Code 363LA2100X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2100X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (MELISSA LYNN MARINO)
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 |
|---|---|
363LG0600X — Nurse Practitioner, GerontologyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology | State: TN | License: 39459 | Primary: Secondary |
363LA2100X — Nurse Practitioner, Acute CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care | State: AR | License: 236794 | Primary: Secondary |
363LA2100X — Nurse Practitioner, Acute CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care | State: TN | License: 39459 | Primary: Yes (Primary) |
363LA2100X — Nurse Practitioner, Acute CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care | State: MO | License: 2026012430 | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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