CMS-1500 Box 24J / 33a • NPI
1174955306
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LP2300X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care
Box 32 Service Location & ZIP+4
3385 POTOMAC WAY, IDAHO FALLS, ID, 83404-4978
✓ 9-Digit EDI 837 ZIP+4 (83404-4978)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1174955306 (BRYCE WADE ANDERSEN, NP-C) 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
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1174955306)
Medicare Beneficiaries
77
Total Billed Services
194
Distinct CPT/HCPCS Codes
7
Medicare Allowed Total
$14,109.80
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 21 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 164 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Amoxicillin-Clavulanate Potass Amoxicillin/Potassium Clav | 12 | 12 |
| Celecoxib Celecoxib | 19 | <11 |
| Cyclobenzaprine Hcl Cyclobenzaprine Hcl | 11 | <11 |
| Fentanyl Fentanyl | 15 | <11 |
| Gabapentin Gabapentin | 43 | 19 |
| Hydrocodone-Acetaminophen Hydrocodone/Acetaminophen | 95 | 36 |
| Hydromorphone Hcl Hydromorphone Hcl | 13 | <11 |
| Oxycodone Hcl Oxycodone Hcl | 32 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1174955306 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | BRYCE WADE ANDERSEN, NP-C |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care NUCC Code: 363LP2300X (Nurse Practitioner, Primary Care) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 3385 POTOMAC WAY, IDAHO FALLS, ID, 83404-4978 |
| Practice Telephone / Fax | Tel: (208) 522-7246 |
| Administrative Mailing Address | 690 N 700 E, FIRTH, ID, 83236-1134 |
| Enumeration & Last Sync | Enumerated: 2013-07-30 | CMS Record Updated: 2024-03-11 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in IDAHO FALLS
🔒 Are you BRYCE WADE ANDERSEN, NP-C? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (363LP2300X)
What Does Taxonomy Code 363LP2300X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LP2300X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BRYCE WADE ANDERSEN, NP-C)
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 |
|---|---|
363LP2300X — Nurse Practitioner, Primary CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care | State: ID | License: NP1303A | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.