MARY BOTHWELL, C.S.B. — NPI 1184058646 (Licensed & Credentialed Religious Nonmedical Practitioner in MONTROSE, CA)

CMS-1500 Box 24J / 33a • NPI

1184058646

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

374K00000X

Licensed & Credentialed Religious Nonmedical Practitioner

Box 32 Service Location & ZIP+4

2409 HONOLULU AVE STE 4, MONTROSE, CA, 91020-1871

✓ 9-Digit EDI 837 ZIP+4 (91020-1871)

Practice Phone & Referral Fax

(626) 449-2003

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1184058646 (MARY BOTHWELL, C.S.B.) 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

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1184058646` (NPI-1 Individual Practitioner)
Provider / Legal Name	MARY BOTHWELL, C.S.B.
Plain-English Specialty	Licensed & Credentialed Religious Nonmedical Practitioner NUCC Code: `374K00000X` (Religious Nonmedical Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2409 HONOLULU AVE STE 4, MONTROSE, CA, 91020-1871
Practice Telephone / Fax	Tel: (626) 449-2003
Administrative Mailing Address	1710 KNOLLWOOD DR, PASADENA, CA, 91103-1908
Enumeration & Last Sync	Enumerated: 2013-09-02 \| CMS Record Updated: 2013-09-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2409 HONOLULU AVE STE 4, MONTROSE, CA, 91020-1871

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Plain-English Taxonomy & CMS Crosswalk (374K00000X)

What Does Taxonomy Code 374K00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 374K00000X translates to:
"Licensed & Credentialed Religious Nonmedical Practitioner"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Religious Nonmedical Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MARY BOTHWELL, C.S.B.)

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

Common Therapeutic Classes:

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
`374K00000X` — Religious Nonmedical Practitioner Plain English: Licensed & Credentialed Religious Nonmedical Practitioner	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MARY BOTHWELL, C.S.B. (NPI #1184058646)