JESSICA L BALCOM, FNP-C — NPI 1205320777 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family in PAYSON, AZ)

CMS-1500 Box 24J / 33a • NPI

1205320777

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LF0000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family

Box 32 Service Location & ZIP+4

807 S PONDEROSA ST, PAYSON, AZ, 85541-5542

✓ 9-Digit EDI 837 ZIP+4 (85541-5542)

Practice Phone & Referral Fax

(928) 471-3222

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205320777 (JESSICA L BALCOM, FNP-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

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	`1205320777` (NPI-1 Individual Practitioner)
Provider / Legal Name	JESSICA L BALCOM, FNP-C
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: `363LF0000X` (Nurse Practitioner, Family)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	807 S PONDEROSA ST, PAYSON, AZ, 85541-5542
Practice Telephone / Fax	Tel: (928) 471-3222
Administrative Mailing Address	52423 N AZ HWY 188, PAYSON, AZ, 85541
Enumeration & Last Sync	Enumerated: 2018-06-19 \| CMS Record Updated: 2018-09-24

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

807 S PONDEROSA ST, PAYSON, AZ, 85541-5542

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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)

What Does Taxonomy Code 363LF0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Family for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (JESSICA L BALCOM, FNP-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

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
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: AZ \| License: `AP11809` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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JESSICA L BALCOM, FNP-C (NPI #1205320777)