MUTIAT B BAMGBALA, Provider — NPI 1205528635 (Licensed & Credentialed Private Vehicle in LEXINGTON, NC)

CMS-1500 Box 24J / 33a • NPI

1205528635

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

347C00000X

Licensed & Credentialed Private Vehicle

Box 32 Service Location & ZIP+4

254 ASHFIELD LN, LEXINGTON, NC, 27292-8348

✓ 9-Digit EDI 837 ZIP+4 (27292-8348)

Practice Phone & Referral Fax

(860) 986-0003

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205528635 (MUTIAT B BAMGBALA, Provider) 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	`1205528635` (NPI-1 Individual Practitioner)
Provider / Legal Name	MUTIAT B BAMGBALA, Provider
Plain-English Specialty	Licensed & Credentialed Private Vehicle NUCC Code: `347C00000X` (Private Vehicle)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	254 ASHFIELD LN, LEXINGTON, NC, 27292-8348
Practice Telephone / Fax	Tel: (860) 986-0003
Administrative Mailing Address	355 FAITH RD, SALISBURY, NC, 28146-7007
Enumeration & Last Sync	Enumerated: 2023-05-24 \| CMS Record Updated: 2023-10-06

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

254 ASHFIELD LN, LEXINGTON, NC, 27292-8348

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Plain-English Taxonomy & CMS Crosswalk (347C00000X)

What Does Taxonomy Code 347C00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 347C00000X translates to:
"Licensed & Credentialed Private Vehicle"

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 Private Vehicle for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MUTIAT B BAMGBALA, Provider)

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
`342000000X` — Transportation Network Company Plain English: Licensed & Credentialed Transportation Network Company	State: NC \| License: `000048761695` \| Primary: Secondary
`347C00000X` — Private Vehicle Plain English: Licensed & Credentialed Private Vehicle	State: NC \| License: `000048761695` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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MUTIAT B BAMGBALA, Provider (NPI #1205528635)