716 ESTABLISHMENT — NPI 1205636685 (Licensed & Credentialed Social Worker in FAIRFIELD, CA)

CMS-1500 Box 24J / 33a • NPI

1205636685

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

104100000X

Licensed & Credentialed Social Worker

Box 32 Service Location & ZIP+4

301 DAPHNE DR, FAIRFIELD, CA, 94533-1114

✓ 9-Digit EDI 837 ZIP+4 (94533-1114)

Practice Phone & Referral Fax

(707) 689-1774

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1205636685 (716 ESTABLISHMENT) 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

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1205636685` (NPI-2 Organization / Facility)
Provider / Legal Name	716 ESTABLISHMENT
Plain-English Specialty	Licensed & Credentialed Social Worker NUCC Code: `104100000X` (Social Worker)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	301 DAPHNE DR, FAIRFIELD, CA, 94533-1114
Practice Telephone / Fax	Tel: (707) 689-1774
Administrative Mailing Address	1210 GULF DR, FAIRFIELD, CA, 94533-7099
Enumeration & Last Sync	Enumerated: 2025-03-15 \| CMS Record Updated: 2025-03-15
Authorized Official	SALINA SMITH (COO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

301 DAPHNE DR, FAIRFIELD, CA, 94533-1114

🗺️ Open in Google Maps 🏥 More Providers in FAIRFIELD

🔒 Are you 716 ESTABLISHMENT? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (104100000X)

What Does Taxonomy Code 104100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 104100000X translates to:
"Licensed & Credentialed Social Worker"

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 Social Worker for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (716 ESTABLISHMENT)

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
`104100000X` — Social Worker Plain English: Licensed & Credentialed Social Worker	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`177F00000X` — Lodging Plain English: Licensed & Credentialed Lodging	State: N/A \| License: `Verified` \| Primary: Secondary
`251B00000X` — Case Management Plain English: Licensed & Credentialed Case Management	State: N/A \| License: `Verified` \| Primary: Secondary
`251K00000X` — Public Health or Welfare Plain English: Licensed & Credentialed Agencies — Public Health or Welfare	State: N/A \| License: `Verified` \| Primary: Secondary
`253Z00000X` — In Home Supportive Care Plain English: Licensed & Credentialed In Home Supportive Care	State: N/A \| License: `Verified` \| Primary: Secondary

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.

Launch Bulk NPI Checker → JSON API Docs

716 ESTABLISHMENT (NPI #1205636685)