CMS-1500 Box 24J / 33a • NPI
1205809225
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
2900 LAKEVIEW AVE, SAINT JOSEPH, MI, 49085-2379
✓ 9-Digit EDI 837 ZIP+4 (49085-2379)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1205809225 (CAROLE ANNE DERUCKI, FNP-BC) 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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1205809225 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | CAROLE ANNE DERUCKI, FNP-BC |
| 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 | 2900 LAKEVIEW AVE, SAINT JOSEPH, MI, 49085-2379 |
| Practice Telephone / Fax | Tel: (269) 932-7859 | Fax: (269) 932-7859 |
| Administrative Mailing Address | 23448 SHURTE ST, CASSOPOLIS, MI, 49031-9738 |
| Enumeration & Last Sync | Enumerated: 2006-02-09 | CMS Record Updated: 2024-02-29 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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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"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (CAROLE ANNE DERUCKI, FNP-BC)
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 |
|---|---|
174400000X — SpecialistPlain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) | State: IN | License: 71002723A | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: MI | License: 4704166108 | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: IN | License: 71002723A | Primary: Secondary |
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: MI | License: 4704166108 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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