CMS-1500 Box 24J / 33a • NPI
1215776422
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
313M00000X (CMS A3[10])
Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility
Box 32 Service Location & ZIP+4
102 BAILEY ST, FARMINGTON, MO, 63640-1819
✓ 9-Digit EDI 837 ZIP+4 (63640-1819)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1215776422 (PENBERTHYHOLDINGS, LLC) 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 | 1215776422 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | PENBERTHYHOLDINGS, LLC |
| Plain-English Specialty | Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility NUCC Code: 313M00000X (Nursing Facility/Intermediate Care Facility) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 102 BAILEY ST, FARMINGTON, MO, 63640-1819 |
| Practice Telephone / Fax | Tel: (573) 756-6374 |
| Administrative Mailing Address | 7164 ROSEMARY LN, CEDAR HILL, MO, 63016-3130 |
| Enumeration & Last Sync | Enumerated: 2024-05-20 | CMS Record Updated: 2024-05-20 |
| Authorized Official | BRANDON PENBERTHY (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (313M00000X)
What Does Taxonomy Code 313M00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 313M00000X translates to:
"Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (PENBERTHYHOLDINGS, LLC)
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 |
|---|---|
313M00000X — Nursing Facility/Intermediate Care FacilityPlain English: Licensed & Credentialed Nursing and Custodial Care Facilities — Nursing Facility | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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