SHARON OTHELLO, RN — NPI 1215807466 (Licensed & Credentialed Registered Nurse in JACKSON, MS)

CMS-1500 Box 24J / 33a • NPI

1215807466

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

163W00000X

Licensed & Credentialed Registered Nurse

Box 32 Service Location & ZIP+4

4780 I 55 N STE 100-119, JACKSON, MS, 39211-5542

✓ 9-Digit EDI 837 ZIP+4 (39211-5542)

Practice Phone & Referral Fax

(404) 806-4301

Fax: (470) 200-0836

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1215807466 (SHARON OTHELLO, RN) 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	`1215807466` (NPI-1 Individual Practitioner)
Provider / Legal Name	SHARON OTHELLO, RN
Plain-English Specialty	Licensed & Credentialed Registered Nurse NUCC Code: `163W00000X` (Registered Nurse)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4780 I 55 N STE 100-119, JACKSON, MS, 39211-5542
Practice Telephone / Fax	Tel: (404) 806-4301 \| Fax: (470) 200-0836
Administrative Mailing Address	3869 MONCURE MARBLE RD, TERRY, MS, 39170-8855
Enumeration & Last Sync	Enumerated: 2025-11-11 \| CMS Record Updated: 2025-11-15

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4780 I 55 N STE 100-119, JACKSON, MS, 39211-5542

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Plain-English Taxonomy & CMS Crosswalk (163W00000X)

What Does Taxonomy Code 163W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 163W00000X translates to:
"Licensed & Credentialed Registered Nurse"

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 Registered Nurse for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (SHARON OTHELLO, RN)

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
`163W00000X` — Registered Nurse Plain English: Licensed & Credentialed Registered Nurse	State: MS \| License: `853949` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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SHARON OTHELLO, RN (NPI #1215807466)