ADVANCED SPECIALTY ASSOCIATES, LTD — NPI 1265583652 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology

CMS-1500 Box 24J / 33a • NPI

1265583652

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207YS0123X (CMS 04)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology — Facial Plastic Surgery

Box 32 Service Location & ZIP+4

13359 ISLE DR, SUITE 1, BAXTER, MN, 56425-2221

✓ 9-Digit EDI 837 ZIP+4 (56425-2221)

Practice Phone & Referral Fax

(218) 454-8888

Fax: (888) 835-7231

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1265583652 (ADVANCED SPECIALTY ASSOCIATES, LTD) 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	`1265583652` (NPI-2 Organization / Facility)
Provider / Legal Name	ADVANCED SPECIALTY ASSOCIATES, LTD
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology — Facial Plastic Surgery NUCC Code: `207YS0123X` (Otolaryngology, Facial Plastic Surgery)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	13359 ISLE DR, SUITE 1, BAXTER, MN, 56425-2221
Practice Telephone / Fax	Tel: (218) 454-8888 \| Fax: (888) 835-7231
Administrative Mailing Address	13359 ISLE DR, BAXTER, MN, 56425-2221
Enumeration & Last Sync	Enumerated: 2007-01-15 \| CMS Record Updated: 2023-09-19
Authorized Official	KURTIS WATERS (Director)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

13359 ISLE DR, SUITE 1, BAXTER, MN, 56425-2221

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Plain-English Taxonomy & CMS Crosswalk (207YS0123X)

What Does Taxonomy Code 207YS0123X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207YS0123X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology — Facial Plastic Surgery"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 04 (Physician/Otolaryngology)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Otolaryngology, Facial Plastic Surgery for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADVANCED SPECIALTY ASSOCIATES, LTD)

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
`207YS0123X` — Otolaryngology, Facial Plastic Surgery Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Otolaryngology — Facial Plastic Surgery	State: MN \| License: `37843` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ADVANCED SPECIALTY ASSOCIATES, LTD (NPI #1265583652)