CAMMI JO FRUIN, AGNP-C — NPI 1275127490 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers

CMS-1500 Box 24J / 33a • NPI

1275127490

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363L00000X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner

Box 32 Service Location & ZIP+4

450 W 910 S STE 203, HEBER CITY, UT, 84032-2447

✓ 9-Digit EDI 837 ZIP+4 (84032-2447)

Practice Phone & Referral Fax

(801) 712-0994

Fax: (888) 807-7464

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1275127490 (CAMMI JO FRUIN, AGNP-C) 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	`1275127490` (NPI-1 Individual Practitioner)
Provider / Legal Name	CAMMI JO FRUIN, AGNP-C
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: `363L00000X` (Nurse Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	450 W 910 S STE 203, HEBER CITY, UT, 84032-2447
Practice Telephone / Fax	Tel: (801) 712-0994 \| Fax: (888) 807-7464
Administrative Mailing Address	1144 N 455 W UNIT 6, MIDWAY, UT, 84049-6493
Enumeration & Last Sync	Enumerated: 2021-02-28 \| CMS Record Updated: 2022-04-26

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

450 W 910 S STE 203, HEBER CITY, UT, 84032-2447

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Plain-English Taxonomy & CMS Crosswalk (363L00000X)

What Does Taxonomy Code 363L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CAMMI JO FRUIN, AGNP-C)

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
`363LG0600X` — Nurse Practitioner, Gerontology Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology	State: UT \| License: `341638-4405` \| Primary: Secondary
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: UT \| License: `341638-4405` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CAMMI JO FRUIN, AGNP-C (NPI #1275127490)