CARLEY JEAN BACON, PA-C — NPI 1316417157 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical in CAMBRIDGE, MN)

CMS-1500 Box 24J / 33a • NPI

1316417157

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363AS0400X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical

Box 32 Service Location & ZIP+4

701 DELLWOOD ST S, CAMBRIDGE, MN, 55008-1920

✓ 9-Digit EDI 837 ZIP+4 (55008-1920)

Practice Phone & Referral Fax

(763) 689-8700

Fax: (763) 688-7941

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1316417157 (CARLEY JEAN BACON, PA-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	`1316417157` (NPI-1 Individual Practitioner)
Provider / Legal Name	CARLEY JEAN BACON, PA-C
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical NUCC Code: `363AS0400X` (Physician Assistant, Surgical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	701 DELLWOOD ST S, CAMBRIDGE, MN, 55008-1920
Practice Telephone / Fax	Tel: (763) 689-8700 \| Fax: (763) 688-7941
Administrative Mailing Address	PO BOX 43, MINNEAPOLIS, MN, 55440-0043
Enumeration & Last Sync	Enumerated: 2018-12-04 \| CMS Record Updated: 2024-01-04

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

701 DELLWOOD ST S, CAMBRIDGE, MN, 55008-1920

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Plain-English Taxonomy & CMS Crosswalk (363AS0400X)

What Does Taxonomy Code 363AS0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363AS0400X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant, Surgical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (CARLEY JEAN BACON, PA-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
`363AS0400X` — Physician Assistant, Surgical Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Surgical	State: TX \| License: `PA12540` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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CARLEY JEAN BACON, PA-C (NPI #1316417157)