VINTAGE SPECIALIZED SERVICES LLC — NPI 1366002073 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family in RIVES JUNCTION, MI)

CMS-1500 Box 24J / 33a • NPI

1366002073

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363LF0000X (CMS 50)

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

Box 32 Service Location & ZIP+4

2055 PERRINE RD, RIVES JUNCTION, MI, 49277-9735

✓ 9-Digit EDI 837 ZIP+4 (49277-9735)

Practice Phone & Referral Fax

(517) 574-2401

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366002073 (VINTAGE SPECIALIZED SERVICES 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

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	`1366002073` (NPI-2 Organization / Facility)
Provider / Legal Name	VINTAGE SPECIALIZED SERVICES LLC
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: `363LF0000X` (Nurse Practitioner, Family)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2055 PERRINE RD, RIVES JUNCTION, MI, 49277-9735
Practice Telephone / Fax	Tel: (517) 574-2401
Administrative Mailing Address	207 E BELLEVUE ST, LESLIE, MI, 49251-9373
Enumeration & Last Sync	Enumerated: 2019-06-14 \| CMS Record Updated: 2019-06-14
Authorized Official	LATOSHIA BARUTI (Administrator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2055 PERRINE RD, RIVES JUNCTION, MI, 49277-9735

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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)

What Does Taxonomy Code 363LF0000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"

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

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (VINTAGE SPECIALIZED SERVICES 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

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
`363LF0000X` — Nurse Practitioner, Family Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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VINTAGE SPECIALIZED SERVICES LLC (NPI #1366002073)