CMS-1500 Box 24J / 33a • NPI
1396178497
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
2083P0500X (CMS 84)
Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine, Preventive Medicine — Occupational Environmental Medicine
Box 32 Service Location & ZIP+4
200 EXCELSIOR MILL RD, PENDLETON, SC, 29670-9000
✓ 9-Digit EDI 837 ZIP+4 (29670-9000)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1396178497 (HEALTHSTAT ON-SITE CLINIC/MILLIKEN PENDLETON) 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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1396178497 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | HEALTHSTAT ON-SITE CLINIC/MILLIKEN PENDLETON |
| Plain-English Specialty | Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine, Preventive Medicine — Occupational Environmental Medicine NUCC Code: 2083P0500X (Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 200 EXCELSIOR MILL RD, PENDLETON, SC, 29670-9000 |
| Practice Telephone / Fax | Tel: (864) 646-4779 |
| Administrative Mailing Address | 4651 CHARLOTTE PARK DR, CHARLOTTE, NC, 28217-1956 |
| Enumeration & Last Sync | Enumerated: 2013-08-13 | CMS Record Updated: 2013-08-13 |
| Authorized Official | WARREN HUTTON (COO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (2083P0500X)
What Does Taxonomy Code 2083P0500X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2083P0500X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine, Preventive Medicine — Occupational Environmental Medicine"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (HEALTHSTAT ON-SITE CLINIC/MILLIKEN PENDLETON)
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
- 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 |
|---|---|
2083P0500X — Preventive Medicine, Preventive Medicine/Occupational Environmental MedicinePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine, Preventive Medicine — Occupational Environmental Medicine | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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