CMS-1500 Box 24J / 33a • NPI
1417378555
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
152W00000X (CMS 41)
Licensed & Credentialed Eye and Vision Service Providers — Optometrist
Box 32 Service Location & ZIP+4
702 10TH ST, WORTHINGTON, MN, 56187-2767
✓ 9-Digit EDI 837 ZIP+4 (56187-2767)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1417378555 (AVERA MARSHALL) 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 | 1417378555 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | AVERA MARSHALL |
| Plain-English Specialty | Licensed & Credentialed Eye and Vision Service Providers — Optometrist NUCC Code: 152W00000X (Optometrist) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 702 10TH ST, WORTHINGTON, MN, 56187-2767 |
| Practice Telephone / Fax | Tel: (507) 376-5535 | Fax: (507) 376-4805 |
| Administrative Mailing Address | 300 S BRUCE ST, MARSHALL, MN, 56258-1934 |
| Enumeration & Last Sync | Enumerated: 2013-12-16 | CMS Record Updated: 2022-12-02 |
| Authorized Official | DEBBIE STREIER (CEO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (152W00000X)
What Does Taxonomy Code 152W00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152W00000X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (AVERA MARSHALL)
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 |
|---|---|
152W00000X — OptometristPlain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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