CMS-1500 Box 24J / 33a • NPI
1417445107
Type 1 Individual Rendering/Ordering
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
6410 ROCKLEDGE DR STE 503, BETHESDA, MD, 20817-7822
✓ 9-Digit EDI 837 ZIP+4 (20817-7822)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1417445107 (BETHLEHEM ADDIS, NP) 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
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1417445107)
Medicare Beneficiaries
254
Total Billed Services
493
Distinct CPT/HCPCS Codes
16
Medicare Allowed Total
$49,826.71
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
51702 | Simple insertion of temporary bladder tube | 20 |
51705 | Simple change of bladder tube | 11 |
99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 15 |
99222 | Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes | 100 |
99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 115 |
99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 83 |
99233 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes | 99 |
G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's | 21 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Oxycodone Hcl Oxycodone Hcl | 24 | 24 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1417445107 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | BETHLEHEM ADDIS, NP |
| 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 | 6410 ROCKLEDGE DR STE 503, BETHESDA, MD, 20817-7822 |
| Practice Telephone / Fax | Tel: (301) 530-1700 |
| Administrative Mailing Address | 11105 FLANAGAN LN, GERMANTOWN, MD, 20876-1748 |
| Enumeration & Last Sync | Enumerated: 2018-04-27 | CMS Record Updated: 2025-05-27 |
Clinic Location, Accessibility & Directions
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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"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BETHLEHEM ADDIS, NP)
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 |
|---|---|
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: MD | License: R203814 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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