CMS-1500 Box 24J / 33a • NPI
1417800129
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
2083B0002X (CMS 84)
Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine — Obesity Medicine
Box 32 Service Location & ZIP+4
234 WATERFALL DR STE C, ELKHART, IN, 46516-3683
✓ 9-Digit EDI 837 ZIP+4 (46516-3683)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1417800129 (ACTIVA HEALTH) 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 | 1417800129 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ACTIVA HEALTH |
| Plain-English Specialty | Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine — Obesity Medicine NUCC Code: 2083B0002X (Preventive Medicine, Obesity Medicine) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 234 WATERFALL DR STE C, ELKHART, IN, 46516-3683 |
| Practice Telephone / Fax | Tel: (574) 307-5502 | Fax: (866) 598-4540 |
| Administrative Mailing Address | 234 WATERFALL DR STE C, ELKHART, IN, 46516-3683 |
| Enumeration & Last Sync | Enumerated: 2026-02-20 | CMS Record Updated: 2026-02-20 |
| Authorized Official | TALHIA JUAREZ-AGUILAR (Owner/CEO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (2083B0002X)
What Does Taxonomy Code 2083B0002X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2083B0002X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine — Obesity Medicine"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ACTIVA HEALTH)
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: N/A | License: Verified | Primary: Secondary |
2083B0002X — Preventive Medicine, Obesity MedicinePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Preventive Medicine — Obesity Medicine | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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