17 11 JE 2060 — NPI 1457217390 (Licensed & Credentialed Specialist, Research Study in DES MOINES, IA)

CMS-1500 Box 24J / 33a • NPI

1457217390

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1744R1102X

Licensed & Credentialed Specialist, Research Study

Box 32 Service Location & ZIP+4

1444 E WALNUT ST APT 18, DES MOINES, IA, 50316-3828

✓ 9-Digit EDI 837 ZIP+4 (50316-3828)

Practice Phone & Referral Fax

(515) 802-7198

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1457217390 (17 11 JE 2060) 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	`1457217390` (NPI-2 Organization / Facility)
Provider / Legal Name	17 11 JE 2060
Plain-English Specialty	Licensed & Credentialed Specialist, Research Study NUCC Code: `1744R1102X` (Specialist, Research Study)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1444 E WALNUT ST APT 18, DES MOINES, IA, 50316-3828
Practice Telephone / Fax	Tel: (515) 802-7198
Administrative Mailing Address	1444 E WALNUT ST APT 18, DES MOINES, IA, 50316-3828
Enumeration & Last Sync	Enumerated: 2026-01-03 \| CMS Record Updated: 2026-01-03
Authorized Official	JOHNNIE CAMPBELL (President/Founder)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1444 E WALNUT ST APT 18, DES MOINES, IA, 50316-3828

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Plain-English Taxonomy & CMS Crosswalk (1744R1102X)

What Does Taxonomy Code 1744R1102X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1744R1102X translates to:
"Licensed & Credentialed Specialist, Research Study"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Specialist, Research Study for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (17 11 JE 2060)

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
`1744R1102X` — Specialist, Research Study Plain English: Licensed & Credentialed Specialist, Research Study	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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17 11 JE 2060 (NPI #1457217390)