ICARE CENTER FOR CHANGE — NPI 1508554940 (Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Addiction (Substance Abuse Disorder) in BUHL, ID)

CMS-1500 Box 24J / 33a • NPI

1508554940

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

103TA0400X (CMS 62)

Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Addiction (Substance Abuse Disorder)

Box 32 Service Location & ZIP+4

1689 E 4000 N, BUHL, ID, 83316-5647

✓ 9-Digit EDI 837 ZIP+4 (83316-5647)

Practice Phone & Referral Fax

(208) 918-2473

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1508554940 (ICARE CENTER FOR CHANGE) 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	`1508554940` (NPI-2 Organization / Facility)
Provider / Legal Name	ICARE CENTER FOR CHANGE
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Addiction (Substance Abuse Disorder) NUCC Code: `103TA0400X` (Psychologist, Addiction (Substance Use Disorder))
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1689 E 4000 N, BUHL, ID, 83316-5647
Practice Telephone / Fax	Tel: (208) 918-2473
Administrative Mailing Address	1689 E 4000 N, BUHL, ID, 83316-5647
Enumeration & Last Sync	Enumerated: 2023-04-25 \| CMS Record Updated: 2023-04-25
Authorized Official	KELLY GRAFF (Owner, clinician)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1689 E 4000 N, BUHL, ID, 83316-5647

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Plain-English Taxonomy & CMS Crosswalk (103TA0400X)

What Does Taxonomy Code 103TA0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103TA0400X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Addiction (Substance Abuse Disorder)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 62 (Psychologist, Clinical)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Psychologist, Addiction (Substance Use Disorder) for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ICARE CENTER FOR CHANGE)

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
`103TA0400X` — Psychologist, Addiction (Substance Use Disorder) Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist, Addiction (Substance Abuse Disorder)	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ICARE CENTER FOR CHANGE (NPI #1508554940)