PORTERESHICE SHUNTA BRABHAM — NPI 1528309606 (Licensed & Credentialed Health Maintenance Organization in FAIRFAX, SC)

CMS-1500 Box 24J / 33a • NPI

1528309606

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

302R00000X

Licensed & Credentialed Health Maintenance Organization

Box 32 Service Location & ZIP+4

345 AMELIA ST, FAIRFAX, SC, 29827-5967

✓ 9-Digit EDI 837 ZIP+4 (29827-5967)

Practice Phone & Referral Fax

(803) 682-7110

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1528309606 (PORTERESHICE SHUNTA BRABHAM) 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

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1528309606` (NPI-1 Individual Practitioner)
Provider / Legal Name	PORTERESHICE SHUNTA BRABHAM
Plain-English Specialty	Licensed & Credentialed Health Maintenance Organization NUCC Code: `302R00000X` (Health Maintenance Organization)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	345 AMELIA ST, FAIRFAX, SC, 29827-5967
Practice Telephone / Fax	Tel: (803) 682-7110
Administrative Mailing Address	345 AMELIA ST, FAIRFAX, SC, 29827-5967
Enumeration & Last Sync	Enumerated: 2013-03-14 \| CMS Record Updated: 2013-03-14

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

345 AMELIA ST, FAIRFAX, SC, 29827-5967

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Plain-English Taxonomy & CMS Crosswalk (302R00000X)

What Does Taxonomy Code 302R00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 302R00000X translates to:
"Licensed & Credentialed Health Maintenance Organization"

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 Health Maintenance Organization for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PORTERESHICE SHUNTA BRABHAM)

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
`302R00000X` — Health Maintenance Organization Plain English: Licensed & Credentialed Health Maintenance Organization	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PORTERESHICE SHUNTA BRABHAM (NPI #1528309606)