CMS-1500 Box 24J / 33a • NPI
1568446524
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
1041C0700X (CMS 80)
Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical
Box 32 Service Location & ZIP+4
1782 HACKETT DR, LA PINE, OR, 97739-9118
✓ 9-Digit EDI 837 ZIP+4 (97739-9118)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1568446524 (673D MEDGRP-JBER ELMNDRF-RICH) 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 | 1568446524 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 673D MEDGRP-JBER ELMNDRF-RICH |
| Plain-English Specialty | Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: 1041C0700X (Social Worker, Clinical) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1782 HACKETT DR, LA PINE, OR, 97739-9118 |
| Practice Telephone / Fax | Tel: (442) 245-4585 |
| Administrative Mailing Address | 25016 HENDON ST, LAGUNA HILLS, CA, 92653-4629 |
| Enumeration & Last Sync | Enumerated: 2005-12-02 | CMS Record Updated: 2026-09-14 |
| Authorized Official | JEN LEWANDOWSKI (Air Force UBO Analyst) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)
What Does Taxonomy Code 1041C0700X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (673D MEDGRP-JBER ELMNDRF-RICH)
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 |
|---|---|
1041C0700X — Social Worker, ClinicalPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical | State: N/A | License: Verified | Primary: Yes (Primary) |
261QM1100X — Clinic/Center, MilitaryU.S. Coast Guard OutpatientPlain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center | State: N/A | License: Verified | Primary: Secondary |
261QM1101X — Clinic/Center, Military and U.S. Coast Guard Ambulatory ProcedurePlain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center | State: N/A | License: Verified | Primary: Secondary |
286500000X — Military HospitalPlain English: Licensed & Credentialed Hospitals — Military Hospital | State: N/A | License: Verified | Primary: Secondary |
332000000X — MilitaryU.S. Coast Guard PharmacyPlain English: Licensed & Credentialed MilitaryU.S. Coast Guard Pharmacy | State: N/A | License: Verified | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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