CMS-1500 Box 24J / 33a • NPI
1588445852
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LA2100X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care
Box 32 Service Location & ZIP+4
885 N SANDUSKY AVE, UPPER SANDUSKY, OH, 43351-1098
✓ 9-Digit EDI 837 ZIP+4 (43351-1098)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1588445852 (DANIELLE RENE BOUILLON) 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
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1588445852)
Medicare Beneficiaries
105
Total Billed Services
144
Distinct CPT/HCPCS Codes
11
Medicare Allowed Total
$13,226.59
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 22 |
99223 | Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes | 39 |
99232 | Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes | 38 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Amlodipine Besylate Amlodipine Besylate | 18 | <11 |
| Atorvastatin Calcium Atorvastatin Calcium | 15 | <11 |
| Carvedilol Carvedilol | 12 | <11 |
| Clopidogrel Clopidogrel Bisulfate | 14 | <11 |
| Isosorbide Mononitrate Er Isosorbide Mononitrate | 11 | <11 |
| Losartan Potassium Losartan Potassium | 12 | <11 |
| Metoprolol Succinate Metoprolol Succinate | 33 | 16 |
| Ranolazine Er Ranolazine | 13 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1588445852 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | DANIELLE RENE BOUILLON |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care NUCC Code: 363LA2100X (Nurse Practitioner, Acute Care) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 885 N SANDUSKY AVE, UPPER SANDUSKY, OH, 43351-1098 |
| Practice Telephone / Fax | Tel: (419) 294-4991 | Fax: (419) 731-4167 |
| Administrative Mailing Address | 885 N SANDUSKY AVE, UPPER SANDUSKY, OH, 43351-1098 |
| Enumeration & Last Sync | Enumerated: 2023-10-11 | CMS Record Updated: 2024-10-16 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LA2100X)
What Does Taxonomy Code 363LA2100X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LA2100X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (DANIELLE RENE BOUILLON)
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 |
|---|---|
363LA2100X — Nurse Practitioner, Acute CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Acute Care | State: OH | License: APRN.CNP.0034378 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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