CMS-1500 Box 24J / 33a • NPI
1609205863
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
204C00000X (CMS 12)
Licensed & Credentialed Allopathic & Osteopathic Physicians — Neuromusculoskeletal Medicine, Sports Medicine
Box 32 Service Location & ZIP+4
42104 N VENTURE DR STE A102, ANTHEM, AZ, 85086-3824
✓ 9-Digit EDI 837 ZIP+4 (85086-3824)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1609205863 (ADVANCED HEALTH & WELLNESS CENTER) 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 | 1609205863 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED HEALTH & WELLNESS CENTER |
| Plain-English Specialty | Licensed & Credentialed Allopathic & Osteopathic Physicians — Neuromusculoskeletal Medicine, Sports Medicine NUCC Code: 204C00000X (Neuromusculoskeletal Medicine, Sports Medicine) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 42104 N VENTURE DR STE A102, ANTHEM, AZ, 85086-3824 |
| Practice Telephone / Fax | Tel: (480) 322-1553 |
| Administrative Mailing Address | 42104 N VENTURE DR STE A102, ANTHEM, AZ, 85086-3824 |
| Enumeration & Last Sync | Enumerated: 2013-11-07 | CMS Record Updated: 2025-06-24 |
| Authorized Official | ERIC POOLE (Manager/Member) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (204C00000X)
What Does Taxonomy Code 204C00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 204C00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Neuromusculoskeletal Medicine, Sports Medicine"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED HEALTH & WELLNESS CENTER)
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 |
|---|---|
111N00000X — ChiropractorPlain English: Licensed & Credentialed Chiropractic Providers — Chiropractor | State: N/A | License: Verified | Primary: Secondary |
363LP2300X — Nurse Practitioner, Primary CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care | State: N/A | License: Verified | Primary: Secondary |
204C00000X — Neuromusculoskeletal Medicine, Sports MedicinePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Neuromusculoskeletal Medicine, Sports Medicine | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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