EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC — NPI 1609930593 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1609930593

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

1420 W ASHLEY RD, BOONVILLE, MO, 65233-2112

✓ 9-Digit EDI 837 ZIP+4 (65233-2112)

Practice Phone & Referral Fax

(660) 882-6115

Fax: (660) 882-6120

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1609930593 (EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC) 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	`1609930593` (NPI-2 Organization / Facility)
Provider / Legal Name	EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1420 W ASHLEY RD, BOONVILLE, MO, 65233-2112
Practice Telephone / Fax	Tel: (660) 882-6115 \| Fax: (660) 882-6120
Administrative Mailing Address	1420 W ASHLEY RD, BOONVILLE, MO, 65233-2112
Enumeration & Last Sync	Enumerated: 2006-12-21 \| CMS Record Updated: 2007-10-16
Authorized Official	JILL MCCORMICK (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1420 W ASHLEY RD, BOONVILLE, MO, 65233-2112

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC)

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
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: MO \| License: `108639` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC (NPI #1609930593)