RAE BARDELL, BCBA, LCSWM — NPI 1629025044 (Licensed & Credentialed Behavior Analyst in SYCAMORE, IL)

CMS-1500 Box 24J / 33a • NPI

1629025044

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

103K00000X

Licensed & Credentialed Behavior Analyst

Box 32 Service Location & ZIP+4

920 W PRAIRIE DR STE G, SYCAMORE, IL, 60178-3123

✓ 9-Digit EDI 837 ZIP+4 (60178-3123)

Practice Phone & Referral Fax

(815) 291-3887

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1629025044 (RAE BARDELL, BCBA, LCSWM) 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	`1629025044` (NPI-1 Individual Practitioner)
Provider / Legal Name	RAE BARDELL, BCBA, LCSWM
Plain-English Specialty	Licensed & Credentialed Behavior Analyst NUCC Code: `103K00000X` (Behavior Analyst)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	920 W PRAIRIE DR STE G, SYCAMORE, IL, 60178-3123
Practice Telephone / Fax	Tel: (815) 291-3887
Administrative Mailing Address	206 S STANTON ST, SHANNON, IL, 61078-9311
Enumeration & Last Sync	Enumerated: 2006-05-30 \| CMS Record Updated: 2025-10-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

920 W PRAIRIE DR STE G, SYCAMORE, IL, 60178-3123

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Plain-English Taxonomy & CMS Crosswalk (103K00000X)

What Does Taxonomy Code 103K00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103K00000X translates to:
"Licensed & Credentialed Behavior Analyst"

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 Behavior Analyst for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (RAE BARDELL, BCBA, LCSWM)

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
`103K00000X` — Behavior Analyst Plain English: Licensed & Credentialed Behavior Analyst	State: IL \| License: `152001169` \| Primary: Secondary
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: IL \| License: `149.014536` \| Primary: Secondary
`1041S0200X` — Social Worker, School Plain English: Licensed & Credentialed Social Worker, School	State: N/A \| License: `Verified` \| Primary: Secondary
`103K00000X` — Behavior Analyst Plain English: Licensed & Credentialed Behavior Analyst	State: N/A \| License: `1-18-30939` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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RAE BARDELL, BCBA, LCSWM (NPI #1629025044)