ACTIVE SPORTS PSYCHOLOGY, APC — NPI 1649636903 (Licensed & Credentialed Community/Behavioral Health in TUSTIN, CA)

CMS-1500 Box 24J / 33a • NPI

1649636903

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

251S00000X

Licensed & Credentialed Community/Behavioral Health

Box 32 Service Location & ZIP+4

10825 DUROY CT, TUSTIN, CA, 92782-1341

✓ 9-Digit EDI 837 ZIP+4 (92782-1341)

Practice Phone & Referral Fax

(714) 625-7784

Fax: (714) 838-0186

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1649636903 (ACTIVE SPORTS PSYCHOLOGY, APC) 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	`1649636903` (NPI-2 Organization / Facility)
Provider / Legal Name	ACTIVE SPORTS PSYCHOLOGY, APC
Plain-English Specialty	Licensed & Credentialed Community/Behavioral Health NUCC Code: `251S00000X` (Community/Behavioral Health)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	10825 DUROY CT, TUSTIN, CA, 92782-1341
Practice Telephone / Fax	Tel: (714) 625-7784 \| Fax: (714) 838-0186
Administrative Mailing Address	2030 E 4TH ST, SANTA ANA, CA, 92705-3940
Enumeration & Last Sync	Enumerated: 2016-01-01 \| CMS Record Updated: 2016-01-01
Authorized Official	ROBERT CONBOY (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

10825 DUROY CT, TUSTIN, CA, 92782-1341

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Plain-English Taxonomy & CMS Crosswalk (251S00000X)

What Does Taxonomy Code 251S00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 251S00000X translates to:
"Licensed & Credentialed Community/Behavioral Health"

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 Community/Behavioral Health for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ACTIVE SPORTS PSYCHOLOGY, APC)

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
`251S00000X` — Community/Behavioral Health Plain English: Licensed & Credentialed Community/Behavioral Health	State: CA \| License: `PSY13159` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ACTIVE SPORTS PSYCHOLOGY, APC (NPI #1649636903)