CMS-1500 Box 24J / 33a • NPI
1700459690
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363L00000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner
Box 32 Service Location & ZIP+4
420 E DIVISION ST, FOND DU LAC, WI, 54935-4560
✓ 9-Digit EDI 837 ZIP+4 (54935-4560)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1700459690 (TIFFANY MARIE BOELK, APNP) 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 #1700459690)
Medicare Beneficiaries
171
Total Billed Services
341
Distinct CPT/HCPCS Codes
12
Medicare Allowed Total
$15,023.93
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
69210 | Removal of impacted ear wax | 205 |
92504 | Exam of ear using a microscope | 32 |
99203 | New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more | 14 |
99212 | Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more | 25 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 41 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Ciprofloxacin-Dexamethasone Ciprofloxacin Hcl/Dexameth | 33 | 20 |
| Fluticasone Propionate Fluticasone Propionate | 44 | 21 |
| Methylprednisolone Methylprednisolone | 22 | 22 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1700459690 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | TIFFANY MARIE BOELK, APNP |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: 363L00000X (Nurse Practitioner) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 420 E DIVISION ST, FOND DU LAC, WI, 54935-4560 |
| Practice Telephone / Fax | Tel: (920) 923-7400 |
| Administrative Mailing Address | N3087 HICKORY RD, BYRON, WI, 53006-1126 |
| Enumeration & Last Sync | Enumerated: 2021-07-20 | CMS Record Updated: 2021-10-12 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363L00000X)
What Does Taxonomy Code 363L00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (TIFFANY MARIE BOELK, APNP)
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 |
|---|---|
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: WI | License: 10905-33 | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: WI | License: 10905-33 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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