BALANCED LIFE SC — NPI 1730299652 (Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) in HOFFMAN ESTATES, IL)

CMS-1500 Box 24J / 33a • NPI

1730299652

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

2084P0800X (CMS 26)

Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)

Box 32 Service Location & ZIP+4

1650 MOON LAKE BLVD, ATTN: DR JIN, HOFFMAN ESTATES, IL, 60194-1010

✓ 9-Digit EDI 837 ZIP+4 (60194-1010)

Practice Phone & Referral Fax

(947) 496-4216

Fax: (847) 358-7516

⚠️ HHS OIG LEIE FEDERAL EXCLUSION ALERT: NPI 1730299652 matches an active entry in the HHS Office of Inspector General List of Excluded Individuals/Entities (Sec. 1128(b)(8) — Entities Controlled by a Sanctioned Individual — Effective 2011-12-20). Verify before submitting Medicare/Medicaid claims.

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	`1730299652` (NPI-2 Organization / Facility)
Provider / Legal Name	BALANCED LIFE SC
Plain-English Specialty	Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician) NUCC Code: `2084P0800X` (Psychiatry & Neurology, Psychiatry)
Certifying / Licensing Body	American Board of Psychiatry and Neurology (ABPN)
Practice Location Address	1650 MOON LAKE BLVD, ATTN: DR JIN, HOFFMAN ESTATES, IL, 60194-1010
Practice Telephone / Fax	Tel: (947) 496-4216 \| Fax: (847) 358-7516
Administrative Mailing Address	PO BOX 946, STREAMWOOD, IL, 60107-3305
Enumeration & Last Sync	Enumerated: 2006-08-30 \| CMS Record Updated: 2020-08-22
Authorized Official	KWAN BO JIN (President)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1650 MOON LAKE BLVD, ATTN: DR JIN, HOFFMAN ESTATES, IL, 60194-1010

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Plain-English Taxonomy & CMS Crosswalk (2084P0800X)

What Does Taxonomy Code 2084P0800X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2084P0800X translates to:
"Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 26 (Physician/Psychiatry) • CMS Code 86 (Physician/Neuropsychiatry)
Certifying / Accrediting Authority: American Board of Psychiatry and Neurology (ABPN)
Clinical Scope: Depression, generalized anxiety, panic attacks, insomnia, bipolar disorder, OCD, PTSD, or medical recovery from substance dependence.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BALANCED LIFE SC)

Typical CPT / Diagnostic Procedures:

Comprehensive Psychiatric Diagnostic Evaluation (CPT 90792)
Psychopharmacological Management & Supportive Psychotherapy
Medication-Assisted Treatment (MAT) for Substance Use Disorders

Common Therapeutic Classes:

SSRIs & SNRIs (Sertraline, Escitalopram, Fluoxetine, Duloxetine)
Bupropion, Mirtazapine & Atypical Antipsychotics (Aripiprazole, Quetiapine)
Buprenorphine/Naloxone & Naltrexone (Addiction Recovery)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2084P0800X` — Psychiatry & Neurology, Psychiatry Plain English: Board-Certified Psychiatrist (Mental Health & Behavioral Medicine Physician)	State: IL \| License: `036069415` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BALANCED LIFE SC (NPI #1730299652)