ADDICTION WELLNESS CENTER IN LLC — NPI 1740197136 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant in JEFFERSONVILLE, IN)

CMS-1500 Box 24J / 33a • NPI

1740197136

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

363A00000X (CMS 97)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant

Box 32 Service Location & ZIP+4

202 E MAPLE ST, JEFFERSONVILLE, IN, 47130-3420

✓ 9-Digit EDI 837 ZIP+4 (47130-3420)

Practice Phone & Referral Fax

(812) 850-0619

Fax: (317) 458-1794

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1740197136 (ADDICTION WELLNESS CENTER IN LLC) 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	`1740197136` (NPI-2 Organization / Facility)
Provider / Legal Name	ADDICTION WELLNESS CENTER IN LLC
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant NUCC Code: `363A00000X` (Physician Assistant)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	202 E MAPLE ST, JEFFERSONVILLE, IN, 47130-3420
Practice Telephone / Fax	Tel: (812) 850-0619 \| Fax: (317) 458-1794
Administrative Mailing Address	1100 BUSINESS PKWY S STE 1, WESTMINSTER, MD, 21157-3048
Enumeration & Last Sync	Enumerated: 2026-08-24 \| CMS Record Updated: 2026-08-24
Authorized Official	JESSIE COSTLEY (Credentialing Manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

202 E MAPLE ST, JEFFERSONVILLE, IN, 47130-3420

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Plain-English Taxonomy & CMS Crosswalk (363A00000X)

What Does Taxonomy Code 363A00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363A00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 97 (Physician Assistant)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physician Assistant for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ADDICTION WELLNESS CENTER IN LLC)

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
`363A00000X` — Physician Assistant Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`363L00000X` — Nurse Practitioner Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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ADDICTION WELLNESS CENTER IN LLC (NPI #1740197136)