GAVEN A BERTRAM — NPI 1740989573 (Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances in FLINT, MI)

CMS-1500 Box 24J / 33a • NPI

1740989573

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

3104A0630X

Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances

Box 32 Service Location & ZIP+4

2444 OAKRIDGE DR, FLINT, MI, 48507-6211

✓ 9-Digit EDI 837 ZIP+4 (48507-6211)

Practice Phone & Referral Fax

(810) 766-9377

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1740989573 (GAVEN A BERTRAM) 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	`1740989573` (NPI-1 Individual Practitioner)
Provider / Legal Name	GAVEN A BERTRAM
Plain-English Specialty	Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances NUCC Code: `3104A0630X` (Assisted Living Facility, Assisted Living, Behavioral Disturbances)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2444 OAKRIDGE DR, FLINT, MI, 48507-6211
Practice Telephone / Fax	Tel: (810) 766-9377
Administrative Mailing Address	1330 KENNETH ST, BURTON, MI, 48529-2206
Enumeration & Last Sync	Enumerated: 2023-03-01 \| CMS Record Updated: 2023-03-01

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2444 OAKRIDGE DR, FLINT, MI, 48507-6211

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Plain-English Taxonomy & CMS Crosswalk (3104A0630X)

What Does Taxonomy Code 3104A0630X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 3104A0630X translates to:
"Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances"

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 Assisted Living Facility, Assisted Living, Behavioral Disturbances for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (GAVEN A BERTRAM)

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
`3104A0625X` — Assisted Living Facility, Assisted Living, Mental Illness Plain English: Licensed & Credentialed Assisted Living Facility, Assisted Living, Mental Illness	State: N/A \| License: `AS250414567` \| Primary: Secondary
`3104A0630X` — Assisted Living Facility, Assisted Living, Behavioral Disturbances Plain English: Licensed & Credentialed Assisted Living Facility, Assisted Living, Behavioral Disturbances	State: MI \| License: `AS250414567` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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GAVEN A BERTRAM (NPI #1740989573)