AGELESS CARE COLLECTIVE WI SC — NPI 1750289120 (Licensed & Credentialed Rehabilitation Practitioner in GREENFIELD, WI)

CMS-1500 Box 24J / 33a • NPI

1750289120

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225400000X

Licensed & Credentialed Rehabilitation Practitioner

Box 32 Service Location & ZIP+4

4848 S 76TH ST STE 110, GREENFIELD, WI, 53220-4361

✓ 9-Digit EDI 837 ZIP+4 (53220-4361)

Practice Phone & Referral Fax

(212) 201-1252

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1750289120 (AGELESS CARE COLLECTIVE WI SC) 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	`1750289120` (NPI-2 Organization / Facility)
Provider / Legal Name	AGELESS CARE COLLECTIVE WI SC
Plain-English Specialty	Licensed & Credentialed Rehabilitation Practitioner NUCC Code: `225400000X` (Rehabilitation Practitioner)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	4848 S 76TH ST STE 110, GREENFIELD, WI, 53220-4361
Practice Telephone / Fax	Tel: (212) 201-1252
Administrative Mailing Address	407 WILLOUGHBY AVE, BROOKLYN, NY, 11205-4590
Enumeration & Last Sync	Enumerated: 2026-10-27 \| CMS Record Updated: 2026-10-27
Authorized Official	SONIKA RANDEV (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

4848 S 76TH ST STE 110, GREENFIELD, WI, 53220-4361

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Plain-English Taxonomy & CMS Crosswalk (225400000X)

What Does Taxonomy Code 225400000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225400000X translates to:
"Licensed & Credentialed Rehabilitation Practitioner"

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 Rehabilitation Practitioner for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AGELESS CARE COLLECTIVE WI SC)

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
`225400000X` — Rehabilitation Practitioner Plain English: Licensed & Credentialed Rehabilitation Practitioner	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AGELESS CARE COLLECTIVE WI SC (NPI #1750289120)