AFFINITY MENTAL HEALTH SERVICES PC — NPI 1770128050 (Licensed & Credentialed Behavioral Health & Social Service Providers

CMS-1500 Box 24J / 33a • NPI

1770128050

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1041C0700X (CMS 80)

Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical

Box 32 Service Location & ZIP+4

1108 KINGWOOD DR, AVON, IN, 46123-5500

✓ 9-Digit EDI 837 ZIP+4 (46123-5500)

Practice Phone & Referral Fax

(317) 204-1100

Fax: (317) 271-7054

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1770128050 (AFFINITY MENTAL HEALTH SERVICES PC) 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	`1770128050` (NPI-2 Organization / Facility)
Provider / Legal Name	AFFINITY MENTAL HEALTH SERVICES PC
Plain-English Specialty	Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical NUCC Code: `1041C0700X` (Social Worker, Clinical)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1108 KINGWOOD DR, AVON, IN, 46123-5500
Practice Telephone / Fax	Tel: (317) 204-1100 \| Fax: (317) 271-7054
Administrative Mailing Address	2445 DIRECTORS ROW STE C, INDIANAPOLIS, IN, 46241-4936
Enumeration & Last Sync	Enumerated: 2019-11-11 \| CMS Record Updated: 2020-10-02
Authorized Official	HAILEY REED (CEO)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1108 KINGWOOD DR, AVON, IN, 46123-5500

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Plain-English Taxonomy & CMS Crosswalk (1041C0700X)

What Does Taxonomy Code 1041C0700X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1041C0700X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 80 (Licensed Clinical Social Worker)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Social Worker, Clinical for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AFFINITY MENTAL HEALTH SERVICES PC)

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
`1041C0700X` — Social Worker, Clinical Plain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Social Worker, Clinical	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AFFINITY MENTAL HEALTH SERVICES PC (NPI #1770128050)