CMS-1500 Box 24J / 33a • NPI
1770294928
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
261QR0405X (CMS D5)
Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center
Box 32 Service Location & ZIP+4
4120 CAMERON PARK DR STE 403, CAMERON PARK, CA, 95682-7287
✓ 9-Digit EDI 837 ZIP+4 (95682-7287)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1770294928 (CAMERON PARK REHAB) 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
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1770294928 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | CAMERON PARK REHAB |
| Plain-English Specialty | Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: 261QR0405X (Clinic/Center, Rehabilitation, Substance Use Disorder) |
| Certifying / Licensing Body | Accreditation Association for Ambulatory Health Care (AAAHC) / CMS |
| Practice Location Address | 4120 CAMERON PARK DR STE 403, CAMERON PARK, CA, 95682-7287 |
| Practice Telephone / Fax | Tel: (310) 343-8684 |
| Administrative Mailing Address | 4120 CAMERON PARK DR STE 403, CAMERON PARK, CA, 95682-7287 |
| Enumeration & Last Sync | Enumerated: 2022-12-08 | CMS Record Updated: 2023-11-01 |
| Authorized Official | SHAINA DONNER (MANAGER) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in CAMERON PARK
🔒 Are you CAMERON PARK REHAB? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (261QR0405X)
What Does Taxonomy Code 261QR0405X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QR0405X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (CAMERON PARK REHAB)
Typical CPT / Diagnostic Procedures:- Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
- Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures
- Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
101YA0400X — Counselor, Addiction (Substance Use Disorder)Plain English: Licensed & Credentialed Counselor, Addiction (Substance Use Disorder) | State: N/A | License: Verified | Primary: Secondary |
101YM0800X — Counselor, Mental HealthPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Counselor | State: N/A | License: Verified | Primary: Secondary |
106H00000X — Marriage & Family TherapistPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Marriage and Family Therapist | State: N/A | License: Verified | Primary: Secondary |
261QR0405X — Clinic/Center, Rehabilitation, Substance Use DisorderPlain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.