CMS-1500 Box 24J / 33a • NPI
1770715906
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
208D00000X (CMS 01)
Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice
Box 32 Service Location & ZIP+4
11903 SAINT CHARLES ROCK RD, BRIDGETON, MO, 63044-2623
✓ 9-Digit EDI 837 ZIP+4 (63044-2623)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1770715906 (ADVANTAGE PAIN MANAGEMENT INC) 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 | 1770715906 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANTAGE PAIN MANAGEMENT INC |
| Plain-English Specialty | Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice NUCC Code: 208D00000X (General Practice) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 11903 SAINT CHARLES ROCK RD, BRIDGETON, MO, 63044-2623 |
| Practice Telephone / Fax | Tel: (314) 770-0900 | Fax: (314) 770-1623 |
| Administrative Mailing Address | 11903 SAINT CHARLES ROCK RD, BRIDGETON, MO, 63044-2623 |
| Enumeration & Last Sync | Enumerated: 2009-08-21 | CMS Record Updated: 2013-02-25 |
| Authorized Official | H. KENNETH GILBERTSON (Owner) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (208D00000X)
What Does Taxonomy Code 208D00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208D00000X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANTAGE PAIN MANAGEMENT INC)
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
- 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 |
|---|---|
111N00000X — ChiropractorPlain English: Licensed & Credentialed Chiropractic Providers — Chiropractor | State: MO | License: 003647 | Primary: Secondary |
247200000X — Technician, OtherPlain English: Licensed & Credentialed Technologists, Technicians & Other Technical Service Providers — Technician, Other | State: N/A | License: Verified | Primary: Secondary |
332B00000X — Durable Medical Equipment & Medical SuppliesPlain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies | State: N/A | License: Verified | Primary: Secondary |
363AM0700X — Physician Assistant, MedicalPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant, Medical | State: N/A | License: Verified | Primary: Secondary |
208D00000X — General PracticePlain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — General Practice | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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