BONNIE SUE BALTOSSER — NPI 1780878579 (Licensed & Credentialed Exclusive Provider Organization in BRYAN, OH)

CMS-1500 Box 24J / 33a • NPI

1780878579

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

302F00000X

Licensed & Credentialed Exclusive Provider Organization

Box 32 Service Location & ZIP+4

415 PARKVIEW AVE, BRYAN, OH, 43506-1636

✓ 9-Digit EDI 837 ZIP+4 (43506-1636)

Practice Phone & Referral Fax

(419) 636-0086

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780878579 (BONNIE SUE BALTOSSER) 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	`1780878579` (NPI-1 Individual Practitioner)
Provider / Legal Name	BONNIE SUE BALTOSSER
Plain-English Specialty	Licensed & Credentialed Exclusive Provider Organization NUCC Code: `302F00000X` (Exclusive Provider Organization)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	415 PARKVIEW AVE, BRYAN, OH, 43506-1636
Practice Telephone / Fax	Tel: (419) 636-0086
Administrative Mailing Address	415 PARKVIEW AVE, BRYAN, OH, 43506-1636
Enumeration & Last Sync	Enumerated: 2007-09-05 \| CMS Record Updated: 2007-09-05

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

415 PARKVIEW AVE, BRYAN, OH, 43506-1636

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Plain-English Taxonomy & CMS Crosswalk (302F00000X)

What Does Taxonomy Code 302F00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 302F00000X translates to:
"Licensed & Credentialed Exclusive Provider Organization"

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 Exclusive Provider Organization for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BONNIE SUE BALTOSSER)

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
`302F00000X` — Exclusive Provider Organization Plain English: Licensed & Credentialed Exclusive Provider Organization	State: OH \| License: `PN 033077` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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BONNIE SUE BALTOSSER (NPI #1780878579)