PATRICK STEPHEN CLYNE, MD — NPI 1790752954 (Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) in FREEDOM, CA)

CMS-1500 Box 24J / 33a • NPI

1790752954

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

208000000X (CMS 37)

Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)

Box 32 Service Location & ZIP+4

222 GREEN VALLEY RD, FREEDOM, CA, 95019-3136

✓ 9-Digit EDI 837 ZIP+4 (95019-3136)

Practice Phone & Referral Fax

(831) 728-2969

Direct NPPES Verification Line

⚠️ HHS OIG LEIE FEDERAL EXCLUSION ALERT: NPI 1790752954 matches an active entry in the HHS Office of Inspector General List of Excluded Individuals/Entities (Sec. 1128(b)(4) — License Revocation, Suspension, or Surrender — Effective 2026-07-20). Verify before submitting Medicare/Medicaid claims.

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	`1790752954` (NPI-1 Individual Practitioner)
Provider / Legal Name	PATRICK STEPHEN CLYNE, MD
Plain-English Specialty	Board-Certified Pediatrician (Infant, Child & Adolescent Medicine) NUCC Code: `208000000X` (Pediatrics)
Certifying / Licensing Body	American Board of Pediatrics (ABP)
Practice Location Address	222 GREEN VALLEY RD, FREEDOM, CA, 95019-3136
Practice Telephone / Fax	Tel: (831) 728-2969
Administrative Mailing Address	222 GREEN VALLEY RD, FREEDOM, CA, 95019-3136
Enumeration & Last Sync	Enumerated: 2006-03-07 \| CMS Record Updated: 2013-02-12

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

222 GREEN VALLEY RD, FREEDOM, CA, 95019-3136

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Plain-English Taxonomy & CMS Crosswalk (208000000X)

What Does Taxonomy Code 208000000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 208000000X translates to:
"Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 37 (Physician/Pediatric Medicine)
Certifying / Accrediting Authority: American Board of Pediatrics (ABP)
Clinical Scope: Newborn jaundice screening, routine childhood vaccinations, developmental milestones, pediatric fevers, ear infections, asthma, or acute gastroenteritis.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PATRICK STEPHEN CLYNE, MD)

Typical CPT / Diagnostic Procedures:

Comprehensive Well-Child Developmental & Growth Visits (CPT 99381–99394)
Childhood Immunization Administration (Rotavirus, MMR, DTaP, HPV, PCV)
Neonatal Bilirubin & Jaundice Transcutaneous/Serum Screening
Rapid Streptococcal, RSV & Influenza Point-of-Care Diagnostics
Pediatric Asthma Nebulization & Spirometry Evaluation

Common Therapeutic Classes:

Amoxicillin / Amoxicillin-Clavulanate (Pediatric Otitis Media & Sinusitis)
WHO Low-Osmolarity Oral Rehydration Salts (ORS) & Zinc Sulfate
Albuterol Sulfate Inhalers & Fluticasone Pediatric Inhalers
Weight-Based Acetaminophen & Ibuprofen Antipyretic Suspensions

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: CA \| License: `G79053` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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PATRICK STEPHEN CLYNE, MD (NPI #1790752954)