KRISTINE MAE FADDISSTUART — NPI 1891635520 (Licensed & Credentialed Peer Specialist in SAN ANDREAS, CA)

CMS-1500 Box 24J / 33a • NPI

1891635520

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

175T00000X

Licensed & Credentialed Peer Specialist

Box 32 Service Location & ZIP+4

590 TOYANZA DRIVE, SAN ANDREAS, CA, 95249-9713

✓ 9-Digit EDI 837 ZIP+4 (95249-9713)

Practice Phone & Referral Fax

(209) 754-6562

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1891635520 (KRISTINE MAE FADDISSTUART) 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	`1891635520` (NPI-1 Individual Practitioner)
Provider / Legal Name	KRISTINE MAE FADDISSTUART
Plain-English Specialty	Licensed & Credentialed Peer Specialist NUCC Code: `175T00000X` (Peer Specialist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	590 TOYANZA DRIVE, SAN ANDREAS, CA, 95249-9713
Practice Telephone / Fax	Tel: (209) 754-6562
Administrative Mailing Address	1825 LIVE OAK DR, VALLECITO, CA, 95251-9603
Enumeration & Last Sync	Enumerated: 2026-03-31 \| CMS Record Updated: 2026-03-31

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

590 TOYANZA DRIVE, SAN ANDREAS, CA, 95249-9713

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Plain-English Taxonomy & CMS Crosswalk (175T00000X)

What Does Taxonomy Code 175T00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 175T00000X translates to:
"Licensed & Credentialed Peer Specialist"

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 Peer Specialist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (KRISTINE MAE FADDISSTUART)

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
`175T00000X` — Peer Specialist Plain English: Licensed & Credentialed Peer Specialist	State: CA \| License: `Mpss-rmodkg` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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KRISTINE MAE FADDISSTUART (NPI #1891635520)