CMS-1500 Box 24J / 33a • NPI
1902361413
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363L00000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner
Box 32 Service Location & ZIP+4
2308B W HIGHWAY 66, STROUD, OK, 74079-6729
✓ 9-Digit EDI 837 ZIP+4 (74079-6729)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1902361413 (CAMERON KEITH ETHRIDGE, APRN) 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
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1902361413)
Medicare Beneficiaries
56
Total Billed Services
275
Distinct CPT/HCPCS Codes
18
Medicare Allowed Total
$8,081.93
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
36415 | Insertion of needle into vein for collection of blood sample | 27 |
83036 | Hemoglobin a1c level | 11 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 83 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 15 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Albuterol Sulfate Hfa Albuterol Sulfate | 37 | 17 |
| Allopurinol Allopurinol | 21 | <11 |
| Amlodipine Besylate Amlodipine Besylate | 56 | 25 |
| Atenolol Atenolol | 19 | <11 |
| Atorvastatin Calcium Atorvastatin Calcium | 87 | 36 |
| Azithromycin Azithromycin | 28 | 27 |
| Buspirone Hcl Buspirone Hcl | 24 | <11 |
| Carvedilol Carvedilol | 37 | 16 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1902361413 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | CAMERON KEITH ETHRIDGE, APRN |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner NUCC Code: 363L00000X (Nurse Practitioner) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2308B W HIGHWAY 66, STROUD, OK, 74079-6729 |
| Practice Telephone / Fax | Tel: (918) 968-4469 | Fax: (918) 987-1622 |
| Administrative Mailing Address | PO BOX 777, STROUD, OK, 74079-0777 |
| Enumeration & Last Sync | Enumerated: 2019-02-08 | CMS Record Updated: 2020-09-30 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363L00000X)
What Does Taxonomy Code 363L00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363L00000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (CAMERON KEITH ETHRIDGE, APRN)
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 |
|---|---|
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: OK | License: 121857 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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