CMS-1500 Box 24J / 33a • NPI
1922374826
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
103T00000X (CMS 62)
Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist
Box 32 Service Location & ZIP+4
24276 166TH STREET AIRPORT ROAD, BOX 1007, EAGLE BUTTE, SD, 57625
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1922374826 (CHEYENNE RIVER SIOUX TRIBE BEHAVORIAL HEALTH) 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 | 1922374826 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | CHEYENNE RIVER SIOUX TRIBE BEHAVORIAL HEALTH |
| Plain-English Specialty | Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist NUCC Code: 103T00000X (Psychologist) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 24276 166TH STREET AIRPORT ROAD, BOX 1007, EAGLE BUTTE, SD, 57625 |
| Practice Telephone / Fax | Tel: (605) 964-0788 |
| Administrative Mailing Address | PO BOX 590, EAGLE BUTTE, SD, 57625-0590 |
| Enumeration & Last Sync | Enumerated: 2012-03-26 | CMS Record Updated: 2022-08-05 |
| Authorized Official | RAMONA SIMON (Tribal Health CEO) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (103T00000X)
What Does Taxonomy Code 103T00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 103T00000X translates to:
"Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (CHEYENNE RIVER SIOUX TRIBE BEHAVORIAL HEALTH)
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 |
|---|---|
261QM0850X — Clinic/Center, Adult Mental HealthPlain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center | State: N/A | License: Verified | Primary: Secondary |
251S00000X — Community/Behavioral HealthPlain English: Licensed & Credentialed Community/Behavioral Health | State: N/A | License: Verified | Primary: Secondary |
103T00000X — PsychologistPlain English: Licensed & Credentialed Behavioral Health & Social Service Providers — Psychologist | State: SD | License: 126 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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