BENJAMIN JACOB ANDRES, PTA — NPI 1922675677 (Licensed & Credentialed Student in an Organized Health Care Education/Training Program in DULUTH, MN)

CMS-1500 Box 24J / 33a • NPI

1922675677

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

390200000X

Licensed & Credentialed Student in an Organized Health Care Education/Training Program

Box 32 Service Location & ZIP+4

940 WOODLAND AVE, DULUTH, MN, 55812-1113

✓ 9-Digit EDI 837 ZIP+4 (55812-1113)

Practice Phone & Referral Fax

(218) 723-6081

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1922675677 (BENJAMIN JACOB ANDRES, PTA) 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	`1922675677` (NPI-1 Individual Practitioner)
Provider / Legal Name	BENJAMIN JACOB ANDRES, PTA
Plain-English Specialty	Licensed & Credentialed Student in an Organized Health Care Education/Training Program NUCC Code: `390200000X` (Student in an Organized Health Care Education/Training Program)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	940 WOODLAND AVE, DULUTH, MN, 55812-1113
Practice Telephone / Fax	Tel: (218) 723-6081
Administrative Mailing Address	940 WOODLAND AVE, DULUTH, MN, 55812-1113
Enumeration & Last Sync	Enumerated: 2021-06-09 \| CMS Record Updated: 2024-09-14

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

940 WOODLAND AVE, DULUTH, MN, 55812-1113

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Plain-English Taxonomy & CMS Crosswalk (390200000X)

What Does Taxonomy Code 390200000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 390200000X translates to:
"Licensed & Credentialed Student in an Organized Health Care Education/Training Program"

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 Student in an Organized Health Care Education/Training Program for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (BENJAMIN JACOB ANDRES, PTA)

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
`225200000X` — Physical Therapy Assistant Plain English: Licensed & Credentialed Physical Therapy Assistant	State: MN \| License: `A2555` \| Primary: Secondary
`390200000X` — Student in an Organized Health Care Education/Training Program Plain English: Licensed & Credentialed Student in an Organized Health Care Education/Training Program	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

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BENJAMIN JACOB ANDRES, PTA (NPI #1922675677)