Innovative Pain Center LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

0425 Issued in SD

Legal business name

INNOVATIVE PAIN CENTER LLC

Practice address

1512 4TH St NE
Watertown, SD 57201-6824

Phone

(605) 884-0100

NPI assigned

Jun 20, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick L Retterath, MD

Title

Provider

Phone

(605) 884-0100

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292976000000",
    "number": "1003851163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 MICKELSON DR STE 2",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572017253",
            "telephone_number": "605-882-0432",
            "fax_number": "605-882-0978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 4TH ST NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572016824",
            "telephone_number": "605-884-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2010-12-22",
        "status": "A",
        "authorized_official_last_name": "RETTERATH",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "605-884-0100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "SD",
            "license": "0425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "73M96IN",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4995163",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "892980000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Watertown, SD
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.