Center for Pain Care P a

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

CENTER FOR PAIN CARE P A

Practice address

115 W Main St
Suite 102
Boise, ID 83702-7302

Phone

(208) 342-4700

Fax

(208) 342-4710

NPI assigned

Aug 1, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Clinton Mallari, MDNPI 1154345585

Title

Administrator

Phone

(208) 342-4700

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11756/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Clinton Mallari, MD

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Boise, ID
  • NPI 1154345585
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1023024684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027302",
            "telephone_number": "208-342-4700",
            "fax_number": "208-342-4710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837027302",
            "telephone_number": "208-342-4700",
            "fax_number": "208-342-4710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PAIN CARE P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "MALLARI",
        "authorized_official_first_name": "CLINTON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "208-342-4700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Boise, ID
• Providers in Boise, ID by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.