NPIMap

Organization Active NPI

Interventional Pain Specialists of Bowling Green PLC

  • Pain Medicine (Anesthesiology) Physician
  • Bowling Green, KY
National Provider Identifier
1033356274
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN PLC
Practice address
165 Natchez Trace Ave
Suite 205
Bowling Green, KY 42103-7940
Phone
(270) 393-1912
Fax
(270) 393-1913
NPI assigned
Jan 9, 2009
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Robert Keith Norman, CRNANPI 1508850223
Title
Owner/President
Phone
(270) 393-1912

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X KY
Psychiatric/Mental Health Nurse Practitioner 363LP0808X
Certified Registered Nurse Anesthetist 367500000X KY
Clinical Psychologist 103TC0700X KY
Anesthesiology Physician 207L00000X KY
Pain Medicine (Anesthesiology) Physician 207LP2900X KY Primary
Pain Medicine Physician 208VP0000X KY
Interventional Pain Medicine Physician 208VP0014X KY

Addresses

Primary practice location

165 Natchez Trace Ave
Suite 205
Bowling Green, KY 42103-7940

Mailing address

165 Natchez Trace Ave
Suite 205
Bowling Green, KY 42103-7940
Phone (270) 393-1912

Other identifiers 4

IdentifierTypeStateIssuer
7100097740MedicaidKY
7100062970OtherKYCRNA GROUP MCD NUMBER
7100063360MedicaidKY
7100152630MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090218000135 KY Part B Supplier - Clinic/Group Practice 6608931035 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
Practice locations: Bowling Green, KY; Franklin, KY; Glasgow, KY

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033356274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 NATCHEZ TRACE AVE",
            "address_2": "SUITE 205",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037940",
            "telephone_number": "270-393-1912",
            "fax_number": "270-393-1913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 NATCHEZ TRACE AVE",
            "address_2": "SUITE 205",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037940",
            "telephone_number": "270-393-1912",
            "fax_number": "270-393-1913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN SPECIALISTS OF BOWLING GREEN PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-09",
        "last_updated": "2022-07-21",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "NORMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "270-393-1912",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100097740",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA GROUP MCD NUMBER",
            "identifier": "7100062970",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100063360",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100152630",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.