Four States Pain Relief Institute, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

FOUR STATES PAIN RELIEF INSTITUTE, LLC

Doing business as

4 Corners Pain Relief Institute, LLC

Practice address

2650 E 32ND St
Suite 101
Joplin, MO 64804-4313

Phone

(417) 624-4277

Fax

(417) 624-4297

NPI assigned

Apr 11, 2011

Organization subpart

No

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

Authorized official

Name

Dr. John Knudsen III, MD

Title

Owner

Phone

(417) 624-4277

Specialties & licenses 1

Addresses

Other names 1

• 4 Corners Pain Relief Institute, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

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

• John Knudsen III, MD

  • Pain Medicine (Anesthesiology) Physician
  • Joplin, MO
  • NPI 1104852342
  Medicare reassignment NPD

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375920000000",
    "number": "1033409198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E 32ND ST",
            "address_2": "STE B",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042905",
            "telephone_number": "417-624-4277",
            "fax_number": "417-624-4297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 E 32ND ST",
            "address_2": "SUITE 101",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648044313",
            "telephone_number": "417-624-4277",
            "fax_number": "417-624-4297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR STATES PAIN RELIEF INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2013-08-08",
        "status": "A",
        "authorized_official_last_name": "KNUDSEN III",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "417-624-4277",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "4 Corners Pain Relief Institute, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Becky Fowkes
• Frank W. Shagets, Jr., M.D., P.C.
• Christa Nicole Frazier, PHARM D
• Ericka Freeborn

• Pain Medicine (Anesthesiology) Physician in Joplin, MO
• Providers in Joplin, MO by specialty
• Pain Medicine (Anesthesiology) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2013; 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.