NPIMap

Organization Active NPI

Interventional Spine and Pain, LLP

  • Pain Medicine (Anesthesiology) Physician
  • Addison, TX
National Provider Identifier
1033509971
Registry record updated Jul 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
INTERVENTIONAL SPINE AND PAIN, LLP
Practice address
17051 North Dallas Parkway
Suite 300
Addison, TX 75001
Phone
(214) 506-2610
Fax
(214) 506-1170
NPI assigned
Jan 30, 2015
Last updated
Jul 23, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2017

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

Authorized official

Name
Pablo Zeballos, DO
Title
Owner
Phone
(214) 506-2610

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU

Addresses

Primary practice location

17051 North Dallas Parkway
Suite 300
Addison, TX 75001

Mailing address

12221 Merit Dr Ste 620
Dallas, TX 75251-3222
Phone (214) 506-2610

Other identifiers 1

IdentifierTypeStateIssuer
193400000XOtherTXTAXONOMY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160229000449 TX Part B Supplier - Clinic/Group Practice 8729383823 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Addison, TX; Dallas, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16920/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1422576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500768000000",
    "number": "1033509971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 MERIT DR STE 620",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752513222",
            "telephone_number": "214-506-2610",
            "fax_number": "972-681-8727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 NORTH DALLAS PARKWAY",
            "address_2": "SUITE 300",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "75001",
            "telephone_number": "214-506-2610",
            "fax_number": "214-506-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND PAIN, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-30",
        "last_updated": "2017-07-23",
        "status": "A",
        "authorized_official_last_name": "ZEBALLOS",
        "authorized_official_first_name": "PABLO",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-506-2610",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY",
            "identifier": "193400000X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Addison, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2017; 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.