Organization Active NPI

Spa City Pain Management

  • Pain Medicine Physician
  • Hot Springs, AR
National Provider Identifier
1043971096
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
SPA CITY PAIN MANAGEMENT
Practice address
117 Piper St Ste L
Hot Springs, AR 71901-8263
Phone
(501) 651-0018
Fax
(501) 463-6326
NPI assigned
Jan 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Authorized official

Name
Donald Crabtree, DONPI 1760649388
Title
Director
Phone
(501) 651-0018

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0000X Primary

Addresses

Primary practice location

117 Piper St Ste L
Hot Springs, AR 71901-8263

Mailing address

11001 Executive Center Dr Ste 200
Little Rock, AR 72211-4393
Phone (501) 812-7215

Other identifiers 1

IdentifierTypeStateIssuer
1760649388OtherARNPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220914001116 AR Part B Supplier - Clinic/Group Practice 8123403086 Receives reassigned benefits from 2 practitioners
Practice locations: Hot Springs, AR
O20230209000789 AR DME Supplier - Physician - Interventional Pain Management 8123403086 Practice locations: Hot Springs, AR

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D2265016Spa City Pain Management Clinic117 Piper Street, Suite L, Hot Springs, AR 71901Certificate of waiverJul 20, 2028

National Provider Directory

National Provider Directory

Locations

117 Piper St
Ste L
Hot Springs, AR 71901
Phone (501) 651-0018

117 Piper St
Ste Ln
Hot Springs, AR 71901

Practitioners & affiliated clinicians

Practitioners 3

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": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659398400000",
    "number": "1043971096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11001 EXECUTIVE CENTER DR STE 200",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722114393",
            "telephone_number": "501-812-7215",
            "fax_number": "501-812-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 PIPER ST STE L",
            "city": "HOT SPRINGS",
            "state": "AR",
            "postal_code": "719018263",
            "telephone_number": "501-651-0018",
            "fax_number": "501-463-6326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPA CITY PAIN MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A",
        "authorized_official_last_name": "CRABTREE",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "501-651-0018",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1760649388",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hot Springs, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.