NPIMap

Organization Active NPI

Skyline Pain Clinic

  • Pain Medicine Physician
  • Ogden, UT
National Provider Identifier
1053308452
Registry record updated Dec 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
260615 Issued in UT
Legal business name
SKYLINE PAIN CLINIC
Practice address
5315 Adams Ave Pkwy
Suite a
Ogden, UT 84405-4766
Phone
(801) 476-4448
Fax
(801) 476-4449
NPI assigned
Sep 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2009

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

Authorized official

Name
Dr. Jahan Imani, MDNPI 1063414969
Title
Owner
Phone
(801) 476-4448

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 260615 UT Primary

Addresses

Primary practice location

5315 Adams Ave Pkwy
Suite a
Ogden, UT 84405-4766

Mailing address

PO Box 9519
Ogden, UT 84409-0519
Phone (801) 476-4448

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
46D1103407Skyline Pain Clinic5315 South Adams Avenue Ste a, Ogden, UT 84405AccreditationJan 17, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261526400000",
    "number": "1053308452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9519",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844090519",
            "telephone_number": "801-476-4448",
            "fax_number": "801-476-4449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5315 ADAMS AVE PKWY",
            "address_2": "SUITE A",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844054766",
            "telephone_number": "801-476-4448",
            "fax_number": "801-476-4449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKYLINE PAIN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-30",
        "last_updated": "2009-12-23",
        "status": "A",
        "authorized_official_last_name": "IMANI",
        "authorized_official_first_name": "JAHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-476-4448",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "UT",
            "license": "260615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.