Southern Interventional Pain Center LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

SOUTHERN INTERVENTIONAL PAIN CENTER LLC

Practice address

619 SW Baya Dr Ste 102
Lake City, FL 32025-4204

Phone

(386) 361-3400

Fax

(855) 313-1262

NPI assigned

Mar 14, 2019

Last updated

Jan 31, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTHERN INTERVENTIONAL PAIN CENTER LLCAs reported in NPPES

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

Authorized official

Name

Maximilian Shahryar Shokat, DONPI 1659559789

Title

Managing Member

Phone

(229) 226-2234

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

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

• Southern Interventional Pain Center LLC

  • Interventional Pain Medicine Physician
  • Thomasville, GA
  • NPI 1306225479

  9436460318

  Same PAC ID

Part of

Southern Interventional Pain Center LLC

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15318/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Maximilian Shahryar Shokat, D.O.

  • Interventional Pain Medicine Physician
  • Thomasville, GA
  • NPI 1659559789
  NPD (past) Authorized official

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1063971596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S HANSELL ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925556",
            "telephone_number": "229-226-2234",
            "fax_number": "229-226-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "619 SW BAYA DR STE 102",
            "city": "LAKE CITY",
            "state": "FL",
            "postal_code": "320254204",
            "telephone_number": "386-361-3400",
            "fax_number": "855-313-1262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INTERVENTIONAL PAIN CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN INTERVENTIONAL PAIN CENTER LLC",
        "enumeration_date": "2019-03-14",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "SHOKAT",
        "authorized_official_first_name": "MAXIMILIAN",
        "authorized_official_middle_name": "SHAHRYAR",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "229-226-2234",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keiry Yulissa Soto Chavez
• Tonna Jeanette Sotolongo, A.R.N.P
• South Florida Surgical Specialists, LLC
• Southeast Radiology Associates PL
• Southern Internal Medicine PLLC
• Southern Open MRI Inc (Southern Open Imaging Center)
• Elizabeth Diane Sparkman
• Speech and Reading Center, LLC
• Patricia Spencer
• Leslee Stafford

• Interventional Pain Medicine Physician in Lake City, FL
• Providers in Lake City, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; 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.