NPIMap

Organization Active NPI

Pain Treatment Centers of America, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Jonesboro, AR
National Provider Identifier
1063995504
Registry record updated Jan 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PAIN TREATMENT CENTERS OF AMERICA, PLLC
Practice address
1710 Mayfield Dr
Jonesboro, AR 72401-4563
Phone
(501) 712-2571
Fax
(888) 630-8885
NPI assigned
Sep 11, 2018
Last updated
Jan 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2023

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

Authorized official

Name
Kristen Nehk
Title
Coo of RCM Services
Phone
(951) 541-6889

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

1710 Mayfield Dr
Jonesboro, AR 72401-4563

Mailing address

108 N Shackleford Rd
Little Rock, AR 72211-2840
Phone (501) 712-2571

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181217002767 AR DME Supplier - Physician - Unknown Physician SpecialtyDME Supplier - Independently-Practicing Physical Therapist 2769608819 Practice locations: Jonesboro, AR

Other NPIs with the same Medicare PAC ID 20

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

View all 20

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
04D2158736Pain Treatment Centers of America, Jonesboro1710 Mayfield Drive, Jonesboro, AR 72401Certificate of waiverDec 4, 2026

National Provider Directory

National Provider Directory
Tax ID family
Pain Treatment Centers27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Locations

1150 E Matthews Ave
Ste 203
Jonesboro, AR 72401
Phone (870) 815-1234

NPI Registry JSON

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

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1063995504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 N SHACKLEFORD RD",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722112840",
            "telephone_number": "501-712-2571",
            "fax_number": "888-630-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 MAYFIELD DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724014563",
            "telephone_number": "501-712-2571",
            "fax_number": "888-630-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN TREATMENT CENTERS OF AMERICA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-11",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "NEHK",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "COO OF RCM SERVICES",
        "authorized_official_telephone_number": "951-541-6889"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.