Gulf Coast Pain Consultants LLC
Organization Active NPI Durable Medical Equipment & Medical Supplies · Fort Walton Beach, FL
NPI 1083455299 · NPPES record last updated Jun 3, 2024
Key facts
- NPI
- 1083455299
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Durable Medical Equipment & Medical Supplies 332B00000X
- Legal business name
- GULF COAST PAIN CONSULTANTS LLC
- Practice address
- 918 Mar Walt Dr
Fort Walton Beach, FL 32547-6706 - Phone
- (855) 527-7246
- Fax
- (833) 905-2461
- NPI assigned
- Jun 3, 2024
- Organization subpart
- No
Authorized official
- Name
- Kacey A Montgomery, MD
- Title
- Regional Medical Director
- Phone
- (850) 791-6895
Other NPIs with the same Medicare PAC ID 9
Corporate family (same tax ID) 8
Practitioners 43
-
John B Adams, D.O.
-
Susan R Belcher, M.D.
-
David A Disanto, MD
-
David Edward Fairleigh, M.D.
-
Morgan Shaye Fusco, APRN
-
Mario Gardner, APRN
-
Rodger Kenneth Garrett, M.D.
-
Kaila Hadden, APRN
-
Arthur D Kalman, DO
-
Taylor Elaine Lane, PA-C
-
David Lee, FNP
-
Jason Qualley, MD, CCP,LP
-
Alison Ray, APRN
-
Varun Kumar Rimmalapudi, M.D.
-
Matthew Sean Spinks, M.D.
-
Douglas Tidwell, MSN, ARNP, FNP-C
-
Brooke Ashleigh Welch, ARNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250225002700 | FL | DME Supplier - Physician - Interventional Pain Management | 1658516570 | Practice locations: Fort Walton Beach, FL |
National Provider Directory
- Tax ID family
- Gulf Coast Pain Consultants PLLC
Locations
180 E Redstone Ave
Bldg 1ABN
Crestview, FL 32539
4415 US Highway 331 S
Ste 500
Defuniak Springs, FL 32435
2318 Saint Andrews Blvd
Panama City, FL 32405
Phone (850) 215-1024
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | |||
| Pain Medicine (Physical Medicine & Rehabilitation) Physician |
2081P2900X | |||
| Pain Medicine Physician |
208VP0000X | |||
| Interventional Pain Medicine Physician |
208VP0014X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | Yes |
Addresses
Primary practice location
918 Mar Walt Dr
Fort Walton Beach, FL 32547-6706
Mailing address
201 Defense Hwy Ste 205
Annapolis, MD 21401-7096
Phone (855) 527-7246
Other names
- Clearway Pain Solutions Institute
Other providers in Fort Walton Beach, FL
- Jerzy Grzebieluch
- Nahlo Gueu
- Guillot Enterprises, LLC
- Aarushi Gulati
- Gulf Coast Immediate Care Center Inc.
- Gulf Coast Treatment Center
- Gulf Coast Youth Services
- Gulf Coast Youth Services
- Gulf Medical Services. Inc.
- Gustavo F Ros MD PA
All providers in Fort Walton Beach, FL · Durable Medical Equipment & Medical Supplies in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.