Organization Active NPI

The Center for Pain and Supportive Care P L L C

  • Pain Medicine Physician
  • Phoenix, AZ
National Provider Identifier
1104009265
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
24521 Issued in AZ
Legal business name
THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C
Practice address
4611 E. Shea Blvd. BLDG. 3
Suite 190
Phoenix, AZ 85028-4258
Phone
(480) 889-0180
Fax
(480) 889-0186
NPI assigned
Dec 12, 2007
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Authorized official

Name
Dr. Gobi ParamanandamNPI 1568677706
Title
Member Manager
Phone
(480) 889-0180

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LH0002X 24521 AZ
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 24521 AZ
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X 24521 AZ Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X 24521 AZ

Addresses

Primary practice location

4611 E. Shea Blvd. BLDG. 3
Suite 190
Phoenix, AZ 85028-4258

Mailing address

4611 E. Shea Blvd. BLDG. 3
Suite 170
Phoenix, AZ 85028-4258
Phone (480) 889-0180

Other practice location 1

9242 W Union Hills Dr Bldg D100-101
Peoria, AZ 85382-8218
Phone (480) 889-0180

Other identifiers 1

IdentifierTypeStateIssuer
518589MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080130000329 AZ Part B Supplier - Clinic/Group Practice 5597847517 Receives reassigned benefits from 6 practitioners
Practice locations: Peoria, AZ; Phoenix, AZ

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
03D1053719Center for Pain and Supportive Care, the4611 E Shea Blvd, BLDG 3, Ste 190, Phoenix, AZ 85028Certificate of waiverMay 2, 2028

National Provider Directory

National Provider Directory

Locations

9242 W Union Hills Dr
Bldg D100101
Peoria, AZ 85382
Phone (480) 889-0180

4611 E Shea Blvd
Bldg 3
Phoenix, AZ 85028
Phone (480) 889-0180

4611 E Shea Blvd
Ste 170
Phoenix, AZ 85028
Phone (480) 889-0180

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1104009265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4611 E. SHEA BLVD. BLDG. 3",
            "address_2": "SUITE 170",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850284258",
            "telephone_number": "480-889-0180",
            "fax_number": "480-889-0186"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 E. SHEA BLVD. BLDG. 3",
            "address_2": "SUITE 190",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850284258",
            "telephone_number": "480-889-0180",
            "fax_number": "480-889-0186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9242 W Union Hills Dr Bldg D100-101",
            "address_purpose": "LOCATION",
            "city": "Peoria",
            "state": "AZ",
            "postal_code": "853828218",
            "country_code": "US",
            "telephone_number": "480-889-0180",
            "fax_number": "480-889-0186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE CENTER FOR PAIN AND SUPPORTIVE CARE P L L C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "PARAMANANDAM",
        "authorized_official_first_name": "GOBI",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "480-889-0180",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207LH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Hospice and Palliative Medicine",
            "state": "AZ",
            "license": "24521",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AZ",
            "license": "24521",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "AZ",
            "license": "24521",
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "AZ",
            "license": "24521",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "518589",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.