NPIMap

Organization Active NPI

Gulf Coast Pain Consultants LLC

Doing business as Clearway Pain Solutions Institute

  • Durable Medical Equipment & Medical Supplies
  • Pace, FL
National Provider Identifier
1104278902
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
GULF COAST PAIN CONSULTANTS LLC
Doing business as
Clearway Pain Solutions Institute
Practice address
3810 Highway 90
Pace, FL 32571-1014
Phone
(850) 484-4080
NPI assigned
Jul 6, 2016
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Kacey A Montgomery, MDNPI 1447455977
Title
Medical Director
Phone
(850) 791-6895

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

3810 Highway 90
Pace, FL 32571-1014

Mailing address

201 Defense Hwy Ste 205
Annapolis, MD 21401-7096
Phone (855) 527-7246

Other names 1

  • Clearway Pain Solutions Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170502002821 FL DME Supplier - Multi-Specialty - Physician 1658516570 Practice locations: Pace, FL

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Pain Consultants LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1467763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1104278902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DEFENSE HWY STE 205",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017096",
            "telephone_number": "855-527-7246",
            "fax_number": "833-810-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3810 HIGHWAY 90",
            "city": "PACE",
            "state": "FL",
            "postal_code": "325711014",
            "telephone_number": "850-484-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PAIN CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-06",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "KACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-791-6895",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pace, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.