Interventional Spine and Joint Specialists, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

INTERVENTIONAL SPINE AND JOINT SPECIALISTS, LLC

Practice address

701 Superior Ave Ste B
Munster, IN 46321-4038

Phone

(219) 333-4757

NPI assigned

Mar 28, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Prasanth Nuthakki, MDNPI 1114046455

Title

Ceo

Phone

(219) 836-0296

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Prasanth Nuthakki, MD

  • Interventional Pain Medicine Physician
  • Munster, IN
  • NPI 1114046455

  Physical Medicine & Rehabilitation

  Medicare reassignment Care Compare group NPD Authorized official
• Kaitlin E Fry, FNP-C

  • Family Nurse Practitioner
  • Hobart, IN
  • NPI 1417729377
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1553731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1104387521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3039",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463210039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SUPERIOR AVE STE B",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214038",
            "telephone_number": "219-333-4757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "24 Joliet St",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463111705",
            "country_code": "US",
            "telephone_number": "219-864-2237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE AND JOINT SPECIALISTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-28",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "NUTHAKKI",
        "authorized_official_first_name": "PRASANTH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-836-0296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "204R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Electrodiagnostic Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Infomedica
• Cory Robert Ingelse
• Nadia Inocencio
• Institute of Advanced Care & Analytics PC
• Interventional Pain Management, LLC
• Interventional Spine and Pain Centers, LLC
• Wing Yee Ip, PHARMD
• Zaklina Ivanovic
• Ivy Infusion Professional Nursing Services LLC
• J & J Rehab Providers Inc.

• Interventional Pain Medicine Physician in Munster, IN
• Providers in Munster, IN by specialty
• Interventional Pain Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.