NPIMap

Organization Active NPI

Wind River Pain Management, LLC

  • Pain Clinic/Center
  • Fort Collins, CO
National Provider Identifier
1104992296
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
License
39525 Issued in CO
Legal business name
WIND RIVER PAIN MANAGEMENT, LLC
Practice address
5873 Highland Hills Cir
Fort Collins, CO 80528-8941
Phone
(970) 420-9904
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. James Alan Derrisaw, M.D.
Title
Ceo
Phone
(970) 420-9904

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Clinic/Center 261QP3300X 39525 CO Primary

Addresses

Primary practice location

5873 Highland Hills Cir
Fort Collins, CO 80528-8941

Mailing address

5873 Highland Hills Cir
Fort Collins, CO 80528-8941
Phone (970) 420-9904

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104992296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5873 HIGHLAND HILLS CIR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288941",
            "telephone_number": "970-420-9904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5873 HIGHLAND HILLS CIR",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805288941",
            "telephone_number": "970-420-9904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIND RIVER PAIN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DERRISAW",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-420-9904",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "CO",
            "license": "39525",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Collins, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.