NPIMap

Organization Active NPI

Interventional Pain Management, PA

  • Pain Medicine (Anesthesiology) Physician
  • Nacogdoches, TX
National Provider Identifier
1114113669
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
J8185 Issued in TX
Legal business name
INTERVENTIONAL PAIN MANAGEMENT, PA
Practice address
3312 N University Dr
Suite J
Nacogdoches, TX 75965-2637
Phone
(936) 560-2222
Fax
(936) 569-1788
NPI assigned
Sep 19, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
INTERVENTIONAL PAIN MANAGEMENT, PAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
James D Davis, MDNPI 1255313581
Title
MD/Owner
Phone
(936) 560-2222

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X J8185 TX Primary

Addresses

Primary practice location

3312 N University Dr
Suite J
Nacogdoches, TX 75965-2637

Mailing address

3312 N University Dr
Suite J
Nacogdoches, TX 75965-2637
Phone (936) 560-2222

Other identifiers 2

IdentifierTypeStateIssuer
184657801MedicaidTX
DF4810OtherPALMETTO GBA

National Provider Directory

National Provider Directory
Part of
Interventional Pain MGMT PA

Locations

3312 N University Dr
Ste J
Nacogdoches, TX 75965
Phone (936) 560-2222

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1190160000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1114113669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3312 N UNIVERSITY DR",
            "address_2": "SUITE J",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652637",
            "telephone_number": "936-560-2222",
            "fax_number": "936-569-1788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3312 N UNIVERSITY DR",
            "address_2": "SUITE J",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759652637",
            "telephone_number": "936-560-2222",
            "fax_number": "936-569-1788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN MANAGEMENT, PA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERVENTIONAL PAIN MANAGEMENT, PA",
        "enumeration_date": "2007-09-19",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "936-560-2222",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TX",
            "license": "J8185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184657801",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "DF4810",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.