Boulder Headache and Pain PLLC

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

46517 Issued in CO

Legal business name

BOULDER HEADACHE AND PAIN PLLC

Practice address

5377 Manhattan Cir Ste 200
Boulder, CO 80303-4345

Phone

(303) 225-6625

Fax

(303) 225-6626

NPI assigned

Dec 4, 2017

Organization subpart

No

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

Authorized official

Name

Alex G Reish, DONPI 1760694525

Title

Owner

Phone

(303) 225-6625

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17330/brand/1/csg/1/fhir/r4

Practitioners 1

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

• Alex G Reish, DO

  • Neuromusculoskeletal Medicine & OMM Physician
  • Boulder, CO
  • NPI 1760694525
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1512345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1114432903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5377 MANHATTAN CIR STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034345",
            "telephone_number": "303-225-6625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5377 MANHATTAN CIR STE 200",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803034345",
            "telephone_number": "303-225-6625",
            "fax_number": "303-225-6626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER HEADACHE AND PAIN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-04",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "REISH",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-225-6625",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "CO",
            "license": "46517",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "46517",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62451383",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.