Organization Active NPI

Interventional Pain & Spine Center PLLC

  • Pain Medicine (Psychiatry & Neurology) Physician
  • Wexford, PA
National Provider Identifier
1114768843
Registry record updated Sep 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P2900X
Legal business name
INTERVENTIONAL PAIN & SPINE CENTER PLLC
Practice address
100 Bradford Road
Ste 410
Wexford, PA 15090-8489
Phone
(724) 965-8946
Fax
(724) 965-8953
NPI assigned
Jun 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2024

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

Authorized official

Name
Mohammad Khizar Ali, MDNPI 1023428919
Title
Authorized Official
Phone
(724) 965-8946

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neurophysiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0600X
Pain Medicine (Psychiatry & Neurology) Physician 2084P2900X Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

100 Bradford Road
Ste 410
Wexford, PA 15090-8489

Mailing address

100 Bradford Road
Ste 410
Wexford, PA 15090-8489
Phone (724) 965-8946

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240925000922 PA Part B Supplier - Clinic/Group Practice 7012452493 Receives reassigned benefits from 2 practitioners
Practice locations: Wexford, PA

National Provider Directory

National Provider Directory

Locations

217 N Jefferson St
Ste C
New Castle, PA 16101

100 Bradford Rd
Ste 410
Wexford, PA 15090
Phone (724) 719-2441

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIIFDD

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1717545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726012800000",
    "number": "1114768843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BRADFORD ROAD",
            "address_2": "STE 410",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150908489",
            "telephone_number": "724-965-8946",
            "fax_number": "724-965-8953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BRADFORD ROAD",
            "address_2": "STE 410",
            "city": "WEXFORD",
            "state": "PA",
            "postal_code": "150908489",
            "telephone_number": "724-965-8946",
            "fax_number": "724-965-8953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN & SPINE CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-05",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A",
        "authorized_official_last_name": "ALI",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "KHIZAR",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "724-965-8946",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Clinical Neurophysiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wexford, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; 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.