NPIMap

Organization Active NPI

Northshore Interventional Pain Management, Apmc

  • Specialist
  • Covington, LA
National Provider Identifier
1114963501
Registry record updated Mar 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
NORTHSHORE INTERVENTIONAL PAIN MANAGEMENT, APMC
Practice address
7015 Highway 190 East Service Rd
Ste. 101
Covington, LA 70433-4960
Phone
(985) 809-1997
Fax
(985) 809-1664
NPI assigned
Jun 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2015

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

Authorized official

Name
Mrs. Paulette Watts
Title
Business Manager
Phone
(985) 809-1997

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

7015 Highway 190 East Service Rd
Ste. 101
Covington, LA 70433-4960

Mailing address

7015 Highway 190 East Service Rd
Ste. 101
Covington, LA 70433-4960
Phone (985) 809-1997

Other identifiers 2

IdentifierTypeStateIssuer
DA3921OtherLARAILROAD MEDICARE
174463900OtherLAOFFICE OF WORKERS COMP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000484 LA Part B Supplier - Clinic/Group Practice 6305838368 Receives reassigned benefits from 9 practitioners
Practice locations: Covington, LA

National Provider Directory

National Provider Directory

Locations

7015 Highway 190 East Service Rd
Ste 101A
Covington, LA 70433

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425945600000",
    "number": "1114963501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7015 HIGHWAY 190 EAST SERVICE RD",
            "address_2": "STE. 101",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704334960",
            "telephone_number": "985-809-1997",
            "fax_number": "985-809-1664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7015 HIGHWAY 190 EAST SERVICE RD",
            "address_2": "STE. 101",
            "city": "COVINGTON",
            "state": "LA",
            "postal_code": "704334960",
            "telephone_number": "985-809-1997",
            "fax_number": "985-809-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSHORE INTERVENTIONAL PAIN MANAGEMENT, APMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2015-03-10",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "985-809-1997",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DA3921",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE OF WORKERS COMP",
            "identifier": "174463900",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Covington, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2015; 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.