San Dimas Pain Management Medical Center Inc.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

A53113 Issued in CA

Legal business name

SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC.

Practice address

125 Wheeler Ave
Suite C
Arcadia, CA 91006-3220

Phone

(626) 294-4866

Fax

(626) 294-4872

NPI assigned

Dec 21, 2005

Last updated

Mar 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Bernadette A Clifford

Title

Chief Operating Officer

Phone

(626) 294-4866

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

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.

• John Paul Madanat, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Arcadia, CA
  • NPI 1851571020
  Medicare reassignment NPD
• John E Bohm, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Calexico, CA
  • NPI 1992771604
  Medicare reassignment
• Nabil Samir Dahi, MD

  • Interventional Pain Medicine Physician
  • Arcadia, CA
  • NPI 1639369697
  Medicare reassignment

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678665600000",
    "number": "1124004114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 WHEELER AVE",
            "address_2": "SUITE C",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910063220",
            "telephone_number": "626-294-4866",
            "fax_number": "626-294-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 WHEELER AVE",
            "address_2": "SUITE C",
            "city": "ARCADIA",
            "state": "CA",
            "postal_code": "910063220",
            "telephone_number": "626-294-4866",
            "fax_number": "626-294-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIMAS PAIN MANAGEMENT MEDICAL CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2023-03-13",
        "certification_date": "2023-03-13",
        "status": "A",
        "authorized_official_last_name": "CLIFFORD",
        "authorized_official_first_name": "BERNADETTE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "626-294-4866",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "CA",
            "license": "A53113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jan Laudise Salvay, MA, MFT
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• Jennifer Crystal Sanchez Baca

• Interventional Pain Medicine Physician in Arcadia, CA
• Providers in Arcadia, CA by specialty
• Interventional Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2023; 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.