Institute for Low Back Care LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

4806 Issued in ND

Legal business name

INSTITUTE FOR LOW BACK CARE LLC

Practice address

300 Main Ave
Suite 212
Fargo, ND 58103-1930

Phone

(701) 297-0817

Fax

(701) 297-6870

NPI assigned

Sep 20, 2006

Last updated

May 7, 2013By 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

Dr. Panjini M. Sivanna, MDNPI 1013948116

Title

President

Phone

(701) 297-0817

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

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.

• Panjini M Sivanna, MD

  • Interventional Pain Medicine Physician
  • Thief River Falls, MN
  • NPI 1013948116
  NPD (past) Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1124125109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 MAIN AVE",
            "address_2": "SUITE 212",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031930",
            "telephone_number": "701-297-0817",
            "fax_number": "701-297-6870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN AVE",
            "address_2": "SUITE 212",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581031930",
            "telephone_number": "701-297-0817",
            "fax_number": "701-297-6870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE FOR LOW BACK CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "SIVANNA",
        "authorized_official_first_name": "PANJINI",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-297-0817",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "ND",
            "license": "4806",
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ND",
            "license": "4806",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6826334",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Fargo, ND
• Providers in Fargo, ND by specialty
• Ambulatory Surgical Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.