NPIMap

Organization Active NPI

Comprehensive Pain Center of Mississippi

  • Interventional Pain Medicine Physician
  • Madison, MS
National Provider Identifier
1124275565
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
16855 Issued in MS
Legal business name
COMPREHENSIVE PAIN CENTER OF MISSISSIPPI
Practice address
129 Fountains Blvd
Madison, MS 39110
Phone
(769) 300-0730
Fax
(601) 949-2782
NPI assigned
Aug 27, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Authorized official

Name
Leonel Kevin Vance, M.D.NPI 1669507943
Title
Owner
Phone
(769) 300-0730

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X 16855 MS Primary

Addresses

Primary practice location

129 Fountains Blvd
Madison, MS 39110

Mailing address

129 Fountains Blvd
Madison, MS 39110
Phone (601) 949-9994

Other identifiers 1

IdentifierTypeStateIssuer
2389791MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20081006000325 MS Part B Supplier - Clinic/Group Practice 5193893014 Receives reassigned benefits from 14 practitioners
Practice locations: Madison, MS
O20100930081795 MS DME Supplier - Physician - Interventional Pain Management 5193893014 Practice locations: Madison, MS

National Provider Directory

National Provider Directory

Locations

129 Fountains Blvd
Ste 201
Madison, MS 39110
Phone (769) 300-0730

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1219795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741132800000",
    "number": "1124275565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 FOUNTAINS BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "601-949-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 FOUNTAINS BLVD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "39110",
            "telephone_number": "769-300-0730",
            "fax_number": "601-949-2782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PAIN CENTER OF MISSISSIPPI",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-27",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "status": "A",
        "authorized_official_last_name": "VANCE",
        "authorized_official_first_name": "LEONEL",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "769-300-0730",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MS",
            "license": "16855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2389791",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2025; 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.