NPIMap

Organization Active NPI

Novaspine Pain Institute, PLC

  • Durable Medical Equipment & Medical Supplies
  • Sun City, AZ
National Provider Identifier
1124579628
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
42290 Issued in AZ
Legal business name
NOVASPINE PAIN INSTITUTE, PLC
Practice address
13203 N 103Rd Ave
Suite H5
Sun City, AZ 85351-3028
Phone
(623) 777-4747
Fax
(623) 777-4748
NPI assigned
Oct 19, 2016
Last updated
Apr 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Authorized official

Name
Dr. Clifford T Baker, M.D.NPI 1235342775
Title
Owner/Physician
Phone
(602) 538-1180

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 42290 AZ Primary

Addresses

Primary practice location

13203 N 103Rd Ave
Suite H5
Sun City, AZ 85351-3028

Mailing address

13203 N 103Rd Ave
Suite H5
Sun City, AZ 85351-3028
Phone (623) 777-4747

Other identifiers 1

IdentifierTypeStateIssuer
42990OtherAZAZ LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170330002728 AZ DME Supplier - Physician - Interventional Pain Management 9931323359 Practice locations: Sun City, AZ

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Novaspine Pain Institute PLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

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

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1124579628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13203 N 103RD AVE",
            "address_2": "SUITE H5",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853513028",
            "telephone_number": "623-777-4747",
            "fax_number": "623-777-4748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13203 N 103RD AVE",
            "address_2": "SUITE H5",
            "city": "SUN CITY",
            "state": "AZ",
            "postal_code": "853513028",
            "telephone_number": "623-777-4747",
            "fax_number": "623-777-4748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVASPINE PAIN INSTITUTE, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-19",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "602-538-1180",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "42290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZ LICENSE",
            "identifier": "42990",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sun City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; 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.