NPIMap

Organization Active NPI

Therapeutic Spine and Pain Center, LTD.

  • Interventional Pain Medicine Physician
  • Bloomington, IL
National Provider Identifier
1124787940
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
THERAPEUTIC SPINE AND PAIN CENTER, LTD.
Practice address
3801 General Electric Rd Ste 4
Bloomington, IL 61704-4193
Phone
(309) 319-2341
NPI assigned
Dec 9, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Dr. Craig W Carmichael, MDNPI 1497761100
Title
President
Phone
(309) 824-8670

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 Primary

Addresses

Primary practice location

3801 General Electric Rd Ste 4
Bloomington, IL 61704-4193

Mailing address

19646 Briar Dr
Bloomington, IL 61705-4030
Phone (309) 824-8670

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220111001136 IL Part B Supplier - Clinic/Group Practice 7810389418 Receives reassigned benefits from 5 practitioners
Practice locations: Bloomington, IL; Pekin, IL

National Provider Directory

National Provider Directory

Locations

375 N Wall St
Ste P5100
Kankakee, IL 60901

2354 Broadway St
Ste a
Pekin, IL 61554
Phone (309) 319-2341

2351 Broadway St
Ste A
Pekin, IL 61554

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1124787940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19646 BRIAR DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617054030",
            "telephone_number": "309-824-8670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 GENERAL ELECTRIC RD STE 4",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044193",
            "telephone_number": "309-319-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERAPEUTIC SPINE AND PAIN CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-09",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "CARMICHAEL",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-824-8670",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; 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.