Pain Treatment Center

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

Legal business name

PAIN TREATMENT CENTER

Practice address

106 Asbury Cir
Hattiesburg, MS 39402-1302

Phone

(601) 268-8698

NPI assigned

Dec 29, 2006

Last updated

Jan 20, 2011By 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. David L McKellar, MDNPI 1700947579

Title

Ceo/Medical Director

Phone

(601) 268-8698

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174689533. Details of each certification follow.

• CCN 25C0001032 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 25C0001032

Legal name

PAIN TREATMENT CENTER, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Aug 23, 2001

Last certification

May 16, 2019

Ownership / control type

Proprietary

Facility address

106 Asbury Circle
Hattiesburg, MS 39402

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

• David Loflin McKellar, MD

  • Pain Medicine (Anesthesiology) Physician
  • Hattiesburg, MS
  • NPI 1700947579
  NPD (past) Authorized official

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295481600000",
    "number": "1174689533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 ASBURY CIRCLE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "39402",
            "telephone_number": "601-268-8698",
            "fax_number": "601-296-3049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 ASBURY CIR",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021302",
            "telephone_number": "601-268-8698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-29",
        "last_updated": "2011-01-20",
        "status": "A",
        "authorized_official_last_name": "MCKELLAR",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "601-268-8698",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASC ID NUMBER",
            "identifier": "25C0001032",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00770530",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sabrittany Page
• Shatara Page
• Shirley C Page, FNP
• Shawn Paige, RN
• Pain Consultants of South Mississippi PA
• Christopher Painter, D.O.
• Scott S Paladichuk, O.D.
• Cheri Papizan, MD
• Eun Park
• Lynley Park

• Pain Clinic/Center in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Pain Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.