Pain Care Surgery, PC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7002900 Issued in IL

Legal business name

PAIN CARE SURGERY, PC

Practice address

108 Airway Dr
Marion, IL 62959-5841

Phone

(618) 997-7820

Fax

(618) 997-6721

NPI assigned

Feb 24, 2006

Last updated

Oct 5, 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. Laxmaiah Manchikanti, M.D.NPI 1730178799

Title

Medical Director

Phone

(618) 997-7820

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Pain Care Surgery PCCCN 14C0001113

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 2

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.

• Erin Morrow, APRN

  • Family Nurse Practitioner
  • Paducah, KY
  • NPI 1942811179

  IL

  Medicare reassignment NPD
• Laxmaiah Manchikanti, M.D.

  • Interventional Pain Medicine Physician
  • Paducah, KY
  • NPI 1730178799
  NPD (past) Authorized official

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

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317772800000",
    "number": "1184690570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 AIRWAY DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595841",
            "telephone_number": "618-997-7820",
            "fax_number": "618-997-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 AIRWAY DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595841",
            "telephone_number": "618-997-7820",
            "fax_number": "618-997-6721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CARE SURGERY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-24",
        "last_updated": "2011-10-05",
        "status": "A",
        "authorized_official_last_name": "MANCHIKANTI",
        "authorized_official_first_name": "LAXMAIAH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "618-997-7820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002900",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "BC#50386",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "100812",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brooke Alisa Osman, LPN
• Michele A Otto, RN
• Alexander Owens, PHARMD
• Amanda Page
• Lilybeth Page, BS
• Pain Management Centers of America, PSC
• Adiraju Palagiri, MD
• Klara Palhegyi, DDS
• Brian Pankey
• Lindsey Parker, MSW

• Ambulatory Surgical Clinic/Center in Marion, IL
• Providers in Marion, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.