Colorado Springs Interventional Pain Management PC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

23261 Issued in CO

Legal business name

COLORADO SPRINGS INTERVENTIONAL PAIN MANAGEMENT PC

Practice address

3030 N Circle Dr
210
Colorado Springs, CO 80909-1177

Phone

(719) 228-9440

Fax

(719) 228-9061

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Linda Cisco, RN

Title

Practice Manager

Phone

(719) 228-9440

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• INTERVENTIONAL PAIN MANAGEMENT Other name

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 5

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

• Kaylee Marie Derra, FNP-BC

  • Family Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1528744216
  Medicare reassignment Care Compare group NPD
• Chris John Malinky, MD

  • Pain Medicine (Anesthesiology) Physician
  • Colorado Springs, CO
  • NPI 1669638144
  Medicare reassignment Care Compare group NPD
• Heidi Leea Bennett, P.A.-C.

  • Physician Assistant
  • Colorado Springs, CO
  • NPI 1487756243
  Medicare reassignment Care Compare group
• Dennis Ryan Marcelo, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Jackson, MS
  • NPI 1417343559

  CO

  Medicare reassignment NPD
• Adam Haeffner, PA-C

  • Physician Assistant
  • Colorado Springs, CO
  • NPI 1134474752
  Medicare reassignment

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1215097175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 N CIRCLE DR",
            "address_2": "210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091177",
            "telephone_number": "719-228-9440",
            "fax_number": "719-228-9061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 N CIRCLE DR",
            "address_2": "210",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091177",
            "telephone_number": "719-228-9440",
            "fax_number": "719-228-9061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO SPRINGS INTERVENTIONAL PAIN MANAGEMENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "CISCO",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "719-228-9440",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CO",
            "license": "23261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE- GROUP",
            "identifier": "C473508",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC-BS-GROUP",
            "identifier": "LA646340",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTERVENTIONAL PAIN MANAGEMENT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Pain Medicine (Anesthesiology) Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Pain Medicine (Anesthesiology) Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; 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.