NPIMap

Organization Active NPI

Pacific Sports and Interventional Spine, LLC-P

  • Interventional Pain Medicine Physician
  • Sutherlin, OR
National Provider Identifier
1215898564
Registry record updated Nov 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC-P
Practice address
123 Ponderosa Dr
Sutherlin, OR 97479-9812
Phone
(541) 543-2323
NPI assigned
Nov 18, 2025
Last updated
Nov 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2025

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

Authorized official

Name
Kristin Bunch
Title
Director of Contracting/Cred
Phone
(503) 953-0357

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

123 Ponderosa Dr
Sutherlin, OR 97479-9812

Mailing address

123 Ponderosa Dr
Sutherlin, OR 97479-9812

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260216001250 OR DME Supplier - Physician - General Practice 3072867316 Practice locations: Sutherlin, OR

Other NPIs with the same Medicare PAC ID 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
38D2339427Pacific Sports and Spine LLC123 Ponderosa Drive, Sutherlin, OR 97479Certificate of waiverMar 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
Pacific Sports and Inter2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1763424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763424000000",
    "number": "1215898564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 PONDEROSA DR",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 PONDEROSA DR",
            "city": "SUTHERLIN",
            "state": "OR",
            "postal_code": "974799812",
            "telephone_number": "541-543-2323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SPORTS AND INTERVENTIONAL SPINE, LLC-P",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-18",
        "last_updated": "2025-11-18",
        "certification_date": "2025-11-18",
        "status": "A",
        "authorized_official_last_name": "BUNCH",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "DIRECTOR OF CONTRACTING/CRED",
        "authorized_official_telephone_number": "503-953-0357"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sutherlin, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2025; 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.