NPIMap

Organization Active NPI

Institute of Interventional Pain Management PA

  • Interventional Pain Medicine Physician
  • Brooksville, FL
National Provider Identifier
1235227075
Registry record updated Dec 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
276400470 Issued in FL
Legal business name
INSTITUTE OF INTERVENTIONAL PAIN MANAGEMENT PA
Practice address
11319 Cortez Blvd
Brooksville, FL 34613-5407
Phone
(352) 597-0907
Fax
(352) 597-2243
NPI assigned
Oct 10, 2006
Last updated
Dec 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2009

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

Authorized official

Name
Dr. Deborah H Tracy, MDNPI 1538257357
Title
President
Phone
(352) 597-0907

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X 276400470 FL Primary

Addresses

Primary practice location

11319 Cortez Blvd
Brooksville, FL 34613-5407

Mailing address

PO Box 5719
Spring Hill, FL 34611-5719
Phone (352) 597-0907

Other identifiers 4

IdentifierTypeStateIssuer
5301427OtherGHI
CA4235OtherRRMC
377097400MedicaidFL
07882OtherBLUE CROSS/BLUE SHIELD

Other names 1

  • West Florida Anesthesia Former legal business name

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
10D1017154Institute of Interventional Pain Management11319 Cortez Blvd, Spring Hill, FL 34613Certificate of waiverSep 16, 2027

National Provider Directory

National Provider Directory

Locations

12440 Cortez Blvd
Spring Hill, FL 34613
Phone (352) 592-4250

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1262044800000",
    "number": "1235227075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5719",
            "city": "SPRING HILL",
            "state": "FL",
            "postal_code": "346115719",
            "telephone_number": "352-597-0907",
            "fax_number": "352-597-2243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11319 CORTEZ BLVD",
            "city": "BROOKSVILLE",
            "state": "FL",
            "postal_code": "346135407",
            "telephone_number": "352-597-0907",
            "fax_number": "352-597-2243"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INSTITUTE OF INTERVENTIONAL PAIN MANAGEMENT PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2009-12-29",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "352-597-0907",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "276400470",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "5301427",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMC",
            "identifier": "CA4235",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "377097400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "07882",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Florida Anesthesia",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Brooksville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.