NPIMap

Organization Active NPI

Blue Water Pain Solutions, PA

  • Pain Medicine (Anesthesiology) Physician
  • Hollywood, FL
National Provider Identifier
1235533696
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
BLUE WATER PAIN SOLUTIONS, PA
Practice address
4925 Sheridan St
Suite 200
Hollywood, FL 33021-2834
Phone
(954) 447-5206
NPI assigned
Oct 14, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

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

Authorized official

Name
Dr. Lowell S. Davis
Title
President
Phone
(954) 447-5206

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

4925 Sheridan St
Suite 200
Hollywood, FL 33021-2834

Mailing address

PO Box 277597
Miramar, FL 33027-7597
Phone (800) 437-2672

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150330001869 FL Part B Supplier - Clinic/Group Practice 0143547232 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Plantation, FL; Pembroke Pines, FL; Miramar, FL; Boca Raton, FL; Hollywood, FL; Lauderdale Lakes, FL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Blue Water Pain Solutions P5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

4925 Sheridan St
Ste 200
Hollywood, FL 33021
Phone (954) 755-5900

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1413244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413244800000",
    "number": "1235533696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277597",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330277597",
            "telephone_number": "800-437-2672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 SHERIDAN ST",
            "address_2": "SUITE 200",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330212834",
            "telephone_number": "954-447-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PAIN SOLUTIONS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-14",
        "last_updated": "2014-10-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LOWELL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-447-5206",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.