Pro Pain LLC
Organization Active NPI Interventional Pain Medicine Physician · Saint Peters, MO
NPI 1235965401 · NPPES record last updated Sep 12, 2024
Key facts
- NPI
- 1235965401
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Interventional Pain Medicine Physician 208VP0014X
- Legal business name
- PRO PAIN LLC
- Practice address
- 114 Piper Hill Dr Ste 103
Saint Peters, MO 63376-1661 - Phone
- (636) 442-5035
- NPI assigned
- Sep 12, 2024
- Organization subpart
- No
Authorized official
- Name
- Chad Conrad Shelton, MD
- Title
- Owner
- Phone
- (636) 442-5035
Other NPIs with the same Medicare PAC ID 1
Practitioners 9
-
Jennifer Lynn Moyes, FNP
-
Calvin Gerard Cajigal, M.D.
-
Jihan Wray Clay, P.A.-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241111002064 | MO | DME Supplier - Physician - Interventional Pain Management | 0941563225 | Practice locations: Saint Peters, MO |
National Provider Directory
Locations
1055 Bowles Ave
Ste 202
Fenton, MO 63026
Phone (636) 326-7821
114 Piper Hill Dr
Saint Peters, MO 63376
Phone (314) 895-3828
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician |
208VP0014X | Yes |
Addresses
Primary practice location
114 Piper Hill Dr Ste 103
Saint Peters, MO 63376-1661
Mailing address
114 Piper Hill Dr Ste 103
Saint Peters, MO 63376-1661
NPI Registry JSON
{
"created_epoch": "1726099200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1726099200000",
"number": "1235965401",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "114 PIPER HILL DR STE 103",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 PIPER HILL DR STE 103",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633761661",
"telephone_number": "636-442-5035"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRO PAIN LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-09-12",
"last_updated": "2024-09-12",
"certification_date": "2024-09-12",
"status": "A",
"authorized_official_last_name": "SHELTON",
"authorized_official_first_name": "CHAD",
"authorized_official_middle_name": "CONRAD",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "636-442-5035",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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All providers in Saint Peters, MO · Interventional Pain Medicine Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.