NPIMap

Organization Active NPI

Advanced Pain Management Clinic, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Jacksonville, FL
National Provider Identifier
1255565388
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
OS8432 Issued in FL
Legal business name
ADVANCED PAIN MANAGEMENT CLINIC, INC
Practice address
5757 Booth Rd
Building 100
Jacksonville, FL 32207-5980
Phone
(904) 683-2596
Fax
(904) 683-2597
NPI assigned
May 4, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Authorized official

Name
Dr. Michael Scott Willens, D.O.NPI 1932159381
Title
President
Phone
(904) 635-5555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X OS8432 FL Primary

Addresses

Primary practice location

5757 Booth Rd
Building 100
Jacksonville, FL 32207-5980

Mailing address

5757 Booth Rd
Building 100
Jacksonville, FL 32207-5980
Phone (904) 683-2596

National Provider Directory

National Provider Directory
Tax ID family
Advanced Pain Management Clinic LLC2 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.

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": "1241395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349049600000",
    "number": "1255565388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 BOOTH RD",
            "address_2": "BUILDING 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075980",
            "telephone_number": "904-683-2596",
            "fax_number": "904-683-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 BOOTH RD",
            "address_2": "BUILDING 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322075980",
            "telephone_number": "904-683-2596",
            "fax_number": "904-683-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PAIN MANAGEMENT CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-04",
        "last_updated": "2012-10-01",
        "status": "A",
        "authorized_official_last_name": "WILLENS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-635-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "OS8432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.