Prestige Spine Interventional Pain Management, LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

PRESTIGE SPINE INTERVENTIONAL PAIN MANAGEMENT, LLC

Practice address

650 United Dr Ste 340
Conway, AR 72032-7826

Phone

(501) 358-6791

NPI assigned

Aug 21, 2020

Organization subpart

No

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

Authorized official

Name

April Johnson, MEMBER

Title

Member

Phone

(501) 993-8300

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JFICCD

Practitioners 5

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

• Taylor Barger, APRN

  • Acute Care Nurse Practitioner
  • Sherwood, AR
  • NPI 1407696123
  Medicare reassignment Care Compare group NPD
• Daniel Thornton Judkins, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Conway, AR
  • NPI 1447518840
  Medicare reassignment Care Compare group NPD
• Sheffield Kent, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Conway, AR
  • NPI 1679831440

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Desiree D Herman, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Russellville, AR
  • NPI 1932591179
  Medicare reassignment NPD
• Allysa Mayo, FNP-C

  • Family Nurse Practitioner
  • Conway, AR
  • NPI 1114777257
  Medicare reassignment NPD

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

{
    "created_epoch": "1597968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1265044119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 UNITED DR STE 340",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720327826",
            "telephone_number": "501-993-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 UNITED DR STE 340",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720327826",
            "telephone_number": "501-358-6791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTIGE SPINE INTERVENTIONAL PAIN MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-21",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "APRIL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "501-993-8300",
        "authorized_official_credential": "MEMBER"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Power Spine & Sport PA
• PPG Store 6 LLC
• Sloane Ashton Precure, PA-C
• Allison Mae Predmore, RN
• Amanda Blair Presley, LCSW
• Anna Price
• Daniel Lee Price, MD
• Kashanna Price
• Niah Pridgeon
• Jon Priest, LPE

• Interventional Pain Medicine Physician in Conway, AR
• Providers in Conway, AR by specialty
• Interventional Pain Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.