NPIMap

Organization Active NPI

Gulf Coast Pain Consultants LLC

Doing business as Clearway Pain Solutions Institute

  • Pain Medicine (Anesthesiology) Physician
  • Pensacola, FL
National Provider Identifier
1265099386
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
GULF COAST PAIN CONSULTANTS LLC
Doing business as
Clearway Pain Solutions Institute
Practice address
10437 Sorrento Rd Ste 203
Pensacola, FL 32507-7620
Phone
(850) 484-4080
Fax
(850) 484-8801
NPI assigned
May 23, 2019
Last updated
Jan 31, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Authorized official

Name
Kacey A Montgomery, MDNPI 1447455977
Title
Medical Director
Phone
(850) 791-6895

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

Addresses

Primary practice location

10437 Sorrento Rd Ste 203
Pensacola, FL 32507-7620

Mailing address

201 Defense Hwy Ste 205
Annapolis, MD 21401-7096
Phone (855) 527-7246

Other names 1

  • Clearway Pain Solutions Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130326000183 FL Part B Supplier - Clinic/Group Practice 1658516570 Receives reassigned benefits from 50 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Niceville, FL; Sarasota, FL; Pensacola, FL; Panama City, FL; Pace, FL; Navarre, FL; Fort Walton Beach, FL; Defuniak Springs, FL…
O20201007000286 FL DME Supplier - Multi-Specialty - Physician 1658516570 Practice locations: Pensacola, FL

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

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
10D2169507Clearway Pain Solutions Institute10437 Sorrento Rd Unit 203, Pensacola, FL 32507Certificate of waiverJul 22, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1558569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1265099386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DEFENSE HWY STE 205",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017096",
            "telephone_number": "855-527-7246",
            "fax_number": "833-810-1165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10437 SORRENTO RD STE 203",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325077620",
            "telephone_number": "850-484-4080",
            "fax_number": "850-484-8801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PAIN CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-23",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "KACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "850-791-6895",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.