NPIMap

Organization Active NPI

Interventional Pain Center, PLLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Hendersonville, TN
National Provider Identifier
1285976407
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
DO0000002339 Issued in TN
Legal business name
INTERVENTIONAL PAIN CENTER, PLLC
Practice address
353 New Shackle Island Rd Ste 148C
Hendersonville, TN 37075-2366
Phone
(615) 972-1000
Fax
(615) 537-4950
NPI assigned
Mar 26, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Dr. Brad Paul Wilson, DONPI 1205002227
Title
President
Phone
(615) 972-1100

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 (Physical Medicine & Rehabilitation) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2081P2900X DO0000002339 TN Primary

Addresses

Primary practice location

353 New Shackle Island Rd Ste 148C
Hendersonville, TN 37075-2366

Mailing address

353 New Shackle Island Rd
Suite 101-a
Hendersonville, TN 37075-2379
Phone (615) 972-1100

Other identifiers 1

IdentifierTypeStateIssuer
1531251MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130617000365 TN Part B Supplier - Clinic/Group Practice 8628217973 Receives reassigned benefits from 8 practitioners
Practice locations: Hendersonville, TN; Nashville, TN
O20130906000510 TN DME Supplier - Physician - General PracticeDME Supplier - Physician - Physical and Rehabilitation 8628217973 Practice locations: Hendersonville, TN

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1364256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1285976407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "353 NEW SHACKLE ISLAND RD",
            "address_2": "SUITE 101-A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752379",
            "telephone_number": "615-972-1100",
            "fax_number": "615-537-4950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 NEW SHACKLE ISLAND RD STE 148C",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752366",
            "telephone_number": "615-972-1000",
            "fax_number": "615-537-4950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-26",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-972-1100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "TN",
            "license": "DO0000002339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1531251",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.