Interventional Pain Specialists of Nwa, PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

INTERVENTIONAL PAIN SPECIALISTS OF NWA, PLLC

Practice address

509 E Millsap Rd Ste 109
Fayetteville, AR 72703-4862

Phone

(479) 595-8192

Fax

(479) 442-1748

NPI assigned

Feb 24, 2011

Organization subpart

No

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

Authorized official

Name

Miss Loddie Conway

Title

Receptionist

Phone

(479) 595-8192

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Practitioners 4

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

• Jared Ennis, MD

  • Interventional Pain Medicine Physician
  • Fayetteville, AR
  • NPI 1467539155
  Medicare reassignment Care Compare group NPD
• Louanna Dawn Watts, NP

  • Nurse Practitioner
  • Springdale, AR
  • NPI 1750101655
  Medicare reassignment Care Compare group NPD
• Jason Holt, MD

  • Interventional Pain Medicine Physician
  • Fayetteville, AR
  • NPI 1932328267
  Medicare reassignment NPD
• Samantha Breyfogle, LPC, LMFT

  • Mental Health Counselor
  • Fayetteville, AR
  • NPI 1922836394
  NPD

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

{
    "created_epoch": "1298505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298505600000",
    "number": "1295032407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 E MILLSAP RD STE 109",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034862",
            "telephone_number": "479-595-8192",
            "fax_number": "479-442-1748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 E MILLSAP RD STE 109",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034862",
            "telephone_number": "479-595-8192",
            "fax_number": "479-442-1748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN SPECIALISTS OF NWA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-24",
        "last_updated": "2011-02-24",
        "status": "A",
        "authorized_official_last_name": "CONWAY",
        "authorized_official_first_name": "LODDIE",
        "authorized_official_title_or_position": "RECEPTIONIST",
        "authorized_official_telephone_number": "479-595-8192",
        "authorized_official_name_prefix": "Miss"
    },
    "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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• Into the Wild
• Robert A Irwin, MD
• Lucien Nahum Isaac, LPC
• Frederick Michael Isaacson, D.O.
• Aneeqa Ishtiaq, M.S., LPC

• Interventional Pain Medicine Physician in Fayetteville, AR
• Providers in Fayetteville, 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 Feb 24, 2011; 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.