Southern Interventional Pain Center LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

SOUTHERN INTERVENTIONAL PAIN CENTER LLC

Practice address

615 S Hansell St
Thomasville, GA 31792-5556

Phone

(229) 226-2234

NPI assigned

May 22, 2015

Organization subpart

No

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

Authorized official

Name

Dr. Maximilian Shokat, D.O.NPI 1659559789

Title

Medical Director

Phone

(229) 226-2234

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, FL3 enrollments

Enrollment records 3

Other NPIs with the same Medicare PAC ID 1

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

• Southern Interventional Pain Center LLC

  • Interventional Pain Medicine Physician
  • Lake City, FL
  • NPI 1063971596

  9436460318

  Same PAC ID

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

CLIA laboratory certificates

Locations

Practitioners 6

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

• Maximilian Shahryar Shokat, D.O.

  • Interventional Pain Medicine Physician
  • Thomasville, GA
  • NPI 1659559789

  FL

  Medicare reassignment Care Compare group NPD Authorized official
• Randy E. Lane, PA

  • Physician Assistant
  • Albany, GA
  • NPI 1578965208
  Medicare reassignment Care Compare group NPD
• Roger Jerome Pierce Jr., APRN, FNP-C

  • Family Nurse Practitioner
  • Thomasville, GA
  • NPI 1578347761

  FL

  Medicare reassignment Care Compare group NPD
• Jonathan D Tarin, NP-C

  • Family Medicine Physician
  • Thomasville, GA
  • NPI 1790312387

  FL, Pain Medicine

  Medicare reassignment Care Compare group NPD
• Dominique Maria Ferro Greene, DNP, ACNPC-AG

  • Nurse Practitioner
  • Gainesville, FL
  • NPI 1902334626
  Medicare reassignment Care Compare group NPD
• William L Dougherty, PAC

  • Physician Assistant
  • Thomasville, GA
  • NPI 1063520880
  Medicare reassignment NPD

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1306225479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S HANSELL ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925556",
            "telephone_number": "229-226-2234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S HANSELL ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925556",
            "telephone_number": "229-226-2234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2056 Centre Pointe Ln",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323084300",
            "country_code": "US",
            "telephone_number": "850-404-9400",
            "fax_number": "855-313-1262",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "619 SW Baya Dr Ste 102",
            "address_purpose": "LOCATION",
            "city": "Lake City",
            "state": "FL",
            "postal_code": "320254204",
            "country_code": "US",
            "telephone_number": "386-361-3400 x38636",
            "fax_number": "855-313-1262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN INTERVENTIONAL PAIN CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "SHOKAT",
        "authorized_official_first_name": "MAXIMILIAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "229-226-2234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; 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.