NPIMap

Organization Active NPI

Interventional Pain Management LLC

  • Ambulatory Surgical Clinic/Center
  • La Porte, IN
National Provider Identifier
1306274097
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
INTERVENTIONAL PAIN MANAGEMENT LLC
Practice address
208 Legacy PLZ W
La Porte, IN 46350-5285
Phone
(219) 326-7246
Fax
(219) 326-7234
NPI assigned
Oct 16, 2013
Organization subpart
Yes
Parent organization
INTERVENTIONAL PAIN MANAGEMENT LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Authorized official

Name
Ujwala S Puranik
Title
Administrator
Phone
(630) 391-3994

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X Primary

Addresses

Primary practice location

208 Legacy PLZ W
La Porte, IN 46350-5285

Mailing address

208 Legacy PLZ W
La Porte, IN 46350-5285
Phone (219) 326-7246

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20260528003097 IN Part B Supplier - Ambulatory Surgical Center 3274768692 Receives reassigned benefits from 6 practitioners
Practice locations: La Porte, IN

Hospital certification: CCN 150188

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
INTERVENTIONAL PAIN MANAGEMENT LLC
Certification status
Terminated Voluntary: merger or closure, Dec 31, 2021
Provider type (POS)
Hospital – Short-term
Participating since
May 21, 2020
Last certification
May 21, 2020
Beds
1
Ownership / control type
Private (for profit)
Facility address
208 Legacy Plaza West
La Porte, IN 46350

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Interventional Pain Management LLCCCN 15C0001191
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
Interventional Pain Management LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

208 Legacy Plz W
Laporte, IN 46350
Phone (219) 326-7246

Practitioners & affiliated clinicians

Practitioners 7

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": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738540800000",
    "number": "1306274097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 LEGACY PLZ W",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463505285",
            "telephone_number": "219-326-7246",
            "fax_number": "219-326-7234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 LEGACY PLZ W",
            "city": "LA PORTE",
            "state": "IN",
            "postal_code": "463505285",
            "telephone_number": "219-326-7246",
            "fax_number": "219-326-7234"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN MANAGEMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERVENTIONAL PAIN MANAGEMENT LLC",
        "enumeration_date": "2013-10-16",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A",
        "authorized_official_last_name": "PURANIK",
        "authorized_official_first_name": "UJWALA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "630-391-3994"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Porte, IN

Sources for this page

Verify at the official NPI Registry.