NPIMap

Organization Active NPI

Pain Clinic Associates PLLC

  • Interventional Pain Medicine Physician
  • Southaven, MS
National Provider Identifier
1306496567
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN CLINIC ASSOCIATES PLLC
Practice address
7600 Airways Blvd Ste a
Southaven, MS 38671-5138
Phone
(901) 747-0040
Fax
(901) 747-0038
NPI assigned
Sep 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Authorized official

Name
Ray Saunders
Title
Practice Administrator
Phone
(901) 507-1595

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

7600 Airways Blvd Ste a
Southaven, MS 38671-5138

Mailing address

PO Box 931320
Atlanta, GA 31193-1320

Other practice location 1

7600 Airways Blvd Ste E
Southaven, MS 38671-5138
Phone (901) 747-0040

Other identifiers 1

IdentifierTypeStateIssuer
1306496567OtherMSNPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191204002513 MS Part B Supplier - Clinic/Group Practice 4486610664 Receives reassigned benefits from 5 practitioners
Practice locations: Southaven, MS

Other NPIs with the same Medicare PAC ID 1

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

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
25D2173998Pain Clinic Associates PLLC7600 Airways Blvd Ste a, Southaven, MS 38671Certificate of waiverOct 21, 2027
44D2036251Pain Clinic Associates PLLC7600 Airways Blvd Ste E, Southaven, MS 38671ComplianceSep 30, 2027

National Provider Directory

National Provider Directory

Locations

7600 Airways Blvd
Ste C
Southaven, MS 38671
Phone (901) 683-4600

7600 Airways Blvd
Ste E
Southaven, MS 38671

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1568764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1306496567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 931320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "311931320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 AIRWAYS BLVD STE A",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386715138",
            "telephone_number": "901-747-0040",
            "fax_number": "901-747-0038"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7600 Airways Blvd Ste E",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386715138",
            "country_code": "US",
            "telephone_number": "901-747-0040",
            "fax_number": "901-747-0038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAIN CLINIC ASSOCIATES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-18",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "SAUNDERS",
        "authorized_official_first_name": "RAY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "901-507-1595"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1306496567",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; 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.