NPIMap

Organization Active NPI

Gulf Coast Pain Consultants LLC

Doing business as Clearway Pain Solutions Institute

  • Durable Medical Equipment & Medical Supplies
  • Navarre, FL
National Provider Identifier
1306587241
Registry record updated Feb 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
GULF COAST PAIN CONSULTANTS LLC
Doing business as
Clearway Pain Solutions Institute
Practice address
7552 Navarre Pkwy Unit 54
Navarre, FL 32566-7305
Phone
(855) 527-7246
Fax
(833) 810-1165
NPI assigned
Apr 5, 2022
Last updated
Feb 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2024

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

Authorized official

Name
Kacey A Montgomery, M.D.
Title
Regional Medical Director
Phone
(352) 359-6634

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X NU
Pain Medicine Physician 208VP0000X NU
Interventional Pain Medicine Physician 208VP0014X NU
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

7552 Navarre Pkwy Unit 54
Navarre, FL 32566-7305

Mailing address

201 Defense Hwy Ste 205
Annapolis, MD 21401-7096
Phone (855) 527-7246

Other names 1

  • Clearway Pain Solutions Institute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220511001418 FL DME Supplier - Physician - General Practice 1658516570 Practice locations: Navarre, FL

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Gulf Coast Pain Consultants PLLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707955200000",
    "number": "1306587241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 DEFENSE HWY STE 205",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017096",
            "telephone_number": "855-527-7246",
            "fax_number": "866-229-5063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7552 NAVARRE PKWY UNIT 54",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325667305",
            "telephone_number": "855-527-7246",
            "fax_number": "833-810-1165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF COAST PAIN CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-05",
        "last_updated": "2024-02-15",
        "certification_date": "2024-02-15",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "KACEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "REGIONAL MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "352-359-6634",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clearway Pain Solutions Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Navarre, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.