Advanced Pain Management Clinic, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

OS8432 Issued in FL

Legal business name

ADVANCED PAIN MANAGEMENT CLINIC, LLC

Practice address

5757 Booth Road
BLDG 100
Jacksonville, FL 32207

Phone

(904) 683-2596

Fax

(904) 683-2597

NPI assigned

Aug 11, 2009

Last updated

Jul 26, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael S Willens, D.O.NPI 1932159381

Title

President

Phone

(904) 635-5555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

Tax ID family

Advanced Pain Management Clinic Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Advanced Pain Management Clinic, Inc

  • Pain Medicine (Anesthesiology) Physician
  • Jacksonville, FL
  • NPI 1255565388
  NPD tax ID

Locations

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.

• Michael Scott Willens, D.O.

  • Interventional Pain Medicine Physician
  • Jacksonville, FL
  • NPI 1932159381
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1249948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280102400000",
    "number": "1316179245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 BOOTH ROAD",
            "address_2": "BLDG 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32207",
            "telephone_number": "904-683-2596",
            "fax_number": "904-683-2597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 BOOTH ROAD",
            "address_2": "BLDG 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32207",
            "telephone_number": "904-683-2596",
            "fax_number": "904-683-2597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PAIN MANAGEMENT CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-11",
        "last_updated": "2010-07-26",
        "status": "A",
        "authorized_official_last_name": "WILLENS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-635-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": "OS8432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Medical Centers LLC
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• Advanced Medical Health Center, Inc (Advanced Medical Health Clinic)
• Advanced Otolaryngology Services PA
• Advanced Pain Management Clinic, Inc
• Advanced Pain Management Group, Inc.
• Advanced Pediatric Care
• Advanced Vascular Resources of Jacksonville, LLC
• Advanced Wound Care of North Florida, LLC
• Pooja Prem Advani, MD

• Pain Medicine (Anesthesiology) Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pain Medicine (Anesthesiology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; 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.