Progressive Pain Management LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

25MA08847600 Issued in NJ

Legal business name

PROGRESSIVE PAIN MANAGEMENT LLC

Practice address

802 W Park Ave Ste 223
Ocean, NJ 07712-8526

Phone

(732) 493-2040

Fax

(732) 493-4582

NPI assigned

Nov 4, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Brian Alwin Bannister, MDNPI 1588815765

Title

Ceo/Member

Phone

(347) 424-6157

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ2 enrollments

Enrollment records 2

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 2

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

• Brian Alwin Bannister, MD

  • Pain Medicine (Anesthesiology) Physician
  • Syracuse, NY
  • NPI 1588815765

  NJ

  Medicare reassignment NPD Authorized official
• Dora Perez, MS, ANP

  • Adult Health Nurse Practitioner
  • New York, NY
  • NPI 1467852251

  NJ

  Medicare reassignment NPD

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

{
    "created_epoch": "1383523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1326477985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 W PARK AVE STE 223",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077128526",
            "telephone_number": "732-493-2040",
            "fax_number": "732-493-4582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 W PARK AVE STE 223",
            "city": "OCEAN",
            "state": "NJ",
            "postal_code": "077128526",
            "telephone_number": "732-493-2040",
            "fax_number": "732-493-4582"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "432 Ocean Blvd",
            "address_purpose": "LOCATION",
            "city": "Long Branch",
            "state": "NJ",
            "postal_code": "077405669",
            "country_code": "US",
            "telephone_number": "347-424-6157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROGRESSIVE PAIN MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-04",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "BANNISTER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "ALWIN",
        "authorized_official_title_or_position": "CEO/MEMBER",
        "authorized_official_telephone_number": "347-424-6157",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NJ",
            "license": "25MA08847600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Pizzo, APN
• Varsha M Pohuja, PT
• Ira S Port, DMD
• Prana Counseling Services, LLC
• Prime Rehabilitation Services, Inc.
• Provision Consultants PC
• Melinda A Pullano, PT
• Vicki E Raab, M.D.
• Robert William Rachlin, DMD
• Brian R Rath, PA

• Pain Medicine (Anesthesiology) Physician in Ocean, NJ
• Providers in Ocean, NJ by specialty
• Pain Medicine (Anesthesiology) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.