Collaborative Pain Management, PLLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

COLLABORATIVE PAIN MANAGEMENT, PLLC

Practice address

10400 Eaton PL Ste 312
Fairfax, VA 22030-2208

Phone

(703) 261-6758

Fax

(703) 995-4860

NPI assigned

Dec 7, 2020

Organization subpart

No

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

Authorized official

Name

Michelle Marie Jacques, NPNPI 1194172726

Title

Managing Member

Phone

(703) 261-6758

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

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

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/22660/brand/1/csg/1/fhir/r4

Practitioners 3

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

• Michelle Marie Jacques, RN-BC,AGPCNP-BC,CMT

  • Nurse Practitioner
  • Fairfax, VA
  • NPI 1194172726

  DC

  Medicare reassignment NPD Authorized official
• Oana Balasa

  • Physical Therapist
  • Fairfax, VA
  • NPI 1952421430
  NPD
• Landon Keith Owen, PT

  • Physical Therapist
  • Fairfax, VA
  • NPI 1174523997
  NPD

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1356947295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 EATON PL STE 312",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302208",
            "telephone_number": "703-261-6758",
            "fax_number": "703-995-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 EATON PL STE 312",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302208",
            "telephone_number": "703-261-6758",
            "fax_number": "703-995-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLABORATIVE PAIN MANAGEMENT, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "JACQUES",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "703-261-6758",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nailey Mary Cole, RN
• Eva Coleman, MD
• Lois Nan Coleman, CNP
• Elan Coley
• Francisca D Colindres Reyes
• Claudia Mabel Collado Zabala
• Courtney Lynn Collado, LCSW, CSAC-C
• Lauren Colletti
• Kaitlin Collier, MSW
• Anne Marie Colligan

• Pain Medicine Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pain Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; 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.