Kentucky Pain Management Services

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

29445 Issued in KY

Legal business name

KENTUCKY PAIN MANAGEMENT SERVICES

Practice address

311 Roy Campbell Drive
Hazard, KY 41701

Phone

(606) 487-0776

Fax

(606) 487-0777

NPI assigned

Jan 9, 2007

Last updated

Aug 15, 2015By 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

Mr. Phillip R Mullins

Title

Ceo

Phone

(606) 487-0776

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in KY

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

Tax ID family

Kentucky Pain Management Services2 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.

• Kentucky Pain Management Services

  • Specialist
  • Vicco, KY
  • NPI 1588771042
  NPD tax ID

Locations

Practitioners 4

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.

• Robetta Melaine Baker, APRN

  • Family Nurse Practitioner
  • Hazard, KY
  • NPI 1043590227
  Medicare reassignment Care Compare group NPD
• Elizabeth Suzanne Crank, MSN, APRN, RD, LD

  • Nurse Practitioner
  • Hazard, KY
  • NPI 1417153727
  Medicare reassignment Care Compare group NPD
• Thomas E. Karelis Jr., MD

  • Internal Medicine Physician
  • Hazard, KY
  • NPI 1053324129
  Medicare reassignment Care Compare group NPD
• Ionut Stefanescu Sturz, MD

  • Internal Medicine Physician
  • Hazard, KY
  • NPI 1124023973
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439596800000",
    "number": "1376692657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1297",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "41702",
            "telephone_number": "606-487-0776",
            "fax_number": "606-487-0777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 ROY CAMPBELL DRIVE",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "41701",
            "telephone_number": "606-487-0776",
            "fax_number": "606-487-0777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENTUCKY PAIN MANAGEMENT SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2015-08-15",
        "status": "A",
        "authorized_official_last_name": "MULLINS",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "606-487-0776",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "KY",
            "license": "29445",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "29445",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100002910",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS",
            "identifier": "000000509781",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kentucky Medical Services Foundation
• Kentucky Mountain Health Alliance (Kentucky Mountain Health Alliance Pharmacy)
• Kentucky Mountain Health Alliance, Inc.
• Kentucky Mountain Imaging LLC
• Kentucky Mountain Radiology Services PLLC
• Kentucky Pain Physicians
• Kentucky Pain Physicians, PSC
• Kentucky Primary Medical Services LLC
• Kentucky River Area Dev Dist
• Kentucky River Children's Advocacy Center

• Pain Clinic/Center in Hazard, KY
• Providers in Hazard, KY by specialty
• Pain Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2015; 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.