NPIMap

Organization Active NPI

Blue Water Pain Solutions, PA

  • Pain Medicine (Anesthesiology) Physician
  • Lauderdale Lakes, FL
National Provider Identifier
1386059517
Registry record updated Jun 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
BLUE WATER PAIN SOLUTIONS, PA
Practice address
4850 W Oakland Park Blvd
Suite 201
Lauderdale Lakes, FL 33313-7260
Phone
(954) 447-5206
NPI assigned
Jun 26, 2014
Last updated
Jun 26, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2014

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

Authorized official

Name
Dr. Lowell S. Davis, D.O.NPI 1114907409
Title
President
Phone
(954) 447-5206

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

4850 W Oakland Park Blvd
Suite 201
Lauderdale Lakes, FL 33313-7260

Mailing address

PO Box 277597
Miramar, FL 33027-7597
Phone (954) 447-5206

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150330001869 FL Part B Supplier - Clinic/Group Practice 0143547232 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Weston, FL; Plantation, FL; Pembroke Pines, FL; Miramar, FL; Boca Raton, FL; Hollywood, FL; Lauderdale Lakes, FL

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2052884Blue Water Pain Solutions4850 W Oakland Park Blvd Ste 201, Lauderdale Lakes, FL 33313Certificate of waiverJan 21, 2027

National Provider Directory

National Provider Directory
Tax ID family
Blue Water Pain Solutions P5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1403740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403740800000",
    "number": "1386059517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277597",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330277597",
            "telephone_number": "954-447-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4850 W OAKLAND PARK BLVD",
            "address_2": "SUITE 201",
            "city": "LAUDERDALE LAKES",
            "state": "FL",
            "postal_code": "333137260",
            "telephone_number": "954-447-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER PAIN SOLUTIONS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-26",
        "last_updated": "2014-06-26",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LOWELL",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "954-447-5206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lauderdale Lakes, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2014; 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.