NPIMap

Organization Active NPI

Southern Interventional Pain Center LLC

  • Interventional Pain Medicine Physician
  • Tallahassee, FL
National Provider Identifier
1407315948
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
SOUTHERN INTERVENTIONAL PAIN CENTER LLC
Practice address
1931 Welby Way Ste 4
Tallahassee, FL 32308-4473
Phone
(850) 404-9400
Fax
(855) 313-1262
NPI assigned
Mar 14, 2019
Organization subpart
Yes
Parent organization
SOUTHERN INTERVENTIONAL PAIN CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Authorized official

Name
Dr. Maximilian Shahryar Shokat, DONPI 1659559789
Title
Managing Member
Phone
(229) 226-2234

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

1931 Welby Way Ste 4
Tallahassee, FL 32308-4473

Mailing address

615 S Hansell St
Thomasville, GA 31792-5556
Phone (229) 226-2234

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address drshokat@sipaincenter.com Direct

National Provider Directory

National Provider Directory
Part of
Southern Interventional

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1552521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1407315948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 S HANSELL ST",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317925556",
            "telephone_number": "229-226-2234",
            "fax_number": "229-226-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1931 WELBY WAY STE 4",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084473",
            "telephone_number": "850-404-9400",
            "fax_number": "855-313-1262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN INTERVENTIONAL PAIN CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN INTERVENTIONAL PAIN CENTER LLC",
        "enumeration_date": "2019-03-14",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "SHOKAT",
        "authorized_official_first_name": "MAXIMILIAN",
        "authorized_official_middle_name": "SHAHRYAR",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "229-226-2234",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "drshokat@sipaincenter.com",
            "affiliation": "N",
            "endpointDescription": "practice email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2056 Centre Pointe Ln",
            "city": "Tallahassee",
            "state": "FL",
            "country_code": "US",
            "postal_code": "323084300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.