Physician Associate Interdisciplinary Clinic (Pain-C)

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1805 Issued in TN

Legal business name

PHYSICIAN ASSOCIATE INTERDISCIPLINARY CLINIC (PAIN-C)

Practice address

4131 Kirby Pkwy Ste 1
Kirby-Raines Medical Center
Memphis, TN 38115-3206

Phone

(706) 536-3272

NPI assigned

Aug 23, 2017

Organization subpart

No

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

Authorized official

Name

Maurice Skillern, DMS, PA-CNPI 1073525903

Title

President / Ceo

Phone

(706) 536-3272

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Practitioners 1

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

• Maurice Skillern, DMS-PA

  • Physician Assistant
  • Memphis, TN
  • NPI 1073525903
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1503446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636502400000",
    "number": "1407373210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4131 KIRBY PKWY STE 1",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381156500",
            "telephone_number": "706-536-3272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4131 KIRBY PKWY STE 1",
            "address_2": "KIRBY-RAINES MEDICAL CENTER",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381153206",
            "telephone_number": "706-536-3272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIAN ASSOCIATE INTERDISCIPLINARY CLINIC (PAIN-C)",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-23",
        "last_updated": "2021-11-10",
        "certification_date": "2021-11-10",
        "status": "A",
        "authorized_official_last_name": "SKILLERN",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "706-536-3272",
        "authorized_official_credential": "DMS, PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC NPI NUMBER",
            "identifier": "1407373210",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Memphis, TN
• Providers in Memphis, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 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.