NPIMap

Organization Active NPI

Cordova Pain Specialists, PLLC

Doing business as NorthStar Pain Management

  • Pain Medicine Physician
  • Cordova, TN
National Provider Identifier
1437565900
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
2168 Issued in TN
Legal business name
CORDOVA PAIN SPECIALISTS, PLLC
Doing business as
NorthStar Pain Management
Practice address
1540 Appling Care LN
Suite 105
Cordova, TN 38016-4957
Phone
(901) 444-3950
Fax
(901) 444-3866
NPI assigned
Jul 6, 2014
Last updated
Mar 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Authorized official

Name
John Wyatt Miles, DONPI 1528263647
Title
Authorized Official
Phone
(901) 444-3950

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
Anesthesiology Physician 207L00000X 2168 TN
Pain Medicine Physician 208VP0000X 2168 TN Primary

Addresses

Primary practice location

1540 Appling Care LN
Suite 105
Cordova, TN 38016-4957

Mailing address

1540 Appling Care LN
Suite 105
Cordova, TN 38016-4957
Phone (901) 444-3950

Other practice location 1

905 S Church St
Murfreesboro, TN 37130-4915
Phone (901) 444-3950

Other identifiers 1

IdentifierTypeStateIssuer
1520769MedicaidTN

Other names 2

  • NorthStar Pain Management Doing business as
  • Cordova Pain Specialists, PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140910001813 TN Part B Supplier - Clinic/Group Practice 1759500523 Receives reassigned benefits from 15 practitioners
Practice locations: Cordova, TN

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
44D2081755Cordova Pain Specialists1540 Appling Care LN Ste 105, Cordova, TN 38016AccreditationMay 15, 2028

National Provider Directory

National Provider Directory

Locations

3566 N Highland Ave
Jackson, TN 38305
Phone (901) 444-3950

630 Broadmor St
Ste 120
Murfreesboro, TN 37129
Phone (615) 962-7058

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1404604800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1437565900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 APPLING CARE LN",
            "address_2": "SUITE 105",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380164957",
            "telephone_number": "901-444-3950",
            "fax_number": "901-444-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 APPLING CARE LN",
            "address_2": "SUITE 105",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380164957",
            "telephone_number": "901-444-3950",
            "fax_number": "901-444-3866"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "905 S Church St",
            "address_purpose": "LOCATION",
            "city": "Murfreesboro",
            "state": "TN",
            "postal_code": "371304915",
            "country_code": "US",
            "telephone_number": "901-444-3950",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORDOVA PAIN SPECIALISTS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-06",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "MILES",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WYATT",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "901-444-3950",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "2168",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "TN",
            "license": "2168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1520769",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthStar Pain Management",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cordova Pain Specialists, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Cordova, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; 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.