Pain Management of North Idaho, PLLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

M7860 Issued in ID

Legal business name

PAIN MANAGEMENT OF NORTH IDAHO, PLLC

Practice address

1686 W Riverstone Dr
Ste 1
Coeur D Alene, ID 83814-5779

Phone

(208) 765-4807

Fax

(208) 765-2903

NPI assigned

Mar 7, 2007

Organization subpart

No

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

Authorized official

Name

Tina Marie Botai

Title

Practice Administrator

Phone

(208) 765-4807

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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 6

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

• Denise Christine Love, ARNP

  • Nurse Practitioner
  • Coeur D Alene, ID
  • NPI 1972944866
  Medicare reassignment Care Compare group NPD
• Scott Karl Magnuson, MD

  • Pain Medicine (Anesthesiology) Physician
  • Coeur D Alene, ID
  • NPI 1174593404
  Medicare reassignment Care Compare group NPD
• Denise Struhs, ARNP

  • Nurse Practitioner
  • Coeur D Alene, ID
  • NPI 1114763489
  Medicare reassignment Care Compare group NPD
• Clinton M Thome, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Coeur D Alene, ID
  • NPI 1558654756
  Medicare reassignment Care Compare group NPD
• Regina Marie Kendra

  • Nurse Practitioner
  • Coeur D Alene, ID
  • NPI 1790192284
  Medicare reassignment Care Compare group
• Reva Gay Reese, FNP

  • Family Nurse Practitioner
  • Fairchild Afb, WA
  • NPI 1578996740

  ID

  Medicare reassignment NPD

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750896000000",
    "number": "1467583153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1686 W RIVERSTONE DR",
            "address_2": "STE 1",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145779",
            "telephone_number": "208-765-4807",
            "fax_number": "866-573-0853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 W RIVERSTONE DR",
            "address_2": "STE 1",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145779",
            "telephone_number": "208-765-4807",
            "fax_number": "208-765-2903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MANAGEMENT OF NORTH IDAHO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-07",
        "last_updated": "2025-06-26",
        "certification_date": "2025-06-26",
        "status": "A",
        "authorized_official_last_name": "BOTAI",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "208-765-4807"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "ID",
            "license": "M7860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pacifica L 44 LLC
• Pacifica Sherman LLC
• Jeanna Padilla, CPNP-PC
• Tye Padilla, DMD
• Shadell Padmore
• Erin Anne Paisley
• Paladin Services, LLC
• Angela Marie Palmer, CADC
• John Ryan Palmer, LMSW
• Matthew David Palmer, NP

• Interventional Pain Medicine Physician in Coeur D Alene, ID
• Providers in Coeur D Alene, ID by specialty
• Interventional Pain Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; 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.