NPIMap

Organization Active NPI

Dubuque Pain Clinic

  • Interventional Pain Medicine Physician
  • Dubuque, IA
National Provider Identifier
1467863472
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
34875 Issued in IA
Legal business name
DUBUQUE PAIN CLINIC
Practice address
250 Mercy Dr
Dubuque, IA 52001-7320
Phone
(563) 589-8665
NPI assigned
May 13, 2014
Last updated
May 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Authorized official

Name
Ivan Fomitchev, MDNPI 1699742312
Title
President
Phone
(563) 564-1283

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 34875 IA
Interventional Pain Medicine Physician 208VP0014X 34875 IA Primary

Addresses

Primary practice location

250 Mercy Dr
Dubuque, IA 52001-7320

Mailing address

2260 Samantha Dr
Dubuque, IA 52002-0485

National Provider Directory

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": "1399939200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399939200000",
    "number": "1467863472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2260 SAMANTHA DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520020485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 MERCY DR",
            "city": "DUBUQUE",
            "state": "IA",
            "postal_code": "520017320",
            "telephone_number": "563-589-8665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBUQUE PAIN CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-13",
        "last_updated": "2014-05-13",
        "status": "A",
        "authorized_official_last_name": "FOMITCHEV",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "563-564-1283",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IA",
            "license": "34875",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IA",
            "license": "34875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dubuque, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2014; 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.