NPIMap

Organization Active NPI

Ic Pain, LLC

  • Anesthesiology Physician
  • Poplar Bluff, MD
National Provider Identifier
1477024743
Registry record updated Dec 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
IC PAIN, LLC
Practice address
Northwest Medical Center
2210 Barron Rd, Suite 203
Poplar Bluff, MD 63901
Phone
(573) 776-0157
Fax
(573) 776-6504
NPI assigned
Dec 16, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2018

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

Authorized official

Name
Kip Cardell Newell, DO
Title
Owner/DO
Phone
(402) 547-9405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

Northwest Medical Center
2210 Barron Rd, Suite 203
Poplar Bluff, MD 63901

Mailing address

Northwest Medical Center
2210 Barron Rd, Suite 203
Poplar Bluff, MD 63901
Phone (573) 776-0157

National Provider Directory

National Provider Directory

Locations

2210 Barron Rd
Ste 203
Poplar Bluff, MO 63901
Phone (573) 686-4133

NPI Registry JSON

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

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544918400000",
    "number": "1477024743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "NORTHWEST MEDICAL CENTER",
            "address_2": "2210 BARRON RD, SUITE 203",
            "city": "POPLAR BLUFF",
            "state": "MD",
            "postal_code": "63901",
            "telephone_number": "573-776-0157",
            "fax_number": "573-776-6504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NORTHWEST MEDICAL CENTER",
            "address_2": "2210 BARRON RD, SUITE 203",
            "city": "POPLAR BLUFF",
            "state": "MD",
            "postal_code": "63901",
            "telephone_number": "573-776-0157",
            "fax_number": "573-776-6504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IC PAIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A",
        "authorized_official_last_name": "NEWELL",
        "authorized_official_first_name": "KIP",
        "authorized_official_middle_name": "CARDELL",
        "authorized_official_title_or_position": "OWNER/DO",
        "authorized_official_telephone_number": "402-547-9405",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; 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.