NPIMap

Individual provider Active NPI

Dean Stanley Collis, MD

  • Pain Medicine Physician
  • Louisville, KY
National Provider Identifier
1477560530
Registry record updated Jun 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
32071 Issued in KY
Practice address
315 E Broadway
Ste 250
Louisville, KY 40202-3700
Phone
(502) 589-4765
Fax
(502) 589-4799
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 32071 KY Primary

Addresses

Primary practice location

315 E Broadway
Ste 250
Louisville, KY 40202-3700

Mailing address

315 E Broadway
Ste 250
Louisville, KY 40202-3700
Phone (502) 589-4765

Other identifiers 5

IdentifierTypeStateIssuer
20232790AMedicaidIN
0007332133OtherAETNA
1103006MedicaidKY
64320716MedicaidKY
000000065792OtherANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070119000155 KY Practitioner - Interventional Pain ManagementPractitioner - Anesthesiology 9234180415 Reassigns benefits to 1 organization
I20070314000036 IN Practitioner - Pain ManagementPractitioner - Anesthesiology 9234180415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
University of Louisville School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Interventional Rehabilitation of Kentucky PSCGroup PAC ID 6103850482, 2 clinicians

Practice addresses (Care Compare)

315 E Broadway
Louisville, KY 40202-3703
Phone (502) 589-4765

360 Missouri Ave
Suite 102
Jeffersonville, IN 47130-3013
Phone (812) 722-1480

Hospital & facility affiliations

  • Norton Hospitals, Inc Hospital, Louisville, KY, CCN 180088

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Interventional Rehabilitation of Kentucky, P.S.C Pain Medicine CurrentSince Aug 1, 1999 Accepting new patients

Locations

360 Missouri Ave
Ste 102
Jeffersonvlle, IN 47130
Phone (502) 364-0902

315 E Broadway
Ste 250
Louisville, KY 40202
Phone (502) 583-5015

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213228800000",
    "number": "1477560530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 E BROADWAY",
            "address_2": "STE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023700",
            "telephone_number": "502-589-4765",
            "fax_number": "502-589-4799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 E BROADWAY",
            "address_2": "STE 250",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402023700",
            "telephone_number": "502-589-4765",
            "fax_number": "502-589-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLIS",
        "first_name": "DEAN",
        "middle_name": "STANLEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2008-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "KY",
            "license": "32071",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20232790A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007332133",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1103006",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64320716",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000065792",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.