Organization Active NPI

Richmond Interventional Pain Management PC

  • Pain Medicine (Anesthesiology) Physician
  • Staten Island, NY
National Provider Identifier
1477912822
Registry record updated Feb 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
RICHMOND INTERVENTIONAL PAIN MANAGEMENT PC
Practice address
2066 Richmond Ave Ste 202
Staten Island, NY 10314-3961
Phone
(718) 698-3900
Fax
(855) 564-5600
NPI assigned
Feb 14, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2017

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

Authorized official

Name
Marianne Dwyer
Title
Practice Manager
Phone
(718) 698-3900

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

2066 Richmond Ave Ste 202
Staten Island, NY 10314-3961

Mailing address

2066 Richmond Ave Ste 202
Staten Island, NY 10314-3961
Phone (718) 698-3900

Other names 1

  • Richmond Interventional Pain Management Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170213000989 NY Part B Supplier - Clinic/Group Practice 4183907405 Receives reassigned benefits from 2 practitioners
Practice locations: Staten Island, NY

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
33D2088390Richmond Interventional Pain Management2066 Richmond Avenue, Suite 202, Staten Island, NY 10314Certificate of waiverDec 14, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1455408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487203200000",
    "number": "1477912822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2066 RICHMOND AVE STE 202",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143961",
            "telephone_number": "718-698-3900",
            "fax_number": "855-564-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2066 RICHMOND AVE STE 202",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103143961",
            "telephone_number": "718-698-3900",
            "fax_number": "855-564-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHMOND INTERVENTIONAL PAIN MANAGEMENT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-14",
        "last_updated": "2017-02-16",
        "status": "A",
        "authorized_official_last_name": "DWYER",
        "authorized_official_first_name": "MARIANNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "718-698-3900"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Richmond Interventional Pain Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Staten Island, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2017; 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.