Professional Physicians Pain Services, LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

PROFESSIONAL PHYSICIANS PAIN SERVICES, LLC

Doing business as

Professional Pain Physicians

Practice address

10012 Kennerly Rd
Suite 404
Saint Louis, MO 63128-2197

Phone

(314) 729-7100

Fax

(314) 729-0292

NPI assigned

Oct 23, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Michael Scott Boedefeld, M.D.

Title

Partner

Phone

(314) 729-7100

Specialties & licenses 1

Addresses

Other names 1

• Professional Pain Physicians Doing business as

Tax ID family

Professional Pain Physicians2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Professional Physician Pain Services, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Saint Peters, MO
  • NPI 1871729723
  NPD tax ID

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258329600000",
    "number": "1487980660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31434",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631310434",
            "telephone_number": "314-729-7100",
            "fax_number": "314-729-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10012 KENNERLY RD",
            "address_2": "SUITE 404",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631282197",
            "telephone_number": "314-729-7100",
            "fax_number": "314-729-0292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL PHYSICIANS PAIN SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-11-16",
        "status": "A",
        "authorized_official_last_name": "BOEDEFELD",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "314-729-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Professional Pain Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Robert Cory Proffer, PHYSICIAN ASSISTANT
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• Pain Medicine (Anesthesiology) Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Pain Medicine (Anesthesiology) Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2009; 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.