NPIMap

Organization Active NPI

Midwest Pain Institute Center for Minimally Invasive Spine PC

  • Interventional Pain Medicine Physician
  • Carmel, IN
National Provider Identifier
1497785273
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
MIDWEST PAIN INSTITUTE CENTER FOR MINIMALLY INVASIVE SPINE PC
Practice address
12289 Hancock St Ste 34
Carmel, IN 46032-5888
Phone
(317) 815-8950
Fax
(317) 815-8951
NPI assigned
Jul 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Sharyl Jo Border, PHD
Title
Practice Administrator
Phone
(317) 815-8950

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

12289 Hancock St Ste 34
Carmel, IN 46032-5888

Mailing address

12289 Hancock St
Ste 34
Carmel, IN 46032-5801
Phone (317) 815-8950

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050228000980 IN Part B Supplier - Clinic/Group Practice 5597718791 Receives reassigned benefits from 2 practitioners
Practice locations: Carmel, IN
O20100930054302 IN DME Supplier - Physician - General Practice 5597718791 Practice locations: Carmel, IN

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
15D2010985Midwest Pain Institute Ctr for Minimally Invasive12289 Hancock St, Ste 34, Carmel, IN 46032Certificate of waiverAug 9, 2026

National Provider Directory

National Provider Directory

Locations

1126 Reliable Pkwy
Chicago, IL 60686

12289 Hancock St
Ste 34
Carmel, IN 46032
Phone (317) 815-8950

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15200/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 7

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": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1497785273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12289 HANCOCK ST",
            "address_2": "STE 34",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325801",
            "telephone_number": "317-815-8950",
            "fax_number": "317-815-8951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12289 HANCOCK ST STE 34",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325888",
            "telephone_number": "317-815-8950",
            "fax_number": "317-815-8951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PAIN INSTITUTE CENTER FOR MINIMALLY INVASIVE SPINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A",
        "authorized_official_last_name": "BORDER",
        "authorized_official_first_name": "SHARYL",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "317-815-8950",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.