NPIMap

Organization Active NPI

Comprehensive Pain Management of the Fox Valley, SC

  • Interventional Pain Medicine Physician
  • Appleton, WI
National Provider Identifier
1497810857
Registry record updated Jan 24, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
36140-20 Issued in WI
Legal business name
COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, SC
Practice address
820 E Grant St
Suite 335
Appleton, WI 54911-3490
Phone
(920) 733-7230
NPI assigned
Dec 26, 2006
Last updated
Jan 24, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2013

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

Authorized official

Name
Alexander E Yakovlev, MDNPI 1497855118
Title
Owner/President
Phone
(920) 733-7230

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207LP2900X 36140-20 WI
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X 36140-20 WI Primary
Durable Medical Equipment & Medical Supplies 332B00000X 36140-20 WI

Addresses

Primary practice location

820 E Grant St
Suite 335
Appleton, WI 54911-3490

Mailing address

100 Theda Clark Medical PLZ
Suite 252
Neenah, WI 54956-2763
Phone (920) 733-7230

Other identifiers 1

IdentifierTypeStateIssuer
34086400MedicaidWI

National Provider Directory

National Provider Directory

Locations

820 E Grant St
Ste 335
Appleton, WI 54911
Phone (920) 733-7230

100 Theda Clark Medical Plz
Ste 252
Neenah, WI 54956
Phone (920) 733-7230

100 Theda Clark Medical Plz
Ste A252
Neenah, WI 54956
Phone (920) 721-9881

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358985600000",
    "number": "1497810857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 THEDA CLARK MEDICAL PLZ",
            "address_2": "SUITE 252",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562763",
            "telephone_number": "920-733-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 E GRANT ST",
            "address_2": "SUITE 335",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113490",
            "telephone_number": "920-733-7230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-26",
        "last_updated": "2013-01-24",
        "status": "A",
        "authorized_official_last_name": "YAKOVLEV",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "920-733-7230",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "WI",
            "license": "36140-20",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "WI",
            "license": "36140-20",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "36140-20",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34086400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2013; 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.