NPIMap

Organization Active NPI

Choice Pain & Rehabilitation Center, LLC

  • Physical Medicine & Rehabilitation Physician
  • Lanham, MD
National Provider Identifier
1568809598
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
CHOICE PAIN & REHABILITATION CENTER, LLC
Practice address
7404 Executive PL Ste 503
Lanham, MD 20706-2268
Phone
(240) 786-1001
NPI assigned
May 31, 2013
Last updated
Jan 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Authorized official

Name
Dr. Tristan Julian Shockley, M.D.NPI 1932242542
Title
Medical Director
Phone
(240) 786-1001

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary
Interventional Pain Medicine Physician 208VP0014X

Addresses

Primary practice location

7404 Executive PL Ste 503
Lanham, MD 20706-2268

Mailing address

8843 Greenbelt Rd Ste 117
Greenbelt, MD 20770-2451
Phone (240) 786-1001

Other practice location 1

9841 Greenbelt Rd
Suite 208
Lanham, MD 20706-6269
Phone (240) 206-0621

Other practice location 2

7404 Executive Pl Ste 503
Lanham, MD 20706-2268
Phone (240) 786-1001

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD, DE4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20130827000063 DC Part B Supplier - Clinic/Group Practice 1850534645 Receives reassigned benefits from 24 practitioners
Practice locations: Montgomery Village, MD; Oxon Hill, MD; Olney, MD; Lanham, MD; Hyattsville, MD
O20151117003221 MD DME Supplier - Physician - General Practice 1850534645 Practice locations: Lanahm, MD
O20161216001355 MD Part B Supplier - Clinic/Group Practice 1850534645 Receives reassigned benefits from 22 practitioners
Practice locations: Baltimore, MD; Columbia, MD; Dundalk, MD; Rosedale, MD
O20210929002440 DE Part B Supplier - Clinic/Group Practice 1850534645 Receives reassigned benefits from 8 practitioners
Practice locations: Milford, DE; Newark, DE

National Provider Directory

National Provider Directory

Locations

550 S DuPont Blvd
Milford, DE 19963
Phone (302) 424-0600

6475 New Hampshire Ave
Ste 620
Hyattsville, MD 20783

Practitioners & affiliated clinicians

Practitioners 40

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.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1369958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642982400000",
    "number": "1568809598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8843 GREENBELT RD STE 117",
            "city": "GREENBELT",
            "state": "MD",
            "postal_code": "207702451",
            "telephone_number": "240-786-1001",
            "fax_number": "240-786-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7404 EXECUTIVE PL STE 503",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207062268",
            "telephone_number": "240-786-1001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9841 Greenbelt Rd",
            "address_2": "Suite 208",
            "address_purpose": "LOCATION",
            "city": "Lanham",
            "state": "MD",
            "postal_code": "207066269",
            "country_code": "US",
            "telephone_number": "240-206-0621",
            "fax_number": "240-206-6024",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7404 Executive Pl Ste 503",
            "address_purpose": "LOCATION",
            "city": "Lanham",
            "state": "MD",
            "postal_code": "207062268",
            "country_code": "US",
            "telephone_number": "240-786-1001",
            "fax_number": "240-786-1002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHOICE PAIN & REHABILITATION CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-31",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "SHOCKLEY",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_middle_name": "JULIAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "240-786-1001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.