NPIMap

Organization Active NPI

Comprehensive Pain Rehab of Southern Indiana LLC

  • Pain Medicine Physician
  • Bloomington, IN
National Provider Identifier
1578870879
Registry record updated Sep 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
Legal business name
COMPREHENSIVE PAIN REHAB OF SOUTHERN INDIANA LLC
Practice address
2920 McIntire Drive
Suite 150B
Bloomington, IN 47403-4213
Phone
(812) 333-7246
Fax
(812) 333-4471
NPI assigned
Sep 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2010

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

Authorized official

Name
Derk Frasier
Title
Owner
Phone
(812) 333-7246

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X IN
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X IN Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X IN
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X IN

Addresses

Primary practice location

2920 McIntire Drive
Suite 150B
Bloomington, IN 47403-4213

Mailing address

2920 McIntire Drive
Suite 150B
Bloomington, IN 47403-4213
Phone (812) 333-7246

Other names 1

  • Pain Management Surgery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Comprehensive Pain Rehab of Southern Indiana LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1283904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1283904000000",
    "number": "1578870879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 MCINTIRE DRIVE",
            "address_2": "SUITE 150B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034213",
            "telephone_number": "812-333-7246",
            "fax_number": "812-333-4471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 MCINTIRE DRIVE",
            "address_2": "SUITE 150B",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034213",
            "telephone_number": "812-333-7246",
            "fax_number": "812-333-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PAIN REHAB OF SOUTHERN INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-08",
        "last_updated": "2010-09-08",
        "status": "A",
        "authorized_official_last_name": "FRASIER",
        "authorized_official_first_name": "DERK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-333-7246"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pain Management Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2010; 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.