NPIMap

Organization Active NPI

Pain Clinic of Northwestern Wisconsin SC

  • Interventional Pain Medicine Physician
  • Eau Claire, WI
National Provider Identifier
1609844000
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
PAIN CLINIC OF NORTHWESTERN WISCONSIN SC
Practice address
1221 Whipple St
Eau Claire, WI 54703-5270
Phone
(715) 552-5346
Fax
(715) 838-6596
NPI assigned
Mar 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Authorized official

Name
Stephen Mathias Endres
Title
Authorized Representative
Phone
(715) 552-5346

Specialties & licenses 1

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

Addresses

Primary practice location

1221 Whipple St
Eau Claire, WI 54703-5270

Mailing address

PO Box 1185
Eau Claire, WI 54702-1185
Phone (715) 552-5346

Other identifiers 1

IdentifierTypeStateIssuer
32805000MedicaidWI

National Provider Directory

National Provider Directory

Locations

204 S Adams St
St Croix Fls, WI 54024
Phone (715) 483-3221

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": "1141948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542758400000",
    "number": "1609844000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1185",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547021185",
            "telephone_number": "715-552-5346",
            "fax_number": "715-838-6596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 WHIPPLE ST",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547035270",
            "telephone_number": "715-552-5346",
            "fax_number": "715-838-6596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CLINIC OF NORTHWESTERN WISCONSIN SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-10",
        "last_updated": "2018-11-21",
        "status": "A",
        "authorized_official_last_name": "ENDRES",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MATHIAS",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "715-552-5346"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32805000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.