Organization Active NPI

The Pain Rehabilitation Group of Wichita Falls P.a.

  • Pain Medicine (Anesthesiology) Physician
  • Wichita Falls, TX
National Provider Identifier
1609892074
Registry record updated May 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
THE PAIN REHABILITATION GROUP OF WICHITA FALLS P.A.
Practice address
4301 Maplewood Ave
Ste a
Wichita Falls, TX 76308
Phone
(940) 696-8500
Fax
(940) 696-8546
NPI assigned
Jul 15, 2006
Last updated
May 29, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2018

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

Authorized official

Name
Mark A Workman, M.D.NPI 1447238415
Title
President
Phone
(940) 696-8500

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X NU Primary

Addresses

Primary practice location

4301 Maplewood Ave
Ste a
Wichita Falls, TX 76308

Mailing address

4301 Maplewood Ave
Ste a
Wichita Falls, TX 76308-3879
Phone (940) 696-8500

Other identifiers 1

IdentifierTypeStateIssuer
079982701MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040804001328 TX Part B Supplier - Clinic/Group Practice 9739150780 Receives reassigned benefits from 2 practitioners
Practice locations: Wichita Falls, TX

National Provider Directory

National Provider Directory

Locations

4301 Maplewood Ave
Ste Q
Wichita Falls, TX 76308

Practitioners & affiliated clinicians

Practitioners 3

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": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1527552000000",
    "number": "1609892074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 MAPLEWOOD AVE",
            "address_2": "STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763083879",
            "telephone_number": "940-696-8500",
            "fax_number": "940-696-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 MAPLEWOOD AVE",
            "address_2": "STE A",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "76308",
            "telephone_number": "940-696-8500",
            "fax_number": "940-696-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PAIN REHABILITATION GROUP OF WICHITA FALLS P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2018-05-29",
        "status": "A",
        "authorized_official_last_name": "WORKMAN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "940-696-8500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "079982701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2018; 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.