NPIMap

Organization Active NPI

Pain Management Center of Southern Indiana, Inc.

  • Multi-Specialty Clinic/Center
  • Bloomington, IN
National Provider Identifier
1629063797
Registry record updated Jun 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
50003765A Issued in IN
Legal business name
PAIN MANAGEMENT CENTER OF SOUTHERN INDIANA, INC.
Practice address
2920 McIntyre Dr
Suite 150
Bloomington, IN 47403-4221
Phone
(812) 333-7246
Fax
(812) 333-4471
NPI assigned
Sep 15, 2005
Last updated
Jun 15, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2009

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

Authorized official

Name
Kamal Kumar Tiwari, MDNPI 1578558789
Title
President
Phone
(812) 333-7246

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
Multi-Specialty Clinic/Center 261QM1300X 50003765A IN Primary

Addresses

Primary practice location

2920 McIntyre Dr
Suite 150
Bloomington, IN 47403-4221

Mailing address

PO Box 5635
Bloomington, IN 47407-5635
Phone (812) 337-5003

Other identifiers 1

IdentifierTypeStateIssuer
100389270MedicaidIN

National Provider Directory

National Provider Directory

Locations

Dept 6096
Carol Stream, IL 60122

2503 Cota Dr
Bloomington, IN 47403
Phone (812) 337-5003

70 Carr Hill Rd
#B
Columbus, IN 47201
Phone (812) 376-7246

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245024000000",
    "number": "1629063797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5635",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474075635",
            "telephone_number": "812-337-5003",
            "fax_number": "812-337-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 MCINTYRE DR",
            "address_2": "SUITE 150",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474034221",
            "telephone_number": "812-333-7246",
            "fax_number": "812-333-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MANAGEMENT CENTER OF SOUTHERN INDIANA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2009-06-15",
        "status": "A",
        "authorized_official_last_name": "TIWARI",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-333-7246",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "IN",
            "license": "50003765A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100389270",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jun 15, 2009; 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.