NPIMap

Organization Active NPI

Midlands Neurology & Pain Assoc, P.a

  • Interventional Pain Medicine Physician
  • Columbia, SC
National Provider Identifier
1629084132
Registry record updated Nov 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
18323 Issued in SC
Legal business name
MIDLANDS NEUROLOGY & PAIN ASSOC, P.A
Practice address
2601 Millwood Ave
Midlands Neurology & Pain Assoc, P.a
Columbia, SC 29205-1218
Phone
(803) 788-0038
Fax
(803) 788-0655
NPI assigned
Aug 1, 2006
Last updated
Nov 7, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2016

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

Authorized official

Name
E Ogburu-Ogbonnaya MD, MD
Title
President Ceo
Phone
(803) 788-0038

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 18323 SC
Interventional Pain Medicine Physician 208VP0014X 18323 SC Primary

Addresses

Primary practice location

2601 Millwood Ave
Midlands Neurology & Pain Assoc, P.a
Columbia, SC 29205-1218

Mailing address

PO Box 209
Midlands Neurology & Pain Assoc, P.a
State Park, SC 29147-0209
Phone (803) 788-0038

Other identifiers 1

IdentifierTypeStateIssuer
GP1403MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041007000215 SC Part B Supplier - Clinic/Group Practice 2264491034 Receives reassigned benefits from 10 practitioners
Practice locations: Columbia, SC
O20220128001971 SC DME Supplier - Physician - NeurologyDME Supplier - Multi-Specialty - Physician 2264491034 Practice locations: Columbia, SC

National Provider Directory

National Provider Directory
Tax ID family
Midlands Neurology Pain2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 12

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": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1629084132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 209",
            "address_2": "MIDLANDS NEUROLOGY & PAIN ASSOC, P.A",
            "city": "STATE PARK",
            "state": "SC",
            "postal_code": "291470209",
            "telephone_number": "803-788-0038",
            "fax_number": "803-788-0655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 MILLWOOD AVE",
            "address_2": "MIDLANDS NEUROLOGY & PAIN ASSOC, P.A",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292051218",
            "telephone_number": "803-788-0038",
            "fax_number": "803-788-0655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDLANDS NEUROLOGY & PAIN ASSOC, P.A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "OGBURU-OGBONNAYA MD",
        "authorized_official_first_name": "E",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "803-788-0038",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "SC",
            "license": "18323",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "SC",
            "license": "18323",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1403",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; 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.