NPIMap

Organization Active NPI

Alpha Spine and Pain Clinic PLLC

  • Interventional Pain Medicine Physician
  • Bellevue, WA
National Provider Identifier
1669178984
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
ALPHA SPINE AND PAIN CLINIC PLLC
Practice address
1900 116TH Ave NE Ste 100
Bellevue, WA 98004-3052
Phone
(425) 777-4710
Fax
(888) 830-1615
NPI assigned
Feb 7, 2023
Last updated
Feb 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Authorized official

Name
Praveen Kumar MambalamNPI 1790942886
Title
MD
Phone
(425) 774-1538

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

1900 116TH Ave NE Ste 100
Bellevue, WA 98004-3052

Mailing address

PO Box 827
Bellevue, WA 98009-0827
Phone (425) 777-4710

National Provider Directory

National Provider Directory
Tax ID family
Alpha Spine and Pain Clinic PLLC3 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.

Practitioners & affiliated clinicians

Practitioners 1

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": "1675728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675728000000",
    "number": "1669178984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 827",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980090827",
            "telephone_number": "425-777-4710",
            "fax_number": "888-830-1615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 116TH AVE NE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043052",
            "telephone_number": "425-777-4710",
            "fax_number": "888-830-1615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALPHA SPINE AND PAIN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A",
        "authorized_official_last_name": "MAMBALAM",
        "authorized_official_first_name": "PRAVEEN",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "425-774-1538"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.