Pain Relief and Wellness of Minnesota

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

PAIN RELIEF AND WELLNESS OF MINNESOTA

Doing business as

Locketz Rehabilitation

Practice address

4721 Clark Ave
White Bear Lake, MN 55110-3221

Phone

(651) 249-0454

Fax

(651) 560-7013

NPI assigned

Apr 11, 2011

Last updated

Feb 13, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Adam Jason Locketz, MD

Title

Owner/MD

Phone

(651) 249-0454

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Locketz Rehabilitation Doing business as

Locations

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

{
    "created_epoch": "1302480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392249600000",
    "number": "1679863773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 CLARK AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103221",
            "telephone_number": "651-788-6689",
            "fax_number": "651-560-7013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4721 CLARK AVE",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551103221",
            "telephone_number": "651-249-0454",
            "fax_number": "651-560-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN RELIEF AND WELLNESS OF MINNESOTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-11",
        "last_updated": "2014-02-13",
        "status": "A",
        "authorized_official_last_name": "LOCKETZ",
        "authorized_official_first_name": "ADAM",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "OWNER/MD",
        "authorized_official_telephone_number": "651-249-0454",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34536300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "530615900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Locketz Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2014; 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.