Advanced Interventional Spine and Pain Institute. LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

036111184 Issued in IL

Legal business name

ADVANCED INTERVENTIONAL SPINE AND PAIN INSTITUTE. LLC

Practice address

4700 Memorial Drive, Suite 230 Pain Center
4700 Memorial Drive, Memorial Hospital
Breese, IL 62226

Phone

(618) 257-5902

Fax

(618) 257-6671

NPI assigned

Jan 22, 2011

Last updated

Jan 30, 2023By 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. Hongkai Kevin Du, M.D.NPI 1396846598

Title

President/Owner

Phone

(618) 767-3814

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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.

• Hongkai Kevin Du, M.D.

  • Interventional Pain Medicine Physician
  • Belleville, IL
  • NPI 1396846598

  Physical Medicine & Rehabilitation

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1295654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1679878698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24001",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622239001",
            "telephone_number": "618-767-3814",
            "fax_number": "618-257-6671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 MEMORIAL DRIVE, SUITE 230 PAIN CENTER",
            "address_2": "4700 MEMORIAL DRIVE, MEMORIAL HOSPITAL",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "62226",
            "telephone_number": "618-257-5902",
            "fax_number": "618-257-6671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED INTERVENTIONAL SPINE AND PAIN INSTITUTE. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-22",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "DU",
        "authorized_official_first_name": "HONGKAI",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "618-767-3814",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "IL",
            "license": "036111184",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "036111184",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "36111184",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036111184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Breese, IL
• Providers in Breese, IL by specialty
• Interventional Pain Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; 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.