Interventional Pain Service LLC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

ME0063660 Issued in FL

Legal business name

INTERVENTIONAL PAIN SERVICE LLC

Practice address

201 N Clyde Morris Blvd
Suite 120
Daytona Beach, FL 32114-2724

Phone

(386) 254-4029

Fax

(386) 254-4274

NPI assigned

Aug 2, 2006

Last updated

Aug 22, 2020By 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. William Ross Mayfield, M.D.NPI 1578627568

Title

Member Manager

Phone

(386) 254-4029

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

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.

• William Ross Mayfield, M.D.

  • Interventional Pain Medicine Physician
  • Daytona Beach, FL
  • NPI 1578627568
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689681793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 120",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142724",
            "telephone_number": "386-254-4029",
            "fax_number": "386-254-4274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 120",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142724",
            "telephone_number": "386-254-4029",
            "fax_number": "386-254-4274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN SERVICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROSS",
        "authorized_official_title_or_position": "MEMBER MANAGER",
        "authorized_official_telephone_number": "386-254-4029",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "FL",
            "license": "ME0063660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "372693200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "18828",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Interventional Pain Medicine Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Interventional Pain Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.