Active NPI
Jan Paul Maddox, M.D.
- Interventional Pain Medicine Physician
- Riverside, CA
National Provider Identifier
1699770974
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- License
- A26683
- Practice address
- 4500 Brockton Ave
Ste 305
Riverside, CA 92501-4028 - Phone
- (951) 715-3963
- Fax
- (951) 715-3960
- NPI assigned
- Jun 14, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | A26683 | CA | Primary |
Addresses
Primary practice location
4500 Brockton Ave
Ste 305
Riverside, CA 92501-4028
Mailing address
PO Box 1509
Riverside, CA 92502-1509
Phone (951) 715-3963
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A320460 | Other | CA | MEDI-CAL |
| ZZZ05981Z | Other | CA | BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A26683 | CA | MD | Interventional Pain Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Menifee Valley Medical Center | Past | Accepting new patients | |
| Universal Health Services of Rancho Springs Inc | Interventional Pain Medicine | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Acute Care Hospital
- Sun City, CA
- NPI 1881781482
-
- General Acute Care Hospital
- Murrieta, CA
- NPI 1245221050
Interventional Pain Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1118707200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195430400000",
"number": "1699770974",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1509",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925021509",
"telephone_number": "951-715-3963",
"fax_number": "951-715-3960"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 BROCKTON AVE",
"address_2": "STE 305",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925014028",
"telephone_number": "951-715-3963",
"fax_number": "951-715-3960"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MADDOX",
"first_name": "JAN",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-14",
"last_updated": "2007-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": "CA",
"license": "A26683",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "00A320460",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD ID",
"identifier": "ZZZ05981Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.