Active NPI
KBS Medical PA
- Interventional Pain Medicine Physician
- Miramar, FL
National Provider Identifier
1710865993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- Legal business name
- KBS MEDICAL PA
- Practice address
- 3350 SW 148TH Ave Ste 110
Miramar, FL 33027-3237 - Phone
- (909) 442-4965
- NPI assigned
- Aug 25, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa Kennedy
- Title
- Coo
- Phone
- (909) 679-3482
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | Primary |
Addresses
Primary practice location
3350 SW 148TH Ave Ste 110
Miramar, FL 33027-3237
Mailing address
169 Madison Ave Ste 15824
New York, NY 10016-5101
Other practice location 1
5470 Kietzke Ln Ste 300
Reno, NV 89511-2099
Phone (909) 679-3482
Other practice location 2
29777 Telegraph Rd Ste 4200
Southfield, MI 48034-7640
Phone (909) 679-3482
Other practice location 3
5201 Eden Ave Ste 300
Edina, MN 55436-2315
Phone (909) 679-3482
Other practice location 4
The Schraffts Center Power House, 529 Main Street
Suite 200
Charlestown, MA 02129
Phone (909) 679-3482
Other practice location 5
3295 W Elder St Ste 209
Boise, ID 83705-4772
Phone (909) 679-3482
Other practice location 6
875 N Michigan Ave Fl 31
Chicago, IL 60611-1962
Phone (909) 679-3482
Other practice location 7
700 Main St Ste 3
Bangor, ME 04401-6800
Phone (909) 679-3482
Other practice location 8
20 Foundry St Fl 2
Concord, NH 03301-5419
Phone (909) 679-3482
Other practice location 9
388 S Main St Ste 440
Akron, OH 44311-4407
Phone (909) 679-3482
Other practice location 10
322 N Shore Dr Bldg 1B
Pittsburgh, PA 15212-5875
Phone (909) 679-3482
Other practice location 11
2 N Central Ave Ste 1800
Phoenix, AZ 85004-2139
Phone (909) 679-3482
Other practice location 12
175 Capital Blvd Fl 4
Rocky Hill, CT 06067-3914
Phone (909) 679-3482
Other names 1
- Innerwell
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20260413002926 | MA | Part B Supplier - Clinic/Group Practice | 4587183454 |
Receives reassigned benefits from 1 practitioner Practice locations: Charlestown, MA |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1756080000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1776297600000",
"number": "1710865993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "169 MADISON AVE STE 15824",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100165101",
"fax_number": "844-440-2410"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3350 SW 148TH AVE STE 110",
"city": "MIRAMAR",
"state": "FL",
"postal_code": "330273237",
"telephone_number": "909-442-4965"
}
],
"practiceLocations": [
{
"address_1": "5470 Kietzke Ln Ste 300",
"address_purpose": "LOCATION",
"city": "Reno",
"state": "NV",
"postal_code": "895112099",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "29777 Telegraph Rd Ste 4200",
"address_purpose": "LOCATION",
"city": "Southfield",
"state": "MI",
"postal_code": "480347640",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5201 Eden Ave Ste 300",
"address_purpose": "LOCATION",
"city": "Edina",
"state": "MN",
"postal_code": "554362315",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "The Schraffts Center Power House, 529 Main Street",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Charlestown",
"state": "MA",
"postal_code": "02129",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "3295 W Elder St Ste 209",
"address_purpose": "LOCATION",
"city": "Boise",
"state": "ID",
"postal_code": "837054772",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "875 N Michigan Ave Fl 31",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606111962",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "700 Main St Ste 3",
"address_purpose": "LOCATION",
"city": "Bangor",
"state": "ME",
"postal_code": "044016800",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "20 Foundry St Fl 2",
"address_purpose": "LOCATION",
"city": "Concord",
"state": "NH",
"postal_code": "033015419",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "388 S Main St Ste 440",
"address_purpose": "LOCATION",
"city": "Akron",
"state": "OH",
"postal_code": "443114407",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "322 N Shore Dr Bldg 1B",
"address_purpose": "LOCATION",
"city": "Pittsburgh",
"state": "PA",
"postal_code": "152125875",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2 N Central Ave Ste 1800",
"address_purpose": "LOCATION",
"city": "Phoenix",
"state": "AZ",
"postal_code": "850042139",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "175 Capital Blvd Fl 4",
"address_purpose": "LOCATION",
"city": "Rocky Hill",
"state": "CT",
"postal_code": "060673914",
"country_code": "US",
"telephone_number": "909-679-3482",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "KBS MEDICAL PA",
"organizational_subpart": "NO",
"enumeration_date": "2025-08-25",
"last_updated": "2026-04-16",
"certification_date": "2026-04-16",
"status": "A",
"authorized_official_last_name": "KENNEDY",
"authorized_official_first_name": "LISA",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "909-679-3482"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Innerwell",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Miramar, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2026; 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.