Manoochehr Mazloomdoost P S C

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

MANOOCHEHR MAZLOOMDOOST P S C

Doing business as

Wellward

Practice address

1100 Cumberland Falls Hwy
Corbin, KY 40701-2715

Phone

(859) 275-4878

NPI assigned

Mar 12, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Danesh Mazloomdoost, MDNPI 1851447072

Title

Medical Director

Phone

(859) 275-4878

Specialties & licenses 5

Addresses

Other names 1

• Wellward Doing business as

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Manoochehr Mazloomdoost PSC

  dba Wellward Regenerative Medicine

  • Pain Medicine (Anesthesiology) Physician
  • Lexington, KY
  • NPI 1770555492

  O20031208000172

  Same enrollment

Tax ID family

Pain Management Medicine3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Manoochehr Mazloomdoost PSC

  dba Pain Management Medicine

  • Pain Medicine Physician
  • Lexington, KY
  • NPI 1063711018
  NPD tax ID
• Pain Management Medicine

  • Pain Clinic/Center
  • Lexington, KY
  • NPI 1124578703
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Danesh Mazloomdoost, MD

  • Pain Medicine (Anesthesiology) Physician
  • Lexington, KY
  • NPI 1851447072
  NPD Authorized official
• Travis Bridges, DO

  • Physical Medicine & Rehabilitation Physician
  • Lexington, KY
  • NPI 1508392044

  Single Specialty

  NPD
• Patrick Scott Campbell, DC

  • Chiropractor
  • Richmond, KY
  • NPI 1679676605
  NPD
• James Eric Escaloni, PT

  • Physical Therapist
  • Lexington, KY
  • NPI 1467643064
  NPD
• Camellia Mazloomdoost, MD

  • Psychiatry Physician
  • Lexington, KY
  • NPI 1952372419
  NPD
• Phillip Robert Williams, P.T.

  • Physical Therapist
  • Richmond, KY
  • NPI 1700960473
  NPD

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

{
    "created_epoch": "1173657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660694400000",
    "number": "1720110182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 N EAGLE CREEK DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405091806",
            "telephone_number": "859-275-4878",
            "fax_number": "859-276-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 CUMBERLAND FALLS HWY",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407012715",
            "telephone_number": "859-275-4878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOOCHEHR MAZLOOMDOOST P S C",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-12",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-17",
        "status": "A",
        "authorized_official_last_name": "MAZLOOMDOOST",
        "authorized_official_first_name": "DANESH",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "859-275-4878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "KY",
            "license": "17083",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellward",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Donna Jo Mahan, LPCC, CADC
• Jessica Mahan
• Matthew Majors
• Queentessa Manning
• James Ahmad Manns, BS
• Cassidy Rae Marcum
• Charles Lee Marcum, M.D.
• Linda S Marcum, MA, CPP
• Veronica Ann Marcum
• Maria Cristina Atienza PSC

• Pain Medicine (Anesthesiology) Physician in Corbin, KY
• Providers in Corbin, KY by specialty
• Pain Medicine (Anesthesiology) Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.