Select Interventional Pain, PC

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

Legal business name

SELECT INTERVENTIONAL PAIN, PC

Practice address

794 McDonough Rd
Suite 108
Jackson, GA 30233-1572

Phone

(470) 251-5300

Fax

(470) 251-5301

NPI assigned

Dec 20, 2014

Last updated

Feb 19, 2017By 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. Derrell L Leggett, MDNPI 1306025630

Title

President

Phone

(470) 251-5300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14337/brand/1/csg/1/fhir/r4

Practitioners 5

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.

• Derrell Levohn Leggett, M.D.

  • Interventional Pain Medicine Physician
  • Jackson, GA
  • NPI 1306025630
  Medicare reassignment NPD Authorized official
• Jennifer Monsrud, NP

  • Family Nurse Practitioner
  • Jackson, GA
  • NPI 1699335810
  Medicare reassignment NPD
• Deandra Lashay White, APRNC

  • Family Nurse Practitioner
  • Locust Grove, GA
  • NPI 1174116446
  Medicare reassignment NPD
• Dana B Bass Burch, PA

  • Medical Physician Assistant
  • Jackson, GA
  • NPI 1992943195
  NPD (past)
• Jaimi Marie Norrell, NP-C

  • Family Nurse Practitioner
  • Jackson, GA
  • NPI 1306126529
  NPD (past)

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

{
    "created_epoch": "1419033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487462400000",
    "number": "1750789947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "794 MCDONOUGH RD",
            "address_2": "SUITE 108",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331572",
            "telephone_number": "470-251-5300",
            "fax_number": "470-251-5301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "794 MCDONOUGH RD",
            "address_2": "SUITE 108",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331572",
            "telephone_number": "470-251-5300",
            "fax_number": "470-251-5301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELECT INTERVENTIONAL PAIN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-20",
        "last_updated": "2017-02-19",
        "status": "A",
        "authorized_official_last_name": "LEGGETT",
        "authorized_official_first_name": "DERRELL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "470-251-5300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Rosser, PHYSICAL THERAPY AST
• RR Long Inc (Jackson Drug Co)
• S&S Imaging Associates, LLC
• Clyde William Sandford, LPC
• Sanjeeva Rao MD PC
• Amir Shaheer
• Shashi Madan MD PC
• Beverly Shaw, FNP-C
• Heather Nicole Smith
• Meredith Smith

• Interventional Pain Medicine Physician in Jackson, GA
• Providers in Jackson, GA by specialty
• Interventional Pain Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.